Like most people, you’ve received one of those brochures in the mail with a headline screaming something like “Health Screening Can Save Your Life!” They’re filled with photos of happy, healthy people on golf courses or with their grandchildren and are liberally sprinkled with quotes like, “Dan’s alive today because an ultrasound revealed his aneurysm.”
Don’t ask me how I know (I just do) that in today’s Comments section somebody’s going to tell me their Uncle Frank is alive today because he had one of these screenings.
So let’s walk through it. You learn from the brochure that a mobile health clinic will be in your area on a certain date, offering a prepackaged menu of tests to detect early cardiovascular disease for one low price. But there’s more! You can also buy an “advanced package” for few more dollars, and as long as you’re already scheduling, why not?
You may idly wonder why it’s cash only, no insurance accepted, but, hey, you’re getting all those tests for one low price so it’s probably a bargain. The answer is that health insurance companies, who don’t like paying for much of anything related to health care these days, will definitely not cover tests they think you don’t need.
Scanning the brochure, you notice the event, named something cheery like “Summertime Health Screening,” is sponsored by your local hospital. Remembering the good job the hospital did with your husband’s hernia, you think this all must really be on the up-and-up.
My opinion: recycle the brochure while you’re ahead
Toss it and spend the $179 (basic) or $379 (advanced) on something fun, like a day at a water park or a weekend walking getaway. Interestingly, this very suggestion, though phrased somewhat differently, aligns with that of the American College of Cardiology (ACC) on the issue of direct-to-consumer testing, which is what these brochures are all about.
A piece on this subject appeared in JAMA this week, the ACC writing in part: Other than assessing blood pressure and serum cholesterol, being attentive to diabetes and promoting a healthy weight with regular exercise, we do not recommend broad and untargeted screening.
The JAMA article specifically addresses widespread direct-to-consumer screening by a company called HealthFair. The whole idea of such testing has come under a lot of scrutiny, mainly because of misrepresentation of facts and questionable ethical tie-ins with hospitals. (Parenthetically, my own idea of a “fair” is oriented more toward Tilt-A-Whirls and deep fried elephant ears than assembly lines of worried looking people getting their aortas and carotids scanned.)
The usual tests offered in the basic screening package are:
- Electrocardiogram (which reads the electrical pattern of your heart).
- Echocardiogram (which draws a picture of your heart using sound waves).
- Doppler flow studies of your arteries, including your aorta, carotid arteries, and the arteries in your legs to check circulation.
- Arterial stiffness index (a controversial and not widely accepted test that purports to measure the elasticity of your arteries).
The advanced package adds a variety of blood tests, often including tests for PSA (prostate-specific antigen, a controversial prostate cancer screening), testosterone, CRP (to gauge inflammation), and TSH (to check your thyroid). I’ve written at length about the PSA because doctors are now advised not to order it for patients, leading as it does to unnecessary and potentially dangerous surgical procedures.
“What’s not to like about preventive testing? These screenings could save my life,” you might be thinking. You may even wonder momentarily, as I did, whether the word is “preventive” or “preventative.” The answer is that either is correct, though probably the word of choice should be “exploitative” (“exploitive” is also correct, by the way) because that’s what’s really going on.
These packages aren’t good preventive medicine, but they’re great revenue generators
The usefulness of this type of broad, untargeted screening just doesn’t stand up to statistical scrutiny. In fact, these packaged screenings serve no helpful purpose at all except to make serious money for the screening companies. HealthFair, one of the larger players, has screened north of one million people.
There’s also the financial benefit to the sponsoring hospitals, which the ACC views as highly questionable.
What the advertising brochures leave out is precisely the information that would help you make an informed decision about the utility of these tests. For example, how many random ultrasounds of the aorta in an otherwise healthy population do you think it would take before someone actually turned up with an aneurysm?
At least the Publishers Clearance House advertisements are required to state your actual chances of winning their multimillion dollar prizes. The health screening companies operate under no such requirement. The way their brochures read, you might wonder if the aorta of someone in your bridge club is about to pop or if your neighbor’s heart makes her a walking time bomb.
And then there’s the vaguely unethical tie with the sponsoring hospital. After all, if the slightest abnormality is found in any of your results, you’ll be whisked off to one of the hospital’s cardiologists, who will likely order one or more expensive tests or perform a procedure before he tells you “False alarm. We see a lot of false positives with those screening tests.”
My guess is that when a screening company is fishing for sponsorship, it presents data that’s a symphony to a hospital CEO’s ears. I can imagine this line in their pitch: “Based on statistics from other sponsors, if your hospital can bring in 500 screenings, you’ll ultimately generate X million in added hospital revenue from procedures such as angiograms, bypass surgeries, and the like. It’s a win-win! Sponsorship pays for itself, hands down!”
If you do go through the bundled testing, next time I see you you’ll likely hand me your “Your Physician’s Copy” of the results. I’ll politely congratulate you on your normal echocardiogram, EKG, or Doppler Flow studies. I do like the graphics, especially the colored charts with red for danger and green, I imagine, for longevity. And just like those Jiffy Lube windshield stickers that remind you when your next oil change is due, there’s also a suggested date for getting all these tests repeated. You’ll likely receive a reminder card or email letting you know when the magic bus will be in your area again.
I’m not thrilled about how these results can instill a false confidence among our patients who may have genuine risk factors, including very high cholesterol, being overweight or sedentary, or smoking.
The ACC limits genuine heart disease prevention to these basic steps
- Keep active.
- Keep your weight under control.
- Monitor your blood pressure.
- Know, and keep under control, your cholesterol and blood sugar levels.
- Don’t smoke.
Regular Health Tip readers might find my opposition to these screenings at odds with my near-constant admonishing to be proactive in taking personal responsibility for your own health care. Not really. Without intending to sound smug, sometimes your doctor really does know more than you (or the traveling carnival of tests you may not need) about what’s helpful and what’s a waste of money.
For example, if you’re my 50-something patient and you’ve got some actual heart risks (being sedentary, high blood pressure, and so forth) and especially if one of your parents or grandparents had an aneurysm or died of a stroke, I’d send you immediately for one of the bundle of tests offered by the direct-to-consumer marketers.
Importantly, because I ordered the test based on actual risk factors, your insurance would pick up the tab.
But to sign up for a constellation of tests because the machines happen to be in your neighborhood and the sponsor is your local hospital—well, you needn’t be quite that proactive, but you do need to step up your cynicism.
And if in the end you do bite on the marketing brochure and end up with a big bandage over your groin from a coronary angiogram, IV fluids dripping in, urine dripping out, and a cheerful cardiologist saying, “It was nothing, you’re fine, must have been a fluke on that screening test you had,” you might wonder where you’d be right now be if you’d simply recycled the brochure, worked on your risk factors, and kept your regular appointment with us.
David Edelberg, MD