Health News Review

In the Guardian newspaper, UK physician and writer Margaret McCartney wrote, “Private health screening tests are oversold and under-explained: Health screening can cause more harm than it prevents, so companies have a duty to provide full information to customers.”

In the article, she introduced a new website called PrivateHealthScreening.org.  She writes that:

“…out of frustration and anger, myself and a few colleagues — including GPs and neurologists — have set up a website, www.privatehealthscreening.org to share information about screening and suggest things that people who are considering private tests might want to think about first. One of our collaborators is emeritus professor of neurology Charles Warlow, who went for a Life Line Screening in his local church call and concluded, in the BMJ, “Why is this nonsense tolerated or allowed?

It’s a good question and one that UK regulators seem not to be asking.”

Screenshot of the new site’s masthead:

The site includes examples of “misleading advertisements.

And it lists links to an “Evidence Bank” for the following screening tests:

Screening the carotid artery

http://www.uspreventiveservicestaskforce.org/uspstf/uspsacas.htm
http://www.ahrq.gov/downloads/pub/prevent/pdfser/cas/cases.pdf
http://www.screening.nhs.uk/private-screening

ECG screening

http://annals.org/article.aspx?volume=155&page=375
http://www.screening.nhs.uk/private-screening

Prostate cancer screening

jama.ama-assn.org/content/305/22/2295.long
www.nejm.org/doi/full/10.1056/NEJMoa0810696
jnci.oxfordjournals.org/content/101/6/362.long

Genetic screening

http://www.bmj.com/content/339/bmj.b4253?ijkey=ad53d505ed72605e862d1821393dbfe9152e3b21&keytype2=tf_ipsecsha&linkType=FULL&journalCode=bmj&resid=339/oct29_3/b4253

Osteoporosis

http://www.screening.nhs.uk/osteoporosis
http://www.bmj.com/content/344/bmj.e3502.full?ijkey=tzRK2ncLto2JJ9I&keytype=ref

Liver function tests

www.springerlink.com/content/x6kvhu744u700103/

Brain scans – incidental findings in the population and aneurysms

www.nejm.org/doi/full/10.1056/NEJMoa070972
www.nejm.org/doi/full/10.1056/NEJM199812103392401

This is a very important contribution to the public dialogue about screening tests – and about the tradeoffs of potential benefits and potential harms.

Comments

Joelle Reizes posted on October 18, 2012 at 4:03 pm

While we understand there will always be debates about health screenings, Life Line Screening will continue to offer high quality, convenient, affordable private screenings that individuals can voluntarily choose if they have appropriate risk factors and decide that the screenings are right for them. Recent criticism of private health screenings fails to account for the context in which screenings are taking place. Others are free to disagree, but we believe a model that promotes education and prevention can serve a vital role in the health care continuum. Please visit our blog for more facts about health screenings and to read our full response to recent critiques: http://www.lifelinescreeningblog.com/index.php/presenting-the-facts-by-addressing-margaret-mccartneys-issues-against-life-line-screening/

Joelle Reizes
Communications Director at Life Line Screening

    Gary Schwitzer posted on October 18, 2012 at 5:37 pm

    Joelle,

    We will publish your comment, even though our comments policy clearly states that I will delete any comment “with any kind of product pitch” – which is how some might interpret your comment. But we will publish it because your link is a response to Dr. McCartney’s writings.

    But I’m curious: did you comment about Dr. McCartney’s article in the newspaper or on the website of The Guardian where it was originally published?

mgt mccartney posted on October 19, 2012 at 6:19 pm

I’ve posted this on the lifeline screening blog.

Dear Joelle

Sadly your response does not actually address the issue, which is that people have been advertised to by your company through making false promises of the benefits of your tests. Screening is usually complex and always contains a balance of pros and cons. You have not informed people about the drawbacks, uncertainties, hazards or lack of evidence for what you offer. This is the real problem and one that you haven’t addressed. Your new UK adverts are a slight improvement in that they don’t make some unproven claims as before, but still do not explain the downsides of screening.

Your comments about me then effectively suggesting that I have told people to just go on ‘waiting for symptoms’ simply doesn’t reflect the evidence or indeed what I have said. People can do many things to reduce their risk of many diseases. Most of this advice is straightforward. Eat a varied diet, don’t be over or underweight, exercise daily, don’t smoke, drink moderately, do work you enjoy, see friends and meet people. My comments do however reflect the fact that screening tests can lead to harm through unnecessary interventions. The less chance of benefit, then the greater risk of unnecessary harm.

The study you cite (4) above, was a complex long term intervention examining many types of cardiovascular risk factors, in particular BP treatment. It is not possible to attribute any potential benefit (and there may have been problems with this trial in that the effect may not have been down to the activities done because of the trial, see the discussion section) to the activities of Lifeline Screening based on this.

Next, customer testimonials do not count as evidence. We know that harmed people tend to report fewer adverse outcomes because of the ‘popularity paradox’ – people tend to feel grateful that a false positive was a false positive rather than feeling angry that they were unnecessarily tested for something that wasn’t going to harm them. Also, seriously harmed patients can’t always speak up for themselves either. Testimonials are not reliable evidence.

You also say that “No screening is without risk, and any screening has a small, but certain risk of adverse outcomes as have any medicines or surgeries. On the basis of probabilities, however, its advantages far outweigh potential risks.” That’s really pretty incredible, given the huge amount of research that has been done on screening, and the many findings of ineffective screening tests – that did too much harm to make the benefits worthwhile. And in any case, it should be up to the person to decide what level of risk is acceptable to them – not for a commercial company to make that value judgement for them.

Why don’t you read the extensive evidence about the balance of benefit and harms that we have on our website?

http://privatehealthscreen.org/evidencebank.html

There is no reason to think that knowledge and prevention of disease has to include non evidence based screening tests, and the arguments you are using are similar to those that people who promote homeopathy use.

I’d like you to consider what informed choice really means and whether or not your customers are being given fair and unbiased information before handing over their money.