Most patients think that more testing equates to better medicine, and companies are profiting from that myth.
Some offer non-invasive screening tests (via Schwitzer), often times performed in church basements, screening the healthy, general population for carotid artery disease, peripheral vascular disease, or abdominal aortic aneurysms.
The typical cost is $50 per test, or five tests for $159. The price transparency is welcome, especially when health care costs are normally hard to come by.
The problem is, none of the tests are recommended by the USPSTF, and can be potentially harmful as they lead patients to undergo more invasive studies for findings that may eventually be benign. Generally, patients do not have a good sense of what is backed by evidence or not, and hence, fall back to the fallacy that “more must be better.”
Consider the described case of a blocked carotid artery that was found during incidental screening. The patient presented the results to her doctor, who repeated the test, confirming the findings. The patient then underwent surgery to clear out the arteries.
However, the physician addresses the conundrum that arises in this asymptomatic patient: “She never had any symptoms. Now you could argue that she might have had a stroke without a test, but what if she wouldn’t have? She just went through a risky double procedure for unclear gain.”
Patients like certainty, and often fail to appreciate the risk and nuance involving screening tests. And until they do, there will always be a market for companies to profit from that gray area.
Related posts:
- Should heart disease screening tests be covered by insurance?
- My take: Just say no to unnecessary tests
- Op-ed: Not all screening tests lead to early, better treatment
- Unnecessary tests vs bankruptcy
- A doctor who advocates no screening tests
- Which cancer screening tests are really necessary?
- Incentives promote unnecessary, excessive tests in the ER
{ 5 comments }
The above comment from the doctor is uneducated and misleading. There is very well known risk stratification for carotid artery disease that determines who benefits most from an endarterectomy versus who benefits most from medical management. If this patient was appropriately evaluated and subsequently recieved the standard of care, then she had great benefit from being screened.
That being said, I don’t doubt for a minute that there are less than honest players in this lucrative market.
JFS
The title of this post indicates a left wing bias (it is a bad thing to make money). If a customer(patient) is willing to pay for a service that they deem valuable, then so be it. That is called capitalism. It should be up to the purchaser(not government) to decide if the service provided is worth it.
Used to be a lot of ads for one of those ‘heart check’ super-fast CT outfits in my area. They featured testimonials from patrons who learned they were immediate candidates for quadruple bypass or chemo/radiation/surgery for lung cancer – it saved their lives (or gave them peace of mind if results were dire for a loved one/friend/co-worker but came up benign for them).
Do you think insurance companies got tired of paying for tests like this that led to ‘incidentalomas’? Don’t these tests provide incremental cancer risk due to radiation exposure?
Inquiring minds need to know…
Sucher beat me to it. We have good data to support CEA in aymptomatic carotid disease with significant narrowing (60-99%).
Google:
ACAS trial
ACST trial
I did google for these trials. They both look specifically at patients with narrowing. How were these patients selected? Could it be that they had specific risk factors? Since most of the population isn’t routinely screened, there must’ve been some reason why it was known that these patients in fact have significant narrowing?
Neither of these trials looked specifically at screening general population i.e. people for whom you don’t know if there is narrowing. When you screen the general population, the absolute risk reduction goes down (since you include a lot of healthy people) while the number of those with false positives (an potential harm from more invasive tests) goes up. So you cannot extrapolate from either of these tests to the general population. The numbers of those who benefit vs those who are harmed is different from screening those at higher risk that to screening general population.
Aren’t doctors taught epidemiology?
The title of this post indicates a left wing bias (it is a bad thing to make money). If a customer(patient) is willing to pay for a service that they deem valuable, then so be it.
This wouldn’t be bad if the advertising included accurate information about benefits and risks of tests, evidence (or lack thereof) of benefit. As is, the customer is not knowledgeable enough to make an informed decision. Moreover, this advertising not only deliberately misleads customers as to the evidence of the tests’ benefit for the general population, it also uses scare tactic to do so.
Given this, I’d say it’s not only unethical, it’s a borderline fraud: you tell people they’ll die unless they have the test and give deliberately false information.
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