Tag Archives: screening

KevinMD: Media is key to curbing MRI overuse

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

On the MedPage Today outlet KevinMD.com, Dr. Kevin Pho himself writes that media coverage of the overuse of certain screening procedures is “long overdue,” and praises The New York Timesrecent coverage of a study showing that in some cases MRIs can lead to more harm than good.

In the Times, reporter Gina Kolata explained, when unleashed upon the throwing shoulders of 31 healthy professional baseball pitchers, “M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent.” It’s a result, Kolata wrote, that shows that MRIs are “easily misinterpreted and can result in misdiagnoses leading to unnecessary or even harmful treatments.”

Back at his web portal, Pho writes that there are two steps that need to be taken to curb the overuse of the MRI. The first is cracking down on physicians who own their own MRI machines or otherwise profit from the tests, and the second is what he calls “adjusting patient expectations.” That’s where, he says, the media comes in.

there are some, but not all, patients who expect a scan and equate an MRI with “being thorough.” In fact, when orthopedic fellows cited in the Times story suggest that patients may not need a scan, patients “look at them like, ‘You don’t know what you’re doing.’”

Doctors can help educate patients away from the mythical benefits of overtesting. But the most effective teacher is the media, which wields significantly more influence. That’s why a story like this in the Times should be applauded, and promoted.

A fun aside? The study was conducted by none other than Dr. James Andrews, whose name will be familiar to anyone with even a passing familiarity with the sports pages.

ProPublica’s Allen opens window into screening business

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

In an investigation co-published with his old friends at the Las Vegas Sun, ProPublica’s Marshall Allen offers a revealing investigation into Heart Check America, a company whose high-pressure sales tactics and dubious quality record have earned it reams of consumer complaints and attention from state authorities.

Allen’s first-person anecdotal opener alone is enough to make the story worth reading, and the fact that he backs it up with thorough investigative work that appears to have already launched probes in two states is just the icing on the cake.

Heart Check America’s business model is eerily similar to that of the time-share industry, which is exactly where manager David Haddad earned his business stripes before being forced out by a state attorney general. Patients are lured in with the promise of free tests, then subjected to high-pressure sales tactics until they fork over thousands of dollars for long-term medical screening packages which they likely didn’t need in the first place.

It’s a classic investigation with evidence unearthed from a legion of sources; here’s just a sample of what Allen has assembled:

Colorado regulators checked Heart Check America’s Denver center. They found a litany of deficiencies, including no proof that staffers operating the scanner were qualified, no controls to ensure patients received as little radiation as possible, and that tests were being conducted without doctors’ orders.

Inspectors also found that the clinic was not supervised by a physician licensed in Colorado and that test results weren’t being read by a qualified radiologist or delivered to patients in a timely manner.

Allen’s work plays right into the debate over the efficacy of various screening procedures, especially those applied to low-risk patients, which makes one paragraph at the end of the story particularly ominous.

Haddad said he is continuing to look for opportunities in the imaging business. He has formed a new company, Cancer Check America, in Hilton Head, S.C, to focus on cancer screening.

Related

Prof: Mammogram debate is data vs. anecdotes

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

When it comes to the recent news that a government task force opposes routine mammograms for women under 50, the public must balance research with anecdotal evidence, according to a professor who studies how breast cancer is portrayed in the media.

Cynthia Ryan, Ph.D., an associate professor of English at the University of Alabama at Birmingham, says the media is doing a “decent” job of covering the debate between the new guidelines from the U.S. Preventive Services Task Force and individuals who are advising that women continue to start having mammograms at age 40.

The professor, who has a book coming out about “the rhetoric of breast cancer in popular women’s magazines,” explains why consumers are torn:

Ryan says that when confronted with extreme representations, there is a part of the human brain that wants to go with scientific study “because we figure it must be credible and rational,” she says. “But another part of our brain embraces anecdotal advice that links the message with a face.

Business pushes screenings despite guidelines

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Jeff Baillon, a reporter for KMSP-Minneapolis/St. Paul, saw Life Line’s ubiquitous mailers (here’s the one AHCJ’s Gary Schwitzer received) in which former Olympian Peggy Fleming urges people to go in for medical screening and decided to take a closer look at the company. Ohio-based Life Line sends a van to local neighborhoods and offers a variety of tests for a few hundred dollars.

Baillon and his crew, who went undercover for the occasion, found that the Life Line scans were so quick (as short as four minutes) that they wouldn’t yield good pictures, and would be more likely to turn up false positives and miss real problems. They also covered scans, like carotid artery scans, that guidelines generally advise against, and made no mention of government guidelines when scanning patients, even when prompted. For its part, Life Line, a for-profit business which screens about a million people every year and suggests tests even for low-risk groups, says they don’t “trick” customers and, in fact, actually help save lives.

Baillon’s piece:

(Hat tip to Gary Schwitzer)

Researcher: Screening could save young athletes

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

Writing for Time, Eben Harrell looks into whether athletes should be screened for cardiac problems in an effort to prevent sudden cardiac death (SCD). The condition, in which the heart suddenly stops working, is more likely to strike down athletes than it is their couch-potato counterparts.

There is evidence that screening, including the electrocardiogram, can prevent most cases of SCD.

Analyzing data from 42,000 athletes in the northeastern Veneto region of the country between 1979 and 2004, Italian researchers found that ECG screening resulted in an almost 90% drop in sudden cardiac deaths. Incidence of SCD among the unscreened non-athletic population did not change significantly during that time.

Noting the ECG’s shortcomings – it costs about $500 and produces false positives 7 percent of the time – Harrell adds that there is some evidence that a simple physical examination could be equally effective.

Related

Find tips about reporting on the health of student athletes and links to a number of articles, tip sheets, journal articles and other resources in AHCJ’s new “Reporting on sports injuries in school-age children” tip sheet.

Urological group pushes PSA screenings

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

The Cancer Letter‘s Paul Goldberg reports that the American Urological Association released a list of best practices that included beginning prostate screening at age 40 (see page 3 of this PDF for the announcement).

It came, Goldberg reports, “Less than a month after the New England Journal of Medicine published trial results that point to overdiagnosis and low or no benefit from screening men over the age of 50.” The American Cancer Society says it “does not support routine testing for prostate cancer in men at average risk at this time.”

Meanwhile, Cancerwise’s Julie Penne looked at the American Urological Association’s partnership with the NFL and a Houston event at which partnering doctors screened 37 men between the ages of 31 and 77.”

Recently, M. D. Anderson and the American Urological Association (AUA) teamed up to screen 37 NFL retirees from the Houston area as part of a 10-city series that the NFL Player Care Foundation initiated to address the medical needs of retired players. The M. D. Anderson screening… was the seventh site in the year-long tour that has held screening events in Kansas City, Atlanta, Dallas, Tampa Bay, Washington, D.C., and Canton, Ohio, the home of the NFL Hall of Fame.

Other than a UPI story and the aforementioned blog post, the initiative doesn’t seem to have attracted much attention, though University of Minnesota professor and AHCJ member Gary Schwitzer posted his reaction. Unfortunately, overshadowed by H1N1, the AUA’s new guidelines and the controversy surrounding them have gotten little attention as well. The Los Angeles Times‘ Shari Roan offers a roundup of the issues.