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M
ind Over Matter
 


Beam me up, Scotty: Technology at a Cost

© Barry Bittman MD

The following is one in an ongoing series of columns entitled Mind Over Matter by Barry Bittman MD. View all columns in series
Star date 3629 - the crew of the Enterprise prepares for docking with the alien vessel Aura approaching from HMO-387. Kirk to Bones, "scan the Klingons prior to authorizing entrance to the bridge."

Sounds far-fetched, you're probably thinking. Yet the concept seems to be taking hold even though it's being criticized as no more than a frill for the wealthy.

While physicians of our era do not use miniature diagnostic scanning modules the size of Palm Pilots (though I wouldn’t be surprised if they're developed in this century), doctors in Beverly Hills are now offering comprehensive whole body CT (computerized tomography) scans to detect diseases before they're otherwise apparent...even for their healthiest patients.

While viewed by insurers and HMO’s as an economic "Death Star," people who can afford these procedures are convinced such screening can actually benefit them by detecting early signs of disease.

Frankly, I agree.

While the CT scanner certainly has limitations (currently more precise technologies are available for specific diseases), the chief of neuroimaging at Access Medical Imaging in Beverly Hills claims he finds some abnormality that needs medical attention in 1 of 30 patients scanned.

As an example, the procedure can effectively demonstrate calcium deposits in the blood vessels of the heart even though it cannot precisely gage the degree of a blockage. The technique is also light-years ahead of standard chest x-rays which have been proven to be basically ineffective for the early detection of lung cancer. Advance warning of kidney stones is also an obvious plus which can prevent some of the most painful ER visits and complications imaginable. And "virtual colonoscopy" can surely save many lives by offering a painless alternative to a procedure often avoided based upon the prospect of embarrassment alone.

Reality - early detection makes sense.
Reality check - presently it's unaffordable to perform routine CT screenings.
Bottom line - two elements are needed prior to offering routine CT scans to the public.

The first is research to determine the cost-effectiveness of CT scanning in disease prevention, and the second is reducing the cost of the procedure, which may actually be feasible today simply by spreading the cost over greater utilization.

The real challenge is demonstrating cost-effectiveness. One should realize it's not just comparing this procedure with other diagnostic methods that's important. We must factor in the potential savings of routine scanning vs. typical detection based upon symptoms alone. Expenditures must be projected based on long-term disease management. While time consuming and costly, such an analysis is likely to reveal the real benefits (economic and otherwise) of early detection.

Opponents of the procedure describe it as a waste of time and effort. They question what doctors will do next based upon the findings. Some contend the procedure will result in unnecessary tests such as biopsies which are sometimes associated with significant risks. Others cite the fact that patients are likely to be more stressed by knowing they have a very small (perhaps benign) nodule that has to be followed with subsequent tests.

It's interesting to note that similar arguments surfaced over mammograms in the not so distant past. Today routine screening mammography is well accepted as a life-saving and cost-effective procedure.

While some of the criticism has merit, I cannot support the notion that "what you don’t know, won't hurt you." Such thinking would have kept medicine deeply entrenched in the middle ages. If we are to win the war against cancer and other diseases, early detection is paramount to success. For society's sake, I hope that a financial decision alone does not become the prevailing factor in sculpting the future of healthcare.

At a cost of $1325 (not covered by insurance) for a complete body scan and virtual colonoscopy, it's obvious that only a limited number of people are likely to request routine testing. However, by reducing the cost to half and spreading it over 12 months, roughly $50+/month (out-of-pocket) could substantially impact one's quality of life and survival. Actually, it amounts to less than the cost of one prescription/month or a 30-day supply of cigarettes.

For the poor, the realistic prospects of such screening presently seem impossible. Yet for populations at risk, the benefits (economic and otherwise) might actually be greater than originally anticipated.

While I'm not advocating calling your doctor and demanding a whole body scan today, I am supportive of serious research to better judge what superficially appears to be a frivolous procedure.

Yet perhaps it's time to determine the real value of exemplary healthcare from a personal perspective. When you compare the monetary outlay of routine whole body CT screening to the typical choices in purchasing a car such as leather seats or that fabulous stereo system, perhaps you’ll opt for outliving the car payment - Mind Over Matter!

© 2000 Barry Bittman, MD all rights reserved

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About The Author
Barry Bittman, MD is a neurologist, author, international speaker, award-winning producer/director and inventor. As CEO and Medical Director of the Mind-Body Wellness Center, a comprehensive, interdisciplinary outpatient medical facility in Meadville, PA., Dr. Bittman has pioneered a new paradigm for treating the “whole person.” Based upon extensive......more
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