(This commentary was not written by CRD, but by the authors of the DH Register).
For opportunistic advice by GP to quit smoking:
1) Only heart attacks and angina are considered, not for example, lung cancer.
2) The cost of intervention is miscalculated (overestimated).
3) The effect of changes in treatment costs for CHD is not discussed
4) Incorrect discounting in the ready-reckoner means that the estimated QALYs saved is too high.
For opportunistic screening by GP for hypertension and treatment for the upper quintile: 5) Only heart attacks and angina are considered, not, for example, stroke
6) Drug therapies can have adverse side-effects
7) The quality of life implications for the large numbers treated are not discussed.
For opportunistic screening by GP of serum cholesterol level and treatment for the upper quintile:
8) Drug therapies have adverse side-effects and are associated with increased mortality from other causes.