News story shines light on hospitals promoting questionable screenings

Kudos to Julie Appleby, Kaiser Health News, and the Washington Post for publishing the story, “Hospitals promote screenings that experts say many people do not need.”

It’s a story that is reported infrequently, even though it could be reported any time in almost any city in the US – the practice is that widespread.

The story begins:

“Hospitals hoping to attract patients and build goodwill are teaming up with medical-screening companies to promote tests they say might prevent deadly strokes or heart disease.

What their promotions don’t say is that an influential government panel recommends against many of the tests for people without symptoms or risk factors. The panel says such screenings find too few problems to outweigh the drawbacks, which include false positive results and unnecessary follow-up procedures and surgery. Other medical experts warn that the tests could needlessly raise health-care spending.

“A lot that ends up being found is clinically of no importance at all,” Steven Weinberger, executive vice president and chief executive of the American College of Physicians, wrote in an August piece in the Annals of Internal Medicine. He and two co-authors argued it was “unethical” for hospitals to promote the tests without disclosing potential downsides.”

The story focused on heart and blood vessel system screening:

“…ultrasound tests for blockages of the carotid artery and weak spots in the abdominal aorta; an electrocardiogram, or EKG; a test of elasticity of the arteries; and another for blockages in arteries serving the legs, a condition called peripheral arterial disease. Similar test packages are offered by Life Line Screening and its hospital partners.

The U.S. Preventive Services Task Force, an independent government panel charged with evaluating such care, recommends against routine use of four of the five tests in adults without symptoms or risk factors. The panel does support the ultrasound looking for abdominal aortic aneurysms — but only for men age 65 to 75 who have smoked.

Additionally, two of the tests — EKGs and ultrasounds for blocked carotid arteries — are among 130 procedures that a coalition of 19 physician organizations say are overused and should be questioned by both patients and their doctors.”

But, remember: this doesn’t just happen with cardiovascular screenings.

Dr. Otis Brawley, chief medical officer of the American Cancer Society, has criticized hospitals promoting non-evidence-based cancer screenings as well.  He said, “Many of these free screening things, by the way, are designed more to get patients for hospitals and clinics and doctors than they are to benefit the patients. That’s a huge ethical issue that needs to be addressed.”

And this site captured Brawley’s story about hospitals profiting from prostate cancer screening:

“Brawley recounts an experience he had on a site visit to a hospital in 1998 while an Assistant Director at the National Cancer Institute. During the visit a marketing executive explains to Brawley the publicity value and financial rewards of a free prostate screening program offered by the hospital at a local mall. The plan is to screen the first 1,000 men over 50 who come to the mall for testing. I’ve transcribed Brawley’s recollections from the video and they provide a great explanation for the profit-driven practices that continue to occur today, 14 years later:

“If they screen 1,000 men they’re going to have 145 abnormals. They’re going to charge about $3,000 to figure out what is abnormal about these abnormals, that’s how they pay for the free screening. About 10 of the 145 won’t come to this hospital so that’s business for their competitors, but they’ll get 135 times $3,500 on average. Of the 135, 45 are going to die of prostate cancer and the other percentage are going to get radical prostatectomy at about $30-40,000 a case; there’s a percentage that’s going to get seeds at about $30,000 a case; a percentage were going to get radiation therapy that (at the time) was about $60,000. Then [the marketing executive’s] business plan goes further, he knows how many guys are going to have so much incontinence that diapers aren’t going to do it so he had in his business plan how many artificial sphincters urologists were going to implant. And then he was a little apologetic because there was this new thing called Viagra that screwed up his estimates for how many penile implants he was going to sell because guys were upset about impotence related to prostate cancer treatment.”

Brawley says, “this is 1998, I ask him, if you screen 1,000 people how many lives are you going to save? He took off his glasses and looked at me like I was some kind of fool and said, ‘Don’t you know, nobody’s ever shown that prostate cancer screening saves lives, I can’t give you an estimate on that.’”

What is the level of fully-informed, shared decision-making encounters at such screenings?  Don’t bet the ranch on it.


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