Talk:Prenatal testing

From Wikipedia, the free encyclopedia
  (Redirected from Talk:Prenatal diagnosis)
Jump to: navigation, search
WikiProject Medicine / Medical genetics / Reproductive medicine (Rated C-class, High-importance)
WikiProject icon This article is within the scope of WikiProject Medicine, which recommends that medicine-related articles follow the Manual of Style for medicine-related articles and that biomedical information in any article use high-quality medical sources. Please visit the project page for details or ask questions at Wikipedia talk:WikiProject Medicine.
C-Class article C  This article has been rated as C-Class on the project's quality scale.
 High  This article has been rated as High-importance on the project's importance scale.
Taskforce icon
This article is supported by the Medical genetics task force (marked as Mid-importance).
Taskforce icon
This article is supported by the Reproductive medicine task force (marked as High-importance).
 
WikiProject Women's Health (Rated C-class, High-importance)
WikiProject icon This article is within the scope of WikiProject Women's Health, a collaborative effort to improve the coverage of Women's Health on Wikipedia. If you would like to participate, please visit the project page, where you can join the discussion and see a list of open tasks.
C-Class article C  This article has been rated as C-Class on the quality scale.
 High  This article has been rated as High-importance on the importance scale.
 


Personal Opinion[edit]

Article uses many loaded terms like "needlessly worry", etc. — Preceding unsigned comment added by 76.127.54.50 (talk) 05:20, 1 December 2016 (UTC)

Ethics[edit]

It seemed to me that the ethics issues are delicate. I changed the lanugage to be more neutral and non-judgmental.

Removed " or mental retardation" from section. The sentence was that women should have their child screened if their partner comes from an ethnic background prone to genetic disorders "or mental retardation". Sounds like something from the 50s to me.

Reply to anonymous. The problem you noticed was not obsolescence but rather that an encyclopedia like this should be descriptive, not prescriptive. It should describe what people do, it can describe what a certain authoritative organization advocates, it can describe the views of those who support or oppose certain actions, but it should not say "you should do x" or "a woman over 40 should do x" or anything similar. The other part of the problem is that nowhere in the introductory paragraphs is there a reason for prenatal diagnosis. There are three purposes of prenatal diagnosis: (1) to enable timely treatment of a condition before or after delivery, (2) to give the parents the chance to abort a fetus with the diagnosed condition, and (3) to give parents the chance "to prepare" for a baby with a problem (this last is emphasized in the article but in fact it is the first two reasons that have really driven policy and practices in this field and we should not be shy about acknowledging them. alteripse 00:12, 5 July 2006 (UTC)

prenatal diagnosis vs prenatal screening[edit]

This generally excellent article seems to be more about screening than diagnosis but it sort of covers both without explaining the distinction. This is my first look at this article and I dont know if it is currently "tended" by anyone. I am going to set up a redirect from prenatal screening, which is what I was looking for when I found this. Anybody want to keep them two distinct articles? Anybody object to renaming this article prenatal screening and making prenatal diagnosis the redirect? This is not my field of expertise or special interest. alteripse 00:12, 5 July 2006 (UTC)

Reply - I agree; it would be better for this article to be titled 'prenatal screening' and redirected from 'diagnosis'. Tynam 13:52, 29 January 2007 (UTC)

Non-invasive techniques[edit]

  • This article seems strong on invasive and ultrasound diagnostic techniques but says little about the (increasingly common) use of non-invasive protein and hormone measurements for preliminary screening. This is related to the rather vague distinction this article makes between screening and diagnosis. Compare to the 'prenatal screening' section under Down syndrome or in individual marker articles such as Alpha-fetoprotein. Do we need separate sections on non-invasive and invasive tests? Tynam 13:59, 29 January 2007 (UTC)
  • The article presents "invasive = diagnosis, non-invasive = screening", which is false. Non-invasive ultrasound scanning can be used to correctly diagnose many problems (eg, bulky tumors, spina bifida, anencephaly, missing limbs). Invasive amniocentesis sampling can be used to screen for but not diagnose some problems (eg, open abdominal wall, spina bifida). Una Smith 03:21, 14 June 2007 (UTC)

Merge here?[edit]

Fetal screening is a stub. Merge it here? --Una Smith (talk) 00:23, 1 January 2008 (UTC)

Screening versus diagnosis[edit]

Currently the article does not adequately explain the differences and relationships between screening and diagnostic tests. --Una Smith (talk) 17:01, 2 January 2008 (UTC)

Seems like the article might be better titled Prenatal testing, which would encompass both diagnostic and screening tests. But it does seem like several places diagnosis is used in the article when screening would be better term, (probably because the article started with that title, rather than because it is the right term). Zodon (talk) 09:17, 21 September 2008 (UTC)

Sex and gender[edit]

The article links to sex but in that context it really means gender. Follow both of these links and judge for yourself. Spotfixer (talk) 00:32, 17 December 2008 (UTC)

The determination is typically done by genetic testing or observation of physical characteristics, which gives an estimate of the sex of the fetus/embryo. (See for instance sex#genetic). According to the wikipedia article, gender refers primarily to sociology or grammar. (I haven't heard of prenatal test to determine gender, (e.g. identify those "whose gender identity feels incongruent with their biological sex" etc.)) Zodon (talk) 00:56, 17 December 2008 (UTC)

April 2009 new sections and US-centric legal commentary[edit]

New user with connection to fetal genetic testing from maternal blood (commendably disclosed) added a lot of new information and sections. They need though some further work to integrate better into the article, prevent duplication of some details, and also consider some US-centric legal aspects.

  • IMHO a new test will need to await its commercial release before inclusion in wikipedia article
  • Will need sources other than just those of the company to provide the idealised secondary sources that WP:MEDRS aspires to.
  • Some of specificity and sensitivity details of new 'Typical screening sequence' section duplicates that of existing 'False positives and false negatives' section - I'm not sure which way to proceed to copyedit this - thoughts please :-)
  • 'Informed consent and medical malpractice' section needs work:
    1. Firstly that off-topic here to spend too long discussing what are basic issues for all testing and medical procedure consenting issues - better for perhaps just short section with link to main article of informed consent
    2. Currently reads as somewhat of instruction manual for a patient rights (i.e. WP:NOTGUIDE applies) (and investor of a new test not best person IMHO to add such direction re potential for perception of COI - but I fully accept new editor had best of motives and at least some consideration of this diffcult ethical area needs mentioning)
    3. US-centric in suggesting that women have right to be informed of all possible tests and choose which ones they will have. In UK there are clear screening guidelines and NHS service commitments, but outside of that a women without specific risk-factors has no inaliable "right" to additonal tests nor therefore expectation to be counselled on them (hence whilst poor practice not to offer testing to those over 35, no NHS access for Nuchal Thickness scans for those under 35 and so no requirement to consent on this topic - yet plenty of other aspects that would still need be covered such as our routine UK morphology scans at 18-21 weeks that provides a layer of universal screening).

Anyway link to discussion thread on my talk page is here, but further discussion is probably better undertaken below :-) David Ruben Talk 21:24, 20 April 2009 (UTC)

amniocentesis risk dramatically overstated[edit]

See Wikipedia entry on amniocentesis for more accurate information about the risks of amnio. The 1 in 200 miscarriage rate from amnio is a very old statistic and may never have been accurate for an experienced practitioner--certainly that's a dramatic overestimate given the way things are done nowadays (although there is probably significant variation among doctors and facilities). It's outrageous that it's taken so long to start updating the information people are given in deciding whether to have an amnio.

Anyhow, the risk estimate should be updated here. See http://www.marchofdimes.com/printableArticles/14332_1164.asp#head5, for example. —Preceding unsigned comment added by Katydid99 (talkcontribs) 21:12, 31 January 2010 (UTC)

Societal Pressures on testing[edit]

I realize this page is in start-up mode, but this section really shouldn't stand as-is with a note that it applies to the U.S.

Some states go by a Reasonable Doctor standard and some states go by a Reasonable Patient standard. The tie-in to informed consent is messy. — Preceding unsigned comment added by 24.18.107.31 (talk) 07:01, 23 August 2011 (UTC)

Flash in the pan[edit]

Lots of diagnostic tests come on the market with varying fanfare. Many fall into disuse because of a variety of reasons. Promising new tests that promise to change the way medicine is practiced usually fail to live up to the hype. WP:MEDRS prefers reviews (secondary sources) to singular studies (primary sources) for this reason. A test for a single entity may have no appreciable impact on the practice of prenatal diagnostics. When it does, as evidenced in the form of reviews and recommendations by relevant bodies, then we add new information. Per WP:SPECULATION, we write about what is done, not what might be done.Novangelis (talk) 14:43, 24 October 2011 (UTC)

Response: I'm not sure where to begin a more productive discussion on the subject of advances in prenatal testing. I have made an effort to provide information that is directly backed by a peer-reviewed publication from a well respected group at Brown University in a well regarded medical journal. In the case where I modified the math case study, increasing the denominator from 4000 screened women to 400,000 screened women, it was purely because the using a small number fails to illustrate the shortcomings of a prenatal test like MaterniT21 that does have a 0.9% false-negative rate and a 0.1% false-positive rate. If I kept it at 4000, then it would have made it look like using MaterniT21 in high-risk women resulted in perfect results. This is the opposite of hype... this is my effort to short exactly how the test works and doesn't work.

I've also devoted some effort to explaining why there is a drive in the OBGYN field to use more accurate tests... particularly that false-positives result in many unnecessary invasive tests which carry a known risk of miscarriage. This is not speculation. This is intrinsic to how patients and physicians and the experts who write the ACOG guidelines thinks about which test to use. The references I provided back all this up.

This is an area that I have monitored for many years, attended conferences, advised several companies, and invested in several companies. I do indeed what to see MaterniT21 used - because the alternatives are substantially worse. Why would anyone want to subject their baby to a 0.5-1% risk of miscarriage to find out if the baby has Down Syndrome when there is now a non-invasive blood test available? Cost is certainly an issue, though I have stayed away from that because it is such a moving target (the test will be free to some, cost $235 to others, and will cost $1900 for yet others... but as insurance plans pick up coverage, the distribution of cost will change and eventually it will be free or have a low co-pay for most patients).

Why would you want to treat this test like it's some kind of crazy experiment that should be kept in the shadows? Wikipedia has tons of references to all sort of speculative tests, such as non-invasive tests based on fetal cells, that have failed for 20 years and remain science projects. But when a CLIA-certified test is actually brought to market and made available to women and characterized in a large study by the same people at Brown University who validated the last major advance in prenatal screening (the Prenatal Integrated Screen... which is a combination of NT ultrasound with 1st trimester blood markers and 2nd trimester Quad test), the news is treated like it's speculative garbage.

Who do you think is going to update Wikipedia with this information? Someone who doesn't care? Of course it's going to be with someone who cares enough to bother to sit down and write all this out and subject themselves to having all their revisions undone repeatedly by people who are suspicious that everyone else is a sales rep posting lies to sell snake oil. How is anyone supposed to get through that filter when you throw the babies out with the bathwater?

So please don't just UNDO everything I've written. Go into each section and point out what it is that you think is "speculative".

(talk) —Preceding undated comment added 18:17, 24 October 2011 (UTC).

The reply, is speculation: "as insurance plans pick up coverage, the distribution of cost will change". Wikipedia is not interested in your Crystal ball. Wikipedia uses reviews by reliable sources—per policy. Yes, ACOG relies on primary studies when it reviews tests. Wikipedia relies upon those reviews which are yet to exist. We don't know what ACOG will recommend. This makes it all speculative. CLIA-certified tests have come to market and foundered. It could turn out that a competing test using the same method or tests using other same method will work better and get the recommendation.[1] We'll see what the new model is when there is a new model.Novangelis (talk) 22:14, 24 October 2011 (UTC)

That's fine, I can remove that line about insurance coverage, though it's not exactly speculation considering that the definition of insurance covering a test is that they pick up more of the bill. Please take a look at this update to ISPD recommendations on prenatal screening. This is a medical society that advises on best practices. http://ispdhome.org/public/news/2011/ISPD_RapidResponse_MPS_24Oct11.pdf

Putting information on Wikidedia about MaterniT21 is no more about selling that test than having information about the Quad test or Ultrasound or Amniocentesis is trying to sell those tests/procedures. Please also appreciate that every single test available for prenatal screening/testing is currently CLIA certified. In fact, the vast majority of diagnostics are CLIA certified and not FDA approved. 90% of the business would vanish if you only focused on FDA approved tests. Furthermore, it is not important whether another test will come to market and displace MaterniT21; if you have a crystal ball, that's fine, but currently the only test of its kind that does exist is MaterniT21 and so it merits being discussed. But if you are interested, Verinata is at least months away from launching their test and Tandem is under the radar but still has to complete large studies. Sequenom has the leading patents in the field, possibly with some overlap with Verinata, but those two companies would have a strong case to make in court to exclude others from the market in the US and other parts of the world (unless they too a license) and so, whatever may happen, Sequenom and Verinata are in the strongest position to be dominant and betting on others would be increasingly speculative.

Why are you so determined to remove reference to a test that safely gives women a more accurate determination of their Down Syndrome risk? If I rewrite what I put up there originally and stripped out any predictions such as the comment about insurance, would this be acceptable to you?

Ne1ofmany (talk) 13:35, 25 October 2011 (UTC)Ne1ofmany

Use third-party (people who have not been involved with the company), secondary (review) sources per WP:MEDRS.Novangelis (talk) 14:07, 25 October 2011 (UTC)
And the IPSD report did qualify. I took the liberty of adding their conclusions which are far more sober than a company brochure.Novangelis (talk) 17:08, 25 October 2011 (UTC)

-- Ok, baby steps for me. I made a few edits and provided a summary of the basis of each edit. I stayed conservative. I'll check back in a little while and see if you have objections.

I would still like to expand the math example where the article discussed 4000 women being screened. I wrote that piece a couple of years ago because I felt that it would help people understand how sensitivity and specificity more tangible. By simply multiplying all those values by a factor of 100, it will make it easier to introduce into this example other tests as they emerge that have accuracies so high that you just can't see their flaws until you go to numbers like 400,000 screened women. I would be misleading to talk about 4000 women being screened with MaterniT21 and saying that the test would catch all 10 of the Down Syndrome cases simply because 99.1% of 10 is 9.91 and therefore rounds up to 10. But if we multiplied by a factor of 100, then you could see that the test would miss 9 Down Syndrome pregnancies out of 1000 that one would expect in a population of 400,000 women. In the spirit of being balanced, I think you would agree that showing the limitations of MaterniT21 and tests like it is informative and desirable.

So lets hash out your thoughts on this modification before I spend any time on modifying that section.

Ne1ofmany (talk) 21:37, 26 October 2011 (UTC)Ne1ofmany

Numerous core policies were breached.
Pillar: WP:Neutrality;
WP:Verifiability — statements do not match sources;
WP:MEDRS — excessive use of primary sources;
WP:UNDUE — excessive emphasis of a just-released test with no clear impact on practice (WP:SPECULATION); excessive emphasis on the availability of one test where others are likely to be released (WP:RECENTISM);
WP:PROMOTION (WP:REFSPAM).
Underlying this is WP:Conflict of interest: "Accounts that appear, based on their editing history, to be single-purpose accounts that exist for the sole or primary purpose of promotion (e.g., of a person, company, product, service, website, or organization), in apparent violation of this guideline, should be warned and made aware of this guideline. If the same pattern of editing continues after the warning, the account may be blocked." Novangelis (talk) 02:16, 28 October 2011 (UTC)

--- your behavior is appalling. You clearly do not understand the topic, as evidenced by your flawed summary of the ISPD document. You criticize what I wrote because of excessive use of primary sources? Would a tabloid be more credible? And then you object that I write about the one test that has been validated and allowed to come to market and recognized by an international body of experts (ISPD), but you saw I'm unfairly focusing on this test one test to the exclusions of others that will come later... aren't you being speculative giving others so much credit? Just look at the stuff you overlooked on this page? If you applied your rules, you would delete half the comments. Who nominated you the arbiter of everything that goes on this page?

Fine - I'm done with this - let someone else play this spiteful tug of war with you. Or maybe for the sake of all the people who come to read this page, you'll do more homework and drop your attitude.

I'm sure there is someone else out there, OB/GYN or someone who also agrees that the introduction of a more accurate Down syndrome blood test is the most significant improvement in the field of prenatal diagnosis to happen in the last 10 years and therefore deserves to be explained in detail on this Wikipedia page. Hopefully you won't make their experience feel like conversing with a wall.

166.137.136.25 (talk) 17:52, 28 October 2011 (UTC)Ne1ofmany

External links modified[edit]

Hello fellow Wikipedians,

I have just added archive links to one external link on Prenatal diagnosis. Please take a moment to review my edit. If necessary, add {{cbignore}} after the link to keep me from modifying it. Alternatively, you can add {{nobots|deny=InternetArchiveBot}} to keep me off the page altogether. I made the following changes:

When you have finished reviewing my changes, please set the checked parameter below to true to let others know.

As of February 2018, "External links modified" talk page sections are no longer generated or monitored by InternetArchiveBot. No special action is required on behalf of editors regarding these talk page notices, other than regular verification, as with any edit, using the archive tools per instructions below. This message updated dynamically through the template {{sourcecheck}} (last update: 1 May 2018).

  • If you have discovered URLs which were erroneously considered dead by the bot, you can report them with this tool.
  • If you found an error with any archives or the URLs themselves, you can fix them with this tool.


Cheers.—cyberbot IITalk to my owner:Online 13:19, 7 January 2016 (UTC)

possible source[edit]

See

-- Jytdog (talk) 23:23, 2 April 2017 (UTC)

US country bias[edit]

The last section, after discussing general ptoperties of tests and some probably globally similar pregnancy checkups, all of a sudden reads "Performing tests to determine possible birth defects is mandatory in all states." Most probably this should have meant "US states", and not "states" as "countries". Not knowing what all more in the article is US only, and not being able to find the correct country bias or POV template that I could feel safe placing in the article text, I make at least this note here, hoping that someone will pick it up and act upon it. Thank you in advance! --Blahma (talk) 01:07, 12 December 2017 (UTC)

I made the edit for you. You should not be discouraged from making this kind of edit in the future. Deleet (talk) 03:00, 12 December 2017 (UTC)