Wilson & Jungner published Principles and Practice of Screening for Disease in 1968. Their criteria for screening are summarised below:
1. The condition sought should be an important health problem.
2. There should be an accepted treatment for patients with recognized disease.
3. Facilities for diagnosis and treatment should be available.
4. There should be a recognizable latent or early symptomatic stage.
5. There should be a suitable test or examination.
6. The test should be acceptable to the population.
7. The natural history of the condition, including development from latent to declared disease, should be adequately understood.
8. There should be an agreed policy on whom to treat as patients.
9. The cost of case-finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole.
10. Case-finding should be a continuing process and not a “once and for all” project.
• The screening programme should respond to a recognized need.
• The objectives of screening should be defined at the outset.
• There should be a defined target population.
• There should be scientific evidence of screening programme effectiveness.
• The programme should integrate education, testing, clinical services and programme management.
• There should be quality assurance, with mechanisms to minimize potential risks of screening.
• The programme should ensure informed choice, confidentiality and respect for autonomy.
• The programme should promote equity and access to screening for the entire target population.
• Programme evaluation should be planned from the outset.
• The overall benefits of screening should outweigh the harm.
A decade after 1968, the BS 5750 regime was being pushed through the ISO and became ISO 9000. It was written under inspection bureaucrats whose expertise was naval, not in public health or laboratory medicine, and who did not understand population screening tests.
Wilson et al. have provided data and likened ISO 17025 quality accreditation to a very poor screening test for the health of laboratories.
Read the criteria Wilson & Jungner proposed for disease screening.
Compare each point to what the ISO management standards claim and deliver in your workplace.
See how the ISO inspection criteria fall short of being correctly applied screening tests in the first place.
Clue: screening everyone for everything using unproven tests is not helpful, cost-effective or safe.
We have previously asked why hospitals accept ISO accreditation without testing it against the Cochrane criteria used to validate other treatments according to evidence based medicine. It’s not just because the ones who copied your homework are now running the NHS. Most medically-qualified staff have failed to speak out against it.
We must ask again – why are medical professionals not applying their own criteria to the accreditation schemes they are submitting their institutions to?