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AJPH First Look, published online ahead of print Feb 28, 2007
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April 2007, Vol 97, No. 4 | American Journal of Public Health 589
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2006.107169

LETTER

METHODOLOGY MATTERS

Lainie Friedman Ross, MD, PhD

Lainie Friedman Ross is with the Section of Community Health Sciences in the Institute for Molecular Pediatric Sciences and the MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Ill.

Correspondence: Request for reprints should be sent to Lainie F. Ross, University of Chicago, Department of Pediatrics, 5841 S. Maryland Ave, MC 6082, Chicago, IL 60637 (e-mail: lross{at}uchicago.edu).

I want to thank Green et al. for discussing important challenges and complexities in newborn screening (NBS).1 However, in their review of NBS for cystic fibrosis, Green et al. only considered programs that applied an immunoreactive tryspsinogen (IRT) screen that "triggered genetic analysis"1(p1957) for those with a positive screen. As Green et al. realize, although most US programs use an IRT/DNA methodology, not all do so.2 Rather, some use an IRT/IRT method, although this method has the disadvantage of requiring a second blood sample.2 However, there has been some work on using a pancreatitis-associated protein enzyme-linked immunosorbent assay combined with the IRT,3 and this can be done on a single sample with approximately 100% sensitivity and a false-positive rate less than 0.25%.3

Why should we consider a non–genetic-based alternative? As Green et al. note, "the detection rate of DNA mutation testing is highly dependent on racial and ethnic background."1(p1958) The panels in use in the United States are much less sensitive for African American and Hispanic children, and therefore, the decision to use IRT/DNA may contribute to health care disparities.

Given its public health focus on identifying all children with treatable diseases, testing methodologies for NBS should be chosen to improve, not worsen, current health care disparities.

References

1. Green NS, Dolan SM, Murray TH. Newborn screening: complexities in universal genetic testing. Am J Public Health. 2006;96:1955–1959.[Abstract/Free Full Text]

2. Wilfond BS, Gollust SE. Policy issues for expanding newborn screening programs: the cystic fibrosis newborn screening experience in the United States. J Pediatr. 2005;146:668–674.[CrossRef][Web of Science][Medline]

3. Sarles J, Berthezene P, Le Louarn C, et al. Combining immunoreactive trypsinogen and pancreatitis-associated protein assays, a method of newborn screening for cystic fibrosis that avoids DNA analysis. J Pediatr. 2005;147:302–305.[CrossRef][Web of Science][Medline]





This Article
Right arrow Extract Freely available
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
AJPH.2006.107169v1
97/4/589    most recent
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Citing Articles
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Google Scholar
Right arrow Articles by Ross, L. F.
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PubMed
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Right arrow Articles by Ross, L. F.
Related Collections
Right arrow Ethics
Right arrow Public Health Practice
Right arrow African Americans/Blacks
Right arrow Hispanics/Latinos

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