Aging Americans are often bombarded with warnings to get health screenings that might help them catch a disease early – when it is easier to treat. And for some patients, the tests do that.
But the issue of screenings has been controversial – even in the medical community – with critics warning that the tests can lead to costly, unnecessary over-treatment, and in some cases, harm. High-profile debates about a wide array of health screenings, from prostate tests to mammograms, have raged in the last few years.
“The layman would be shocked to know we actually do not have science to show that these screening, early detection tests actually decrease mortality or are beneficial to the patient,” Dr. Otis Brawley, chief medical officer for the American Cancer Society, told the New York Times.
Brawley wrote the 2011 book "How We Do Harm," about the failings of the medical profession, and he describes financial conflicts of interest that sometimes determine care. He told the Times that he became a "loudmouth" in the prostate cancer screening debate after talking to a hospital marketing exec who wanted to drum up business with a free screening at a shopping mall.
"We’re making promises to patients and making them think we know things we don’t know and making money off of them," Brawley told the Times.
Screenings for sale: A Life Line?
Inside that broader debate over screening has arisen a specific controversy over the growing number of health-screening companies that bypass doctors and take their tests right to consumers, much like drug companies that advertise directly to consumers. But the screening outfits undermine physicians who want to provide "high-quality, cost-conscious screening services to patients through shared decision making," three physicians argued in an opinion piece in the Annals of American Medicine.
The Duluth News Tribune in Minnesota is among the latest media outlets to dig into the thriving industry.
The newspaper talks with a Duluth local whose 74-year-old husband got a mailing that urged him to sign up for five screenings, to be done at a Shriners Temple. The mailing was from an Ohio-based for-profit company called Life Line Screening, which does a brisk business conducting screenings all over the country.
Life Line frequently sets up screenings – typically about $149 for tests that take about an hour – at local churches and community centers. The company has screened more than 8 million Americans over the years, NPR News noted in a report last year.
But some people find it distasteful to get a solicitation for a personal health screening in the mail, along with their clothing catalogs and Walmart circulars.
"I smelled a rat right away," mailing recipient Sue Majewski told the News Tribune.
NPR reported that a few of the tests Life Line and other screening companies perform can do more harm than good – and should be avoided by healthy people, according to the U.S. Preventive Services Task Force, an independent group that advocates evidence-based treatments. While some of the tests might not be invasive, doctors say follow-up tests and procedures might be, increasing a patient's risk for harm and over-treatment, NPR notes.
Among the tests is a carotid artery screening, a procedure aimed at measuring plaque buildup in a neck artery, a possible sign of stroke risk. Life Line and other companies do the screening, but it is on the American Academy of Family Physicians' list of procedures patients should avoid.
Among the tests' adverse effects, doctors say, is the risk of false alarms – and the fact that screenings needlessly worry patients. One healthy Oklahoma 60-something gym teacher, who was in top physical form, anxiously rushed to his doctor after a third-party screening suggested he was at minor risk for stroke.
"Though his report described the risk as mild, all that mattered to him were the words 'disease' and 'stroke,'" the Tulsa doctor, John Henning Schumann, wrote in an opinion piece. "By the time he came to see me, I had to work pretty hard to calm him down."
To be sure, the commercial health screeners have vigorous defenders, namely, the screeners. Dr. Andy Manganaro, medical director of Life Line Screening and a veteran vascular surgeon, defended his company and its screenings in the NPR report.
He said the tests save lives. And he shrugs off critics who argue several Life Line screenings are more likely to cause harm than good, calling their research out of date. Manganaro also adds that his screening offer patients stark, eye-opening test results that change their behavior, prodding patients to quit smoking, for example. (This claim is controversial, too, and disproved by research, critics note.)
Finally, Manganaro argues that the screenings are just that – tests. His company says patients should use the results as a starting point for a conversation with their doctors, he told the Wall Street Journal.
So which screenings should I get?
All of this can leave the consumer confused. Which tests are best for you?
Start by talking to your own doctor. Experts generally agree that patients should press their trusted physicians about which screenings are really necessary for them, and at what ages, Mayo Clinic notes.
Here's a good 3-minute video from Consumer Reports and Choose Wisely that features five questions you should ask your doctor about any medical test or procedure:
You can also get good information on the web, if you look in the right spots. Here's an easy-to-read list of recommended screenings (and ages for them) from the National Institutes of Health and the U.S. Preventive Services Task Force.
Another good place to start is the site Choose Wisely, where you can easily search for screening and testing information by ailment. The Choose Wisely effort was started two years ago by doctors groups to urge their colleagues away from unnecessary testing. The goal: Helping patients choose tests that are evidence-based, free from harm and truly necessary.
There's also more good screening info from the American Academy of Family Physicians here.
As for those mailing solicitations, Dr. John Santa, medical director of the Consumer Reports Health Ratings Center, offers this advice: "When information comes in the form of an advertisement or promotion, regardless of the source, be skeptical. Realize that from a health point of view, if this was a really good and important thing to do, you probably wouldn't need to be advertising and promoting it."