Trust me, I'm a doctor...
Private health screening is big business, luring the worried well with promises of peace of mind. But critics say it's unethical, a rip-off and even risky – and now a group of doctors is fighting back
Tuesday 06 November 2012
Interested in something to "save your life", or to help you "plan for the future"? Something that (according to one leaflet) "puts your mind at ease" as you don your baseball cap and a wide grin and go skipping to the beach for a picnic? That sort of happy, healthy freedom from worry can come, according to claims, by opting for private health screening. These days, links to health-check websites pop up all over the internet, and advertisements in newspapers offer "the means to help prevent stroke" plus "the ultimate healthcheck".
Now, though, doctors and consumers are asking some tough questions about the need, and the safety, of these services. A new website (privatehealthscreen.org) spells out their concerns.
"It's like selling a stair lift to someone who lives in a bungalow," says Martin Brunet, a GP in Godalming, Surrey, who was first alerted to private screening when a 40-year-old family member told him she had received marketing inviting her to a screening. "To me, knowing her age and history, it seemed crazy. I'm concerned at the way these screenings are not evidence-based. Some tests can be easily done by your GP and many are best offered to people who are already unwell or who show signs of needing one."
Screening is offered in the UK by companies who hire premises such as church halls and community centres. They set up their scanners and other equipment, charging between £130 and £2,000 for the tests – some of which, says Dr Brunet, are a "rip-off" and others which "open a can of worms" leading to anxiety and the risk of unnecessary and possibly hazardous further tests and investigations.
Take screening for abdominal aortic aneurysm – a test often offered by the private screening companies. This condition – a bulge in the blood vessel leading to the abdomen – is usually no threat to health, but occasionally the aneurysm can rupture, which is fatal. Preventive surgery is possible, but risky, and would almost always be avoided with elderly or frail patients. Even in fit people, an operation would be a major decision, given the risks of surgery. Discovering an aneurysm can cause fear and anxiety, much of it unwarranted, says Dr Brunet. "There's an assumption that knowledge is always good, but it's not necessarily the case."
The disadvantages and risks of the screening are downplayed, say campaigners. Companies avoid any discussion of false positives and false negatives, which are inevitable with virtually all forms of screening, as well as the implications of finding conditions that are best left "unfound".
Complaints have been lodged with the Advertising Standards Authority, and in some cases rulings have made companies amend their claims. While it remains illegal in the UK for prescription pharmaceuticals to be marketed directly to consumers, screening services are not subject to the same limitations. "In fact, screening is sold as something any responsible person, concerned about their health, would go for," says Glasgow GP Margaret McCartney, author of a new book The Patient Paradox, which includes a questioning look at screening of all types. "The potential hazards of private health screening are real – and a lot of the patients I see simply can't afford £130 anyway. A person's own doctor is usually in a far better position to offer unbiased information and the chance to discuss the need for investigations, and to give support."
In 2009, Which? magazine found none of the private screening companies visited offered written information about possible downsides, and there was worrying variability in the results, depending on the company.
In October this year. I tested the system myself, calling Life Line screening's free advice phone number as a consumer. I asked twice very clearly during my call if there was any disadvantage, downside, or risks, with any aspect of the screening, and I was assured on each occasion there was not. 'Really, there's nothing to be worried about at all,' came the reply.
Rose, 87, from North Tyneside, first went to Life Line screening last year, encouraged by a friend who had seen a newspaper advert. This year, Life Line wrote to her and offered her a further appointment.
"I thought of it as a 'health MOT', I suppose. They suggested additional tests, on top of the ones in the original package I'd had before. I'm not sure what the tests were for, though they did explain them. I honestly don't think the explanation was good enough – it wasn't clear to me what they were looking for, but I thought getting further checks would probably be a good thing anyway. I'm in fairly good health, though I do have a balance problem, and I wondered if the screening would help reveal why.
"The sequence of checks took about 45 minutes. I turned up at the church hall in Whitley Bay where it was happening, and I was seen quickly – there was little waiting between the stages, and they were quite efficient. I thought I'd have a chance to speak to a doctor about my balance, but there was no opportunity. No one asked me if I had any particular health concerns, but I'm not sure who was a doctor and who was a nurse, or whatever, anyway.
"The results came within a fortnight, and I couldn't understand them. I'm not very well up on medical terminology, and I suppose I hoped if something concerning had reared its head, it would be made clear.
I showed the results to my son, who's a GP, and he said, 'there's nothing you need do, Mum, don't worry,' so that was OK, but of course not everyone has someone who can interpret things for them. I'd never thought there could be any drawback to the screening. It's only since talking to other people that I know things aren't as simple and straightforward as I thought."
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