Health News Review

This is the third year I’ve written about questionable screening test promotions presented by Minneapolis TV station KARE-11 at the Minnesota State Fair.

It’s 2013 MN State Fair time, and KARE-11 is back again with its “Know Your Numbers” campaign.

It’s clear that vested interests have helped create a large population of “numbers-obsessed” patients – “lab-test junkies.”

The “Know Your Numbers” obsession may cause as much harm as it does good.

Just think about the folly of some of what’s done at KARE-11 State Fair health promotion.

You can have your blood glucose checked and there’s a sign saying that you don’t even have to fast first.  So what good is this blood glucose test going to be for people who have been walking around the State Fair for hours eating bourbon wurst, cajun pork rinds, breakfast sausage corndogs, candied bacon cannolis, cocoa cheese bites, deep fried bread pudding, English toffee fudge puppies, fried pickles ‘n’ chocolate, funnel cake sundaes, and deep-fried Snickers bars? Is this really the test result that is going to give people a true indication of their usual daily blood glucose?

Certainly there’s no harm in reminding people about the importance of occasional blood glucose testing.  But the US Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower.  The USPSTF reminds us that we don’t know “the longer-term effects of labeling a large proportion of the adult U.S. population as abnormal.”  At the very least, doing blood glucose screening in a general population at a fried food and saturated fat fiesta like the MN State Fair is going to result in many elevated scores, many of which will return to normal once people return to their normal routines, yet some of which might cause anxiety and unnecessary medical visits.

More bothersome – and for the second straight year we criticize KARE-11 for this – is the osteoporosis testing that is done by quick ultrasound scans of the heel. At right is a picture I took of the scanning in action – at rear right in the photo.

Maybe KARE-11 should pay attention to what happened in Indiana seven years ago (my emphasis added).:

“..the Indiana State Department of Health ended a free bone density screening program in June 2006. The program had been in existence since 2000.

The State’s Office of Women’s Health had offered the free tests, which involved ultrasound scans of the heel. Tests had been given to about 51,000 women in Indiana over the six-year period and cost the state approximately $600,000.

In deciding to end the free screening program, State Health Commissioner Judith Monroe, MD, cited concerns that the tests could be inaccurate. Her office reviewed the program and learned that the use of heel ultrasound technology is not as reliable as the dual-energy x-ray absorptiometry; that tests were conducted on any woman 18 years or older who wanted one; and tests were conducted without taking the women’s risk factors into account. Risk factors were not considered until the test was finished.”

As you read the medical literature, it’s easy to find concerns about the uncertainty over how to interpret a heel bone density test. Some bone density experts say that in order to get a helpful test, you must measure density in the hip or spine.

The US Preventive Services Task Force “recommends screening for osteoporosis in women aged 65 years or older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors.” In other words – for specific groups of women – but not for all women.  At the TV station’s state fair health fair, I saw much younger women lining up for the heel scans.  And it’s not clear that anyone was turned away.  The Task Force says there’s not evidence on men being scanned.  But our photo (above) captures a man being scanned.  Was he told about the lack of evidence?

Last year I noted that a commentary in the Annals of Internal Medicine, with the CEO of the American College of Physicians as one of the authors, stated concerns about the ethics of some commercial health fair screening tests, citing heel ultrasounds as one example (my emphasis added) :

“We are particularly concerned about the misapplication of technology (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. Although popular with consumers and physicians alike, technology has contributed to a substantial increase in health care costs, and patients are increasingly demanding testing from their physicians. …

Anyone can purchase these tests—regardless of age or risk factors for disease or whether testing is truly indicated—if they are willing to pay the advertised fee. 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.  …

…misuse of preventive services, under the guise of saving lives and saving costs, may actually lead to increased cost and harm due to unnecessary follow-up testing and treatment with associated avoidable complications. We suggest that medical entities and physicians withdraw from the unethical business of promoting unproven and potentially harmful screening tests.”

We suggest – for the third straight year – that KARE-11 withdraw from promoting questionable screening tests.  The TV station must answer to ethical concerns about this practice as well.

Last year when I wrote about this, Susan Perry of MinnPost.com followed up with some of her own reporting and her own perspective:

“They are totally optional,” said Craig Hotvedt, executive director of Health Fair 11, the nonprofit organization that organizes the State Fair screenings for KARE-11, in a phone interview. “It’s not like we are forcing them on people.”

People go to the State Fair to have fun and not for a medical consultation, he added, and therefore they understand that the findings from the ultrasound heel screenings are not to be taken “as written in stone.”

I’m not sure everyone will understand that. KARE-11′s heel screening may cost only a nominal $4, but caveat emptor nevertheless.”

Nobody said KARE was forcing people to be scanned.

More to the point, no one is forcing KARE to endorse these scans by letting vendors sell them – even for only a few dollars – in their State Fair health fair. Someone at the station has apparently decided they know more than some expert physicians, including the CEO of the nation’s largest medical-specialty organization and second-largest physician group.

I suggest it’s TV station marketing gone bad.  If KARE really cares about helpful health fair promotions, it should have a booth endorsing truly informed shared-decision making that educates consumers about facts such as:

  • In health care, more is not always better.  More testing is not always better.
  • In the words of Dr. Muir Gray, “All screening programs do harm.  Some also do good.”

And then they should address these issues in their newscasts as well.

Caveat emptor, indeed, lest later you feel like a heel for what you didn’t know or weren’t told.

ADDENDUM on August 27:

“…that the specific screening tests offered by the “Know Your Numbers” campaign at the State Fair may change next year. “Every year we have discussions about which screenings we should do and not do,” he said. “I think we will certainly want to take a closer look at these screens.”

Should I get an osteoporosis screening at the pharmacy?

Not if the screening device scans your heel to capture your bone density measurement, instead of the lower spine or hip. Bone density measurements help determine if you have osteoporosis. But heel scans can be inaccurate, say our medical consultants. The problem is that “normal” results could provide a false sense of security. For a better assessment, and to help determine whether you even need the test at all, discuss with your doctor.

“The heel may not be representative of the rest of the skeletal system,” says Marvin M. Lipman, M.D., chief medical adviser for Consumer Reports. “And the ultrasound equipment used in these settings does not produce nearly as accurate a result as scans of the hip and lower spine.”

Regardless of the setting, bone density screenings are frequently overdone. Women at average risk for osteoporosis don’t need to be tested until age 65; men, age 70. In younger people, any bone loss is likely to be a milder form called osteopenia that does not substantially increase fracture risk. In those cases, any small benefit to be gained from using bone-building drugs is far outweighed by their risks, which include heartburn, difficulty swallowing, throat or chest pain, and, paradoxically, a risk of thigh fractures.

————————

Follow us on Twitter:

https://twitter.com/garyschwitzer

https://twitter.com/healthnewsrevu

and on Facebook.

 

Comments

Laurence Alter posted on August 26, 2013 at 9:40 am

Dear Staff,

Why do you take television “”journalism”" seriously? Why lower yourselves?
I presume you know the difference between print and non-print (“broadcast”) journalism.

In college, I had a child psychology professor (“Developmental Psychology” was the course name) who once said that the best orphanage was worse than the worst foster home. Consider that an appropriate analogy for your (supposed) choice of best television reporting.

Yours,

Laurence

    Gary Schwitzer posted on August 26, 2013 at 10:49 am

    Laurence,

    This had nothing to do with television journalism.

    This was about a television station hosting a Health Fair at the MN State Fair.

    It had more to do with their marketing/promotions/community relations departments than it did with their news department.

    Nonetheless, it is a media ethics issue.

Sarah posted on August 27, 2013 at 12:49 pm

I have had the opportunity to take part in the HealthFair 11 screening that you are speaking of. Let me first ask you if you have taken the time to do this screening or asked for an explanation from the people that are performing it? I have some medical background and was very curious about the screening. Upon reading the consent form, it is very clear that the test performed is not diagnostic but a screening tool. In fact, I was told that the only diagnostic tool for osteoporosis is the DEXA scan. One thing that piqued my interest was the fact that I am no longer building bone, as I am 39 years old, and was curious as to what recommendations they could give me to help maintain good bone health. I walked away with more information about osteoporosis risks, such as nicotine and alcohol’s roles in calcium absorption. It was $4 well spent.

    Gary Schwitzer posted on August 27, 2013 at 1:26 pm

    Sarah,

    Thanks for your note.

    It is the heel scan’s use as a screening tool that was criticized by the experts I cited – the commentary in the Annals of Internal Medicine and the abandonment of the free (not $4 charge) screening once offered by The Indiana State Department of Health. We didn’t write anything about the heel scan being a diagnostic tool. There are enough questions about it as a screening tool, much less looking at it as a diagnostic tool.

    I’m happy for you that you are happy with your experience. The evidence-based concerns about the practice stand nonetheless. The meaning of caveat emptor, as you undoubtedly know, is “let the buyer beware.” If you know about the limitations of the procedure and still want to do it, that’s totally up to you.