The science of health screening: evidence, wishful thinking and commercial manipulation
| Photograph Nancy Hughes |
Talk by Dr Angela Elisabeth Raffle, Bristol University
Journalist Christopher Martyn once said “reading the facts about screening is like the intellectual equivalent of a cold shower”. In this talk Dr Raffle will explain her own ‘cold shower’ as, in the 1980’s, she naively took the lead for organising cervical screening in her area, in full expectation that screening was both simple and wonderfully effective (if only it was ‘done right’).
She will explain how, by gradually uncovering the true consequences of cervical screening since its chaotic beginnings two decades earlier, this set her on a path to become part of a network of people committed to turning UK screening from a totally haphazard and science-free zone, into something better. Gradually the UK National Screening Programmes became better researched, more evidence-based programmes, delivered to good quality standards, with the aim of achieving more good than harm at affordable cost. Dr Raffle will unfold the biases that bedevil screening research, the hidden assumptions and beliefs that make the idea of screening so popular and compelling, and the behind-the-scenes forces that dominate the public discourse, making it hard for scientific truths to see the light of day.
Following junior doctor posts in England and overseas, Angela specialised in Public Health. She has been a Consultant to the UK National Screening Programmes since 1996. Her publications have highlighted the diverse consequences of screening, including the key problem of overdiagnosis. Her influence has helped achieve delivery of screening as high quality end-to-end national programmes, and has improved screening’s information-giving and ethics. She is lead author of an international textbook known affectionately as ‘the screening bible’ (Screening; evidence and practice OUP 2019 2nd edition). She is a Fellow of the Faculty of Public Health, and holds an Honorary Doctorate for her services to climate change and sustainability. Angela lives in Bristol and has four grown up children.