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Making policy on screening programmes 

Making policy on screening programmes
Chapter:
Making policy on screening programmes
Author(s):

Angela E. Raffle

, Anne Mackie

, and J. A. Muir Gray

DOI:
10.1093/med/9780198805984.003.0008
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date: 23 October 2020

This chapter shows how resources, values, beliefs, and commercial factors all influence screening policy, and gives clear insight into some of the ethical dilemmas involved. Case histories include celebrity selling of HPV testing, the USA ‘Mammography Wars’ incident, the Cartwright Inquiry into events at National Women’s Hospital in Auckland in the 1960s and genetic testing. The chapter strongly emphasises the value of following robust and explicit processes when making screening policy, and argues that this is best done at national level. The reasons why screening policy-making can be difficult are explored in detail, and clear lessons are drawn from the case examples. The chapter addresses the technical aspects of using evidence, and also explains the power of the cultural belief that all screening must automatically be a good thing and of commercial, professional and institutional interests, often enacted through invisible lobbying using ‘third party’ techniques. The ethical conflicts inherent within screening are described and explored.

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