The advocates of screening, usually for impeccable motives, conclude that the pre-existing evidence plus commonsense—in the face of the ongoing toll of disability and untimely death—demand massive screening programmes for the detection of citizens with risk factors for these disorders now, even in the absence of experiments to determine whether the alteration of many risk factors will, in fact, alter risk. In "keeping the faith", screening advocates may find themselves forced to accept or reject evidence not so much on the basis of its scientific merit as on the extent to which it supports or rejects the stand that screening is good.

The methodologists, on the other hand, are wed not to a conclusion but to a series of criteria and strategies which if rigorously applied they believe will maximise the likelihood that the ultimate conclusion is correct. They insist that screening, like any other untested health manoeuvre, may do more harm than good and must meet scientific as well as political criteria before it is implemented. In "maintaining objectivity" methodologists will be forced to offer tentative conclusions and to change their minds as more valid evidence appears.... The decision to apply an unproven remedy to a single patient costs relatively little and limits the human risk of toxicity and side-effects, should the remedy later be shown to be useless or harmful. The opportunity for waste and harm is greatly magnified if this remedy is proposed for all such patients identified through a screening programme.

A wrong community decision now, subsequently revealed, makes the implementation of later community decisions, however valid, much more difficult.

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