Read the set reading , two journal papers drawn from a recent special issue of Sociology of Health & Illness on the sociology of medical screening. Pick an illness or disease that is (or could be) screened for (e.g. breast cancer, Huntington's disease). Focusing on your example, write 200-300 words on what medical screening is, who it might benefit or harm and why. Post your text in the virtual seminar and review/reply to others’ as they appear.
Mine is quite a personal example of screening and one that I only have really thought about sincerely since the lecture yesterday. I am Jewish and as Sara mentioned, there are quite a lot of diseases that seem to affect specific Jews more than others. At my Jewish secodary school, they offered us all Tay Sachs screening in order to establish if any of us were carriers - from this, we were then advised (by a leaflet rather than a talk), that if we were carriers that in essence, "don't marry a carrier" , as you have a 1/4 chance of having a child who suffered from Tay Sachs.
Medical screening - to me - is the process of the "pre". it is the ability to screen a population or a specific group of people to see whether they have either genetic lines that can predict what may happen or able to show someone at a particular time whether they are at risk. It is different from diagnostic screening that allows a diagnosis to be made. Screening makes me think of the PRE before the FUTURE. Maybe screening and pre sound similar to me!?
However, I know from experience, that it can bring more harm than benefit. It allows anxiety to appear and between my friends and I, we spent many a lunch break debating over what we would do if our tests were positive. Before we had had the tests, I don't think any of us had thought about the possibility of carrying a genetic disease but now, it had been brought to life. It makes the mind wander to all the possibilities of what could happen in the future, what might need to happen now etc and can pull some people into a sense of false security (depending what the test is on - not so much with Tay Sachs). Of course, no test is ever 100% and this was carefully reiterated to us, but once the two week window of 'if-we-contact-you-you-most-likely-have-the-gene-problem' had passed, everyone seemed to move on. But the test isn't a security blanket. It isn't a checklist. Just because I have had the test doesn't mean I am immune to having a child with Tay Sachs - yes, I am unlikely as 1) I am not Ashkenazi 2) no one in my family has ever had it and 3) I did test positive - but I think the media and society has become too reliant on "if screening = negative, me=healthy". Of course, we never thought about the fact that other things might get picked up on - but then, I never got a call... So how would I know?
Benefits are obvious - knowledge of a either carrying or not carrying the Tay Sachs gene is clear. This can really help you espeically in certain communities where being able to write this on a "matchmaking form" allows you entry to the "matchmaking circles". For some people, knowledge IS a necessity. It benefits future generations, where despite increased treatment of such a fatal disease such as tay sachs1, knowledge is still paramount to treatment. It can prevent you from getting into such situations.
I feel that tests are only as beneficial as the amount of people that have them - of course this links to specificity and sensitivity but especially with he Tay Sachs example, how can I consider marriage with someone if I was positive and I didn;'t know their status... If no one was having tests done, I feel that having children (amongst some Jewish populations especially) would be challenging and thus, why I advocate screening for such diseases despite the risks.
The word 'risk' was also mentioned (at the time and in the lecture) and it is hard to separate it from the way we have learnt it from childhood, in Epi and Stats and the way it is applied to screening. Are we at risk before? Or more at risk after? Especially with recent breast cancer stories, whereby screening has increased their risk of getting breast cancer, is risk the right word to use to describe the 'chance' of getting a disease?
....running out of room, so I'll wait for others to post to continue!
references:
1. Tay Sachs , 9/11/2012 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002390/
In reply to Deleted user
Re: THINKING CRITICALLY ABOUT MEDICAL SCREENING
Your story above made me think of 'screening' tests I may have had along the same lines. I use inverted comas because I'm not sure I appreciated the reasons I was having these tests. I was tested for sickle cell trait and Thalassemia once when having a blood test. The first I knew of it was when I was informed that I had had a negative result. Unlike you, my experience did not raise any anxiety as I didn't know it was being done. However, in retrospect, the potential implications are massive on an individual level and I can see why blanket screening programmes may be falling out of favour.
However, given that for some people, knowledge is a necessity, how do people feel about the possibility of scaling down screening?
Hi Amelia, great post! I have never considered screening from a 'matchmaking' point of view ... but it's a really interesting way to look at it. I guess it reflects deeply on culture, and considering the fact that Tay Sachs is so much more common in the Jewish population than in others you can understand why they screen. But to screen in secondary school, when many teenagers have self-image issues already seems a little irresponsible to me. Like you said, what to do if you received a positive test was not communicated in the most sensitive way possible and it strikes me that this has the potential to cause a lot of problems. Screening whilst in school means that you achieve a high coverage of the population, but this needs to be weighed against the benefits of screening later e.g after 18 perhaps, when individuals might be better equipped to understand and deal with a positive result, and also it seems in this case that re-addressing how you communicate what to do if given a positive result is very important.
Great post, Amelia! I think that you brought out a lot of interesting points in regards to screening. There is a huge psychological aspect of getting screened and a lot of anxiety that may come along with it, which could be lessened by more information to the patient. As you mentioned they gave you a leaflet, which is impersonal, but understandably time and resources of doctors and nurses may be scarce.
I also never considered the matchmaking aspect of screening and the implications that it may cause, especially if it could possibly be passed down to your children. But as you said, what is more of a risk? Living with the positive result and concerns that may limit your life OR the possibility of passing on the gene or trait being unaware. I feel it is more responsible to find out if you are positive.
David checking in. Great post Amelia--I think you have really highlighted how screening can make us feel sick even when we might have never suffered a disease.
Nicely put David and great post Amelia. Lots in there that is v relevant to the whole topic of risk!
I particuarly like how you've drawn out the uncertainty surrounding any result and that it doesn't offer a guarantee. Whilst screening might offer a way of managing risks, it seems it can also raise more questions than answers.
Also your point about matchmaking.... how despite uncertainty about results, the status of 'being negative' appears more socially acceptable and offers a route into matchmaking circles.
Really interesting post Amelia, thanks for that!
I agree with a lot that you have said. Your post reminds me of how in some specific ethnic groups have certain diseases that are more common. For example, sickle cell anaemia amongst people from African/Middle Eastern descent.
With screening, as you mentioned, there is the psychological effect and it can cause anxiety!
I agree with you guys. considering the fact that screening is a preventive measure in medicine and it can reduce the risk of having a particular disease ,it comes with alot of disadvantages considering the recent controversial issue of breast cancer sreening when trying to identify people at risk,you might over diagnose to treat people for disease they do not have.Even before being tested the patient already has this "fear of the unknown" so being positive or negative either increase or get rid the psychological effect.
