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From Health Law Daily, August 15, 2014

Hospitals beware, direct-to-consumer screeners may be infectious partners

By Melissa Skinner, JD

Spurred by a recent controversy, which was brought to light by Public Citizen—a consumer advocacy organization—the Journal of the American Medical Association (JAMA) examined the relationship between hospitals and direct-to-consumer (DTC) screening companies. Specifically, the JAMA viewpoint suggested that hospitals be wary of partnering with these companies, which often make claims that could be false and misleading. JAMA recommended either aiming for a transparent relationship between the hospital and the DTC screeners or avoiding those relationships altogether.

Direct-to-consumer screenings. DTC screening companies provide the general public with screening tests such as those that focus on the “early detection of atherosclerotic disease and prevention of catastrophic vascular events.” However, JAMA stated that the outcomes promised by such DTC screening companies are “advertised and supported by evidence of early disease detection and emotional consumer testimonials rather than quality outcomes-based evidence demonstrating reductions in morbidity and mortality.” According to JAMA, faced with an increasingly competitive industry, hospitals have begun to sponsor or co-brand with screening companies, which often includes arrangements that allow for the DTC screeners to use the hospital’s name in advertising, the hospital’s location to perform screenings, or both.

Public Citizen campaign. Public Citizen’s claims of impropriety on the part of DTC screening companies were directed at one particular company, HealthFair, a prominent cardiovascular health screener. In particular, on June 19, 2014, Public Citizen sent a letter to 20 hospitals that had arrangements with HealthFair that stated its “heavily promoted, community-wide cardiovascular health screening programs are unethical and are much more likely to do harm than good.” These letters were supported by peer-reviewed evidence. HealthFair, in turn, issued a press release refuting the claims made in Public Citizen’s letter.

JAMA findings. The JAMA article notes other industry support of the claim that these screenings may be ineffective and even, unsafe. In that light, it acknowledged statements made by the American College of Cardiology, stating that it did not recommend “broad and untargeted screening.” Moreover, the JAMA article highlights the potential for high profit levels for HealthFair and other screening companies. “HealthFair’s response is not surprising, because the business model for such DTC screening depends on volume; the more screening tests purchased, the more revenue generated.” Finally, JAMA turns to the main issue at hand, which is the connection between hospitals and these DTC screening companies. The article argues that while the benefits that DTC screeners receive from partnering with hospitals is clear, the costs to those affiliated hospitals may outweigh the benefits received, especially given the growing concerns of the unethical and potentially unsafe behavior of these companies.

As a result, JAMA recommends that not only should DTC screening companies “fully disclose the risks and benefits of their test offerings,” but that hospitals should “clearly and publicly explain their relationships with DTC screening companies, given the lack of evidence to support mass vascular screenings,” Barring that, JAMA supports Public Citizen’s recommendation of severing ties between hospitals and DTC screeners.

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