177663 Scans and scams: Direct to consumer marketing of unnecessary screening tests

Monday, October 27, 2008: 2:30 PM

Martin Donohoe, MD, FACP , School of Community Health, Portland State University, Lake Oswego, OR
     
Unnecessary testing is becoming increasing common and consumer demand for certain types of tests have escalated. Such testing is expensive, diverts patient and provider time and attention from addressing evidence-based screening, can provide unwarranted reassurance or cause unnecessary anxiety, and can lead to further follow-up interventions, which may carry risks of physical harm and even death.

In this talk I will briefly note the criteria for (and give examples of) appropriate screening tests. I will then discuss unnecessary tests marketed directly to consumers, including whole body computed tomography (CT) scans and “metabolic screens”. Due to poor health literacy and/or a powerful need for reassurance, many individuals are willing to pay large amounts for screening tests which lack scientific merit. Regrettably, numerous companies have sprung up to meet this demand. For example, the Biophysical 250 company charges $3400 “to screen for hundreds of diseases and conditions.” Companies offering “metabolic screens” and whole body scans prey on people's fears of heart disease and cancer and on their natural desire to detect such problems early, in hopes of achieving a cure, or at least avoiding potentially toxic therapies.

Full-body screening CT scanning became increasingly popular after television talk show host Oprah Winfrey underwent this $1000 test in 2001. The number of self-referral imaging centers totaled 161 in 2003, up from 88 in 2001. One company, Ultra Life, offers “real time color ultrasound” of various organs, or for those inclined, a $500 “full body scan.” A 2004 survey of 500 Americans found that 85% would choose a full-body CT scan over $1000 cash. Regrettably, such scans expose the “victim” to substantial amounts of dangerous radiation.

I will also cover the unwarranted broadening of indications for screening tests which occurs commonly in luxury care (or concierge practices). Such practices are commonly associated with academic medical centers, which ironically present themselves as beacons of evidence-based medicine where trainees learn how to rationally utilize screening tests.

A framework for evaluating test claims and separating science from scam will be offered.

Learning Objectives:
1. Describe the criteria for an evidence-based approach to screening. 2. Discuss screening and monitoring tests which are frequently misused. 3. Articulate the costs and health risks of unnecessary tests which are marketed directly to consumers, such as whole-body CT scans and “metabolic screens.” 4. Describe the link between unnecessary testing and luxury care. 5. Develop a framework to assess health claims promulgated by screening tests marketed directly to consumers.

Keywords: Screening, Marketing

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I researched this talk and am solely responsible for its content.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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