Wilson and Jungner’s criteria were primarily formulated in the context of screening for adult diseases specifically carcinomas and hepatitis B (Table 1). The authors’ intention was for the criteria to
be adapted and developed within differing situations, as opposed to strict Selleck GS-9973 adherence to a formula. However, in practice, many health systems appear to regard them as static, rather than an evolving regime. They are frequently referred to as a ‘gold standard’ for screening (Andermann et al. 2008). Although Wilson and Jungner’s criteria have undergone some refinement to incorporate issues such as the validity of tests (Cochrane and Holland 1971), they nevertheless remain as a set of criteria that have attained a state of almost biblical reverence for many commentators. Table 1 The principles proposed by Wilson and Jungner (1968) for the early detection of disease 1. The condition sought should be an important health problem. 2. There should
be an accepted selleck screening library treatment for patients with recognized disease. 3. Facilities Berzosertib cost for diagnosis and treatment should be available. 4. There should be a recognizable latent or early symptomatic stage. 5. There should be a suitable test or examination. 6. The test should be acceptable to the population. 7. The natural history of the condition, including development from latent to declared disease, should be adequately understood. 8. There should be an agreed policy on whom to treat as patients. 9. Elongation factor 2 kinase The cost of case finding (including diagnosis and treatment of patients diagnosed) should be economically balanced in relation to possible expenditure on medical care as a whole. 10. Case finding should be a continuing process and not a “once
and for all” project. However, this poses difficulties when attempts are made to impose the criteria in the context of dissimilar disease categories, such as newborn metabolic screening. Indeed, Wilson and Jungner noted that it was at an early developmental phase at the time, and consequently did not factor newborn metabolic screening into the development of their criteria (Wilson and Jungner 1968). In contrast to cancer screening, situations such as newborn screening for a range of diseases are distinct in their nature. For instance, the newborn baby lacks the autonomy of an adult who decides to undergo screening for cancer. Instead, these decisions are made by and directly impact upon the baby’s parents, an additional complication that needs special consideration. Despite this, there has been no international consensus on an appropriate set of criteria for the newborn context (Clague and Thomas 2002; Padilla et al. 2010; Tuuminen et al. 1994). In order to explore how these difficulties are managed in practice, we now turn to a specific case study: New Zealand.