Buyer beware on ‘direct-to-consumer’ health screenings

They’re back!

Life Line Screening, that is.

On Tuesday, I received an unsolicited letter from that Ohio-based company inviting me to participate here in Minneapolis “in a simple, potentially lifesaving screening to assess your risk for stroke, abdominal aortic aneurysms and other vascular diseases.”

I received a similar letter from them a couple of years ago, only then it was “written” by Olympic figure-skating star Peggy Fleming.

If I call now, my new letter promised, I could get “all 5 screenings for only $149 and SAVE $126!”

Wow! What a deal! Right?

Wrong.

For the vast majority of us — no matter what our age — these screening tests are pointless, a waste of time and money. And they may even be harmful. That’s been the conclusion of many doctors and other health experts, including Dr. Kimberly Lovett, a professor of family and preventive medicine at the University of California, San Diego, and Dr. Bryan Liang, executive director of UC-San Diego’s Institute of Health Law Studies.

‘Targeting consumer fear’

Here’s what they wrote last June about Life Line Screening and other “direct-to-consumer” screening companies in a commentary article in the Journal of the American Medical Association (JAMA):

These [direct-to-consumer] companies market primarily by targeting consumer fear about undetected disease and acquiring a symptomatic, sometimes fatal, disease. … Beyond the suspect ethics of preying on consumer fears, some screening tests are suspect on evidence-based grounds.

Two other physicians, Drs. Erik Wallace and John Schumann, both associate professors of internal medicine at the University of Oklahoma’s School of Community Medicine, were even more blunt in an op-ed piece that appeared in the Tulsa World in January:

Consumers should have the freedom to spend their money as they see fit. But direct-to-consumer screening tests that offer little to no value wrapped in marketing claims of great medical benefit without disclosure of the potential risks are at best disingenuous and at worst unethical.

The tests that Life Line Screening wants me to have fail on the evidence. Four of the tests claim to be screening for heart disease and stroke. Two are ultrasound tests of arteries in the neck and abdomen. A third test measures blood pressure in your arms and legs to determine if your arteries are “hardening.” And a fourth uses EKG electrodes to identify an irregular heartbeat.

But, as the U.S. Preventive Services Task Force (USPSTF) — our leading and most independent authority on screening tests — has noted (for example, here and here), there is no evidence that these tests help save the lives of people with no existing symptoms of heart disease or stroke.

And that’s the group that screening tests are, by definition, aimed at: asymptomatic people.

The only exceptions are male smokers aged 65 to 75 years old. Such individuals, say the USPSTF, may benefit from an aortic aneurysm ultrasound screening. But those men should talk about the test with their personal physician first.

The problem of false positives

As for the rest of us, the harms of these tests far outweigh the benefits. Those harms include false positive results — results that suggest you have a health problem when you don’t.

“Many times, follow-up tests need to be arranged to disprove a falsely positive screening test,” explain Wallace and Schumann. “These follow-up tests, such as CT scans, MRIs, and additional procedures or surgeries may be anxiety-provoking, painful and carry risks such as allergic reactions, bleeding, infection, kidney damage, exposure to unnecessary radiation, stroke or heart attack.”

That’s right: Stroke and heart attack, the very same illnesses you wanted the original screening tests to “catch early” for you.

Negative results can also be harmful because they “may lead people to avoid important care,” write Lovett and Liang. “Without professional guidance, patients may be falsely reassured and forgo further care because they may assume the conclusiveness of a single negative result.”

Once again: The USPSTF does not recommend these tests unless you have symptoms. And if you think you are experiencing symptoms of heart disease or stroke, you really should be talking with your doctor (or going to the emergency room of your local hospital), not having an ultrasound test in the parish hall of a Minneapolis church (which is where Life Line Screening has scheduled its screenings next month).

Line Line Screening has a carefully worded statement in the little brochure that accompanies its unsolicited letter about why doctors “can’t” do the screenings offered by the company. “Most physicians can only order diagnostic tests if you are experiencing symptoms,” the brochure says. “They are usually not able to order them as a preventive measure because insurance will not cover them.”

What Life Line Screening doesn’t say, of course, is that doctors don’t order the tests — and insurers won’t pay for them — because there is no good evidence they save lives in asymptomatic people.

Diagnostics tests follow symptoms

Also, note how Life Line Screening refers to “diagnostic” tests in that statement. Diagnostic tests are tests that are ordered after symptoms appear. They’re used to determine if a disease or medical condition exists. So, yes, physicians do only order diagnostic tests if you’re experiencing symptoms. For asymptomatic people they recommend screening tests — but (and I feel I must repeat myself here) only if those tests have been proven to save lives.

Oh, and the fifth screening test in the Life Line line-up? It’s an “osteoporosis risk assessment.” That, too, is unnecessary, according to the USPSTF, except in women aged 65 and older or in younger women with definite risk factors.

But the best and most predictive test for assessing bone density and the risk of future, potentially life-threatening fractures, the USPSTF adds, is dual-energy x-ray absorptiometry (DXA) performed at the hip joint — not the ultrasound scan of the heel that Life Line Screening offers.

If you’re worried about heart disease or stroke or osteoporosis, talk with your doctor. And ignore your junk mail.