Do-It-Yourself Diagnosis
A CT scan can send a powerful message. So what's wrong with this picture?
Feeling OK but maybe sweating the effects of a lifetime of cheeseburgers on your coronary arteries? You smoked when you were young and dumb, and now you wake up nights wondering what you might have done to your lungs. Modern technology has the answer. Step right in, ma'am. Try one of our special fast-CT scans. Find little problems before they become big ones; it could save your life. And we take credit cards.
Walk-in CT scanning centers have taken root in cities and tony suburbs where the worried well are willing to pay from several hundred to more than a thousand dollars out of pocket. (Neither private health insurance nor Medicare will cover the cost.) In states where a doctor's referral is required, a physician at the center will be delighted to write one. Many centers offer a smorgasbord of tests, typically a heart scan, lung scan, whole-body scan, and colon scan, or virtual colonoscopy. Their ads stress convenience, speed, and comfort. After the scan, a physician consults with you, raising points to discuss with your doctor. And if you need to alter your unhealthful ways, the scan will help nudge you to do that, too. Right?
Some people see the light. But in last week's Journal of the American Medical Association, the first large study to investigate scanning's potential to change behavior suggested that the majority don't. The discouraging conclusion: The initial alarm at an ominous scan typically fizzles into apathy. For many clinical researchers, it is one more reason, along with marketing techniques they consider dubious, to slam the scans.
The study investigators examined 450 U.S. Army regulars stationed near Washington, D.C., who were due for their annual physical. Besides the usual exam and counseling, half received an electron-beam computed tomography (EBCT) heart scan. After a year, those in the EBCT group at elevated risk for a heart attack, indicated by calcified deposits in the coronary arteries that glowed in white on the images, were no better than high-risk members of the unscanned group at shedding their bad behaviors.
It was a blow to the "teachable moment" that physicians yearn for, when a patient is uniquely receptive to a doctor's entreaties to do the right thing. Allen Taylor, a study coauthor and director of cardiovascular research at Walter Reed Army Medical Center, believes the results can be applied to the general population. "There is this impression of military people as being in better shape than most of us, that they watch their health, that they take advice seriously," he says. "Well, this was a population that had a number of real risk factors. The military guy down the block could be anybody."
Teachable moments do exist, especially if someone is scared to death. "A good example is the patient who has had a heart attack," says Philip Greenland, chairman of the department of preventive medicine at Northwestern Memorial Hospital in Chicago, who wrote an editorial praising the study. If Marian Hayden doesn't exactly fit the category of someone shocked into action, her children do. Starting in high school, the 72-year-old Chicago resident smoked for more than 40 years before she quit. In late 1999, her smokers' cough prompted her children to push her to have a $325 walk-in lung scan they had seen advertised by Rush North Shore Medical Center in nearby Skokie, Ill. A hospital radiologist found a suspicious half-inch nodule in her right lung, and in January Hayden had a lobectomy to remove the bottom third of the lung. Twice-yearly CT scans since then have been clear. The scan very possibly saved her life.
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