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HEALTH CARE

Some doctors skeptical of mobile health screenings

Most people have no symptoms and no problems are uncovered, but a few screenings find stroke, heart disease risk signs.

By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Tuesday, August 05, 2008 

For about $200, anyone curious about his or her risk of heart attack or stroke can undergo a series of tests without a doctor's referral now that at least two companies operating mobile clinics in Central Texas are offering ultrasound of the heart and arteries along with other tests to people willing to pay out-of-pocket. 

Although several leading cardiologists and other health authorities said such companies can detect a life-threatening blockage, they think such findings are rare. 

The companies, HealthYes of Austin and HealthFair USA of Orlando, Fla., don't take insurance but said they can do the noninvasive tests for hundreds of dollars less than hospitals and doctors because they don't have the overhead. 

"Spend a few minutes ... SAVE YOUR LIFE," says one of the ads HealthYes ran in the Austin American-Statesman featuring a $199.95 package to assess a person's risk of stroke, aneurysm, cardiovascular disease and osteoporosis. 

John Austin of Driftwood said the company's ultrasound of his carotid artery in June discovered a 95 percent blockage that resulted in surgery three days later that he thinks prevented a stroke. 

But doctors are skeptical of the elective screenings and worried about "false positives" (finding disease when there is none), the lack of a patient-doctor relationship and the value of the information produced. 

"I think it's a bad idea," said Dr. Blase Carabello, chief of medicine at the Michael E. DeBakey VA Medical Center in Houston and vice chairman of the Department of Medicine at Baylor College of Medicine in Houston. "It depends on whether or not the patient is symptomatic (having symptoms) or asymptomatic (not having symptoms). If they feel perfectly well, most of the information is useless." 

He did, however, see merit to screening for bone density, which is done to determine osteoporosis risk. 

Guidelines from the American Heart Association/American Stroke Association say that it does not support "mass screenings" by for-profit companies. 

"Science studies illustrate that we must screen 100,000 individuals in a general population to gain the potential to save one life," the guidelines say. 

The chairman of the group's local chapter, Michael Cress, who heads an Austin health consulting company, said he is "all for awareness and education. But if you get a false result or if they don't explain (a result) to you correctly ... the person may end up stressing out and going on for more expensive tests. I'm a little leery of those situations." 

Dr. James Rohack, president-elect of the American Medical Association and director of Scott & White's Center for Healthcare Policy, said he worries about diseases being missed. Patients should talk to their doctors if they're worried about their health, not go get screened, he said. 

Screening company officials said they encourage patients to talk to their doctors and share results with them. 

Jorge Medina, vice president of operations for HealthFair USA, said he's not surprised some doctors would be critical. 

"You have to keep in mind that doctors do their job for profit, and any work we do is work they won't (get to) do," he said. 

He added that many doctors support the service, and some send uninsured patients to the clinics because they are more affordable. 

Austin, 58, said his hand and fingers tingled for a week or more before he heard a HealthYes commercial on the radio. The testing was offered near the Kyle construction site where he works. 

"I lost a grandpa to a heart attack, and I have a brother who had two strokes," he said. 

HealthYes gave him his test results, including the images from the carotid ultrasound, and told him to see a doctor within 48 hours, he said. The surgeon took new scans before operating. 

Carabello, who spoke on behalf of the American College of Cardiology, said getting the actual image is important to the doctor. Some companies provide only the radiologist's report, which is an interpretation of the scan. 

HealthYes gives the film to patients and encourages them to speak to their doctor, said Craig Lindley, co-founder and vice president. 

HealthFair USA said it mails the report to the patient's doctor and then to the patient. 

"We keep ultrasound films on file," Medina said. "If a doctor really wants to see the film ... they can see the film upon request." 

HealthFair has been in business for 10 years and is in 24 states, including Texas. The company tests hundreds of thousands of Americans each year, including 1,500 in Texas since services began in May, Medina said. Insured people come because "90 percent of the time, if you don't have any symptoms, the insurance companies won't pay for it," Medina said. 

HealthYes has mobile teams in Central Texas four days a week, seeing 35 to 40 people a day, Lindley said. 

"There's a real need for these (tests) and a real lack of awareness of vascular disease," he said. 

The Department of State Health Services regulates mobile clinics, but it does not license them and might inspect them only if it receives a complaint, spokesman William Ayres said. 

Medina and Lindley said their clients are typically older and more likely to have health issues. Although 95 to 97 percent of clients have no symptoms, many stroke and heart attack victims have no symptoms, either, Lindley said. 

"What we're trying to do ... is prevent that," he said. 

Dr. Robert Cook, whom HealthYes identified as one of its advisers and who works as a family practice doctor in Dallas and an assistant clinical professor at UT Southwestern Medical School in Dallas, said the screenings aren't necessary for the general population because "most of the time they don't find disease." 

"It's good from the standpoint it gets people thinking about their health," Cook said. "It oftentimes puts them (patients) in the loop of seeing their doctor. If the test comes out completely normal, the patient receives some reassurance."