Commercial Come-Ons for Medical Screening: Just Say No
We’ve all seen, heard or read the pitch: “Get a bone density screening this weekend!” a typical radio promo might say. Such offers might be extended by churches, pharmacies, fitness clubs and shopping malls in conjunction with companies that provide the technology. Local hospitals, academic medical centers and physician groups are often advertising sponsors, lending them a sense of credibility.
Such direct consumer marketing of medical procedures offers convenience and lower cost than those prescribed by a clinician. But, as regular readers of this blog would know, just as there is no such thing as a free—or cheap—lunch, there is no such thing as a risk-free medical screening.
Some routine screenings are unquestionably good and relatively low tech. Checks for hypertension (blood pressure), dyslipidemia (abnormal cholesterol or blood fats), diabetes and tobacco use—combined with lifestyle modification and medications—can prevent more than half of all heart attacks and strokes, according to a recent article published in the Annals of Internal Medicine.
But, write Drs. Erik A. Wallace, John H. Schumann, and Steven E. Weinberger, “[T]he increasing availability of direct-to-consumer screening tests is undermining physician efforts to provide high-quality, cost-conscious screening services to patients through shared decision making.”
They’re particularly concerned about the misapplication of technology—using hi-tech equipment such as ultrasonography to assess carotid arteries for blockage, for example. Physicians and medical facilities like these tools (and often feel the need to use them liberally to justify their cost), and many patients believe they’re getting a higher level of care with fancy tools. But, as the writers point out, their widespread use contributes to substantial increases in health-care costs.
And, the writers warn, “When screenings are provided in a church and sponsored by a trusted medical organization, consumers may have a false sense of trust in the quality and appropriateness of services provided. Consumers are generally unaware of the potential harms of screening.”
They note that when the screening tests are purchased and performed, the tech companies tell consumers to share any “abnormal” result with their personal doctors. As we’ve discussed, and the journal writers reinforce, most of these tests are not medically indicated in the first place; their questionable use is not disclosed to consumers; and there is no discussion about the possibility of consequences or additional costs.
The harms of unnecessary screening, as we regularly remind, include:
- unnecessary worry and emotional upheaval;
- false positives (the indication of a problem when there isn’t one) that often lead to invasive, uncomfortable, additional testing that can bring complications such as infection, impaired function, loss of work time … and expense.
Absent individual counseling about the potential risks of an “abnormal” result by the purveyors of direct-to-consumer tests, the consumer won’t know that following up with their medical caregivers could invite what the journal writers call “a Pandora’s box of referrals and additional testing to monitor or treat these abnormal findings.”
Advocates of the generous use of screening technology like to promote the idea that someone who knows he has a disease or shows a predisposition to disease is more likely to make lifestyle changes that benefit his health.
That’s fiction. “[E]vidence does not support this hypothesis,” say the journal authors.
They cite the example that although patients who smoke and are interested in quitting have a high incidence of atherosclerosis (narrowing of the carotid artery), people whose carotid ultrasonography results are abnormal are no more likely to quit smoking than those with normal results or those who did not have the test. And the U.S. Preventive Services Task Force recommends against screening the general adult population for atherosclerosis, thanks to a fair certainty that there is no net benefit.
Commercial medical screening is just a Pollyanna way of getting consumers to sample something merchants would like to sell them in perpetuity. From their standpoint, it’s best not to muddy the “information is powerful” message with reality.
That reality, the journal writers say, is that claims such as, “the ultrasound screenings we offer can help save your life” are coercive, unsubstantiated, misleading statements that escape the regulatory control imposed when pharmaceutical companies try to sell drugs directly to consumers. Those companies are required to disclose the potential risks of taking a medication, which is why the possible side effects listed ad nauseum in their TV commercials often take more time than the drug pitch.
When the mobile ultrasonography screening van stops at your local library in the hope of testing the health of your carotid arteries, the journal authors believe, it, too, should “be obligated to disclose from published guidelines the recommended indications and benefits of testing, as well as the potential risks and harms.”
It’s a question not only of patient safety, but ethics. The writers say that:
- Companies offering such screening tests should fully inform customers of the potential risks of positive or negative screening test results before the test is performed.
- Medical organizations, hospitals and physicians should refrain from sponsoring health screenings with commercial companies that offer unproven or harmful testing because it represents a conflict of interest.
If screening someone who shows no symptoms of disease with a test not indicated for their situation is not medically beneficial and doesn’t increase the chances of a positive change in behavior, the writers ask, “how can it be ethical to allow marketing of such tests to the public?”
You cannot make an informed choice about your medical care if you don’t have all the information. And, despite their claims that screening gives you information you need, direct-to-consumer screening operations give you only half the story.
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