RIVM Rapport 442013001
Abstract niet beschikbaar
The progress in medical technology causes an increasing availability of diagnostic tests for early detection of serious, incurable diseases and for making predictions about the occurrence of clinical signs. With reference to the political discussion about prognostic medical research, the National Institute of Public Health and Environmental Protection has on assignment investigated what kind of questions and types of medical-diagnostic tests are being used during pre-employment examinations, life-insurance examinations and disability insurance examinations at this moment and in the near future. Furthermore, the prognostic value of the questions/tests with respect to the purpose of the examinations is reviewed and conclusions are drawn about which questions/tests can, from a scientific point of view, be used meaningful in these examinations. The study is done by means of literature-search and consultation of experts. In the examinations, a multitude of questions and tests is being used, of which a selection has been discussed. A distinction has been made between the validity/predictive value of a question/test and the prognostic value of information about a risk factor/disease towards the purpose of the examinations. The prognostic value of questions and tests, used in the examinations, is strongly dependent on the predicted endpoint ; suitability for a job, risk of industrial disability or mortality-risk. The prognostic value is therefore depending on both the specific question or test and the type of examination. In the last chapter of this report, conclusions have been drawn separately for each type of examination. Subsequently, some draw-backs of the study are discussed.