Value of a negative cervical smear.

Comment Our patient showed a remarkable initial response to high dose intravenous gammaglobulin. The effect on his arthritis was transient, but most of the systemic symptoms were appreciably reduced or absent during the first six months of treatment. A relapse occurred four months after gammaglobulin was stopped, but renewed administration induced the same beneficial effects as before. The mechanism of action is uncertain. Reactions between idiotypes and anti-idiotypes or blockade of the Fc receptors of the macrophages by the gammaglobulin could explain the increased circulating concentration of immune complexes.4 We cannot explain the temporarily increased IgM rheumatoid factor concentration. High dose intravenous gammaglobulin may be useful in treating severe chronic systemic juvenile arthritis. We recommend that a double blind, randomised prospective trial of its effects should be performed. When the cost of clinical activity is calculated negative results of investigations (normal results) are usually assumed to be of no value. I tested this assumption for cervical cytology, in which ascribing a zero value to negative smears puts the cost of saving one life at £300 000.1 Patients, methods, and results The names and addresses of 100 consecutive women who had recently had a cervical smear reported as being normal were obtained from the computer in the cytology laboratory in Blackburn. Each woman was sent a questionnaire, which first stated that the smear was normal and then asked the following questions: "As the smear turned out to be negative was it a waste of time?" "Do you regard the news that the smear was negative of being of value to you in any way?" "Although there is no question of you being charged for the smear, if you feel that the negative smear was of value to you I would like you to try to express this in terms of money" (choices of 50p, £1, £2, £5, £10, and £20 were given). Questions concerning occupation and age were also asked. Eighty four replies were received, the women's ages ranging from 17 to 75. Nine women of working age were from social classes I and II, 15 from class III, and 44 from classes IV and V. Eight women could not be classified and eight were retired. Eleven respondents who valued knowing that the smear was negative did not say how much they would be prepared to pay for it. A further four wrote that they would pay "any amount." Of the …