Pulmonary function testing and the prevention of pulmonary disease.

CHEST, 74: 6, DECEMBER, 1978 to an evaluation of whether those who sought medical help fared any differently from those who did not. In our view, scientific evaluation of the usefulness of detecting high-risk individuals is the next step, an evaluation which is no less a “therapeutic trial” than the large-scale trials of drugs today that are conducted with the precision which comes from good experimental design and careful attention to the characterization of “cases” and “controls.”2 When a number of such trials (carried out in different communities) all indicate that early detection by screening can indeed lead to the institution of measures to improve an individual’s subsequent health and happiness, then and only then, in our view, should mass screening be advocated. Thus, although we welcome the study, we do not share the opinions of Hudgel et al about the desirability at present of screening for obvious disease. Our reasons are the following: (1) we do not know if we can beneficially alter the natural history of the disease at this stage; (2) even if an appropriate intervention were available, we do not know how compliant the high-risk individual would be; and (3) we do not know if the quality of life of an individual who was informed that he was at high risk would improve or decline as a result of this information. As Hiatt has stated with eloquence, in an era when resources are not limitless and the medical commons are rapidly being used up, we believe that before advocating a mass screening program, we must be able to offer the evidence that it “works.” Peter T. Macklem, M.D.#{176}and Margaret R. Becklake, M.D.#{176} Montreal