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Presenting the Facts by Addressing Margaret McCartney’s Issues against Life Line Screening

Joelle Reizes - October 16, 2012



Recent criticism of our work at Life Line Screening comes from an article written by physician and writer Margaret McCartney, along with her new site PrivateHealthScreening.org. Those of us at Life Line Screening understand there will always be debate about health screenings. We’ve always offered high quality, convenient, affordable private screenings that individuals can voluntarily choose if they have appropriate risk factors and decide that the screenings are right for them.

Criticism of Life Line Screening fails to account for the context in which screenings are taking place. In the U.S., stroke is the fourth most common cause of death and is the leading cause of adult disability (1). This is just one statistic among many that prove we need new ideas and strategies to alter these alarming facts. Identifying serious underlying disease before it leads to a catastrophic event is surely better than waiting until the event happens.

Dr. McCartney mentions that she believes that carotid artery screening is only worthwhile once the person has already had a stroke. This simply does not make any sense. And waiting for “symptoms,” as she suggests, is also a poor strategy as most strokes come without any warning. Only about 15% of people who have a stroke have a warning “mini-stroke” ahead of time, so for the vast majority of people, the stroke comes out of the blue (2).

Also, never in this conversation has Dr. McCartney discussed the benefits of a person finding disease and seeing a doctor in time to put preventive strategies in place. While she is extremely focused on the little possibility of false-positives, she never allows for the opposite and even more powerful situation – someone coming in with something serious who is now able to work with his or her doctor to get back on the right path, thus possibly averting a serious crisis. In fact, a recent paper showed that preventive screening and treatment for vascular disease risks resulted in 14% reduction in premature death and an 11% reduction in reliance on long-term care in comparison to those who did not participate in the study (3).

Life Line Screening has many customer testimonials to attest to our services and is actively engaged in research to better understand the utility and efficacy of screening (4, 5). No screening is without risk, and any screening has a small, but certain risk of adverse outcomes as have any medicines or surgeries. On the basis of probabilities, however, its advantages far outweigh potential risks.

Dr. McCartney and others are certainly free to disagree. However, to ignore the possibility that a model that promotes education and prevention can serve a vital role in the health care continuum is to do a disservice to the very patients she cares for. You’ve seen both sides of the story. Educate yourself with the facts. View our video below to discern for yourself.

References:
1. American Stroke Association: About Stroke. 2012. http://www.strokeassociation.org/STROKEORG/AboutStroke/About-Stroke_UCM_308529_SubHomePage.jsp
2. Most Stroke Patients Do Not Get A Warning: A Population-Based Cohort Study. Hackham DG, Kapral MK, Wang JT, Fang J, Hachinski V. Neurology 2009; 73: 1074-1076.
3. The Vascular Society. Outcomes after elective repair of infra-renal abdominal aortic aneurysm. 2012. http://www.vascularsociety.org.uk/
4. Horst Bickel K-H, Bronner M, Etgen T, et al. Reduction of long-term care dependence after an 8-year primary care prevention program for stroke and dementia: The INVADE Trial. J Am Heart Assoc 2012:1. doi: 10.1161/JAHA.112.000786
5. M Chabok, M Aslam, R Farahmandfar, J Coltart, Epidemiological Study and Risk Analysis in Men and Women of Different Ages with Abdominal Aortic Aneurysm (AAA). International Angiology Journal, June 2012, Vol. 31(Suppl. 1-3) 37.




Comments



4 Comments so far
  1. mgt mccartney - October 19, 2012 at 7:11 pm

    Dear Joelle

    Sadly your response does not actually address the issue, which is that people have been advertised to by your company through making false promises of the benefits of your tests. Screening is usually complex and always contains a balance of pros and cons. You have not informed people about the drawbacks, uncertainties, hazards or lack of evidence for what you offer. This is the real problem and one that you haven’t addressed. Your new UK adverts are a slight improvement in that they don’t make some unproven claims as before, but still do not explain the downsides of screening.

    Your comments about me then effectively suggesting that I have told people to just go on ‘waiting for symptoms’ simply doesn’t reflect the evidence or indeed what I have said. People can do many things to reduce their risk of many diseases. Most of this advice is straightforward. Eat a varied diet, don’t be over or underweight, exercise daily, don’t smoke, drink moderately, do work you enjoy, see friends and meet people. My comments do however reflect the fact that screening tests can lead to harm through unnecessary interventions. The less chance of benefit, then the greater risk of unnecessary harm.

    The study you cite (4) above, was a complex long term intervention examining many types of cardiovascular risk factors, in particular BP treatment. It is not possible to attribute any potential benefit (and there may have been problems with this trial in that the effect may not have been down to the activities done because of the trial, see the discussion section) to the activities of Lifeline Screening based on this.

    Next, customer testimonials do not count as evidence. We know that harmed people tend to report fewer adverse outcomes because of the ‘popularity paradox’ – people tend to feel grateful that a false positive was a false positive rather than feeling angry that they were unnecessarily tested for something that wasn’t going to harm them. Also, seriously harmed patients can’t always speak up for themselves either. Testimonials are not reliable evidence.

    You also say that “No screening is without risk, and any screening has a small, but certain risk of adverse outcomes as have any medicines or surgeries. On the basis of probabilities, however, its advantages far outweigh potential risks.” That’s really pretty incredible, given the huge amount of research that has been done on screening, and the many findings of ineffective screening tests – that did too much harm to make the benefits worthwhile. And in any case, it should be up to the person to decide what level of risk is acceptable to them – not for a commercial company to make that value judgement for them.

    Why don’t you read the extensive evidence about the balance of benefit and harms that we have on our website?

    http://privatehealthscreen.org/evidencebank.html

    There is no reason to think that knowledge and prevention of disease has to include non evidence based screening tests, and the arguments you are using are similar to those that people who promote homeopathy use.

    I’d like you to consider what informed choice really means and whether or not your customers are being given fair and unbiased information before handing over their money.

  2. Joelle Reizes - October 26, 2012 at 11:51 am

    Thank you, Dr. McCartney, for your post, and our apologies for the delay in approval. We appreciate comments and take all feedback seriously.

  3. carl heneghan - November 5, 2012 at 10:48 am

    Hi, about a week ago (October 25th to be precise) I posted a response about the above post on your website (it can also be found at http://www.carlheneghan.com)
    I am reposting it as I haven’t seen it displayed or heard anything back yet.

    Life line screening versus Dr McCartney: who is right?
    October 25, 2012 by carl

    Life line report that Dr. McCartney mentions that she believes that carotid artery screening is only worthwhile once the person has already had a stroke. The current evidence certainly backs up this position: we have known for many years that carotid screening is not recommended.

    For example: ‘In the December 18 issue of the Annals of Internal Medicine, the US Preventive Services Task Force (USPSTF) released updated guidelines on the advisability of screening for stenosis (blockage) in the carotid arteries (the main arteries, located in the neck, that supply blood to the brain). In patients who have risk factors but no symptoms suggestive of carotid artery disease, the USPSTF concludes that screening for carotid artery stenosis is not recommended.’

    The reference pointed to by life line is for a study of outcomes after elective repair of infra-renal abdominal aortic aneurysm. I fail to understand how that result can be then associated with carotid artery screening. The last time I checked, the carotid is in the neck, whilst the aorta is in the abdomen.

    In terms of the current evidence-base a recent systematic review, published in the European Journal of Endovascular Surgery, reports there is Limited economic evidence of carotid artery stenosis diagnosis and treatment.

    Of note, the highest quality evidence, an individual patient data analysis published in the Lancet this year concludes: ‘The association between carotid intimedia (cIMT) thickness progression assessed from two ultrasound scans and cardiovascular risk in the general population remains unproven. No conclusion can be derived for the use of cIMT.

    Finally, evidence from a recent meta-analysis reports intervention with carotid endarterectomy is helpful for recently symptomatic patients with carotid artery stenosis ≥50% (NASCET technique) but adds no benefit in terms of stroke/death for asymptomatic patients.

    Therefore the overwhelming body of evidence tells us this intervention is not beneficial in asymptomatic patients.

    Questions that life line screening should answer include how many patients are harmed by such screening and what would you expect a GP to do when you refer such a patient onto primary care. I, like Dr McCartney am a GP, and would inform the patient that this type of screening is not helpful and often creates unwanted anxiety.

    At some point the additional NHS costs will be passed back to those undertaking the tests in the first place.

    If you want the answer and want to know who is right, its simple, stick to the evidence.

  4. Jean Reynolds - November 14, 2012 at 2:32 pm

    On October 1, 2012, I had my first Life Line screening. At 71 I am in perfect health, low fat diet and within my percentile for weight.

    After the screening the ultra sound the screener told me I needed to see my Doctor within 24 hours. The doctor sent me in for another ultrasound, the results came back that my carodid artery was over 70 percent blocked. My surgery was sheduled for Nov 5 and the blockage was removed. The surgeon told me that I would be having strokes within 1 or 2 years if I hadn’t had the surgery.

    I have a physical every year and my doctor did not catch the blockage. I credit Life Line for saving me from medical problems in the years to come. If a Life Line comes to your town I highly recommend you get a screening.


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About the Author

Joelle Reizes

I am the Communications Director at Life Line Screening with more than 15 years of experience in the field of health communications, much of it specifically working with health screening programs. Read More.

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