Medical tests at churches aren't what docs ordered

There's a booming business going on in church basements around Minnesota.

People are flocking in for low-cost medical tests for diabetes, risk of stroke and other ailments, thinking they are doing the right thing and taking responsibility for their health.

Trouble is, local doctors and national experts say, some of the screenings aren't recommended under current medical guidelines. Where they are recommended, they are usually covered by insurance if done at a doctor's office.

At best, these experts say, the screenings waste money and offer false comfort. At worst, they could lead to unnecessary medical procedures.

"The public thinks the more things you screen for, the better off you are," said Dr. Gary Oftedahl of the Institute for Clinical Systems Improvement, a group in Bloomington that compiles evidence-based medical guidelines and counts most of the state's doctors as members. "In reality, in health care, that's not always the case."

The screenings are being done by several for-profit companies, the biggest of which is Life Line Screening of Independence, Ohio, which last year screened 1 million people. Life Line charges $50 per test, with package deals available. Do all five tests and the price drops to $159 -- "$86 savings!" -- according to Life Line's pink flier.

"Money spent on these services may be better than any spent on Cheetos and Coke, but it's not the best way to spend health-care dollars," said Dr. David Hutchinson, president of the Minnesota Academy of Family Physicians and a family doctor in Duluth. "These are things that can be detected more cheaply with a physical exam."

Life Line says its screenings are "one piece of the puzzle," not a substitute for a doctor. "If an individual chooses to do a screening, this provides a convenient and affordable way," said Joelle Reizes, a spokeswoman for Life Line. "We think based on responses from individual doctors and patients, what we do really does improve lives and saves lives."

In Minnesota, where the company has operated for several years, dozens of churches are hosting screenings in the next two months alone. Life Line doesn't pay the churches; the churches view them as a way to promote health and wellness. "It's a nice service we provide because you cannot go to a doctor and demand the same tests," said Jim Anderson, adult minister at St. Michael's Lutheran Church in Bloomington.

The screenings are usually promoted in church newsletters and flagged during Sunday services. Life Line also sends direct mail to non-parishioners who live nearby and partners with area hospitals. In the Twin Cities, its fliers say: "In collaboration with Abbott Northwestern's Vascular Center."

Abbott says its relationship with Life Line does not involve money or an endorsement, but provides a way to give health information to consumers in the form of brochures.

At Hazel Park Congregational United Church of Christ in east St. Paul, about 35 people signed up for screenings last week. A staff of four from Life Line had set up portable machines and two foldable massage tables behind cloth screens at one end of the hall.

Consumer appeal

Screenings have grown popular at a time when people are being urged to take control of their own health care in a system with overworked primary care doctors and increasingly skimpy insurance coverage. The idea of a set price is also appealing in a world where medical prices are often hard to pin down.

The problem, medical experts say, is that most consumers are ill-equipped to judge when such a screening is necessary and when it's a waste of money. Worse, unnecessary screenings can create anxiety and send patients to doctors unnecessarily.

"I feel very sad every time I hear one of these ads, and people think there's a magic formula for getting healthy" instead of going back to basics with exercise, diet and managing stress, said Peggy O'Kane, president of the National Committee for Quality Assurance.

Oftedahl and others say where there is good evidence that screenings work -- colonoscopies, mammograms, cervical cancer screening -- they are covered by Medicare and private insurance -- and still not enough people get them.

"The only [test] you can argue is recommended for a general population is the one for high cholesterol," said Dr. Patrick Courneya, a medical director at HealthPartners. "The others are all questionable."

Unclear gain

Dr. Julie Anderson, a family physician in St. Cloud, says she's seeing more patients show up bearing screening results. Often, she has to re-order the exam to figure out what to do.

In one case, a patient tested positive for blockages in both carotid arteries in a Life Line screen. Anderson ordered another test, which was also positive. The patient then underwent surgery to clean out her carotid arteries.

"She never had any symptoms," Anderson said. "Now you could argue that she might have had a stroke without a test, but what if she wouldn't have? She just went through a risky double procedure for unclear gain."

"I am sure it has saved lives," said Hutchinson, the Duluth family doctor. "Sometimes you randomly find things, which could result in timely intervention."

Still, he said, patients are better off with regular physicals that examine the entire body and explore symptoms, risk factors and family history -- "rather than a blind search for disease."

In 2007, Dr. Mark Erhard, a cardiologist in St. Paul, gave a talk to the Minnesota Academy of Family Physicians titled: "Church Diagnostic Studies: Scan or Scam?" Some audience members said they had patients with abnormal findings that later were found to be inaccurate. But others said they thought the tests were valuable and had saved patients' lives.

For some patients, an abnormal test can be just the kick necessary to get them in a doctor's office. "If the test is abnormal, I think it's helpful," Erhard said. However, if a test is negative, he warns against complacency since the services offered by companies such as Life Line are not certified or regulated by any medical organization.

Whatever doctors think of them, Erhard said, they need to get used to the idea of patients shopping around, especially as more people lose insurance or have high deductibles.