Direct mail direct-to-consumer disease-mongering


I got a nice letter from former Olympic skating champ Peggy Fleming last week.

Peggy Fleming screening letter.jpg

She reminded me that she is a breast cancer survivor and that's why she believes in health screenings - although the tests she was writing about had nothing to do with breast cancer but with vascular disease (or an add-on for osteoporosis if I wanted - which I don't since I'm a man and not at high risk).

Peggy's note to me was, of course, an ad - an ad for the Life Line Screening company. And for the St. Paul Corner Drug store near me that is sponsoring upcoming screenings. All good for business. But potentially bad for consumers.

The "package of four painless stroke, vascular disease and heart rhythm screenings" - costing only $149 - are not recommended by the US Preventive Services Task Force - the gold standard in this country for preventive health recommendations.

For one of the four tests - abdominal aortic aneurysm screening - the USPSTF recommends only one-time screening in men ages 65-75 who have ever smoked. It makes no recommendation for nonsmokers. And it recommends against such screening in women.

For two of the other tests - carotid artery screening and peripheral arterial disease screening - the USPSTF recommends against screening in the general adult population.

For the fourth test - an EKG - the USPSTF recommends against routine screening in adults at low risk. And since Peggy and Life Line don't know my risk, she and they are skating on thin ice.

The Q&A flyer that accompanied Peggy's letter led with this:

Q: Who needs to be screened?
A: Anyone over 50 who wants to be proactive about his or her health.

The flyer also says "Unfortunately Medicare and insurance companies typically will not cover these stroke and vascular screenings without the presence of symptoms. This is is unfortunate since there are often no symptoms for the diseases for which we screen."

Don't make out Medicare and insurance companies as the villains here. They don't cover these tests because the leading evidence-based body in this country says there isn't evidence to support them.

Buyer beware. The story of these "low-cost, painless" screenings is a lot more complicated than it may look at first glance.

So, Peggy, I won't be going to the free screening. If it's a nice early Spring day, I may go for a walk. And if it isn't Spring here yet by then, maybe I'll take you for a spin on the local ice rink. Rather than you spinning the screening story on me.


Gary, Peggy Fleming is a lovely and genuine person who truly believes in preventive health. Her goal, which many others, including doctors, nurses and other health care professionals, share, is to help people identify signs of disease earlier, before symptoms begin. We screen an appropriate audience who have risk factors, including high blood pressure, elevated cholesterol, lack of regular exercise and a family history of cardiovascular disease or bone loss. And contrary to your statement that as a man you are at low risk for osteoporosis, recent data indicates that this is not necessarily the case. According to the National Osteoporosis Foundation, “Today, 2 million American men have osteoporosis, and another 12 million are at risk for this disease. Yet, despite the large number of men affected, osteoporosis in men remains underdiagnosed and underreported.” In addition, while I appreciate your comments about the US Preventive Services Task Force, the Task Force’s statements are often widely misunderstood and applied. Its statement on carotid artery stenosis, for example, examined screening for the purpose of treating with carotid endarterectomy, a surgical procedure. This is not what we do. Our program is one of wellness and early detection -- one in which we link people to doctors when lifestyle changes – such as going for a long walk – and medical management can make a big difference. This isn’t about spinning a story. It is about offering high quality, affordable screenings to individuals who choose to take control of their health.


1. I never said anything about Peggy Fleming not being a lovely and genuine person. I had a serious crush on her way back when. It may be true that she "truly believes in preventive health" but as I explained, I think her selling out to this cause is misguided.

Or do you mean to tell me she's doing this for free? What are you paying her?

2. I never said I was "at low risk for osteoporosis." I said I was not at high risk. If you don't know the difference, we should talk. But if that's the case, you also shouldn't be in the screening business.

I didn't ask for your mail to show up in my mailbox. You sent it. You didn't know anything about me. And if you did - where did you get that data? Either way, if you're going to sell sickness to the general population, you better be prepared to deal with some tough questions. We're not all as gullible and uninformed as you might wish.

The Publisher

About this Entry

This page contains a single entry by Gary Schwitzer published on March 9, 2009 9:00 AM.

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