Monday, August 27, 2012

Just say no to commercial screening tests

In a widely read blog post last year, I harshly criticized the company Life Line Screening for advertising screening tests directly to the public (in that case, my church's unsuspecting congregation) that were either scientifically unproven or potentially harmful. Further, the company's advertisement greatly exaggerated the potential benefits of its tests and omit mention of the frequent "downstream" harms that can result from inappropriate testing, including adverse effects of additional diagnostic procedures or unnecessary treatments. A compelling commentary published today in the Annals of Internal Medicine echoes many of my concerns. Drs. Erik Wallace, John Schumann, and Steven Weinberger argue that at a minimum, commercial screening tests should be held to the same standards as direct-to-consumer drug advertisers:

If screening asymptomatic persons in the general population with nonindicated tests neither is medically beneficial nor enhances behavior change, how can it be ethical to allow marketing of such tests to the public? We believe that promoting and selling nonbeneficial testing violates the ethical principles of beneficience and nonmaleficence. ... Appropriate and truly informed consent cannot be obtained when the companies providing the test do not fully disclose the potential risks and lack of benefit before collecting payment and performing the tests. ... In direct-to-consumer advertising of pharmaceuticals, companies are required to disclose the potential risks of taking a medication. We believe that commerical screening companies should also be obligated to disclose from published guidelines the recommended indications and benefits of testing, as well as the potential risks and harms.

I don't mean to single out Life Line Screening, which is one of several companies that provide (and profit handsomely from) commercial screening services, but like all the others, its website is loaded with celebrity endorsements, deliberately vague about who would benefit from its screenings (primarily people age 50 and older, it says, but younger persons won't be turned away), and says absolutely nothing about the downsides of screening. Most of the tests Life Line Screening offers in various packages have insufficient evidence to show that they improve clinical outcomes - including creatinine screening for chronic kidney disease, according to a report released today by the U.S. Preventive Services Task Force. "7 million screenings since 1993," the Life Line website proudly proclaims; in my view, that's 7 million screenings too many. For information about worthwhile screening tests based on evidence rather than misleading claims, hype, and wishful thinking, skip the commercial screening websites and head to instead.