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Down's Syndrome Screening ReduxFrom: art fougner, md (evsono@pipeline.com)Wed Jun 20 09:05:19 2001
>From today's ReutersHealth - Value of genetic sonogram affirmed in reducing need for amniocentesis Last Updated: 2001-06-19 11:45:05 EDT (Reuters Health) By Karla Gale WESTPORT, CT (Reuters Health) - Second-trimester ultrasonography is valuable for identifying Down syndrome and reducing the need for invasive procedures. That assertion comes from physicians who object strongly to the findings of a meta-analysis published in The Journal of the American Medical Association by Dr. Rebecca Smith-Bindman, et al, which suggested that the technology is useless and potentially harmful (see Reuters Health report, February 27, 2001, "Second-trimester ultrasonography impractical screening test for Down syndrome"). For example, Dr. John C. Hobbins of the University of Colorado Health Sciences Center in Denver and colleagues point out in the Journal of Ultrasound in Medicine for June that erroneous prevalence rates inflated the rate of fetal loss per fetus with Down syndrome diagnosed based on results of amniocentesis. Furthermore, they contend that Dr. Smith-Bindman's group included studies in which ultrasound equipment was outdated by today's standards, and that the authors ignored the value of a negative ultrasonographic finding. "We argue that the most important outcome of using this screening paradigm is to diminish the possibility of Down syndrome, and, consequently, to reduce the number of invasive procedures that might be conducted," Dr. Hobbins and his associates write. Dr. Joshua A. Copel of Yale University School of Medicine in New Haven, Connecticut, and an officer of the American Institute of Ultrasound in Medicine, helped with formulating the response to the Smith-Bindman study. The JAMA article was "startling and unsettling," he told Reuters Health. "We thought they took the worst of the worst, and it was not a fair appraisal of the ability of ultrasound." "A chronic problem you find in medicine is that the term 'meta-analysis' can really be abused," he continued. "People do a review of literature and call it meta-analysis. Even if they do the proper meta-analytic techniques, if they pick articles improperly or do their analysis on the wrong numbers out of the article, they're going to come up with results that don't really reflect what was there." J Ultrasound Med 2001;20:569-572. -Westport Newsroom 203 319 2700 art
-- art fougner, md
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