Examining the evidence behind a community health screening

The following deceptive advertisement appeared in my church’s bulletin yesterday:

Life Line Screening, the nation’s leading provider of preventive health screenings, will offer their affordable, non-invasive, painless health screenings [in the church cafeteria] on April 9th. Five screenings will be offered that scan for potential health problems related to: blocked arteries, which is a leading cause of stroke; abdominal aortic aneurysms, which can lead to a ruptured aorta; hardening of the arteries in the legs, which is a strong predictor of heart disease; atrial fibrillation or irregular heart beat, which is closely tied to stroke risk; and a bone density screening, for men and women, used to assess the risk of osteoporosis. Register for a Wellness Package with Heart Rhythm for $149. Add Disease Risk Assessment with blood testing & biometrics for $79 more.

Although all of these tests sound good, every one is either 1) scientifically unproven; 2) proven to be beneficial only in certain groups of patients (rather than all adults); or 3) likely harmful in the long run, by increasing rates of false positive tests, subsequent unnecessary diagnostic procedures, and the adverse effects of those procedures.

As you know, until last November I worked for a federally-supported program that reviews the scientific evidence to support screening tests, and based on that experience, I would not offer most of these tests to my own patients, much less market them directly to a church congregation.

Specifically:

1. “Blocked arteries” / stroke screening is most likely a carotid ultrasound scan, which doesn’t help because most patients with asymptomatic carotid artery blockages will not suffer strokes. Although the screening test is “non-invasive and painless,” the confirmatory test, angiography, is not (it actually causes a stroke in a small number of patients) and unnecessary carotid endarterectomy can lead to death.

2. Abdominal aortic aneurysm screening is only recommended in men ages 65 to 75 who have ever smoked, because aneurysms are much less common in younger, female, and non-smoking populations. Even in men who are eligible for the test, it’s important to weigh the potential benefits against the potential harms of corrective surgery, which has a not insignificant mortality rate itself.

3. “Hardening of the arteries in the legs,” or screening for peripheral vascular disease with an arterial-brachial index, hasn’t been provent to prevent heart attacks but will certainly lead to many false positive results.

4. I’ve never even heard of atrial fibrillation (irregular heart beat) screening, which I presume is doing a screening EKG, which is also totally unproven. Absolutely no organizations recommend this.

5. Screening for osteoporosis with bone density testing is the only test on the list that’s actually worthwhile for a large number of adults, especially women over 65. But it’s not appropriate to do this test without a prior consultation with a clinician who can discuss the risks and benefits of undergoing this type of screening. And there are still questions about whether men benefit to the same degree as women, or at all.

In a nutshell, that’s why companies like Life Line have no business portraying these services as “preventive health screenings,” in my church or any other community setting. (I’ve sent an e-mail to my pastor recommending that they be dis-invited for the reasons I’ve outlined above.) It’s one thing to draw blood for a cholesterol test and take someone’s blood pressure (which will cost a whole lot less than $149), and quite another to offer these other procedures which are, at the very least, a waste of money and quite possibly harmful.

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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  • Fam Med Doc

    Dear Dr Lin,

    I agree w you 100%. And BRAVO to you for having the courage to speak out & even state the name of this ridiculous company.

    I hope some lay people who read your essay think long & hard before they waste their good money on this foolishness.

  • Finn

    A friend of mine fell for a similar come-on with a slightly different array of tests. The good outcome is that the letter noting several “abnormalities” provoked her to find a new doctor to replace her PCP who had died several years previously. The bad outcome is that these “abnormalities” provoked a series of increasingly expensive and pointless tests, right up through a nuclear stress test, on a middle-aged woman who exercises regularly and experiences absolutely no cardiac symptoms while doing so.

    I got the Life Line letter myself, after hearing them advertise heavily on a local radio station. My favorite part in the ad is the claim that “the first sign of a stroke is usually a stroke itself,” which is technically true while misleadingly implying that there are no detectable risk factors or known risk behaviors for stroke and that carotid ultrasound scan is a useful stroke screening tool, accompanied by the claim that “your doctor can’t offer these tests to you because insurance companies will only pay for them if they’re diagnostic, not for screening.”

    But given the high degree of health illiteracy, coupled with large numbers of people who don’t have a doctor because they’re uninsured and think an all-clear on these tests will mean they don’t have to worry about their health, I’m not surprised that this kind of medical flimflammery appears to be a lucrative business model.

  • http://onhealthtech.blogspot.com/ Margalit Gur-Arie

    This sounds like a page taken straight from Lydia Pinkham’s patent medicine advertising…. The more things change, the more they stay the same.

  • http://marilynmann.wordpress.com Marilyn Mann

    Some years back, when I was more naive about such things, I underwent a similar screening program where I work (a federal agency). I was told I needed to follow up with a cardiologist because I might have a leaky mitral valve. The cardiologist did an EKG and found a minor repolarization abnormality, leading to him ordering a stress test. In the end there was nothing wrong with my heart, but what a waste of time and money!

  • http://ww.davisliumd.blogspot.com Davis Liu, MD

    Completely agree with Dr. Lin. Thanks for bring up this important issue!
    http://davisliumd.blogspot.com/2010/05/life-line-screening-worth-money.html

    Davis Liu, MD
    Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
    (available in hardcover, Kindle, and iPad / iBooks)
    Website: http://www.davisliumd.com
    Blog: http://www.davisliumd.blogspot.com
    Twitter: davisliumd

  • solo fp

    Patients often see these advertisements and do them on their own. What is even more enjoyable is when the company wants the test results faxed to my office, listing mild to moderate potential abnormalities that are nonspecific. The patients often try to get the results by phone, but I require an office visit to go over these elective tests. Often the tests come back with mild cardiovascular disease in the summary report, which then leaves it up to the patient and me to decied what to do. If I tell the patient these tests often are not very reliable but then something happens to the patient in the next couple of years, I am liable potentially. If I order a major workup, the patient may become unhappy with the costs. It is a lose situation, and these companies should be better regulated.

  • Winslow Murdoch

    I am a family doctor with a small primarily older adult clientele. I am often contacted by patients with a list of services being offered by companies like life screen etc. I am asked whether in my opinion i recommend any of the menu of tests that are being offered by these companies.

    I keep records in an organized electronic format and in a few minutes or so can review the patient’s history, prior special study history and prior labs as well as get a gestalt of their willingness based on exam findings, problem list, or risk factors, if any of the tests on the menu might help support a preventive treatment decision based on results.
    Some patients refuse blood pressure medication, or to take compliance seriously, some refuse to change lifestyle or diet or take statins, and are at risk, some need objective findings to effect change.
    Others would not set foot in a medical office or get blood work and feel that these non medical locations are less threatening.
    Any touch point for care, compliance, and understanding has value for a subset of every practices population.
    I wouldn’t suggest every test (or any of these tests for that matter) for general populations.
    If, however, these are done for the right patients in a manner that opens the conversation on prevention that was otherwise a closed door or ignored, then I do see value for these select patients if done selectively in partnership with their primary
    care provider. Compared to the cost of vascular surgeon, neurologist, cardiologist, or radiologist specialist read vascular test, these are inexpensive!

    Of course, screening individual patients who reach out to me for my advice as to what I deem helpful is yet
    another example of value added, highly cognitive
    uncompensated work for primary care providers… That would
    be me!

  • MarylandMD

    What a ripoff. My patients come in with their LifeLine reports and seem so proud of themselves for doing something for their health. It is tempting to bluntly tell them like House or Doc Martin that they wasted their time and their money and the healthiest thing they did was the walks they took between the car and the testing center. Instead I try to break the news to them gently and try to pivot from the discussion of the tests to a discussion of the value of healthy behaviors…

  • http://www.BocaConciergeDoc.com Steven Reznick MD

    Most of what is screened for by LifeLine can be screened for by taking an appropriate history and doing a thorough examination.
    With the empowerment of patients and the spread of information on the internet patients can now contribute to the escalating costs of health care by purchasing services and products they do not need and are of little or no value.
    In many cases when you try and educate them they treat you as if you are a jealous competitor or protector of an old science not quite still in vogue.

  • Joe

    Dear Dr. Lin, I wonder what financial benefit the church gets if any??

  • Leo Holm MD

    The new definition of “prevention”: Trolling for bucks.

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