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More is not always better: routine screening not always beneficial

d cost $500,000 per life-year gained and that screening all asymptomatic children with Down syndrome for celiac disease would cost almost $5 million to prevent a single case of lymphoma.

And the financial cost of routine screening those without symptoms of celiac disease is far from the only issue. Even small decrements in the quality of a child's life caused by dietary restrictions more than off-set the trivial and unproven reduction in the risk of lymphoma.

"As a pediatrician, I know the treatment of celiac disease places a burden on the patient and on the family. The strict gluten-free dietary constraints (the recommended treatment) are not only costly, but more importantly, they make the child stand out when most patients and families are working very hard to integrate the child into society. We have many tools, tests and procedures that can be done but we need to use evidence-based medicine and family-centered care to make effective decisions for the assessment and care of children." said Dr. Swigonski.

An accompanying commentary written by two Brown University physicians noted, "This is an example of where doing more is not better despite good intentions harm can be done and resources may be wasted."


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Contact: Cindy Fox Aisen
caisen@iupui.edu
317-274-7722
Indiana University
11-Aug-2006


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