Whole Body Scan ... or Scam?

He certainly looks trustworthy, but how about the
'breakthrough' technology he's hawking?

Mondays are “Med Days” in our daily paper. Large advertisements devoted to fast, relatively affordable, noninvasive testing of body parts - from heart to whole body - invite us to explore the inner sanctums of physiology in the hope of turning up “nothing” or perhaps finding something early enough to get treatment that avoids disability or death. Who hasn’t wondered and been tempted?

Our final UCDMini-Med School  seminar focused on the technology used in scanning machines, the accuracy of such testing and, importantly, the impact results can have upon the individual tested. Dr. Richard Kravitz  is a professor of Medicine at UC Davis Medical school who is highly published and focuses on the doctor-patient relationship. His advice about jumping into this new arena of discovery? “Maybe not,” he says.

And, here’s why. In general, there are some assumptions made about the publicly available technology that are simply wrong. For example, patients tend to trust technology and most medical personnel in a white coat and, thus, the results of testing. But, studies now show that the accuracy of such scanning tests is questionable. There is a significant percentage of false-positives as well as tagging disease free people incorrectly. “It’s quite common in the real world,” the Doctor said. “No test is perfect.”

 There is also a belief that early detection leads to better outcomes. However, in the case of prostate cancer in which some abnormal cells never become life threatening, the discovery of benign cells can send a patient on a long, painful and costly journey of further medical testing - tests and medications that carry their own set of health risks.

Father of Mini-Med School, Dr. Michael McCloud agrees. “…whole body CT scans can indeed hurt you. That is the very frequent finding of an "incidentaloma" -- a little lump or funny shadow on this or that organ. These very commonly lead to additional, sometimes invasive tests, not to mention angst and expense,” the geriatrician writes in an email. “In most case, they prove to be benign anomalies.”

And, the scans have varying reliability for different parts of the body. Dr. Kravitz reported that whole body CT scans are fairly effective for certain ovarian cancers but don’t have a good record for detecting liver cancers. They are “okay” for lung cancer but not so good at showing coronary artery disease. Those of us checking out the ads in the paper have no way of knowing these variations when slapping down the credit card for a whole body scan.

Then, there is the technology itself. I’d heard some information that CT scans did emit high radiation. But, I thought a momentary zap of radioactivity once in a lifetime was no big deal. After all, the procedure is FDA approved , right? Dr. Kravits set my thinking straight. The radiation delivered during a body scan is “close to the range of exposure” that survivors of the nuclear bomb dropped on Hiroshima received. Whew! Compare that to exposure from an ordinary chest Xray which is equivalent to a couple of days outdoors. A CT scan of the abdomen racks up 400 days of the same exposure to the sun’s radiation.

If that information alone isn’t disincentive enough, there’s something Dr. Kravitz calls “the cascade effect” and Dr. McCLoud referred to earlier as “incidentaloma.”  Seeing potential trouble spots can put a patient on an emotional roller coaster and even bring on a host of new medical problems. Remember, the results could be false-positive or a minor blip that will never turn onto a major disease.

The U.S. spends $8,000 per person on health care, the Doc said. This is much more than any other industrialized country. “It doesn’t show a benefit. It actually produces lower quality care, not higher,” he concluded. Unnecessary testing accounts for a significant chunk of these costs and, with such widely available scanning tests available and being aggressively marketed, that figure is bound to rise as the quality of care falls.

How to proceed when considering tests? Dr. Kravits pointed out the decision

should not be made lightly. He advises talking to our personal doctors first, thinking about what we’d do differently depending on test results and considering what the downstream affects might mean in our lives. Ask “Am I prepared to take on the risks of a false positive”.

To this I will add my own caveat - any time I see a full page ad for a medical miracle - be it a full body scan, a magical back treatment, a weight loss breakthrough or any such quick fix, I hit the “caution” button. I figure the cost of the weekly ad, fly to the Internet and do some serious homework and always apply the old adage “if it sounds too good to be true, it probably is”.

 

Note: We are not done blogging about the important lessons of MMS. More to come next week!