You can have your blood glucose checked and there’s a sign saying that you don’t even have to fast first. So what good is this blood glucose test going to be for people who have been walking around the State Fair for hours eating bourbon wurst, cajun pork rinds, breakfast sausage corndogs, candied bacon cannolis, cocoa cheese bites, deep fried bread pudding, English toffee fudge puppies, fried pickles ‘n’ chocolate, funnel cake sundaes, and deep-fried Snickers bars? Is this really the test result that is going to give people a true indication of their usual daily blood glucose?
Certainly there’s no harm in reminding people about the importance of occasional blood glucose testing. But the US Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower. The USPSTF reminds us that we don’t know “the longer-term effects of labeling a large proportion of the adult U.S. population as abnormal.” At the very least, doing blood glucose screening in a general population at a fried food and saturated fat fiesta like the MN State Fair is going to result in many elevated scores, many of which will return to normal once people return to their normal routines, yet some of which might cause anxiety and unnecessary medical visits.
As Schwitzer points out, however, KARE-11’s osteoporosis testing, which involves ultrasound scans of the heel, is even more problematic. The reliability of such scans has long been questioned. Furthermore, the USPSTF recommends osteoporosis screening for only a specific group of women — those aged 65 years or older and “younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risks factors.”
“At the TV station’s state fair health fair, I saw much younger women lining up for the heel scans,” writes Schwitzer. “And it’s not clear that anyone was turned away.”
Schwitzer says he also saw a man being scanned — despite the fact that the USPSTF says there’s no evidence that men benefit from such screening.
The KARE-11’s State Fair health screening is “TV station marketing gone bad,” Schwitzer concludes.
If KARE really cares about helpful health fair promotions, it should have a booth endorsing truly informed shared-decision making that educates consumers about facts such as:
In health care, more is not always better. More testing is not always better.
In the words of Dr. Muir Gray, “All screening programs do harm. Some also do good.”
As I was searching for a visual this morning to accompany this post, I discovered that UCare, the funder of Second Opinion, is a “sponsoring partner” of the KARE-11 “Know Your Numbers” campaign. I called Dan Ness, UCare’s marketing director, for a comment about Schwitzer’s criticism of some of the tests that are included in the campaign. [For the record: This is the first time since this column was launched almost five years ago that I have spoken with anybody at UCare.]
Ness, who had not read Schwitzer’s blog about the “Know Your Numbers” campaign, said that the screening tests at the State Fair are “as much about education and awareness as the actual screening itself.” He also said he hoped that the post-screening conversations that fair-goers have with the “Know Your Numbers” staff are “well-rounded and not synonymous with going into a clinic or physician’s office.” He acknowledged, however, that he did not know if this were the case.
The concern about such screenings, as Schwitzer points out, is that people will receive inaccurate or meaningless screening results that send them unnecessarily to their doctors for further tests and/or treatments.
Ness pointed out that the specific screening tests offered by the “Know Your Numbers” campaign at the State Fair may change next year. “Every year we have discussions about which screenings we should do and not do,” he said. “I think we will certainly want to take a closer look at these screens.”