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Re: RE HMOs and GTTsFrom: Murray Enkin (enkin@fhs.csu.McMaster.CA)Sat Mar 30 05:54:25 1996
The discussion of HMOs and GTTs seems to be bringing together two quite separate issues, and I think that it might be more productive for them to be discussed separately. That insurance companies, HMOs, governments, or any person or group who are not directly involved with patient care should be the determinant of which tests should be done, or should not be done, seems to me reprehensible. Such decisions should always be made by the physician or direct care giver, after discussion with the patient, and with full attention to the potential benefits and possible adverse effects of the test. (It would be wise of me to refrain from mentioning that outside control of medical practice does not occur in the Canadian system, because that too is bringing up another topic; but I could not resist.) The utility of glucose challenge testing in pregnancy is quite a separate matter. It is certainly possible that such testing combined with appropriate treatment could improve pregnancy outcome. But we also know the possible adverse effects of the test in terms of labelling an otherwise health women as diseased, and the associated costs of further testing and possible treatment. No randomized trial to demonstrate whether or not routine glucose challenge testing improves pregnancy outcome has yet been carried out. The question of whether or not routine glucose challenge tests during pregnancy have a net benefit is too important to leave unanswered. There is sufficient difference of opinion about this to demonstrate clinical equipoise, and make a methodologically sound randomized trial both ethical and necessary.
-- Murray Enkin ***************************************************************************** Murray W. Enkin, Professor Emeritus Depts of Obstetrics and Gynaecology, Clinical Epidemiology and Biostatistics
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