An opinion piece in the Annals of Internal Medicine, “Ethics of Commercial Screening Tests,” makes a strong, clear statement about the problems with many screening test campaigns offered by commercial companies in partnerships with churches, pharmacies, shopping malls or trusted medical organizations. Excerpts:
“Particular concerns about the use of ultrasonography (for example, ultrasonography of the carotid arteries to assess for plaques and stenosis, ultrasonography of the heel to assess for osteoporosis, and echocardiography) in the direct-to-consumer screening market as a driver of expensive and unnecessary care.
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.
Because of a lack of counseling by these companies about the potential risks of an abnormal test result, the consumer is initially unaware that this may open a Pandora’s box of referrals and additional testing to monitor or treat these abnormal findings. Our medical system and society bear the cost of poor coordination of care and additional testing and treatment to follow up on unnecessary abnormal screening test results. That most of these tests are not medically indicated in the first place is left undisclosed to the consumer, nor is there a discussion of potential adverse consequences or additional costs.
Advocates of widespread screening may argue that if patients know that they have disease, they will be more likely to engage in behavior modification. However, evidence does not support this hypothesis.
We respect patients’ autonomy to make their own medical decisions. However, choices should be informed by evidence, not such advertising claims as, the ultrasound screenings that we offer can help save your life. Patients can be coerced through unsubstantiated, misleading statements or omission of factual information into obtaining tests where the actual risk may outweigh the proven benefit. In direct-to-consumer advertising of pharmaceuticals, companies are required to disclose the potential risks of taking a medication. We believe that commercial screening companies should also be obligated to disclose from published guidelines the recommended indications and benefits of testing, as well as the potential risks and harms.”
I’ve written about these commercial screening campaigns in the past.
One year ago at this time – the time of the annual Minnesota State Fair – I wrote about how a local TV station co-sponsored a prostate cancer screening campaign. This year, it does not appear that the prostate screens are being done. But ultrasounds of the heel to check for osteoporosis – one of the very specific issues highlighted as a special cause for concern in the journal editorial cited above, continue. KARE-11 TV of Minneapolis states on its website:
“Put your best foot forward and find out your bone density. Health Strategies will be providing heel scan ultrasound bone density screenings at the fair.”
The TV station promotes this as “Know Your Numbers.” Maybe they should know the evidence (or lack thereof) for some of what they’re promoting.
Other related past posts: