Ethics of commercial screening tests: choice should be informed by evidence, not advertising claims

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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:


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Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.


August 28, 2012 at 2:03 pm

The screenings you’re complaining about are a SYMPTOM of a nation where adequate health care is reserved for the very rich.

It’s hard to assess your motives, but if you think everyone reading criticisms of screenings is thinking “Well, these are educated people with only the good of the public at heart,” you’re wildly disconnected from reality. I read your warnings and immediately think, ‘What health insurance company is paying these guys to say this, because they see every health care screening that they don’t own as an infringement on their precious profits?”

Not the case? You’re truly a Concerned Professional? Then get concerned about promoting single-payer health care for the USA. Then public screening events like this won’t be necessary.

    Gary Schwitzer

    August 28, 2012 at 9:18 pm


    First, let me use your note and your nom de plume to advise readers that I am changing my comments policy. I think readers deserve to know who is making a comment – no fake names – actual identification. Anyone coming to this site can see who I am or who our reviewers are. I will, in the future, reject comments from anyone who doesn’t use their real name.

    But now to the content of your note.

    You wrote: “The screenings you’re complaining about…” I’m not complaining about any screenings. I quoted a medical journal editorial by some top physicians that questioned evidence. And then I applied those physician’s comments to promotion of a certain screening campaign at the MN State Fair.

    You wrote: “It’s hard to assess your motives…” My motives aren’t difficult to assess at all. I couldn’t be more transparent. You only need to devote even a moment to become familiar with what we’ve done on this site for 6.5 years. We comment on journalism or on other media messages about health care. We’re trying to improve the accuracy, balance and completeness of such messages. I’ve worked toward that goal throughout my entire career.

    You wrote: “I read your warnings and immediately think, ‘What health insurance company is paying these guys to say this, because they see every health care screening that they don’t own as an infringement on their precious profits?” Huh? Name me an insurance company that “owns” screening tests. This is a non sequitur. I’m not paid by any health insurance company.

    Finally, you wrote: “You’re truly a Concerned Professional? Then get concerned about promoting single-payer health care for the USA. “ You have no idea what my beliefs are about single payer health care. That’s because I don’t promote anything other than accuracy, balance and completeness in media messages that affect the public dialogue about health care. My site is not about promoting political agendas. You’ve come to the wrong place if you’re looking for that.

Rober Dacey

September 11, 2012 at 11:48 am

While serving as a consumer/patient representative on FDA advisory committee panels from 1998 to 2002, I became acutely aware of the conflicts between the worlds of direct-to-consumer marketing and the science-based evidence of true medical interventions and patient screening. Since then, the marketeers have taken over the information flow process. The commodification of every human life has arrived, with price tags on the quantity and quality of daily living, including health/medical care and treatments. Who is establishing such price tags? Any time the smiling testimonials of “patients” are used to sell a medical service, the value of human life is put into the same marketing category as used cars, furniture, and consumer goods. The overarching issue quickly becomes political. I’ll continue to rely on the science of medicine, while I try to ignore the marketing and DTC advertising. I’ll make my personal medical decisions based on scientific evidence, not on marketing/advertising strategies.


September 25, 2012 at 11:07 am

My concern, from the first time our insurance company began its “health fair screenings”, is that they are working on a long term plan to reject applicants based on information discovered in the screenings. Information that might indicate a future problem and does not have to be addressed at the time (e.g. slightly high glucose), but may be used against the individual at a later time when they are applying for health insurance. While our representative has assured us the information is “ours alone – no one else will have these records”, the point is, when someone applies for health insurance they are required by law to be honest. Therefore, an applicant must disclose any information they have in the application. Of course, if one never changes insurance companies, that risk of rejection is less to none, but most of us change companies for different reasons throughout our lives. What are your thoughts on this? Am I being too paranoid?