Taking Medical Scanning Away From Physicians
from the let-the-market-handle-it dept
A bizarre article about the recent trend of new private, for-profit companies to start offering full medical body scans separate from a doctor's recommendation. As most labs require a physicians recommendation to do a scan, and most insurance companies and HMOs are doing their best to make sure you never get anywhere near a scanner, some see an open market for offering such scans outside of the medical profession - neatly placed in your local mall. The article really focuses on one such company - and while the writer clearly worries about the motives of those who run the chain of scanning storefronts, he doesn't deny that getting scans into the hands of more people could be beneficial to their health. I can just see doctors freaking out when their hypochondriac patients show up with a full body scan of information on why they're sick.
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Whole body screening scans
The big problem we radiologists are grappling with is the fact that a lot of normal people will also have incidental benign findings that don't turn out to be cancer, but will still lead to unnecessary anxieties. If/when these abnormalities undergo surgical biopsy, then there are also non-trivial risks of various complications, as is the case with any surgical procedure. So part of our job as physicians is to develop reasonable guidelines for who should undergo these exams.
As an analogy, consider breast cancer screening. Currently, doctors recommend that all women over 40 get yearly screening mammograms because it's been shown that the benefits of cancer detection outweigh the risks from pursuing abnormalities that ultimately turn out to be nothing. But we don't recommend that women in their 20's and 30's get routine mammograms because breast cancer is very uncommon in these younger women, and the risks of bad things from the inevitable biopsies outweigh the benefits of early cancer detection. (The exception is for young women who have the so-called "breast cancer gene" -- those women do need to be checked out even before age 40). But for normal healthy younger women less than 40 years old, the benefits of routine mammogram screening aren't worth the risks.
We're starting to learn that the same is true for these whole body CAT scans. If you're a smoker, it might be worth it to get a yearly screening CAT scan of the chest, to detect tiny lung cancer before they cause symptoms. But if you're a healthy 30-year old man or woman who doesn't smoke, then any tiny lung abnormalities that are detected are so much more likely to be benign rather than malignant, that the risks of complications from further medical evaluation (including biopsies) outweigh the lives saved from early cancer detection.
Like all things, it's a balancing act, and individual people will feel differently about how they want to manage their health. I understand that some people feel it's worth it for their peace of mind to pay out of their own pockets for these tests. As long as they are fully aware of both the positive and negative consequences of these screening exams, that's fine by me. My only concern is when patients are sold on the positives without being fully informed about the potential negatives.
Believe me, a lot of radiologists are thinking of entering this market because it is so potentially lucrative! For this reason, I'm glad that our professional societies are offering courses on topics like "Medically Principled CT Screening"
aimed at physicians like myself who want to do what's medically justified, based on the scientific data.
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yeah right
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Re: yeah right
Believe it or not, health care providers and insurers do often collide on their interests. The health care economy is really a many-way fight between patients, health care providers, insurance companies, and pharmaceuticals, all with conflicting interests. If health care providers were given free reign, they would waste resources on unnecessary testing, on elaborate treatment for patients who will die anyway. If patients were given free reign, they would live irresponsibly and let the health care system pick up the tab. Bad patients who smoke, drive drunk, get injuries all the time take away resources from good patients.
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The New Cyber Cafe Busines Model...
scanning "clinics" is right next to the local
cyber cafe' gaming hang-out. I'd be willing to
pay a couple of hundred bucks for DVD with
various data sets MRI,thermal,sonagram,xray,etc.
in various formats (a fully articulated 3D
model with tesalated surface and voxulized
internals).
I mean how else are you going to get a resonable
representation of yourself in [insert your
favorate first person shooter game]?
The intertainment value is enough to make money,
but I imagine that it won't be long until
doctors start handing out CD-ROMs with MPEGs of
the sonagram in addition to the polaroids.
As for the medical value, hang the data off your
local DSL connection and let the doctors and/or
researches review the data for you (a complete
inversion of the current disfunctional medical
market place system). Hang new data sets out
there every 6 to 12 months and let the SETI
Alien Doctor @Home client look for emerging
abnormalities.
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Re: yeah right
...well, we all die eventually.
But more to the point: "exactly".
So, let the patient pay for all those unnecessary tests. I'm sure they can be done far less expensively than your average medical community lab. If the patient paid for test warrant further investigation, the tests can always be re-preformed to medical community markup.. uh, I mean "standards".
Think of it as "Medutainment"... making Healthcare both fun *AND* less expensive.
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Re: yeah right
> far less expensively than your average medical
> community lab. If the patient paid for test
> warrant further investigation, the tests can
> always be re-preformed to medical community
> markup.. uh, I mean "standards".
This is indeed happening. We're moving toward a tiered system in which patients willing to pay more will get better treatment. Some states have laws or political pressure against this sort of thing, so the results will be complicated.
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