Is that advertised offer of a low-cost screening for stroke risk and heart disease good public health outreach or an "unethical" exercise in "fear mongering?" According to a consumer group that issued strongly worded letters to 20 hospital systems, the answer is clear—and hospitals need to do something.
Public Citizen announced last week that it is calling on hospital systems across the country to sever partnerships with companies providing the screenings, which are usually well-advertised and often provided in buses adapted for the purpose. Public Citizen asserts that administering the screening to asymptomatic, unselected individuals is an "unethical" and "exploitative" practice that "is more likely to cause harm than benefit."
The group's efforts are focused on screening packages from HealthFair that include 6 tests: echocardiogram, electrocardiogram, carotid artery ultrasound, abdominal aortic aneurysm ultrasound, hardening of the arteries test, and peripheral arterial disease test. When administered to asymptomatic individuals, the group writes, the tests can yield false-positive results that can lead to "unnecessary, risky, and costly diagnostic procedures and treatment interventions" or can result in overdiagnosis, "in which individuals are diagnosed with conditions that will never cause symptoms or death."
In its letter to hospitals, Public Citizen minces no words about the screenings. "It is exploitative to promote and provide medically nonbeneficial testing through the use of misleading and fearmongering advertisements and solicitations in order to general medically unnecessary but profitable referrals to your institution," the group writes, adding that "this screening violates the ethical principles of beneficence … and nonmaleficence."
The questions around the appropriateness of certain tests are similar to other efforts being made within the broader health care provider community. For instance, the American Board of Internal Medicine Foundation’s "Choosing Wisely" campaign is centered around lists of procedures (.pdf) that tend to be done frequently, yet whose usefulness is called into question by evidence. APTA was 1 of the first 3 nonphysician organizations invited to join the campaign, and the association has included its participation within APTA's wider "Integrity in Practice" initiative.
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