LifelineScreening

The Guardian, the Times, the Herald; there are probably more newspapers who have carried full pages adverts for Lifeline Screening over the last few years.

This company offers screening tests – that is, tests on people who are completely well. If you have symptoms, the situation is very different. Screening sounds logical – picking up small or potential problems before they develop into disease. Sadly, the logic doesn’t often bear out in real life. There are many reasons why this is so, but one of the most compelling is that it’s very hard to know which are the abnormalities that will cause problems. The truth is that when we look for problems in perfectly well people, we find them – cysts, narrowing of vessels, enlarged vessels, odd looking bumps or lumps in internal organs. But which ones will cause problems? Which will never cause you any bother? And if treatment is offered, will this be more likely to do you harm than leaving it alone?

A huge amount of effort has gone into trying to work out which are the screening tests worth doing, and which ones cause more harm, overall, than good. The UK National Screening Committee is charged with continually assessing the evidence and making judgements based on the facts.

In 2009, complaints about Lifeline Screening adverts were not upheld by the ASA, which I was very disappointed about, especially considering that as a GP, I had many first hand concerns about the information people were being given. Last year I complained again.  I thought Lifeline Screening overemphasised the benefits, didn’t say what was already available on the NHS, and and didn’t give fair information about the pros and cons, especially about aortic screening. I wrote about my concerns regarding Lifeline, as well as some other similar companies, in the BMJ. Lifeline didn’t respond. I and several other doctors complained to the General Medical Council about the medical director, DrJohn Coltart. They did not investigate primarily because we did not produce evidence of direct patient harm.

Professor of neurology, Charles Warlow, went to a Lifeline Screening session and wrote about it in the BMJ. He wrote “This was just screening, nothing more and nothing less, done for profit – with the results to be dumped in my lap within 21 working days and for my GP to sort out the emotional and physical consequences of any abnormality, true or false, even though she didn’t request the tests…..Why is this nonsense tolerated or allowed? Where is the audit of these screening outfits? Where is the partnership with patients?”

Consultant neurologist David Nicholl, who also complained about Lifeline wrote in the BMJ: ” Carotid doppler is an extremely useful test for those patients who present with symptoms which are suggestive of carotid territory TIA (transient ischaemic attack). It is an utter waste of money and resources to screen a patient who has no symptoms. Indeed the claims of companies such as Lifeline are, in my opinion, extremely misleading”.

The 2011 complaint was eventually upheld by the ASA in 2012. However, on the basis of the new advert – running in the Herald this week – it is every bit as unfair, biased, alarmist and misleading as the last three years. I have attempted to annotate some of the advert in the link above. The points made by the ASA were:

– it was agreed that it was not possible to offer absolute peace of mind

-Lifeline would now work with the Committee of Advertising Practice to rework the adverts so that they were not misleading.

-it would not be acceptable for Lifeline Screening to claim that they could prevent 80% of strokes

-the ASA decided that it was okay for Lifeline NOT to say that aortic aneurysm screening was already available (in an audited, evidenced fashion) on the NHS

Because Lifeline agreed to this without ASA Council involvement, an adjudication was not published. There are several notes of the ‘informally resolved‘ cases.

Yet there are still huge problems with the adverts, as I’ve annotated above. We know, for example that screening carotid arteries for narrowings in well people is a waste of time – and is actually overall BAD for people – see here: “benefit is limited by a low overall prevalence of treatable disease in the general asymptomatic population and harms from treatment.” On osteoporosis screening, “there is insufficient evidence of the effectiveness of treating low-risk populations”.

The bottom line is that Lifeline Screening appear to have the ASA’s approval to continue to run alarmist, misleading and unfair adverts. In the NHS, quite rightly, doctors are very concerned about shared decision making- in other words, losing the paternalistic plinth and sharing uncertainty and choices with patients. This is a very good thing. But it is imperative that people are given fair evidence – not scaremongering or overselling the tests on offer.

If you do want advice about what to for your health, I think it’s quite straightforward.

Don’t smoke,

Don’t drink excessively

Eat a variety of foods, mainly plants

Keep to a reasonable weight

Do exercise you like

Meet people, do things you enjoy, including work

and if you have any symptoms, see your doctor promptly.

It looks as though these adverts will continue with the ASA’s blessing. It is distressing for GPs to meet patients who have spent over £100 on tests they don’t need, with money that could have been used for many other things which were more likely to benefit them. I don’t know what to do, apart from hoping for a broader public debate about the problems of overdiagnosis and overtreatment, of which screening pays a major part.

If you want to read more about screening, there is Sense about Science’s booklet (which I helped with) (and my book, The Patient Paradox, which is cheaper from the publishers (or even cheaper on Kindle).