The long list of warnings about community screening programs is getting longer

Otis Brawley, MD, chief medical officer of the American Cancer Society has said:

“Many of these free screening things 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.”

Three authors, including the executive vice president and chief executive of the American College of Physicians, wrote in the Annals of Internal Medicine about the “Ethics of Commercial Screening Tests.”  Excerpt:

“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.”

Concerned physicians in the UK have even created a website, “PrivateHealthScreening: What To Think About When You’re Thinking About Screening Tests.”

And now the Public Citizen organization has added its voice to the warnings.

The organization has written to 20 hospitals in eight states urging them to “sever their relationships with HealthFair Health Screening because the company’s heavily promoted, community-wide cardiovascular health screening programs are unethical and are much more likely to do harm than good.”

Public Citizen states that:

Winter Park, Fla.-based HealthFair – and most of its hospital and medical institution partners – peddles inexpensive cardiovascular disease screening packages to people living near the hospitals and institutions without identifying who has relevant risk factors that would make each of the screening tests medically appropriate. HealthFair’s basic cardiovascular screening packages include six tests that, among other things, take pictures of the heart, measure its electrical activity and look for blockages in arteries.

The screening tests are performed in buses, often bearing the names and logos of both the partner hospital or medical institution and HealthFair. The buses roam the surrounding geographic areas of the partner hospitals and medical institutions.

These screening packages are promoted directly to consumers through: (1) online advertisement on HealthFair’s website and on the websites of most of the partnered hospitals and medical institutions, and (2) in at least some cases, through solicitation letters mailed directly to people’s homes. The promotions rely on fearmongering and erroneously suggest that for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular illnesses – including heart attacks, strokes and ruptured abdominal aortic aneurysms – and make them sound like an appealing bargain.

In fact, such indiscriminate and widespread testing is more likely to cause harm than good, Public Citizen said in letters sent to the hospitals and medical institutions today. For example, many people undergoing such screening will have false-positive results (appear to show an abnormality that is actually not present) or results showing minor abnormalities that would never cause symptoms or illness. Both circumstances can lead to additional unnecessary and risky tests and treatments that will harm some people, cause unfounded anxiety, and cost patients and insurance companies.

Such widespread screenings are not recommended by medical experts because each of the six tests either benefits only appropriately selected high-risk patients or has not been scientifically shown to provide any clinically meaningful benefit to anyone.

“It is exploitative to promote and provide medically non-beneficial testing through the use of misleading and fearmongering advertisements in order to generate medically unnecessary but profitable referrals to the institutions partnered with HealthFair,” said Dr. Michael Carome, director of Public Citizen’s Health Research Group. “Consumers are being misled to believe that these screening packages are beneficial when in reality, many will undergo additional unnecessary testing, likely putting them at greater risk, not saving them any money and adding unneeded anxiety.”

I’ve written about this topic a great deal.  Some past posts:

• Shuffle off to Buffalo for another questionable prostate screening promotion

• Free Throat, Head, Neck Cancer Screenings Promoted Without Full Info

• In the BMJ: “What companies don’t tell you about screening” and “Routine testicular self examination: it’s time to stop”

• NY Daily News begins second decade of evading evidence on PSA screening

• TV station should stop promoting questionable screening tests at MN State Fair

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