CBS has been at it again, promoting worry and fear about health. As part of its recent series “Early Intervention: Cardiac Arrest,” CBS Early Show reporters went around food courts and picked out people they saw eating “unhealthy” foods or who were fat, and convinced them to get CT scans to check for signs of impending heart disease.
The CBS shows promoted CT scans for detecting the presence of calcium, which purportedly identifies “artery-clogging plaque” and assesses heart health, especially in people with “risk factors.” Just like CBS broadcasts last May [discussed here], viewers were left believing that everyone needed to get screened and know their “calcium score” to be healthy. Here' another number to worry about and another way to make us all feel we’re at risk of dying unless we are constantly diligent about preventive screenings, early intervention and healthy habits to stay well. With about 1,000 “risk factors” now identified for heart disease, according to Dr. Malcomb Kendricks, Medical Director of Adelphi Lifelong Learning, Cheshire, UK, it’s little wonder no one feels healthy anymore. Fears surrounding risk factors not only defy the reality of human biology, and the fact that health is our body’s default position with its wondrous natural resilience, health indice fears have undermined our confidence in our bodies and left us feeling weak and vulnerable. We’ve become easy prey to those selling “health and wellness.” Last May, Dr. Ned Colange, M.D., chairman of the U.S. Preventive Services Task Force addressed the worried well and cautioned CBS Morning News viewers that seeking unnecessary screening tests and unnecessary treatments that they don’t need is harmful. A few specifics on the medical evidence, as well as what’s behind these marketing programs, might provide additional reassurances and help everyone feel better. The USPSTF recommends against routine screening with resting electrocardiography (ECG), exercise treadmill test, or electron-beam computerized tomography (CT) scanning for coronary calcium for either the presence of severe coronary artery stenosis or the prediction of coronary heart disease events in adults at low risk for coronary heart disease events. It also found insufficient evidence to recommend routine screening “in adults at increased risk for coronary heart disease events.” In its rationale, despite what might seem intuitive, it found no evidence that these screenings improve health outcomes for most adults, but that false-positive test results are likely to cause harm, “including unnecessary invasive procedures, over-treatment, and labeling, the USPSTF concluded that the potential harms of routine screening for CHD in this population exceed the potential benefits.” In fact, Dr. Deborah Grady, M.D., MPH, principle investigator of the Systematic Review of Research on the Diagnosis and Treatment of Coronary Heart Disease in Women (Evidence Report/Technology Assessment Number 80), said the evidence showed that “the overall accuracy of computed tomographic (CT) calcium score is low in both men and women.” False positives, however, were especially common in women and could lead to “unnecessary diagnostic testing, over-treatment, and labeling.” He went on to explain: One of the most common reasons patients are referred to our pulmonary practice at Stanford is for evaluation of tiny lung nodules — detected either incidentally in full-body or cardiac CT scans or on upper slices of an abdominal CT scan. Studies show that even in smokers, 98 percent of these “incidentalomas" are benign. (They are often no more than signs of prior infection.) But to ensure they are not malignant, patients may need further tests or invasive biopsies. If the diagnosis remains uncertain, they may even end up receiving surgery or chemotherapy for a presumed cancer.... In the rare event that an incidentaloma is malignant, you should know that early detection does not necessarily equate with better outcomes. In a large Mayo Clinic study of lung CT scans in smokers, those with “early-detected" cancers had additional biopsies, surgery (and probably anxiety), but lived no longer than their non-CT high-risk counterparts. CT scans cost people in other ways, too. They cost $500 to $1,000 but are not covered by insurance. But insurance companies “may use any detected abnormality to raise your premiums or limit future coverage,” he said. “There are no public health organizations that advocate the use of full body or cardiac CT scans in healthy adults, and the American College of Radiology and American Heart Association have released statements recommending against them.” As he wrote in the International Herald this morning in an article, “Stemming the craze on CT scan,” two main groups have been behind the promotion of these tests: The first is a “self-selected group of cardiologists,” which is claiming that 90,000 deaths could be prevented each year with the screenings. The second, he said, is “a self-selected consortium of radiologists called the International Early Lung Cancer Action Program [that] published an uncontrolled study of early detection in which they claimed to cure more than 90 percent of lung cancers; an astonishing rate.” Both groups convinced Texas state legislators to mandate insurance reimbursements for these screenings, he said. But the “so-called Lung Cancer Alliance went further,” he said, and have called for screenings for all smokers while opposing more research, declaring publicly “that the ongoing controlled, blinded clinical trial of screening centered at the National Institutes of Health was unethical.” Why are these organizations going through politicians and media to promote their procedures — [popular junk science tactics] — rather than follow the usual professional channels for clinical guidelines? According to Dr. Kassirer, it appears “namely a profit motive.” There is a lot of money to be made not only for those doing the tests, but also for those selling “preventions” and “treatments” for any problems found. It's the "seek and ye shall find" phenomenon. The more tests we can be convinced to get, the more things someone will find "wrong" with us to treat. He said financial motives became more credible when: Paul Goldberg, a reporter who covers the cancer field, found that the two lead investigators of the lung cancer study held 27 patents on procedures for CT screening and lung biopsy procedures. Information also surfaced that the heart attack prevention guidelines were sponsored by Pfizer, a company likely to benefit from the use of its drugs if extensive cardiac screening were implemented. Medical care and medical screening needs to be evidence-based and that evidence carefully evaluated by experts who are “not influenced by how much their colleagues make or how many pills the companies sell that pay them to speak or consult,” he said. Costs for medical care are already out of sight and we don’t need more expenses that are unnecessary and potentially harmful, but are being marketed by possible financial bias. More importantly, people do not benefit by scares and being led to worry about diseases and feel sick when they’re not.
Of course, CBS isn’t the only television news that’s been advertising these tests. Other networks have been promoting them on local news shows, too. Dr. Barry Ramo, M.D., on staff with a for-profit heart hospital and the medical expert for KOAT-TV based in Albuquerque, New Mexico, for example, advised all women to talk to their doctors about getting a CT scan to determine their calcium score, as well as various other tests, just to be safe. Women already have a strike against them, he told audiences, since women don’t receive as aggressive of cardiac care as men and they need to be extra certain to know their numbers “in order to get the best care.”
Let's start with the evidence - A very good place to start
The U.S. Preventive Services Task Force examined the evidence on screenings for coronary heart disease and its most recent recommendations do not recommend such screening:
What about cancers?
CT scans are also promoted for early detection of cancers. “In addition to radiation risks, unnecessary CT scans can expose you to a host of problems — from risks of invasive biopsies to aggressive treatments for misdiagnosed cancers,” said Dr. Nayer Khazeni, M.D., from Stanford University Medical Center, in the San Francisco Chronicle this morning. This is not to say that when ordered by a doctor for specific diagnostic purposes that the benefits don’t outweigh the risks. But in healthy adults, more than 90% of tests are false positives, he said.
What’s up?
Dr. Jerome P. Kassirer, M.D., professor at Tufts University School of Medicine and former editor-in-chief of the New England Journal of Medicine, provided some insights into why these preventive screenings are being so heavily promoted, despite the fact even major professional organizations oppose them and no evidence supports their use.