[Screening: careful considerations versus commercial medicine]

People no longer seem to view their state of health in a light-hearted manner. The worried well hunger for every scrap of information they can find about their physical well-being, with the result that a veritable diagnostic industry is developing. Is the early detection of a disease always better than waiting for its signs or symptoms? It is difficult to answer this question and properly weigh up the beneficial effects against the side effects. Two main reasons are given for this. First of all, studies on the early detection of disease report the results selectively: beneficial effects are overstated and side effects are underreported. A more comprehensive evaluation method is needed. Secondly, new technological and therapeutic innovations are in competition with the existing techniques under investigation, which makes a long-term evaluation almost impossible. Moreover, this approach obscures questions fundamental to screening practices. There is a widening gulf between medical screening and traditional medicine, with the result that care is being transformed into a commercial product with a huge market. These developments in diagnostics pose new scientific and ethical questions that need to be answered.