Dumb-de-dumb-dumb.

In the wellness industry’s very stable genius pandemic, AngioScreen is Patient Einstein. 

The Deplorables Award, as many of you might remember (you’re excused if you’ve forgotten — it’s been 2 years since a vendor was deemed worthy enough to qualify) goes to that vendor whose combination of dishonesty and patient harms would make Ron Goetzel blush. Angioscreen is all that and more — the kind of outfit that gives clueless wellness vendors a bad name.

Angioscreen had earned the pole position for 2021’s award even before this month’s Journal of the American Medical Association (JAMA) reminded us that — for the third time in as many plate appearances (2007, 2014 and now 2021) —they struck out with the US Preventive Services Task Force (USPSTF). They gave Angioscreen’s go-to carotid artery screen a “D.” In no uncertain terms, JAMA and USPSTF say: “Don’t do these screens to your employees.” 

I “profiled” Angioscreen years ago…but never gave them a Deplorables Award on the assumption that they would asymptotically approach irrelevance on their own merit. After all, what benefits manager would ever retain this outfit? Surely no actuary would be dishonest enough to be paid to “find savings” in these screens, and no consultant or broker would be corrupt enough to take money to pitch them, right? 

Surely someone would notice that right on their very own website, they cited the fact that the USPSTF gives them a “D.”

And surely someone would notice that Angioscreen’s other business is convincing hospitals to screen communities in order to find new well-insured patients to admit for major surgery…and make the obvious inference that the same screens that are designed to generate admissions can’t also reduce admissions, right?

Haha, good ones, Al.

The hospitals nailed this

Angioscreen is a surgery-generating machine.  Here is an employer, who at least had enough sense to withhold his name, bragging about the major vascular surgeries his employees underwent for asymptomatic carotid artery stenosis (CAS) thanks to Angioscreen:

Two of our employees were found to have blockages in their carotid arteries. Through follow-up visits with their physician, these employees found arteries that were significantly blocked that required surgery. 

Maybe the employees really needed the surgery?  In the immortal word of the great philosopher Brittany Spears, oops. The National Institutes of Health warns against precisely this:

Despite a D recommendation from the USPSTF… many surgeries or interventions for asymptomatic CAS continue to be performed [due to] free screenings.

Wait, you might say, maybe those patients needed those screens to avoid a stroke.

Haha, good one again, Al:

• As JAMA says, “only 11% of strokes” are caused by internal carotid stenosis. Since only about 1 in 1000 employer-covered people has a stroke, you’d have to screen almost 10,000 <65 employer-covered people to possibly have a slight chance of preventing a stroke with a major surgery. 
• If Angioscreen’s test is 95% accurate (in their dreams), you’d also refer 500 false positives to their doctors, and some would undergo risky, painful, and expensive major vascular surgery as well, probably like those two in the mercifully unnamed employer above.

The employers got snookered for a change

Funny that Angioscreen wouldn’t attach a name to that reference site, because it’s only a slight exaggeration to say Angioscreen’s customer list includes practically every non-Quizzify-customer (the latter tend to have triple-digit IQs, making them poor prospects for Angioscreen) in the Fortune 500. Here it is:

You might say, that’s not many. True, but that excerpt is only a tiny fraction of the total – I didn’t want to hog the internet by listing all of them. 

Perhaps you see some employers on that list that make you think: “Why would a smart, capable company like so-and-so be an Angioscreen customer?” I asked myself the same thing, as I was surprised to see a Quizzify customer on the list. So I asked them, mentioning my surprise.

Turns out they were every bit as surprised as I was. They had no idea they were on that list and had never heard of Angioscreen. 

But wait…there’s more. Now how many inappropriate screens would you pay for?

Another reason I had originally demurred from bestowing this award on them was that I also thought that maybe after a while their conscience would get the better of them, and they would stop doing these screens. Perhaps they might pivot from decidedly harmful screens into the more mundane screens that are simply a useless waste of money.

How silly of me.

Quite the contrary, once they realized they had stumbled upon a huge untapped market for employee hyperdiagnosis, they added several more inappropriate screens:

If “Ankle Brachial Index” screening sounds familiar, it’s precisely what Marty Makary warned us against in The Price We Pay as the poster-test for generating unneeded and harmful surgeries.

If ”peak systolic velocity” sounds unfamiliar, it’s because it’s such a stupid idea for a screen that the USPSTF has never even bothered to recommend against it, on the theory that no one would screen their asymptomatic patients for this. A doctor would literally lose their license for routinely doing these screens and billing insurance for these.

And, just in case there is still any employee naively of the mistaken impression they are living their lives diagnosislessly, there’s the D-rated ECG/EKG.  These are not supposed to be done because they — get ready — often “reveal” abnormalities that don’t really exist or are harmless…but once revealed, generate follow-up tests.

Fortunately, this next inappropriate screen costs extra, which might discourage a few employers.

Of course, if you indicate to a real doctor something that might suggest you are at risk for an aneurysm, you should get tested, and if the aneurysm is truly large and life-threatening, be referred for this surgery, despite its mortality rate exceeding 7%.  That’s different from an unlicensed vendor playing doctor by screening unsuspecting employees for no reason other than to earn “supplemental” fees. Or, as one commentator put it:

My main objection, however, is that I’m uneasy about taking people off the street who think they are perfectly well and subjecting them to a procedure from which 1 in 14 will die.

Ya think?

And so it is with great honor that I bestow the Deplorables Award on Angioscreen as the fourth recipient of this august distinction, joining Wellsteps, and bankruptcy court denizens Interactive Health and Provant.  (The latter avoided a Deplorables Award only by going bankrupt after our initial expose, before we had time to bestow the award.)