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Public Citizen questions mobile health screenings


By Sabriya Rice
Posted: July 6, 2014 - 12:01 am ET
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The Joint Commission says it is looking into a letter it received June 30 (PDF) from the advocacy group Public Citizen, which called on the national healthcare accreditation organization to suspend accreditation of any organization that partners with the mobile health screening company HealthFair.

In the letter, Public Citizen claims that the company and its partners misled consumers about accreditation status and that it uses fear mongering to scare healthy individuals into getting unnecessary tests.

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In June, the Washington-based group also sent letters to 20 hospitals in eight states asking them to sever relationships with HealthFair, calling the screenings unethical, not consistent with evidence-based guidelines and more likely to do harm than good.

HealthFair President Terry Diaz said in an interview that the company had been accredited for ambulatory care since 2004, but has been in a holding pattern for reaccreditation since Dec. 31, 2013, as the commission revised eligibility requirements. Diaz says the company removed marketing material mentioning Joint Commission accreditation from its website, but anticipates it will be reaccredited this year.

In a 17-page long statement issued June 20, the company said that it “categorically disagrees” with Public Citizen and that its service gives consumers an avenue that “puts healthcare decisions in the hands of consumers and their providers, not in the hands of government.”

In response to the Public Citizen letter, the Joint Commission said in a statement that the group will contact the organizations named in the letter to inform them that HealthFair is no longer accredited and request the organizations revise their promotional materials. But the commission said it has no say about whether an accredited organization should continue to affiliate with mobile screening groups like HealthFair.

HealthFair previously was accredited as an ambulatory care organization, but that expired in December 2013 and the company's leadership was informed it could no longer be accredited, the Joint Commission said.

There has been growing concern over the past few years about the promotion of screenings that government and other specialty health organizations say most patients do not need. Testing asymptomatic patients for everything from heart conditions to cancer can result in false positives, the need for additional testing, or even a false sense of security. Some opponents of screening say the companies use fear tactics to encourage testing and to draw in business, and that more care needs to be taken to ensure appropriate tests are given to the right patients.

Statements that are particularly problematic for Dr. Michael Carome, director of Public Citizen's health research group, are those implying that asymptomatic individuals have lurking, undiagnosed vascular disease that threatens their lives, and only screening will save them.

He points to examples on HealthFair's website that indicate, for example, “that abdominal aortic aneurysms are asymptomatic, not detectable on physical examination, and silent until discovered during a screening test,” and that “preventive health screening tests help identify health abnormalities that lead to heart attack, stroke, aneurysm, diabetes and even cancer.”

HealthFair responded saying that mentioning those statistics is education, not fearmongering.

“We don't say anything outlandish like 'do this or die,'” Diaz said. “It is a delicate balance between encouraging someone to take the necessary steps for a healthier life and educating.”

Patients pay out of pocket to be screened on HealthFair's mobile busses, which are available in communities nationwide. Diaz says direct-mail message goes to individuals age 45 and older, and patients who call in requesting information are prescreened to assess factors such as age, family history, cholesterol and blood pressure. Even if a patient is not qualified, they are still given the choice to undergo the test once the pros and cons of the tests are explained.

“It's about patient choice,” said Diaz, noting age 65 is the average for patients who show up for testing.

Others argue the routine screening of low-risk, asymptomatic patients leads to additional costs and risks. The practice should “be approached with great caution,” said Dr. Richard Chazal, vice president of the American College of Cardiology.

“There's no question you will pick up some abnormalities,” he said. “Then it becomes incumbent to follow that up with more complex, more expensive and sometimes more invasive procedures that could have risks.”

Chazal is also concerned that when it comes to marketing, people who are thoughtfully trying to look out for their health might be particularly vulnerable to messages of potential risks.

Likewise, bioethicist Art Caplan said advertising and marketing campaigns do not need to explicitly say, “You better get screened or else you're going to die,” to induce fear or make a patient feel irresponsible.

“Marketing for outpatient mobile screening has been very aggressive and it deserves a close, hard, independent look,” said Caplan, director of medical ethics at NYU Langone Medical Center. “This is an area where there has been a proliferation of services that aren't demonstrably cost saving or health promoting.”

Public Citizen says it plans to investigate other mobile screening groups and will likely take similar action against some of the larger ones in the future.

Follow Sabriya Rice on Twitter: @MHSRice


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