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Beware of unnecessary health screenings at the State Fair

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

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.

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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.