Health Letter, April 2015
By Vikram Krishnasamy, M.D., and Michael Carome, M.D.
In 2014, Public Citizen launched a campaign against Winter Park, Fla.-based HealthFair, a company that peddles inexpensive cardiovascular disease screening packages to people across the country.
That campaign began in June 2014, when Public Citizen wrote letters to 20 hospitals and medical institutions in eight states urging them to sever their partnerships with HealthFair because the company’s heavily promoted communitywide cardiovascular health screening packages are marketed to people for whom the screenings are medically inappropriate, are unethical and are much more likely to do harm than good.
The campaign so far has achieved remarkable success, with 15 of these institutions since indicating that they have ended or will soon be ending their partnerships with the company.
Public Citizen’s campaign continued in September 2014, when the organization asked the Federal Trade Commission (FTC) to investigate HealthFair’s direct-to-consumer (DTC) advertising and promotional activities. Public Citizen alleged that the company’s advertising and promotional materials were deceptive and contained unsubstantiated medical claims. The FTC’s review of our complaint is ongoing.
Unfortunately, HealthFair is not the only for-profit company offering inappropriate medical screenings to consumers in the U.S. Austin, Texas-based Life Line Screening, a much larger for-profit medical screening company, also partners with hospitals across the country to promote and offer inappropriate DTC health screening tests for cardiovascular disease and for osteoporosis.
According to Life Line Screening’s website and print solicitations, mailed directly to consumers, the company has “helped save thousands of lives” since 1993 and has prevented strokes and other types of cardiovascular disease.
But Life Line Screening has no evidence from rigorously conducted clinical tests proving that its screening tests save lives and prevent strokes and other cardiovascular diseases when used in the general population that its solicitations target. Instead, the company relies on testimonials and anecdotal reports from a small group of people who were screened by the company and claim to have benefited.
On Jan. 22, Public Citizen urged the FTC to investigate the DTC advertising and promotional practices of Life Line Screening. In its letter to the FTC, Public Citizen asserted that the company’s advertising materials make non-evidence-based claims of medical benefit for its package of cardiovascular disease and osteoporosis screening tests. The letter further stated that Life Line Screening’s advertisements omit information about the risks of adverse health-related outcomes and financial harms that may result from the indiscriminate screening offered by the company and about evidence-based guidelines describing if and when such tests should be performed.
On Feb. 19, following submission of its complaint to the FTC, Public Citizen expanded its campaign against Life Line Screening by writing letters to 73 hospitals in 24 states that had partnered with the company to promote its unethical screening practices. Echoing the same themes as those in the letters sent to HealthFair’s partners, Public Citizen called on these hospital partners to immediately terminate their relationships with Life Line Screening, citing five primary reasons:
- There is widespread consensus among medical experts that the package of cardiovascular and osteoporosis screening tests promoted by Life Line Screening is not appropriate for unselected, asymptomatic individuals in the general population and is more likely to cause harm than to provide benefit. No guidelines issued by any major medical professional organization support such screening practices.
- The promotion of Life Line Screening’s primary screening package relies on fearmongering — scaring healthy individuals about their future health.
- For many people, false-positive test results from this screening can lead to unfounded anxiety and additional unnecessary, risky and costly diagnostic procedures and treatment interventions. Moreover, false-positive test results can lead to financial harms because of the costs of unnecessary follow-up testing and interventions.
- Screening unselected, asymptomatic people will lead to overdiagnosis, which occurs when individuals are diagnosed with conditions that will never progress to cause symptoms or death. Like a false-positive result, overdiagnosis leads to unnecessary anxiety and unnecessary medical interventions.
- The promotion and provision of this screening is unethical.
The letters were sent to hospitals and medical institutions in Alabama, California, Delaware, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Nevada, New Jersey, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and West Virginia.
Of note, on Aug. 11, 2014, the Journal of the American Medical Association (JAMA) published an opinion article critical of hospital relationships with DTC disease screening companies such as HealthFair and Life Line Screening. The commentary was prompted, in part, by the publicity surrounding Public Citizen’s campaign against HealthFair.
The authors of the JAMA piece concluded that “hospitals should clearly and publicly explain their relationships with DTC screening companies, given the lack of evidence to support mass vascular screenings.”
In the end, the health care providers and hospitals that have partnered with HealthFair and Life Line Screening have done a grave disservice to the communities they serve and have adversely affected public health on a broader level. It is critical that all health care institutions still in partnerships with these companies sever these relationships and refrain from endorsing the companies’ heavily promoted unethical, unnecessary and harmful screening programs.
In the meantime, consumers can protect themselves by ignoring the companies’ advertisements and tossing their mailed solicitations in the trash.