If you have a mailbox, there's a good chance that you've received a letter from Peggy Fleming urging you to get some health screening scans to help prevent strokes.
I did - and I blogged about it six months ago.
Now Jeff Baillon of KMSP-TV in Minneapolis-St. Paul shows once again how TV news can do a good job of educating consumers on tough health care issues like the overselling of such screening tests.
This is an 8 1/2 minute report. Granted, this station has a one-hour newscast. But what a tribute to this news team to find the time and to make the investment to dig into health care claims as they have done.
(Disclosure: Baillon was a student in my health journalism seminar last Fall.)
I read your blog from 6 months ago and I like it. I particularly like your response to the comment that came from Lifeline. They are surely puzzled by the "Minnesota Nice" reputation we are supposed to have.
Full disclosure, I am the Dr. Courneya in Jeff's story.
My husband, Greg, who was 60 years old at the time, went to Lifeline Screening and was told to see a Dr. within 24 hours. This was on or about 11-22-07. He was checked at our Dr. and the agreed with Lifeline. He had a nearly completely blocked carotid artery. He went in for a stress test and had to have a stent put in before they could operate. They were very concerned and watched him as he needed to wait 30 days because of the blood thinners he had to take after they put in the stent. They did the surgery, which was much more complicated than expected, but completely successful. Greg NEVER had any symptoms. His stent was put in on 12-21-07 and his artery done 1-25-08.
It was such a fluke that he even went to Lifeline. One day a flyer came, and I said "do you want to do this? he said "why not?" so I signed him up.
In September of 2008 he went for a routine colonoscopy and found out he had colon cancer. He had it removed 10-1-08. If he had not been taken care of previously with regard to the stent and blocked artery, and since he never had any symptoms, we are convinced that he would have had problems, possibly fatal, during the surgery, because of what procedures he was in need of. The simple fact that he never had symptoms, not even high cholesterol meds and he is checked every year, and he needed all of this done, shows how important and accurate their tests are.
We cannot thank Lifeline Screening enough. We believe they are the reason Greg is healthy and still with us today.
Linda
9-29/09
Linda,
I’m happy for you that this screening paid off.
For many people it does not, and that is why imbalanced promotion of screening to a broad population is troublesome.
Yes, when you cast a broad net, you will pick up a few cases like your husband who might benefit.
But the fact is that in population-wide screening you will pick up many more false positives who do not, indeed, have a problem. The anxiety, the further testing that will ensue (some of which may carry its own harms), and the possible treatment that may follow (also with its own harms) – all because of a problem that wasn’t really there – is the huge “other side of the story.”
That is why we praised the TV report that gave the other side of the story that many don't get about such screening promotions.
Single anecdotes of happy outcomes fail to over-ride evidence-based recommendations that don't support such mass screening.
Life Line Screening offers a package of screenings aimed at the early identification of disease. Our focus is on people in the right target age group with risk factors, and we conduct our screenings with accuracy. [ http://lifelinescreening.com/aboutus/qualityassurance/Pages/default.aspx ] The stroke prevention components involve the three leading causes of stroke – carotid artery stenosis, atrial fibrillation, and systolic hypertension (high blood pressure). Other screenings include peripheral arterial disease and bone mineral density testing as well as finger-stick blood tests for cholesterol and glucose (sugar).
The story focused almost exclusively on one screening -- the carotid artery screening. There is a valid debate around carotid artery screening in the medical community. There are some doctors who think the carotid artery screening is a valid screening that helps identify those at risk earlier, and those who feel that the testing can lead to anxiety and further unnecessary tests that can cause more harm than good.
The basis of the Fox report is a statement by the U.S. Preventive Services Task Force (USPSTF). USPSTF is a government convened body that examines screenings and gives them a letter grade based on what they see as the evidence and their evaluation of the costs and benefits of screening.
In December of 2008, the Task Force released a statement saying they gave carotid artery screening a "D" grade, which is a low grade, and therefore do not recommend the screening based as what they saw as unacceptable costs versus the benefit to humanity. They arrived at this conclusion by doing a meta-analysis, which is a review of other published studies. As far as Life Line Screening can tell, there were no vascular specialists on the panel that did the review.
The panel's statement was based on the costs of hospital-based screening coupled with a surgical procedure called carotid endarterectomy. This model is the costliest model and since it involves surgery, does carry with it some risk. They found this not to be a good model for a large scale screening process.
But this is not what Life Line Screening does.
Life Line Screening provides community-based screening with the aim of finding disease at an early enough stage that lifestyle changes and medical management can make a difference. Community-based screening is much less expensive than hospital-based because we don't have the overhead expenses associated with maintaining a hospital. In addition, lifestyle coaching and medical management (such as aspirin therapy or statins) are cheaper and safer than surgery. The model is completely different than what the Task Force examined.
There are some additional things your readers might want to know. For example:
* Life Line Screening believes that screening people at-risk for cardiovascular disease risk factors makes sense. Finding disease at an earlier stage, when it is typically silent, is a better option than waiting for symptoms to appear and dealing with advanced disease.
* Most strokes occur out of the blue, with only a fraction having any warnings signs. For most individuals, the first sign of a stroke is the stroke. For people with osteoporosis, the first sign is often a bone fracture.
* The Society for Vascular Surgery recommends the types of vascular screenings LLSA does. http://www.vascularweb.org/members_only/pdf/SVS_Position_Statement_on_Screening.pdf
* The SHAPE Task Force, a task force of medical professionals, also recommends these types of screening. http://www.shapesociety.org/why_screening/
* The American Diabetes Association recommends one of the screenings – peripheral arterial disease – for every person with diabetes age 50 and over. http://www.diabetes.org/type-1-diabetes/well-being/peripheral-arterial-disease.jsp
* A study in the UK found community-based carotid artery screenings to be cost effective and beneficial to saving lives. http://www.cardiovascularultrasound.com/content/6/1/34
* The Mayo Clinic has a statement on its website that says, "Community screenings are an excellent way to raise awareness about common diseases and, in some situations, identify disease in its early stages. The benefit is realized when patients take the next step, seeing their physician for diagnosis and treatment." This is completely in concert with Life Line Screening's mission.
Mentioned briefly but not highlighted is the fact that Fox also received several emails from customers who say that Life Line Screening saved their lives or the lives of people in their families.
Life Line Screening stands behind its quality and is proud to serve and continue to serve the citizens of Minneapolis and Minnesota.
Dr. Manganaro,
Thanks for your note.
You said your “focus is on people in the right target age group with risk factors.”
Then why did I get the Peggy Fleming letter that your company produced? Did someone determine that I was “in the right target age group with risk factors?”
What did you know about my age and about my risk factors? And how did you get that information?
Or was that letter sent to me and thousands of others because you were just trolling for customers?
It has to be one or the other. I’d like to know the answer.
You wrote that The Society for Vascular Surgery recommends the types of vascular screenings that your company does. You also criticized the US Preventive Services Task Force for not having any vascular specialists on the panel that made its recommendation that didn’t support screening. Are you saying that only vascular surgeons can make recommendations? Isn’t good evidence good evidence no matter which initials you have after your name?
You also note that the SHAPE Task Force recommends these types of screenings. Criticism of the SHAPE Task Force is longer than your blog posting.
You pointed out that the local TV station received several emails from customers who say that Life Line Screening saved their lives or the lives of people in their families. Are people supposed to be swayed by anecdotes? Or by data and evidence? The plural of anecdote is not data.
There are two sides to this story. Do people who bite on your promotions hear BOTH sides?
I just got their letter but didn't open it--suspecting it was blanket advertising.
Well, I have greatly reduced such advertising at the senders cost with this cure: Mark the envelope "DELIVERY REFUSED... Please Return To Sender." You can add, "sender unknown," if you think an explaination is in order.
The Post Office charges return postage PLUS a return fee for EACH returned letter.-- Just image the expense if everyone did that with junk mail.
I wondered if there is any documentation from just cardiovascular professionals regarding their views on getting these Life Line screenings or some from like companies. From the information I have looked at the task force is funded by the government. I personally completely disagree with their most recent recommendations on mammograms and maybe inclined to disagree with them on others. People have worked for decades to get ladies to take a more proactive roles in their female health and this new recommendation will cause many to do just the opposite. I also find it interesting timing that the President's new health care initiative will only pay for screenings that the task force gives an A or B rating and mammograms were just dropped to a C. I am very much in favor of listening to a broad perspective of advice and would appreciate any information you can pass on to me. Also I have noticed people writing in about how these screenings have helped them. Is there any known complaints that the screenings have caused them harm? That would be very interesting information and helpful to people in their decision making process. Thank you for your help.
Liz,
Thanks for your note. I’ll try to address the points you raised.
Yes, the USPSTF is funded by the government in the sense that someone has to pay the expenses of the volunteer task force members who come from around the country to work long hours on top of their day jobs – just because they believe in evidence-based recommendations for the American public. I know several task force members. They are not “government bureaucrats” or “big government proponents” as some may have tried to paint them.
You are entitled to “personally completely disagree with their most recent recommendations on mammograms and maybe inclined to disagree with them on others” but on what evidence do you base that disagreement? These are learned, thoughtful people who deliberate for months on their recommendations.
Yes, as you say, women are encouraged “to take a more proactive roles in their female health” but it is a non-sequitur to say that “this new recommendation will cause many to do just the opposite.” How can educating women about the harms and benefits – the evidence – for mammography cause them to take a less proactive role? The essence of the USPSTF mammography recommendation was a promotion of shared decision-making and completely informed decision making between a woman and her doctor. How is that a bad thing? Many special interests have spun the USPSTF recommendations to make them sound evil and ill-considered. I encourage you to read the actual recommendations to see how terribly misconstrued their recommendations have been rendered by the biases of special interest groups.
Your assertion about “the President's new health care initiative will only pay for screenings that the task force gives an A or B rating” is simply inaccurate. I’ve read some of the same rhetoric and fear-mongering that you apparently have, and it is a shame that such disinformation campaigns can actually frighten people when they are patently false.
Thank you for taking the time to respond to my questions. Could you please address my question about people who feel the test caused them harm or unnecessary medical follow-ups? Have you received feed back from that group also. I have tried to find that sort of feed back on my own and have not been successful. I am thinking if there is this tremendous amount of people (whom I may add have $140 expendable income) getting these screenings surely there are some who feel they have been "dooped" or went for follow ups with their own doctors and realized they may have been taken. As far as individual feed back all I find is people who are glad they did the screening. I would like to hear from the group of people who were unhappy with their tests even more so than the task force.
My comment on ladies mammogram studies is accurate. The days following the recommendations were full of news reports from reporters going to hospitals and doctors offices to see if people were cancelling their mammograms and they were. I think a Google of those reports will bring the information up. Also this is a statement form the American cancer society, "With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them," Dr. Otis Brawley, chief medical officer for the American Cancer Society.
How can any one say it doesn't save enough lives? I want mine, my daughters, my mothers, and the other ladies I know to have every opportunity to lead full productive healthy lives. A mammogram does not harm them and in some cases saves them. In my opinion there is no real risk involved and I will not let the task force tell me that even though there is no known potential harm in having the tests it doesn't save enough lives when we all know people it has saved. In my case my aunt and two friends and all three individuals happen to be under 50 years old. Thankfully all three are still leading productive lives. At any rate I really do appreciate the time you have allowed me to ask questions.
I have one more question. If Lifeline is performing these tests and using medical professionals how is it insurance doesn't pay for them? Do they use what the task force recommends as means to refuse payment? Just wondering? Thanks again!
Liz,
Anecdotes of relatives or friends don't prove anything.
There's a saying: "The plural of anecdote is not data."
But, yes, in answer to your question, I have heard through the years from men and women who regret having had screening tests for prostate cancer and breast cancer, for example.
You should read this story - http://www.timesonline.co.uk/tol/life_and_style/health/article6898215.ece - about one such woman who said, "“Screening has caused me considerable and lasting harm. It has certainly not saved or prolonged my life."
Those stories exist. They just aren't told very often.
I have interviewed several dozen women who got a diagnosis of DCIS after mammograms and some of them stated similar regrets about ever having the test.
But, again, I don't dwell on anecdotes and only respond with some when people insist on using their own set of anecdotes.
When people make population-wide screening recommendations, evidence is what matters. Data is what matters. Any individual is free to make whatever choice he/she wishes in the light of that evidence - including ignoring the evidence if one wishes.
And that element of personal choice, of shared decision-making, of assessing one's own values and preferences is what has been lost and so miscommunicated to women in this very clear statement from the US Preventive Services Task Force:
"The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms."
No coercion.
No rationing.
No bans.
Just that it "should be an individual decision."
Regarding your question about insurance coverage, you'd have to ask an insurance company. That's not my line of work.
Well, I just received a letter from Karen R Law with Life Line Screening. I am sure there are paid services out there that sell information about our addresses, phone numbers age etc, so I am sure they know I am 35 years old. I don't believe, considering my age, to be in the "at risk" group though. So, this proves that they send the info to a wide range of people, hoping that a lot of them take the bait.
If you want to hear from real people in real time with no one "filtering" the good or the bad, visit their Facebook page. You'll hear the good and the bad there. My husband uses Life Line Screening because he is diabetic and has quite a few risk factors. His regular checkups are woefully inadequate in my opinion and this gives us peace of mind. I read a lot more positive than negative on the Facebook page. http://www.facebook.com/health.screening
Roxanne,
As you can see, no one "filtered" your comment, which was posted above.
Neither did anyone "filter" the comment left by the company's chief medical officer, above.
But let me correct something you wrote in your comment.
Anyone who "is diabetic and has quite a few risk factors" is technically no longer in the realm of screening. The term "screening" is applied to testing in apparently healthy people with no known risk factors.
You describe followup testing - not screening - in someone at high risk.
The questions that are raised about screening is when it is offered to healthy people for whom we don't have strong evidence of benefit from screening and may even see net harm.
It is crucial in this discussion to understand the distinction.
Someone who "is diabetic and has quite a few risk factors" is in an entirely different category.
It's comparing apples and oranges.
From the comments exchange regarding Lifeline screenings, I am getting the message loud and clear that you are discouraging the waste of time and money for any screenings that are not recommended by a personal doctor such as mammograms and those offered by Lifeline.
My doctor does recommend that I get a mammogram every year because my mother had breast cancer (that was detected with a mammogram) but he does not feel any tests like the ones that Lifeline offers or in fact any others such as a baseline stress tests) are necessary.
While I am overweight, I am only 50, my blood pressure is fine and I have not have had any symptoms, or family history that would make me "at risk" for stroke or vascular problems.
I am one of those ladies that got a flyer in the mail and one that happens to have $140 of expendable income and 60 - 90 minutes of time to spare.
I am a widowed mother of a young child whose husband died with an undetected heart disease (I know unimportant and unnecessary anecdotes of relatives or friends don't prove anything but I am just trying to justify my crazy state of mind for even considering this) so I was considering getting the screening, just to play it safe, when Lifeline came to my community. But I was on the fence wondering if I REALLY want to know if they do find something and more importantly are these guys just a bunch of quacks.
After reading your arguments for not wasting the time and money only to find out (whew) that all's well . . . . or worse yet cause me undo considerable and lasting harm and stress if a false positive came back and then it turned out I could experience the relief of finding out that I was really fine.. . . . it helped me decide that my money and time will be better spent in a much better way.
Spending my $150 "mad" money by going out to a stress reducing gluttonous dinner with drinks and friends sounds like a much better way to spend my time and money. Heck I'll even have enough for a good tip to the babysitter.
Better to wait until I am older, maybe not in as good economic and physical shape and more at risk with other possible complications (because I've waited too long) so the insurance companies can pay for it.
Much better the insurance companies pay for a $200/1 hour office visit for my doctor so he can agree to refer me to these same tests that cost twice as much money and time at his clinic or at the hospital. (Then we wonder why healthcare costs are unaffordable to many).
I know you don't give medical advice but I do appreciate the advice you are giving to save the general public, and me in particular, from a potentially harmful and stressful waste of my hard earned money.
Deb,
Your dripping sarcasm is also dripping with inaccuracies.
I am not, as you charge “discouraging the waste of time and money for any screenings that are not recommended by a personal doctor.” I never wrote that.
You are also inaccurate in referring to your annual mammogram – recommended because your mother had breast cancer – as “screening”. That is technically and semantically inaccurate. You are at higher risk. “Screening” is a term meant for testing in people of unknown risk.
I have addressed this point before.
If you don’t trust your doctor’s advice, that’s between you and your doctor.
If you want to spend your money on screening that is your call. More power to you. Best wishes.
You called ancecdotes about relatives and friends “unimportant and unncecessary.” I didn’t. I said they don’t prove anything. That’s a fact. They don’t.
Let me once again quote American Cancer Society chief medical officer Dr. Otis Brawley, who has written:
"There are some proven harms associated with screening. ...
Many health care provider organizations and many well-meaning community groups … offer mass screening at health fairs and other activities. The American Cancer Society is concerned that so many do not understand that the benefits of screening are still undetermined. The ACS recommends against such mass screening activities because one cannot be assured that the patient has the opportunity to hear a balanced explanation of screening in an environment in which he can feel comfortable to ask questions and make an informed decision."
…
"I heard a radio commercial that brings perspective to the issue. A local celebrity was promoting prostate cancer awareness. He said, "Prostate cancer is 100% curable when caught early." He encouraged all men to get screened and announced that a van was touring the area offering screening in supermarket parking lots. This was a community service project sponsored by the radio station, the supermarket chain, and a radiation oncology practice. A commercial like this plays to our fears and prejudices.
...
Some of the confusion of screening can be avoided if we all clearly label what we know, as what we know; what we do not know, as what we do not know; and what we believe, as what we believe. Of course, one must not confuse what is believed with what is known to do this."
If you want to ignore what your doctor is advising you, what the chief medical officer of the American Cancer Society tells people about screening, and what evidence-based experts such as the U.S. Preventive Services Task Force tells people, you are so entitled.
Again, good luck and best wishes.
I completely understand Linda's endorsement of the screening process that yielded such important outcomes for her husband. Same thing (different specifics, but overall same situation) with my Dad. However, since he has been under near-constant medical supervision for the past several years due to bladder and prostate cancer treatment and surgeries as well as orthopedic surgeries, it came as a surprise to all of us (including his primary medical team) to discover the heart issues. To their credit, his physicians jumped on the screening results from life line without any negativity whatsoever and were, in fact, pleased to have the evidence (data) upon which to base a new course of treatment that has eliminated what they agreed was a legitimate source of concern (and which had been causing some long-standing problems for him that nobody had suspected were related to his heart).
However, I also understand Gary's position. I believe the debate exists because we can consider this issue in terms of a theoretical population or an individual (ie, ourselves or someone close to us).
Either way, it's an case study in the challenges of applied signal detection theory. Over a(theoretical) population sample, it's valid to view a high rate of false positives with concern. Over a sample of 1 (ourselves, our spouse, our parent, etc), however, most of us shift from placing a priority on avoiding false positives to prioritizing hits and minimizing misses. Whether in a physician's office or a mobile screening lab, it's still a matter of probabilities, not certainties, and thus of deciding how conservative you should be in setting your decision criteria. You are unlikely to find the infinitely-narrow sweet spot in which there are nothing but hits and correct rejections, so there will always be some compromise.
Thanks for the information on this page but there is one thing I would like clarified if possible: are the tests actually accurate?
I got a letter in the mail yesterday that "Life Line Screening will be in [my] area for one day only" and I'm wondering whether it would be a good use of money and time or not. If the screenings are not particularly accurate in addition to raising the anxiety level of many people (which would likely include me) I don't want to participate. On the other hand, if the screenings are fairly accurate and all of it is done in one place on one day, perhaps it is worth my time and money.
Do you have any thoughts about the above?
Angela,
Thanks for your note.
We don't give medical advice, and your note is asking for medical advice.
Suffice it to say that you should do your homework very thoroughly because many questions have been raised about these screening practices and promotions.
Is there evidence of false NEGATIVES in screenings by Life Line?