Drew Moghanaki, Professor, Chief of Thoracic Oncology at the Department of Radiation Oncology and Stanley Iezman and Nancy Stark Endowed Chair in Thoracic Radiation Oncology Research at David Geffen School of Medicine at UCLA, and Chief Medical Officer of Respirati, shared a post on LinkedIn about a paper by Ronald Bayer et al. published in the American Journal of Public Health:
“For decades, HIV testing was treated as exceptional – surrounded by special written informed-consent requirements intended to protect patients. The intent was noble. The outcome was not.
As chronicled in a landmark public-health history, mandatory written consent ultimately proved to be a barrier to care, slowing testing, perpetuating stigma, and leaving too many people unaware of a lethal but treatable disease. After years of evidence, debate, and quiet realization, states moved to opt out of testing. The change did not reduce autonomy. It saved lives.
Lung cancer screening is at a strikingly similar inflection point. The Shared Decision-Making (SDM) mandate for low-dose CT screening was created with good intentions – to inform patients and respect autonomy. But in practice, it has become a bureaucratic gatekeeper, requiring a documentation hurdle to meet billing requirements that disproportionately block access, segregate access, and reinforce inequities among those at highest risk.
We already know what works. Annual LDCT screening reduces lung-cancer mortality. We already know what doesn’t. Complex, checkbox-driven consent rituals layered onto routine preventive care in already-busy primary care clinics.
HIV policy evolved when we recognized that exceptionalism was doing harm. Lung cancer screening deserves the same courage. Eliminating the SDM mandate would not eliminate conversations – it would allow them to happen naturally, efficiently, and equitably within routine care.
History has taught us this lesson before. The question is whether we’re willing to apply it now – before more preventable deaths occur.”
Title: The End of Written Informed Consent for HIV Testing: Not With a Bang but a Whimper
Authors: Ronald Bayer, Morgan Philbin, and Robert H. Remien
You can read the Full Article in the American Journal of Public Health (AJPH).
More posts featuring Drew Moghanaki.