Wellness screening offers draw complaints
Sue Majewski says she was irate about a mailer that came to her Morgan Park home on Aug. 30.
The letter, addressed to her husband, Bill Majewski, invited the 74-year-old to sign up for five “recommended” screenings offered by Ohio-based Life Line Screening this Wednesday at the Shriners Temple, 5152 Miller Trunk Highway.
The screenings — for stroke, atrial fibrillation, abdominal aortic aneurysm, peripheral arterial disease and osteoporosis — “aren’t just routine procedures,” an enclosure in the envelope stated. The words were next to a photo of a solemn-faced man in a white jacket, with a stethoscope hanging around his neck.
“They can help save your life,” it concluded, with the final three words underlined.
But some health experts argue that some of the screenings offered by Life Line and similar companies actually can do more harm than good.
“The layman would be shocked to know we actually do not have science to show that these screening, early detection tests actually decrease mortality or are beneficial to the patient,” Dr. Otis Brawley said in a telephone interview.
The chief medical officer for the American Cancer Society and a professor at Atlanta’s Emory University, Brawley wrote the 2011 book “How We Do Harm” on practices he argues benefit everyone except the patient.
Screening the screenings
Findings of the U.S. Preventive Services Task Force support Brawley’s claim, at least in part. An independent, volunteer panel created in 1984, the task force offers letter grades on a wide variety of screenings, from “A” for a wholehearted recommendation to “D” for “recommends against.” An “I” means there isn’t enough evidence for a recommendation.
The “I” is the task force’s finding for one of the screenings that will be offered in Duluth, screening for peripheral artery disease. It recommends, with a “B,” one-time screening for abdominal aortic aneurysm (often referred to as a “Triple A”) for men age 65-75 who have ever smoked. For men of the same age who have never smoked, it’s recommended that clinicians “selectively offer” the screening. It doesn’t recommend the screening for women who have never smoked and finds the evidence insufficient for women who have smoked.
The task force flatly recommends against anyone in the general population being screened for asymptomatic carotid artery stenosis, the screening for stroke.
‘We have to do this’
But some of those recommendations, while well-intended, are “outmoded,” said Joelle Reizes of Life Line Screening.
“Our own research, of which we have a lot, says that the current federal guidelines will miss 50 percent of all Triple A cases,” said Reizes, global communications director for the for-profit company.
Risk factors alone aren’t enough to determine if there’s potential for a stroke or heart attack, she said. “Eighty to 85 percent … of strokes occur with essentially no warning. … So that’s why we have to do this.”
Life Line Screening’s scientific advisory board includes top-flight researchers from academic centers such as New York University and Oxford University in England, Reizes added.
Essentia pulls out
The screening at the Shriners Temple, along with screenings in October in Superior and Virginia, is sponsored by Essentia Health St. Mary’s-Heart and Vascular Center, according to Life Line Screening’s website and the mailer sent to Bill Majewski.
Essentia’s involvement also bothered Sue Majewski.
“Why would Essentia endorse something like this when they’ve got their own screening measures within their own facility?” she asked.
In a more general sense, Brawley shares her concern.
“I worry about hospitals sponsoring these mass screening-type things — a mass screening versus screening in the doctor-patient relationship,” he said.
After hearing from patients concerned about the sponsorship, Essentia ended its relationship with Life Line Screening effective Nov. 1, Essentia spokeswoman Maureen Talarico said.
Essentia had agreed to sponsor the events because “these types of screenings can help people who may not have a primary care physician identify unknown medical issues,” Talarico said.
But Essentia never provided patient information, including mailing lists, to Life Line, and it didn’t receive any payment from the company, she added.
Reizes said the company never pays hospitals for sponsorships and doesn’t have to have a hospital as a partner to provide screenings.
5 screenings, $149
People who come for screenings often are referred by their doctors, Reizes said. Insurance doesn’t cover the tests Life Line Screening offers, but such tests in doctors’ offices usually aren’t covered by insurance anyway, she said. Her company offers a less-expensive alternative, she noted.
The mailing sent to the Majewskis said the five recommended screenings could be purchased for $149 and claims that’s a savings of $181.
Reizes also pointed to a survey commissioned by Life Line Screening stating that nine out of 10 cardiologists, neurologists and vascular surgeonssaid ultrasound tests such as those used by the company “make sense.”
Brawley was unimpressed.
The specialists who should have been asked are epidemiologists, he said, because screenings are a subspecialty of epidemiology.
Cardiologists have a financial interest in supporting screenings, Brawley said, because any abnormalities reported in a screening will be referred to them. He was quick to add that some screenings are recommended, but many more aren’t.
He also disputed the idea that the U.S. Preventive Services Task Force is behind the times.
“Preventive Services Task Force is usually very much up to date and they’re very reasonable,” Brawley said. “They require people on the task force be smart and understand screening but also to be folks who do not have a financial interest in the decision about screening.”
Al Lewis, an author from the Boston area who is a strident critic of what he calls the “wellness industry” says many screenings produce what he calls “hyperdiagnosis.”
Lewis, whose books include “Surviving Workplace Wellness,” calls himself a “convert” from the wellness industry.
“I made a good living in getting companies and health plans to do more of this stuff (such as screenings),” Lewis said. “And then I started doing the arithmetic on my own and just realized that the stuff just did not add up. Then I went completely over to the other side.”
Businesses such as Life Line Screening produce diagnoses that lead to unneeded treatment, such as stents for someone who doesn’t really have diseased arteries, he said. “Their business is basically to generate medical need.”
Life Line Screening is a successful and growing business, Reizes said. But that’s because the company is meeting a legitimate need.
Its screenings give the patient’s doctor the information needed to order further tests — if necessary — that will be covered by insurance, Reizes said.
“We have a business that we believe helps people and gets people information that they need,” she said. “When you work from that kind of a mantra, you tend to be successful.”
U.S. Preventive Services Task Force: uspreventiveservicestaskforce.org
Life Line Screening: lifelinescreening.com