If you get a letter in the mail inviting you to participate in a
simple, potentially lifesaving screening to assess your risk for
stroke, abdominal aortic aneurysms and other scary stuff, you
should probably toss it out with the rest of the junk mail.
Direct-to-consumer screenings are popping up all over. Common
tests offered include ultrasounds of the carotid arteries, heart
and aorta to look for cardiovascular disease; and blood tests,
genetic testing, X-rays and CT scans, among others, all without a
recommendation from a doctor.
"Some of these tests are useful and recommended, like blood
tests to check cholesterol levels. But others, such as
prostate-specific antigen [PSA] testing, are at best controversial
at this time. Some tests, such as a
to look for osteoporosis, are simply not recommended and are not
the standard of care, yet people can buy this, if it is offered,"
says Dr. Erik Wallace, associate professor and associate program
director with the Department of Internal Medicine at the University
of Oklahoma School of Community Medicine in Tulsa.
For those without
, the cost of a direct-to-consumer screening (also called a
commercial screening) is likely less than going to a hospital and
paying out-of-pocket, so it may be an alternative in some
situations, points out Wallace.
There are also potential -- although unproven - benefits. For
example, direct-to-consumer screenings can improve patient autonomy
and lead to greater transparency and competition in health care. It
can also offer more efficient care delivery and improve access to
health care, says Dr. Kimberly Lovett, assistant clinical professor
of family and preventive medicine at the University of California,
"Patient access to care can be impacted by many issues,
including lack of insurance, lack of transportation, and time delay
in seeing a practitioner. The direct-to-consumer medical
marketplace could potentially mitigate each of these access issues
if practiced in a medically and ethically responsible manner," she
But for the few pluses, there is plenty of downside to
direct-to-consumer screening tests. For starters, the industry
doesn't participate in informed consent discussions -- those
conversations where your doctor explains the risks, benefits and
alternatives to a particular treatment plan, especially if it is
invasive -- provide follow-up care for patients or make judgments
about the appropriateness of the screening tests for patients, says
Because of this, if a consumer suffers an adverse outcome, it
would be difficult to hold the provider accountable. Lovett offers
an example: One common service is a heart scan to evaluate
for plaque, which most adults have to some degree. Yet the scan
generally cannot provide a risk assessment in terms of who will
have a heart attack and who will not. A positive result can lead to
a significant amount of worry, and more tests. Some of these tests
may be as mild as blood analysis, but others may be as serious as
unnecessary angiograms and revascularization procedures, says
Furthermore, says Lovett, many of the medical screening tests
are not supported by evidence-based guidelines and therefore expose
patients to tremendous and unnecessary harm. "The data has shown
that many of these tests [when used for disease screening] will
produce far more harm than benefit for most patients," says
Linda Sherry, director of national priorities for Consumer
Action, agrees. "These tests have limited or no diagnostic value
and may trigger stress [and] fear, and encourage further, more
expensive testing to rule out false positives. Insurance won't pay
for them unless they are ordered by a doctor for diagnostic
reasons, not preventive reasons."
If you're looking to save money, "you can take your own blood
pressure at most pharmacy chains and many communities have health
screening days designed to educate people about symptoms that might
require follow-up," says Sherry.
The perils of self-diagnosis
Worse still, people might buy direct-to-consumer health
screenings for their own self-diagnosis and self-treatment for
symptoms of disease. "It's difficult for the lay public to really
appreciate the nuances and wholly understand the difference between
screening and diagnostic testing. Many patients seek screening
tests for symptom diagnosis. These patients can be dangerously
falsely reassured by normal results if they have chosen the wrong
test, or even led in the wrong direction with abnormal results,"
Wallace says the benefits of the tests are either overstated or
misstated. For example, carotid ultrasounds are frequently
advertised as a test to help prevent strokes. However, this test
has not been proved to be of any benefit for people who do not have
symptoms of a blocked carotid artery, says Wallace.
Health-screening companies might offer other tests that have proved
beneficial, such as an ultrasound for an abdominal aortic aneurysm.
But even this test has shown benefit only in men over age 65 who
have smoked. Men who are younger or much older, or who have never
smoked, should not get this test, says Wallace.
Of course, there are several health screening tests that are
beneficial to everyone. "To find out which one you should get and
when, consult your doctor," says Wallace. You can also check with
National Guideline Clearinghouse
and American Academy of Family Physicians for reliable
No insurance coverage for DIY health care
While medical screenings are pitched as an inexpensive way to
"verify your good health," you'll do so on your own dime.
Generally, health insurance does not cover the screenings because
there are no proven benefits for some of the tests, says Wallace.
"Either the tests themselves are not beneficial for the general
population, or the tests are only beneficial to certain people
based on age, sex and risk factors," he adds.
While the medical tests may not cost you big bucks, follow-up
tests may cost a lot more if the initial test indicates a possible
problem. "Although insurance will likely pay for follow up of an
initial abnormal test, the patient still must cover co-pays and
deductibles," says Wallace.
Consumers hope a simple and inexpensive test can catch something
early and lead to an effective treatment or cure. But Wallace says
"there's no guarantee you won't get sick, even those who take great
care of their health. The best thing any of us can do is to do
things that reduce our risk of illness -- eating well, exercising
and not smoking. Focus your time and money on this, instead of