Thinking that ideally everyone would have a health care provider that knows one’s medical history well.
S/he can then best work with you on deciding which screenings are best for you.
By now we are all familiar with the concept ofoverdiagnosis, where “we” is defined as “the readers of THCB and a few other people whose healthcare literacy is high enough to know when not to seek testing and/or when not to automatically believe the test results.”
The rest of the country hasn’t gotten the memo that, quite counter-intuitively, many suspected clinical problems should simply be left alone. Many insignificant conditions get overdiagnosed and subsequentlyovertreated, at considerable cost to the health plans and risk to the patient.
For more information on that we refer you to the bookOverdiagnosed. The thesis of that book is that insured Americans are far more likely to be harmed by too much care than too little.
Rather than use its resources and influence with human resources departments to mitigate overdiagnosis, most workplace wellness companies have opted for the reverse, taking overdiagnosis to a level which, were they physicians billing the government for this work, could cost them their licenses and possibly their freedom. Instead, they winawards for it.
We call this new plateau of clinical unreality “hyperdiagnosis,” and it is the wellness industry’s bread-and-butter. It differs from overdiagnosis four ways: It is pre-emptive. It is either negligently inaccurate or purposefully deceptive. It is powered by pay-or-play forfeitures. The final hallmark of hyperdiagnosis is braggadocio – wellness companies love to announce how many sick people they find in their screens.
Most cases of overdiagnosis start at the doctor’s office, when a patient arrives to join the physician in a generally good faith search for a solution to a manifest problem. The patient comes in need of testing. By contrast, in hyperdiagnosis, there is neither a qualified medical professional providing adult supervision nor good faith. The testing comes in need of patients, via annual workplace screening of up to seventy different lab values. Testing for large numbers of abnormalities on large numbers of people guarantees large numbers of “findings,” clinically significant or not. It is a shell game that the wellness vendor cannot lose.
2.Inaccurate or Deceptive
Most of these findings turn out to be clinically insignificant, no surprise given that the US Preventive Services Task Force recommends annual screening only for blood pressure, because otherwise the potential harms of screening outweigh the benefits. The wellness industry knows this, and they also know that the book Seeking Sickness: Medical Screening and the Misguided Hunt for Diseasedemolishes their highly profitable screening business model. (We are not cherry-picking titles here—there is no book Hey, I Have a Good Idea: Let’s Hunt for Disease.) And yet most wellness programs require annual screens to avoid a financial forfeiture. This includes the four programs covered on THCB this year — CVS, Nebraska, British Petroleum, and Penn State.
Those four programs and most others also obsess with annual preventive doctor visits. Like screening, though, annual “preventive” visits on balance cause more harm than good, according to academic and lay reports. The wellness industry knows this as well. We have posted it on their LinkedIn groups, and presumably they have also access to Google. They addressed the data by banning us from their groups.
3. Pay-or-play forfeitures
Because of the lack of value, the inconvenience, and privacy concerns, most employees would not submit to a workplace screen if left to their own devices. The wellness industry and their corporate customers “solve” that problem by tying large sums of money annually — $600 for hourly workers at CVS, $1200 at Penn State and $521 on average – to participation in these schemes. Yet participation rates are still low. At Penn State, for example, less than half of all employees got screened despite the large penalty.
Few doctors would publicly brag about how many cases of hidden disease they found, especially if they couldn’t convince the patient to do anything about their condition. But boasting is essential to hyperdiagnosis. We’ve already blogged on how Nebraska’s program sponsors bragged (and lied, as they later admitted) about the number of cancer cases they found. They also bragged about the rate of cardiometabolic disease they found — 40% in the screened population — even though they admitted almost no one did anything about those findings. Hence, it’s the worst of both worlds: telling people they are sick without helping them get better.
We’d like to think that all our exposés have made a dent in the wellness industry’s business model, but the forces arrayed in the other direction have so far overwhelmed us. The price of screening has plummeted almost to the $1-per-lab-value level for comprehensive screens, and as with anything, the lower the price, the greater the amount sold.
More ominously, starting in January employers are allowed to tie 30% of premiums to health-contingent employee wellness programs. And they will, thanks to the canard — also debunked on THCB — that the CDC says 75% of health spending is somehow preventable through wellness. This statistic is gospel among benefits consultants, vendors and even pharmaceutical companies like Astra-Zeneca and Johnson and Johnson, which should know better. So as far as the wellness industry is concerned, a 30%-of-premium penalty only scratches the surface, meaning that their hyperdiagnostic jihad against the American workforce has barely begun.
Al Lewis is the author of Why Nobody Believes the Numbers, co-author of Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care, and president of the Disease Management Purchasing Consortium.
Vik Khanna is a St. Louis-based independent health consultant with extensive experience in managed care and wellness. An iconoclast to the core, he is the author of the Khanna On Health Blog. He is also the Wellness Editor-At-Large for THCB.
- Overdiagnosis (whatreallymattersinhealthcare.wordpress.com)
- Patients report doctors not telling them of overdiagnosis risk in screenings (medicalxpress.com)
- Millions Wrongly Treated for ‘Cancer,’ National Cancer Institute Panel Confirms (fromthetrenchesworldreport.com)
- Doctors Rarely Discuss Risks of Cancer Screening (nlm.nih.gov)
- Too Much Medicine Is Bad For Our Health – by Allen Frances MD (therefusers.com)
- Mammogram Alternatives Can Also Be Dangerous (And Often Are) (rinf.com)
- Patients report doctors not telling them of overdiagnosis risk in screenings (eurekalert.org)
- Warning over rise in ADHD misdiagnosis (irishtimes.com)
- Doctors rarely discuss cancer screening risks (sumantasaha.com)
As we enter 2012, many patients will be changing to new insurance plans.
And for a few, deductibles will be rising.
One thing that’s emphasized in the Affordable Care Act, however, is that preventive services would remain “free.”
However, consider this story of a man, who thought he wouldn’t have to pay for his screening colonoscopy, instead was charged over $1,000 for the procedure.
From USA Today,
Bill Dunphy thought his colonoscopy would be free.
His insurance company told him it would be covered 100 percent, with no copayment from him and no charge against his deductible. The nation’s 1-year-old health law requires most insurance plans to cover all costs for preventive care including colon cancer screening. So Dunphy had the procedure in April.
Then the bill arrived: $1,100.
The reason? During the procedure, polyps were found and rightfully removed. But in doing so, it changed the colonoscopy from a screening procedure to a diagnostic procedure, thus making it applicable to the patient’s deductible.
Such semantics are important, as insurance companies will seize them at every opportunity to pass on costs to both patients and hospitals….
- Preventive care: It’s free, except when it’s not (goerie.com)
- Preventive care: It’s free, except when it’s not (usatoday.com)
- Loophole in U.S. law means not all preventive care free (ctv.ca)
- Preventive care: It’s free, except when it’s not (sfgate.com)
- Preventive care: It’s free, except when it’s not (seattlepi.com)
- Preventive Care Is Free — Except For When It’s Not (huffingtonpost.com)
- Preventive Care: It’s Free, Except When It’s Not (maboulette.wordpress.com)
- Preventive care: It’s free, except when it’s not (mysanantonio.com)
- Preventive care: It’s free, except when it’s not (seattletimes.nwsource.com)
- Know What to Expect From Colonoscopy Prep (everydayhealth.com)
An Opportunity to Identify Diabetes, Hypertension, and Other Chronic Diseases
Nearly 20 million Americans annually visit a dentist but not a general healthcare provider, according to an NYU study published today in the American Journal of Public Health.
The study, conducted by a nursing-dental research team at NYU, is the first of its kind to determine the proportion of Americans who are seen annually by a dentist but not by a general healthcare provider.
This finding suggests dentists can play a crucial role as health care practitioners in the front-line defense of identifying systemic disease which would otherwise go undetected in a significant portion of the population, say the researchers.
“For these and other individuals, dental professionals are in a key position to assess and detect oral signs and symptoms of systemic health disorders that may otherwise go unnoticed, and to refer patients for follow-up care,” said Dr. Shiela Strauss, an associate professor of nursing at the NYU College of Nursing and co-director of the statistics and data management core for NYU’s Colleges of Nursing and Dentistry.
During the course of a routine dental examination, dentists and dental hygienists, as trained healthcare providers, can take a patient’s health history, check blood pressure, and use direct clinical observation and X-rays to detect risk for systemic conditions, such as diabetes, hypertension, and heart disease. ……
- Barbers: Cut, Shave, Lower Your Blood Pressure (jflahiff.wordpress.com)
- Dentists Could Screen 20 Million Americans For Chronic Physical Illnesses (medicalnewstoday.com)
- NYU study concludes that dentists could screen 20 million Americans for chronic physical illnesses (eurekalert.org)
- Dentists could screen 20 million Americans for chronic physical illnesses: study (medicalxpress.com)
- Dentists Could Fill Gap in Health Care (nlm.nih.gov)
People resist medical screening, or don’t call back for the results, because they don’t want to know they’re sick or at risk for a disease. But many illnesses, such as HIV/AIDS and cancer, have a far a better prognosis if they’re caught early. How can health care providers break down that resistance?
Have people think about what they value most, finds a new study by University of Florida psychologists Jennifer L. Howell and James A. Shepperd. “If you can get people to refocus their attention from a threat to their overall sense of wellbeing, they are less likely to avoid threatening information,” says Howell. Do that, and people are more likely to face a medical screening even if it means undertaking onerous treatment and even if the disease is uncontrollable. The findings will appear in Psychological Science, a journal published by the Association for Psychological Science.
The researchers undertook three studies, each with about 100 students of both sexes. In all three studies, they asked the participants to think of a trait they valued; they chose traits such as honesty, compassion, and friendliness. Participants then wrote either about how they demonstrated the trait (expressing self-affirmation) or a friend (not affirming themselves) demonstrated the trait….
- Self-affirmation may break down resistance to medical screening (medicalxpress.com)
- Self-affirmation may break down resistance to medical screening (eurekalert.org)
- When Are You Too Old For Routine Screening Tests? (aarp.org)
- Breast cancer screening saves lives – but it causes harm, too (telegraph.co.uk)
- African American Communities Face Aids Crisis (socyberty.com)
- Symptom-Based Screening May Improve Detection Of HIV In High-Risk Men (medicalnewstoday.com)
Excerpts from a Health Day news item
TUESDAY, Oct. 12 (HealthDay News) — Many patients with incurable cancer are still being screened for common cancers, although these tests are unlikely to provide any benefit, researchers from Memorial Sloan-Kettering Cancer Center in New York City have found.
Specifically, many patients diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal or breast cancer are still undergoing the ordeal of routine breast, prostate and colon cancer screening, said the researchers. Not only might these patients suffer from invasive procedures like colonoscopies near the end of life, the researchers said, but they face the unnecessary risk of additional tests, biopsies and psychological distress resulting from the detection of new malignancies.
“For patients living with advanced cancer, cancer screening should not be a routine procedure,” said lead researcher Dr. Camelia S. Sima, an assistant attending biostatistician.
The report is published in the Oct. 13 issue of the Journal of the American Medical Association.
The article is freely available at http://jama.ama-assn.org/cgi/content/full/304/14/1584
There needs to be greater awareness that cancer screening when one is near the end of life is unlikely to provide a benefit, Sima pointed out.
“Screening guidelines could be reassessed to address the appropriateness of screening for patients whose very limited life expectancy due to advanced cancer negates any potential benefit that may be derived,” Sima said.
Commenting on the study, Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society, said that “we can do a lot of good with screening, but we have to recognize that there comes a time when it’s simply not the right thing to do.”
Lichtenfeld suggested that patients should discuss the appropriateness of a screening test with their doctor. “Putting people at the end of life through screening is not appropriate for the person, and from a societal viewpoint, it’s not a good use of our limited resources,” he said.
“Why would this happen in the first place?” Lichtenfeld asked. “It flies in the face of compassion; it flies in the face of common sense.”