Health Letter, July 2014
By Michael Carome, M.D.
If you’re not outraged,
you’re not paying attention!
Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.
On June 19, Public Citizen’s Health Research Group wrote letters to 20 hospitals and medical institutions in eight states urging them to sever their relationships with HealthFair Health Screening because the company’s heavily promoted communitywide cardiovascular health screening programs are unethical and are much more likely to do harm than good.
Winter Park, Fla.-based HealthFair – along with most of its hospital and medical institution partners – peddles inexpensive cardiovascular disease screening packages to people living near those hospitals and institutions without identifying who has risk factors that would make each of the screening tests medically appropriate. HealthFair’s basic cardiovascular screening package includes six tests that, among other things, take pictures of the heart, measure its electrical activity and look for blockages in arteries.
The screening tests are performed in buses, often bearing the names and logos of both the partner hospital or medical institution and HealthFair, that roam the surrounding geographic areas of the partner hospitals and medical institutions.
These screening packages are promoted directly to consumers through: (1) online advertisements on HealthFair’s website and on the websites of most of the partnered hospitals and medical institutions, and (2) in some cases, solicitation letters mailed directly to people’s homes. The promotions rely on fearmongering; erroneously suggest that, for most adults in the general population, these screening tests are useful in the prevention of several potentially life-threatening cardiovascular conditions, including heart attacks, strokes and ruptured abdominal aortic aneurysms; and make the screenings sound like an appealing bargain.
In fact, such indiscriminate and widespread testing is more likely to hurt people than benefit them. For example, many people undergoing such screening will have false-positive results (appearing to show an abnormality that is actually not present) or results showing minor abnormalities that would never cause symptoms or illness. Both circumstances can lead to additional unnecessary and risky tests and treatments that will harm some people, cause unfounded anxiety, and cost patients and insurance companies.
Such widespread screenings are not recommended by medical experts because each of the six tests either benefits only appropriately selected high-risk patients or has not been scientifically shown to provide any clinically meaningful benefit to anyone.
The promotion and provision of this screening is unethical. First, it is exploitative to entice people to undergo medically nonbeneficial testing through the use of misleading and fearmongering advertisements and solicitations, in order to generate medically unnecessary but profitable referrals to the institutions partnered with HealthFair. Second, this screening violates health care providers’ ethical duties to promote good, to act in the best interest of the patient and the health of society, and to do no harm to patients. Third, direct-to-consumer promotional materials for screening tests that fail to disclose published guidelines on recommended indications for these tests, as well as the risks of harm, violate health care providers’ ethical duty to protect and foster patients’ free, fully informed, uncoerced choices.
The hospitals and medical institutions that have sponsored HealthFair and promoted its screening programs directly to the public have done a great disservice to the communities they serve and to public health more broadly. It is imperative that these institutions sever their relationships with HealthFair and stop endorsing the company’s heavily promoted, unethical cardiovascular health screening programs.