The Golden Ticket and polarisation


Agreement: 
I Agree
Body: 

Dear Editor

Elspeth presents an interesting article about polarisation.

I would like to add that one context where polarisation is common is when there is the possibility of a “Golden Ticket” (with acknowledgments to Roald Dahl).

Fictitious example:

Screening for ABC syndrome gives net benefit of zero QALYs. But in this fictitious example that does not mean that nobody benefits. It means that for every 10000 people you screen, 9999 have a trivial decrease in their quality or length of life. But for the lucky one, who can be considered the Golden Ticket winner, he will have an enormous benefit to his quality or length of life.

No rigorous mathematical logic nor learned panel of experts can tell us whether a patient should “rationally” choose to be screened or not. The scope for polarisation is obvious.

No competing Interests: 
Yes
The following competing Interests: 
Electronic Publication Date: 
Wednesday, November 26, 2025 – 13:43
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Full Title: 

The Golden Ticket and polarisation

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Last Name: 
Summers
First name and middle initial: 
Dylan
Address: 
York
Occupation: 
GP
BMJ: Additional Article Info: 
Rapid response



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