Map of life expectancy at birth from Global Education Project.

Friday, June 22, 2012

Speaking of evil bastards . . .

I found in my mailbox a letter from some people who call themselves "Lifeline Screening." They are going to be in my area for one day only, and for $60 they'll do an ultrasound screening of my carotid arteries. They'll also do various other screening tests if I fork over even more dough.

As they explain, my insurance will not pay for this, which is too bad because, if I want to know "Who needs to be screened?" the answer is, "[A]nyone over 50 who wants to be proactive about his or her health." They go on to tell me that my risk of stroke doubles each decade after age 55, but "my doctor won't order these screenings -- and insurance won't pay for them -- unless you have symptoms."

Wow, my doctor isn't look out for my best interests! Neither is my insurance company. It's a good thing these folks came long to save my life.

Oh wait a minute. Here's what the U.S. Preventive Services Task Force has to say:

The USPSTF recommends against screening for asymptomatic carotid artery stenosis (CAS) in the general adult population. (This is a grade "D" recommendation)

And why might this be. Does the USPSTF, along with my doctor and my insurance company, want me to die or be paralyzed from a stroke? Actually no, they don't. Here's some of what else they have to say:

Good evidence indicates that although stroke is a leading cause of death and disability in the United States, a relatively small proportion of all disabling, unheralded strokes is due to CAS. [I.e., carotid artery stenosis, the problem for which these people propose to screen me.]

Benefits of Detection and Early Intervention. Good evidence indicates that in selected, high-risk trial participants with asymptomatic severe CAS, carotid endarterectomy by selected surgeons reduces the 5-year absolute incidence of all strokes or perioperative death by approximately 5%. These benefits would be less among asymptomatic people in the general population. For the general primary care population, the benefits are judged to be no greater than small.
Harms of Detection and Early Intervention. Good evidence indicates that both the testing strategy and the treatment with carotid endarterectomy can cause harms. A testing strategy that includes angiography will itself cause some strokes. A testing strategy that does not include angiography will cause some strokes by leading to carotid endarterectomy in people who do not have severe CAS. In excellent centers, carotid endarterectomy is associated with a 30-day stroke or mortality rate of about 3%; some areas have higher rates. These harms are judged to be no less than small.

In other words, LifeLine Screening is a scam. They are grifters. Keep your wallet in your pocket.


Tom Spradlin said...

All the ads from these con artists include a testimonial from a person whose "life was saved" by this screening. I am still waiting (without holding my breath) to see a testimonial from someone who got a lot of additional expense, worry, and pain from a false positive.

Cervantes said...

Indeed. And their life probably wasn't saved anyway, they just went through a lot of pain, fear, and expense.