Comments on: How companies make money from unnecessary screening tests http://www.kevinmd.com/blog/2009/02/how-companies-make-money-from.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2009/02/how-companies-make-money-from.html#comment-89827 Anonymous Sun, 15 Feb 2009 16:42:00 +0000 http://clients.emmense.com/kevinmd/2009/02/how-companies-make-money-from-unnecessary-screening-tests.html#comment-89827 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?<br/><br/>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.<br/><br/>Aren't doctors taught epidemiology?<br/><br/><i>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.</i><br/>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.<br/>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. 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.

]]> By: Buckeye Surgeonhttp://www.kevinmd.com/blog/2009/02/how-companies-make-money-from.html#comment-89739 Buckeye Surgeon Wed, 11 Feb 2009 00:19:00 +0000 http://clients.emmense.com/kevinmd/2009/02/how-companies-make-money-from-unnecessary-screening-tests.html#comment-89739 Sucher beat me to it. We have good data to support CEA in aymptomatic carotid disease with significant narrowing (60-99%).<br/><br/>Google:<br/>ACAS trial<br/>ACST trial 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

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/02/how-companies-make-money-from.html#comment-89738 Anonymous Tue, 10 Feb 2009 23:08:00 +0000 http://clients.emmense.com/kevinmd/2009/02/how-companies-make-money-from-unnecessary-screening-tests.html#comment-89738 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). <br/><br/>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?<br/><br/>Inquiring minds need to know... 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…

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/02/how-companies-make-money-from.html#comment-89737 Anonymous Tue, 10 Feb 2009 22:01:00 +0000 http://clients.emmense.com/kevinmd/2009/02/how-companies-make-money-from-unnecessary-screening-tests.html#comment-89737 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. 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.

]]> By: Joseph Sucher, MD FACShttp://www.kevinmd.com/blog/2009/02/how-companies-make-money-from.html#comment-89734 Joseph Sucher, MD FACS Tue, 10 Feb 2009 15:32:00 +0000 http://clients.emmense.com/kevinmd/2009/02/how-companies-make-money-from-unnecessary-screening-tests.html#comment-89734 <br/><br/>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.<br/><br/>That being said, I don't doubt for a minute that there are less than honest players in this lucrative market.<br/><br/>JFS 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

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