Local TV report questions LifeLine Screening tests

| 6 Comments

If you have a mailbox, there's a good chance that you've received a letter from Peggy Fleming urging you to get some health screening scans to help prevent strokes.

I did - and I blogged about it six months ago.

Now Jeff Baillon of KMSP-TV in Minneapolis-St. Paul shows once again how TV news can do a good job of educating consumers on tough health care issues like the overselling of such screening tests.



This is an 8 1/2 minute report. Granted, this station has a one-hour newscast. But what a tribute to this news team to find the time and to make the investment to dig into health care claims as they have done.

(Disclosure: Baillon was a student in my health journalism seminar last Fall.)

6 Comments

I read your blog from 6 months ago and I like it. I particularly like your response to the comment that came from Lifeline. They are surely puzzled by the "Minnesota Nice" reputation we are supposed to have.

Full disclosure, I am the Dr. Courneya in Jeff's story.

My husband, Greg, who was 60 years old at the time, went to Lifeline Screening and was told to see a Dr. within 24 hours. This was on or about 11-22-07. He was checked at our Dr. and the agreed with Lifeline. He had a nearly completely blocked carotid artery. He went in for a stress test and had to have a stent put in before they could operate. They were very concerned and watched him as he needed to wait 30 days because of the blood thinners he had to take after they put in the stent. They did the surgery, which was much more complicated than expected, but completely successful. Greg NEVER had any symptoms. His stent was put in on 12-21-07 and his artery done 1-25-08.

It was such a fluke that he even went to Lifeline. One day a flyer came, and I said "do you want to do this? he said "why not?" so I signed him up.

In September of 2008 he went for a routine colonoscopy and found out he had colon cancer. He had it removed 10-1-08. If he had not been taken care of previously with regard to the stent and blocked artery, and since he never had any symptoms, we are convinced that he would have had problems, possibly fatal, during the surgery, because of what procedures he was in need of. The simple fact that he never had symptoms, not even high cholesterol meds and he is checked every year, and he needed all of this done, shows how important and accurate their tests are.

We cannot thank Lifeline Screening enough. We believe they are the reason Greg is healthy and still with us today.

Linda

9-29/09

Linda,

I’m happy for you that this screening paid off.

For many people it does not, and that is why imbalanced promotion of screening to a broad population is troublesome.

Yes, when you cast a broad net, you will pick up a few cases like your husband who might benefit.

But the fact is that in population-wide screening you will pick up many more false positives who do not, indeed, have a problem. The anxiety, the further testing that will ensue (some of which may carry its own harms), and the possible treatment that may follow (also with its own harms) – all because of a problem that wasn’t really there – is the huge “other side of the story.”

That is why we praised the TV report that gave the other side of the story that many don't get about such screening promotions.

Single anecdotes of happy outcomes fail to over-ride evidence-based recommendations that don't support such mass screening.

Life Line Screening offers a package of screenings aimed at the early identification of disease. Our focus is on people in the right target age group with risk factors, and we conduct our screenings with accuracy. [ http://lifelinescreening.com/aboutus/qualityassurance/Pages/default.aspx ] The stroke prevention components involve the three leading causes of stroke – carotid artery stenosis, atrial fibrillation, and systolic hypertension (high blood pressure). Other screenings include peripheral arterial disease and bone mineral density testing as well as finger-stick blood tests for cholesterol and glucose (sugar).

The story focused almost exclusively on one screening -- the carotid artery screening. There is a valid debate around carotid artery screening in the medical community. There are some doctors who think the carotid artery screening is a valid screening that helps identify those at risk earlier, and those who feel that the testing can lead to anxiety and further unnecessary tests that can cause more harm than good.

The basis of the Fox report is a statement by the U.S. Preventive Services Task Force (USPSTF). USPSTF is a government convened body that examines screenings and gives them a letter grade based on what they see as the evidence and their evaluation of the costs and benefits of screening.

In December of 2008, the Task Force released a statement saying they gave carotid artery screening a "D" grade, which is a low grade, and therefore do not recommend the screening based as what they saw as unacceptable costs versus the benefit to humanity. They arrived at this conclusion by doing a meta-analysis, which is a review of other published studies. As far as Life Line Screening can tell, there were no vascular specialists on the panel that did the review.

The panel's statement was based on the costs of hospital-based screening coupled with a surgical procedure called carotid endarterectomy. This model is the costliest model and since it involves surgery, does carry with it some risk. They found this not to be a good model for a large scale screening process.

But this is not what Life Line Screening does.

Life Line Screening provides community-based screening with the aim of finding disease at an early enough stage that lifestyle changes and medical management can make a difference. Community-based screening is much less expensive than hospital-based because we don't have the overhead expenses associated with maintaining a hospital. In addition, lifestyle coaching and medical management (such as aspirin therapy or statins) are cheaper and safer than surgery. The model is completely different than what the Task Force examined.

There are some additional things your readers might want to know. For example:

* Life Line Screening believes that screening people at-risk for cardiovascular disease risk factors makes sense. Finding disease at an earlier stage, when it is typically silent, is a better option than waiting for symptoms to appear and dealing with advanced disease.

* Most strokes occur out of the blue, with only a fraction having any warnings signs. For most individuals, the first sign of a stroke is the stroke. For people with osteoporosis, the first sign is often a bone fracture.

* The Society for Vascular Surgery recommends the types of vascular screenings LLSA does. http://www.vascularweb.org/members_only/pdf/SVS_Position_Statement_on_Screening.pdf

* The SHAPE Task Force, a task force of medical professionals, also recommends these types of screening. http://www.shapesociety.org/why_screening/

* The American Diabetes Association recommends one of the screenings – peripheral arterial disease – for every person with diabetes age 50 and over. http://www.diabetes.org/type-1-diabetes/well-being/peripheral-arterial-disease.jsp

* A study in the UK found community-based carotid artery screenings to be cost effective and beneficial to saving lives. http://www.cardiovascularultrasound.com/content/6/1/34

* The Mayo Clinic has a statement on its website that says, "Community screenings are an excellent way to raise awareness about common diseases and, in some situations, identify disease in its early stages. The benefit is realized when patients take the next step, seeing their physician for diagnosis and treatment." This is completely in concert with Life Line Screening's mission.

Mentioned briefly but not highlighted is the fact that Fox also received several emails from customers who say that Life Line Screening saved their lives or the lives of people in their families.

Life Line Screening stands behind its quality and is proud to serve and continue to serve the citizens of Minneapolis and Minnesota.

Dr. Manganaro,

Thanks for your note.

You said your “focus is on people in the right target age group with risk factors.”

Then why did I get the Peggy Fleming letter that your company produced? Did someone determine that I was “in the right target age group with risk factors?”

What did you know about my age and about my risk factors? And how did you get that information?

Or was that letter sent to me and thousands of others because you were just trolling for customers?

It has to be one or the other. I’d like to know the answer.

You wrote that The Society for Vascular Surgery recommends the types of vascular screenings that your company does. You also criticized the US Preventive Services Task Force for not having any vascular specialists on the panel that made its recommendation that didn’t support screening. Are you saying that only vascular surgeons can make recommendations? Isn’t good evidence good evidence no matter which initials you have after your name?

You also note that the SHAPE Task Force recommends these types of screenings. Criticism of the SHAPE Task Force is longer than your blog posting.

You pointed out that the local TV station received several emails from customers who say that Life Line Screening saved their lives or the lives of people in their families. Are people supposed to be swayed by anecdotes? Or by data and evidence? The plural of anecdote is not data.

There are two sides to this story. Do people who bite on your promotions hear BOTH sides?

I just got their letter but didn't open it--suspecting it was blanket advertising.
Well, I have greatly reduced such advertising at the senders cost with this cure: Mark the envelope "DELIVERY REFUSED... Please Return To Sender." You can add, "sender unknown," if you think an explaination is in order.
The Post Office charges return postage PLUS a return fee for EACH returned letter.-- Just image the expense if everyone did that with junk mail.

About this Entry

This page contains a single entry by Gary Schwitzer published on September 23, 2009 9:15 AM.

e-patient Dave: a health care consumer voice to be reckoned with was the previous entry in this blog.

Questions about the booming medical imaging business in Texas is the next entry in this blog.

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