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α-Fetoprotein Screening and the Standard of Care-Reply

Michael John Hughey, MD
JAMA. 1987;257(2):188-189. doi:10.1001/jama.1987.03390020054019.
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In Reply.—  The survey that was the basis of this study was performed in April 1985, a fact that was regrettably removed from the original manuscript in the editing process. I share Dr Weiss' surprise that only 15% of plans surveyed at the time were routinely offering serum α-fetoprotein screening. Our group model health maintenance organization (NorthCare Medical Group/PruCare of Illinois) reached the same conclusion as Dr Weiss—that serum α-fetoprotein screening should be routinely offered to all patients—and it has offered such screening for several years.Nonetheless, I am uncomfortable in declaring serum α-fetoprotein screening to be "the standard of care," particularly when less than two years ago only 15% of groups routinely offered this test. Neither the current editions of Williams' Obstetrics1 nor Danforth's and Scott's Obstetrics and Gynecology2 recommend that this test be done routinely. Based on my informal knowledge of medical group practices throughout the


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