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Re: HMOs/GTTs gold standard is brass: severe case of laboratoryitisFrom: Clifford J. Goodman, Jr., M.D. (momdoc@getnet.com)Sat Mar 30 12:47:41 1996
Michael Klein wrote: > > 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- > > There was a study by Joe Miller (I think while he was at MUSC), showing > > that if one screens only patients with risk factors, half as many women with > > abnormal GTT's will be ascertained. > > > > David > > David Nagey -University of Maryland School of Medicine -dnagey@c3p0.ab.umd.edu > > - though not for long. > >I tend to agree with you, but I don't see how the literature you quote or the HMO's would help me when I meet the true "brass standard" in court with the plaintifs lawyer and their experts showing that universal glucose screening is the standard of care. My feelings might come from twenty years of practicing in one of the world's most litigious areas, sunny Arizona. It would be great, though, to be able to stop the routine screening of urines for glucose at every prenatal visit!
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