BMJ 7 Apr 2007

In England, we are lucky to have our screening programmes presided over by a sceptical Scot (Muir Gray) who is alert to the dangers of screening. Nevertheless, argues Nicola Law here, we are in the process of adopting a policy for opportunistic Chlamydia screening in young women based on evidence that is contradictory and frequently misrepresented.

As it happens, I had drafted a short piece on coeliac disease in primary care recently with a GP partner who did the first important case-finding study using an antibody assay. It’s clear that we need a clinical prediction rule to save many patients duodenal biopsy, and this study shows that you can omit it in those with a high clinical probability and positive serology, and those with low clinical probability and negative serology. The Sheffield tissue transglutaminase assay doesn’t perform nearly as well as our specially concocted Oxford endomysial antibody assay did 8 years ago (100% positive predictive value in all groups), but theirs is probably more typical of the run of available assays. Roger Jones’ acompanying editorial in my view overstates both the extent to which coeliac disease is currently underdiagnosed in UK general practice, and the importance of detecting it in asymptomatic patients.