Referring to the use of a citizens’ jury to decide new breast screening leaflet content, Paul Pharoah, public health doctor, says Hawkes’s report of the process suggests any conclusion will be seriously flawed (BMJ 2012;345:e8576 doi: 10.1136/bmj.e8576):
“There was agreement, though the question was not put to a vote, that the leaflet should begin by citing the numbers of lives saved by breast cancer screening, 1300 a year according to the Marmot review.” So had the jury been informed that breast cancer screening saves lives – when there is no evidence of this? ‘No randomised trial of breast cancer screening has shown a reduction in all cause mortality.’ Overtreatment is bound to increase deaths from other causes but the Marmot review chose not to evaluate all cause mortality as an endpoint – ‘a serious flaw in the reporting of the results’.
He questions whether the jury would have chosen this option had it been given accurate information about the available data – and this suggests the whole process is questionable and likely to be invalid. http://www.bmj.com/content/345/bmj.e8576.full