July 25, 2014
Updated June 7, 2017 – Kimberly Lovett Rockwell, MD, JD’s Viewpoint published in the May 25, 2017 issue of JAMA addresses the dangers presented by the largely unregulated field of direct-to-consumer medical testing. It reminded me of the following post I wrote three years ago about the conflict between these offerings and Choosing Wisely. The problem persists and merits the attention of the health care community and policymakers. One remedy, which Dr. Rockwell discusses, is requiring patients to obtain an order from a physician or other health care professional to obtain any type of medical testing. A small group of states currently requires this, and more should consider it.
I recently received an e-mail from a frustrated physician who expressed his concerns to me about HealthFair, a company providing screening services at his local academic medical center. Tuned into the Choosing Wisely® campaign, the physician claimed the cardiovascular screenings HealthFair was offering (echocardiograms and electrocardiograms) went against the specialty societies’ recommendations.
Choosing Wisely recommendations from the American College of Cardiology (ACC), the American Society of Echocardiography (ASE) and the American Society of Nuclear Cardiology (ASNC) all recommend against echocardiograms (ECHO) or electrocardiograms (ECG or EKG) for asymptomatic patients:
- ACC: Don’t perform ECHO as routine follow-up of mild, asymptomatic native value disease in adult patients with no change in signs and symptoms.
- ASE: Avoid using stress ECHOs on patients who meet “low risk” scoring criteria for coronary disease.
- ASNC: Don’t perform cardiac imaging for patients who are at low risk.
I urged the physician who e-mailed me to write to the academic medical center that was using the HealthFair’s mobile screening services, which he did. I promised I would further explore the issue. Upon investigation, I found that the consumer rights advocacy group, Public Citizen, already had HealthFair on its radar.
On June 19, Public Citizen released a statement urging hospitals to sever their ties with HealthFair Health Screening. The title of its statement pretty much says it all:
HealthFair’s Cardiovascular Screening Packages Are Unethical, Mislead Consumers, Do More Harm Than Good: Public Citizen Calls on 20 Hospitals and Other Medical Institutions in Eight States to Sever Relationships With Company Over Unnecessary Screening Programs.
Dr. Michael Carome, director of Public Citizen’s Health Research Group, said in Public Citizen’s statement, “It is exploitative to promote and provide medically non-beneficial testing through use of misleading and fear-mongering advertisements in order to generate medically unnecessary but profitable referrals to the institutions partnered with HealthFair… This screening also violates many ethical principles, such as the duty to promote good and act in the best interest of the patient and health of society, the duty to do no harm to patients and the duty to protect and foster a patient’s free, uncoerced choices.”
HealthFair responded to the criticism: “HealthFair stands by our program to educate the consumer, pre-select those that are candidates by screening, and provide them with the choice to obtain testing.”
I am glad to see that Choosing Wisely has increased the sensitivity around issues of value and overtreatment in the screening arena. The campaign has emboldened others to not only recognize these issues but also take action.
Daniel B. Wolfson
EVP & COO, ABIM Foundation