A few weeks ago, a letter arrived from the Life Line Screening company enticing me to come in for a simple, potentially lifesaving screening to assess my risk for strokes and other vascular diseases. The pitch contained the usual scary messages, noting that "cardio-vascular disease is the #1 cause of death in the United States for both men and women.'' A small flyer inside the envelope warned that the offered screenings will give you information that your annual check-up may not reveal,'' explaining that ultrasound screenings can actually see inside your arteries and reveal bad stuff that doctors can't see during an annual exam.
As if that weren't enough to reel in customers, the offer was framed like those bulk sales come-ons you see offered by women's clothing chains'buy $150 worth of merchandise and get $25 off on your next purchase. Life Line Screening, which bills itself as the country's leading provider of community-based preventive health screenings, offered five tests: carotid artery screening, heart rhythm screening, abdominal aortic aneurysm screening, peripheral arterial disease screening and osteoporosis risk assessment, all for only $149. That was a savings of $126 off the complete package of five screenings, which retailed for $275.
Buying in bulk seemed to make sense. Or did it?
The answer gets into the controversial realm of screening tests. Health policy experts implicate unnecessary tests as one reason America's health care tab is so high, and the uber authority on such screenings, the U.S. Preventive Services Task Force (USPSTF), doesn't always recommend every test that some physician or some outfit like Life Line Screening wants to sell. So I went to the USPSTF website for guidance, which is what anyone should do who receives a sales pitch for screenings, no matter how inviting they sound.
The task force has not recommended peripheral artery screening or carotid artery screening for people with no symptoms. It has, however, recommended a one-time screening for abdominal aortic aneurysm in men aged 65 to 75 who have smoked and routine screening for osteoporosis in women 65 and older. Both those screening tests got a B grade, which means there is high certainty that the net benefit is moderate or that there is moderate certainty the net benefit is moderate to substantial. Screening tests that get 'A' grades are those where there is a high certainty that the net benefit is substantial. A graded tests include blood pressure screening and screening for cervical cancer.
Sometimes screening tests do turn up abnormalities as evidenced by the testimonials that sellers like to point to. But evidence examined by the USPSTF indicates that as a whole, many widely advertised screening tests are not beneficial.
And your insurance may not cover any screenings that the USPSTF does not recommend.
Life Line Screening's website tries to push back against official public health guidance about their tests with information they call 'Health Screening Concerns & Complaints.'' The questions they pose and answers they provide are carefully worded to give both the company and screenings a favorable gloss. One question notes for example, that the USPSTF recommends against carotid artery screen for patients with no symptoms and asks if Life Line Screening has 'my best interests in mind.'
The company responds that the task force recommendation is 'widely misunderstood, and adds, 'The US Preventive Services Task Force does not examine community-based screening for the purposes of early identification and treatment with lifestyle coaching and medical management, which is what Life Line Screening does.'' Another Q & A response assures customers that even if your health screening found no problems, knowing that you are on the right track should make the time and money spent well worth it.
Doctors are also beginning to review the value of some often-used screening tests. Nine medical specialty boards, under the leadership of the American Board of Internal Medicine (ABIM), have recently recommended that physicians reconsider the use of 45 common tests and procedures such as M.R.I.s when someone complains of back pain. The docs' announcement, accompanied by their partnership with Consumer Reports for a national 'Choosing Wisely' campaign, is a big deal and should serve as a warning to patients (aka customers of private screening businesses) to do their homework before agreeing to screenings that are not likely to improve their health.