In the March 2013 issue of Consumer Reports, sandwiched between an article called “Best TVs” (just in time for Super Bowl) and one called “Microwave Mystery: When do wayward ovens warrant a recall?” is an article entitled “Save Your Life.”
This article, ensconced as it is in the most widely respected national consumer advice magazine, is about what cancer screening tests are out there and which you, as a patient, should and shouldn’t bother seeking out. Wow. I guess this whole consumer engagement in healthcare thing is for real. You can’t get more “consumerish” than Consumer Reports.
In this particular article, which starts with the premise that “cancer screening remains stuck in a 1960s view of the disease,” there is a rating scale that helps the reader determine whether a variety of commonly prescribed cancer screening tests have benefits that outweigh the harms of having such tests. Just like they do with TVs, microwaves and interior paints (all reviewed in the same issue), Consumer Reports uses a 5-point scale illustrated with red or black dots to help consumers navigate through the tests most commonly prescribed. It is fascinating, not just for its probable accuracy, but for its simplicity and for its willingness to tell patients that their doctor is not always right. To quote:
“When it comes to cancer screening, most people do what their doctor recommends. Unfortunately healthcare providers don’t always agree on what tests are necessary….Don’t assume that your doctor will bring up cancer screening or follow guidelines.”
Even though most of us, particularly those of us who interact with the healthcare system, know that 50% of doctors are worse than average and 50% better than average, it is rare to see this right out in black and white in a magazine that has traditionally been the go-to site for how to select the best electric car or most flavorful beef jerky—more traditional consumer products. Many people, especially those in the medical community, would say that it isn’t right to simplify and report information about cancer screening tests in the same way you would communicate the risks of eating expired canned foods and drinking caffeinated energy drinks, as they do in this same issue of this magazine. But hey, let’s get real; if we don’t simplify health information so consumers can make more educated choices, or at least be more educated about how to interpret their doctors’ guidance, how are they going to navigate, much less prosper in, the coming world of health insurance exchanges and high deductible health plans and personal accountability (aka, will that be cash, check or charge?)?
There has been a lot of talk about how important transparency of cost information is for patients, but what good is cost information without companion information about clinical validity? It isn’t going to help anyone to get a less expensive version of an unnecessary test. And interestingly, more and more screening tests are being marketed directly to consumers through screening companies, pharmacies and others with something to gain financially from administering more tests. As the Consumer Reports article says, “…the message that you have nothing to lose and everything to gain from being screened for cancer—that is, to be tested for a cancer before you have any symptoms of it—simply isn’t true.”
Of course, many cancer-screening tests are not only valid but potentially life-saving. The trick is, as a consumer, to know which is worth having and which are potentially not worth the risk, particularly in cases where the test results are as accurate as a coin flip. And yes, there are many caveats about age and test frequency and at-risk indicators that would give you a different conclusion than the average Consumer Reports reader might draw from the article, but that’s ok. Consumers have a right to information to help them ask the right questions just as they do to information that tells them the answers. “Trust me, I’m a doctor,” just doesn’t cut it anymore.
One thing I find very interesting about this article, which rates the cost/benefit of screening tests for 11 different kinds of cancer (cervical, colon, breast, bladder, lung, skin, oral, prostate, ovarian, pancreatic, and testicular), is that it relies primarily on publicly available information developed by the U.S. Preventative Services Task Force, an independent group supported by the U.S. Department of Health and Human Services. In other words, this is information that was meant to be available to people but which most consumers never see or have any idea how to navigate. Consumer Reports is just taking research and conclusions already formed and putting them into regular old English for their average reader to understand, agenda-free. Notably, the average Consumer Reports reader is basically the entire audience for screening tests, appealing as the magazine does, to regular people who buy stuff and boasting a paid circulation of 7.3 million people. This may not be the New England Journal of Medicine (paid circulation 200,000), but it is something the average consumer might actually read and learn from and it reaches far more of them to be sure. As a result, Consumer Reports is in many ways an ideal medium for this message.Note: Consumer Reports says that screening tests for cervical cancer, colon cancer and breast cancer are the most important; all of the others are generally rated as tests to avoid, with some appropriate caveats for those at high risk due to family or other indicators. The three screening tests they rate as least likely to have benefits that outweigh the potential harms are those for ovarian, pancreatic and testicular cancer.