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Should Health Screening Be Private?
  1. Dr John Fletcher
  1. Research Fellow, Institute of Health Sciences, University of Oxford

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    Jim Thornton, London, Institute of Economic Affairs, 1999, 65 pages, £5.

    Jim Thornton gives us in this book a range of arguments against the state funding of nearly all adult health-related screening programmes but for most screening programmes for children and the handicapped. He justifies the first on the basis of consumers being the best judges of their health preferences and adult screening being largely ineffective. He justifies the second on the basis of the belief that neonatal and childhood screening is more effective and that the state has a duty to decide on behalf of those who are not competent to assert their own rights. He is a practising obstetrician and gynaecologist involved in prenatal and cervical cancer screening.

    The first two chapters introduce the subject of screening and discuss some ethical principles that may be used to justify the state funding of screening programmes. These deal with health needs, equity and the correction of failures of free market mechanisms. Existing and proposed screening programmes for adults and children are considered one by one and a conclusion drawn as to whether each is justified. Some general arguments against state funding of health care are considered in less detail.

    The author draws our attention to the limited effectiveness of many adult screening programmes at preventing disease and the actual harm some may do. Screening is likened to a lottery in which large numbers of healthy people pay a small price, in terms of inconvenience and medical intervention, against the small probability that they will prevent an important future illness in themselves. Screening programmes may also harm those who have contracted the target condition by increasing the social stigma attached to it.

    Like many of us, when faced with complicated real policies, the author adopts a mixture of ethical perspectives rather than applying one, such as free market mechanisms based on subjective valuations of utility, and taking it to its logical conclusions. He does not always alert the reader, when he is changing perspective or, to the implications of following his chosen argument further than the point at which he has stopped. For example, one of the disadvantages of state funding that is identified is the restriction of liberty arising from taxation. This is argued strongly as the state infringing personal property rights. However, screening the homeless for tuberculosis is justified in the author's view since “many are mentally disabled in one way or another, so the state is justified in overriding their preferences”. Since rights appear central to many of the conclusions drawn the subject could have usefully been considered at greater length than is the case.

    The book's 65 pages are not arduous but are thought-provoking and cover useful ground. At five pounds that felt to me like good value for money.

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