By Arthur Vidro
By Arthur Vidro
Last week’s mail brought an invitation from Life Line Screening to sign up for health screenings being performed Oct. 23 at one of Claremont’s most distinguished businesses.
The invitation was nicely presented, with a brochure promoting Life Line Screening’s services. It was sent only to select folks in the community, all of them probably 40 or older.
Why 40 or older? Because the screenings are for conditions that become more prevalent as a person ages.
For $149, one can get tested for all five of the following: Carotid Artery Screening (plaque in the arteries); Heart Rhythm Screening (Atrial Fibrillation); Abdominal Aortic Aneurysm Screening; Peripheral Arterial Disease Screening; and Osteoporosis Risk Assessment.
If you suspect you have one of these conditions, then screening might be a good way to confirm your fears or to allay them. But if you have no reason to think you are suffering from these conditions — if you’ve never even heard of these conditions — should you be screened?
One segment of the medical community insists that more screening leads to better health care. The more, the better. Regardless of the condition for which one is being screened, and regardless of the patient’s health history.
But another segment of the medical community has its doubts that more always means better.
Let’s look at what we know.
Life Line Screening is a private, for-profit company. Such companies are interested, primarily, in generating profits.
But what could be wrong with getting screened? Well, the BBC News, in 2009, looked at Life Line Screening and other players in the field and concluded that these screenings are often expensive, unnecessary, and misleading.
Take expense. The $149 might be just a starting point. To its credit, Life Line is upfront on its website that it does not file insurance claims. If you want to shell out $149, be my guest. But don’t expect reimbursement. And be aware the cost can quickly escalate.
What raised my eyebrows was some small print in the advertisement saying: “Price does not include any applicable review fees.”
Review fees? Reviews by whom? Is there an additional fee to get someone to tell you the results?
From the company’s website: “Abnormal screenings are reviewed by a second technologist.” So if a screening shows you falling outside the parameters for “normal,” then another person gets involved, which usually means an additional fee.
Now, are the screenings necessary? If people had symptoms, their doctors would administer these or comparable tests. These screenings by a traveling troupe are targeting folks without symptoms or without doctors.
Are screenings potentially misleading? That depends on their reliability.
Even if a test is valid, false negatives pose a danger of telling you all is well when that’s not the case.
My fear is false positives, which trigger anxiety that can only be quelled by further, and more expensive, testing.
At its best, a screening might suggest you are in the high-risk group for, let’s say, a stroke. But the lifestyle changes to limit your risk are the same, whether you get tested or not. You don’t need a test to improve your diet, exercise plan, and sleep patterns.
Can screenings be dangerous?
Well, people without symptoms should avoid carotid artery screening, according to the American Academy of Family Physicians.
National Public Radio reported in 2013, “Even though the screening tests are generally non-invasive, follow-up exams and procedures often are not, and can increase a person’s odds of being injured or over-treated.”
Harvard Medical School’s Harvard Health Publishing cautions that off-site physicians interpret the test results (hence extra fees); that the accuracy of the tests are far from fully trustworthy; and that “a positive screening test will always need to be repeated by your clinician at a standard facility, and that test in turn may be followed by a confirmatory test, which carries further risks.”
Yes, some people will be helped by these screenings. But many will be harmed, as results raise concerns that will alarm the patient and trigger tests or treatments for a condition that might not ever harm the patient.
I have lost two relatives to complications caused by needless treatment for serious-sounding conditions that, in all probability, wouldn’t have killed them for another 20 years, if ever.
Screenings are often good at finding abnormalities that would never hurt you — but once found, are hard not to aggressively treat. Even though the safest course often is to do nothing but watch and wait.
A friend named Max, who is closing in on 90 but of sound mind, once advised me: “If you think you’re healthy, that just means you haven’t had enough tests.”
Which means, if you look hard enough, you can find a test for which a given patient will not perform in the optimal range.
That one test will lead to more tests.
Will the October screenings help more people than they harm? Who knows?
Let the buyer beware.
If you have consumerism questions, send them to Arthur Vidro in the care of this newspaper, which publishes his column every weekend.
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