Medical screening tests have become something of a double-edged sword: Though they can alert patients to certain medical conditions, more often, these tests are unnecessary and lead to needless anxiety and over-treatment.
A recent article in the Annals of Internal Medicine discusses this dilemma by pointing out a new trend of companies that sell screening packages directly to consumers. Lead author Dr. Steven Weinberger, executive vice president of the American College of Physicians (ACP), discusses how clever marketers of needless screening exams then encourage their customers to discuss any abnormal results with their physicians. Naturally, this leads directly to more unnecessary testing and even procedures, exacerbating the already dangerous problem of over-diagnosis with over-treatment.
Carotid ultrasound is an example of such direct-to-consumer tests offered by these companies; it s a test used to detect carotid stenosis a condition that is more common among smokers. Marketers of mass screenings often use the argument that if an abnormality is detected, it will likely spur the patient to modify their lifestyle to improve the condition. Yet evidence finds that this rarely happens: One study, for example, found that when people who smoked were told of an abnormal carotid ultrasound, they were no more likely to quit than were those who had a negative ultrasound or did not receive one at all.
Such findings have led the authors to recommend that marketers of such tests should openly state for whom the screening tests are indicated, and that medical establishments and physicians should not sponsor, support, or participate in such mass screening entities.
To this end, an initiative called Choosing Wisely which was founded by the American Board of Internal Medicine Foundation aims to identify commonly overused tests and treatments and alert doctors to them. This is particularly important, since five percent of the country s GNP is spent on tests and procedures that do little to improve a patient s outcome.
Over-screening, which in turn leads to over-diagnosis, is a growing problem in America, says ACSH s Dr. Gilbert Ross. And while it s encouraging to see that at least some physicians are advocating less screening, more patients and even physicians need to be made aware of the harms that may come of this. Unfortunately, he continues, aside from the entirely unjustified direct-to-consumer solicitations for studies of your entire body just to be safe , it s often hard to say in advance what tests are necessary, which are window-dressing, and which are entirely done to make the chart look good in the event of a lawsuit down the road. The extent of such defensive medicine is huge and largely under-studied.
Today s issue of the New York Times also sheds light on the issue of over-treatment, as part of its online series The Agenda. The article recounts several troubling stories of people who have suffered unnecessary testing and treatment.