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HMOs/GTTs gold standard is brass: severe case of laboratoryitisFrom: Michael Klein (mklein@unixg.ubc.ca)Sat Mar 30 07:55:53 1996
Dear David and list: That a test will or will not identify a particular link to another test is not the issue. What we may pick up is a severe form of laboratoryitis. The issue is not if a screening test (50 gm load) will pick up another chemical phenomenon (an abnormal GTT) but whether that phenomenon is a disease. The evidence to date is that it is not a disease. If the outcome is not improved for the universe of women who undergo the test (or worse it just raises the cxion rate without benefit) then we are not helping women in our serch for perfection. As well, there is evidence that we may make people neurotic (anxious) in the bargain. To further complicate the issue, the GTT itself as a "gold standard" may be brass. At BC Women's Michael Bebbington is in the midst of an RCT comparing 50 gm glucose screening for everyone with case finding. The key outcomes include cxion rate and critical newborn and fetal differences in the two approaches. Till then, despite **policies** that are not evidence based, there is no reason to screen. But there is always reason to think, worry and test, imperfect as the test is, in selected patients. Cheers. Michael On Sat, 30 Mar 1996, David Nagey wrote:
> Gail-
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