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Beware of unnecessary health screenings at the State Fair

Gary Schwitzer, publisher of the Minnesota-based HealthNewsReview website, took KARE-11 TV to task Tuesday for offering ultrasound bone-density heel scans at the Minnesota State Fair this year.

As Schwitzer points out, a commentary published Tuesday in the Annals of Internal Medicine questions the ethics of such commercial screening tests. In fact, the commentary, whose authors include Dr. Steven Weinberger, executive vice-president and CEO of the American College of Physicians, specifically cites ultrasound heel scans as an example of the “misapplication of technology”:

Commercial companies may offer various screening tests, some with proven benefit, such as measurement of blood pressure and blood sugar and lipid levels. However, we are particularly concerned about the misapplication of technology, such as 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. ...

Purveyors of these services have sprouted up all over the country, selling “packages” of screening tests outside of the traditional physician–patient relationship at “discounted” prices. Tests are offered at various locations, including churches, pharmacies, fitness centers, and shopping malls, often with a local hospital, academic medical center, or physician group as an advertising sponsor. Some companies use endorsements from celebrities, board-certified physicians, and such agencies as the Better Business Bureau to endorse the benefits of purchasing screening tests. Ultrasonography and other tests are marketed as “safe” and “harmless” to consumers because they do not use radiation or require needlesticks.

Anyone can purchase these tests — regardless of age or risk factors for disease or whether testing is truly indicated — if they are willing to pay the advertised fee. 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. ...

Companies, through waivers and disclaimers, tell consumers to share any “abnormal” test result with their physicians; however, the specific risks and costs of potential downstream testing and treatment are generally not discussed when the screening tests are purchased and performed.

Negligible value, substantial risks

The value of ultrasound heel scans for determining osteoporosis risk is negligible. And there’s a very real risk that the test may lead to unnecessary worry — and treatment.

As Consumer Reports’ medical experts, who agree with the commentary, pointed out on Tuesday, “screening for osteoporosis is a good idea for women 65 and older and some men 70 and older with risk factors. But even then, the recommended test is one called DXA, which takes X-ray images of your hip or spine, not an ultrasound of your heel.”

Not 'written in stone'

KARE-11 TV is co-sponsoring its State Fair scans with Health Strategies Group, which, according to its website, "offers a broad array of tests and preventive health screenings to fit your specific needs." The site also emphasizes that the tests are "not diagnostic," but are offered instead to "maximize the opportunity to offer proactive information on health and lifestyle."

"They are totally optional," said Craig Hotvedt, executive director of Health Fair 11, the nonprofit organization that organizes the State Fair screenings for KARE-11, in a phone interview Wednesday. "It's not like we are forcing them on people."

People go to the State Fair to have fun and not for a medical consultation, he added, and therefore they understand that the findings from the ultrasound heel screenings are not to be taken "as written in stone."

I'm not sure everyone will understand that. KARE-11's heel screening may cost only a nominal $4, but caveat emptor nevertheless.

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Comments (8)

One more example

… of the corporate model for health care being brought to the local, even family, level. Having attended a state-wide "health fair" annually while a Colorado resident, I'll say that such things might bring some needed, minimal-level health screening to portions of the public that are without health care coverage of their own. I was part of that population until I managed to live long enough to qualify for Medicare, which the Republican platform would like to see eliminated.

The screenings offered in Colorado consisted primarily of the kinds of things mentioned in the first paragraph of the commentary from the American College of Physicians – a routine blood workup that included lipids, blood sugar and other common test parameters, plus height, weight, pulse, blood pressure, etc. Eye exams and a few other services were offered, but by licensed health professionals, not representatives of device manufacturers or retailers.

The primary attraction of a "health fair" for someone without health care coverage was that it maximized the information gained for the dollar spent – the blood workup cost less than $50, and I assumed all along that the lab doing the work expected to make up the less-than-usual revenue per test by having a much greater-than-usual number of tests to complete and report on. Both I and my doctor tracked my blood work every year on the basis of that relatively inexpensive test, and one of the ways that Minnesota has disappointed me is that, in a state with a significant minority and poor population, and numerous industries based on health care technology, such a statewide program – heavily advertised (and partly sponsored / subsidized) in Colorado by the TV ratings leader, an NBC affiliate – is apparently not in practice here. It should be.

In the meantime, caveat emptor, indeed.

Why we have expensive but ineffective health care

Now what does "maximize the opportunity to offer proactive information on health and lifestyle" mean? It's an icebreaker? Speak English, please.

Meaning

It means nothing. It's a sales pitch--nothing but several catch-phrases strung together.

reply

It means the information gained from the screening can help establish a baseline of health for people who didn't know their baseline of health was in an abnormal area, in a particular area. Many patients living with a disease process, who go to a screening, probably are not already being treated for a newly discovered disease. Patients being treated for medical issues tend to have a primary care MD and do not find value in a screening when their MD monitors them: which probably costs them some money already, why pay for a screening too. )Unless they have not been compliant. Then a screening is not useful, they will probably be found abnormal and need to return to their MD anyways, just save the screening money and go to the Doctor is what they should do) Back to your original comment, patients who are shown to have abnormal screening results can use the abnormal test results and either make lifestyle modifications or seek medical advice to improve their health and hopefully return themselves to a normal range. For example, a patient with high cholesterol, hypercholesterolemia, found from blood work performed at a screening has a few options. The first is to cut out foods high in saturated fats and cholesterol such as processed meat products like sausages, Not eating my daily sausage in the morning personally lowered my cholesterol from an abnormal to a normal range, at age 28. Another option is cholesterol reducing medications, starting an exercise program and improving diets in other areas. So...my increased cholesterol numbers allowed me to "maximize the opportunity" to be "proactive" with the "information" regarding my "health and lifestyle. Another example is the one from this article. Bone density exams, taken from the heal are not the best or most accurate place to test bone density in places where fractures most often occur. We have all heard the story of the elderly person who fell and broke their hip.Well, actually, the hip usually breaks first, at the femoral head, and then the person falls. I have yet to hear the common story about the elderly person who broke their calcanius bone in the heel. The other most common fracture sites in elderly patients are the vertebra/ back bones and the wrist, so why does this company at the fair and other screening companies like Line LIfe Screening perform heel bone density screenings for osteoporosis? I hope this helps. Joseph www.smarthealthscreening.com

State Fair Gimmick

Reminds me of the handwriting analysis I used to get for $2 at the Fair. Put your signature on a card, submit, and a few minutes later out comes a detailed personality analysis. Probably just as accurate as the heel scan.

REALLY??

Have you taken the time to stop by the booth? I have been going to the booth for a number of years and find the staff to be very knowledgeable and truly care that I understand the results of my screening. I find this article and it comments to be absolutely ridiculous.

Yes, really

If they were truly knowledgable they would know that this type of screening is worthless. The concerns raised in this article are spot on accurate. I'm afraid that the concern you perceived is in fact slick salesmanship.

Great to hear

Jenny,

I am glad to hear you had a good experience at the screening booth. Many "otherwise healthy" individuals find screenings much more cost effective and easier than going into a large hospital or busy clinic to get a quick examination. I run an ultrasound screening company called www.smarthealthscreening.com in Santa Clara California, what were the aspects of your experience that were most positive? I want my company to have very happy clients like you!
Thanks,
Joseph Matthews RVT, RDCS, RPhS