Free aneurysm screenings: Not all K-Mart blue light specials are bargains

K-Mart, Medtronic, and a bunch of specialty medical groups are sponsoring a campaign called “Find the AAAnswers” – the AAA standing for abdominal aortic aneurysms.

It’s clever marketing for K-Mart’s pharmacy business, since the screenings are being offered throughout the Fall at more than 900 K-Mart pharmacies. And it’s not bad business for the specialty medical groups, either, as Larry Husten wrote on his Cardiobrief blog:

“…the expenses of the program and the coalition are entirely underwritten by Medtronic, which sells abdominal stent grafts used to repair AAAs, and the members of the coalition include organizations like the Peripheral Vascular Surgical Society, the Society for Vascular Surgery, and the Society for Vascular Ultrasound, whose members may derive a significant portion of their income from performing AAA repairs and screening.

AAAnswers coalition partners.jpg

No one is disputing that AAA is a bad thing, or that, when appropriate, AAA repair is a life-saving procedure.

But that doesn’t mean that more widespread screening is in the best interest of the public. Here’s the problem: the US Preventive Services Task Force (USPSTF) guidelines for AAA screening are the best current source for information about who is eligible for AAA screening. The USPSTF guidelines recommend against routine screening for women, for instance, while the Kmart-Medtronic program is much more liberal, recommending that a 65 year old woman with no other risk factors except a history of smoking undergo ultrasound. (Everyone agrees that a repair procedure is indicated when ultrasound finds a AAA larger than 5.5 cm.)

Now you might well wonder about the harms associated with screening, especially with a test such as ultrasound, which is entirely noninvasive, and especially when a big company like Medtronic is picking up the tab.

Any screening program and any treatment procedure has both risks and benefits. The surgeons may not like to think about it, but even a life-saving procedure like AAA repair can be harmful if performed in the wrong population.

Medtronic and the coalition members, entirely on their own, set up their own screening program from which they will all benefit financially. The program has no oversight or peer review and never explains its process or methodology. By contrast, the USPSTF guidelines are created by an independent panel of experts who review the scientific evidence and publish their findings in well-documented publications, with all the evidence on full display for anyone to review.

Not all blue light specials turn out to be a good bargain.”

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