[ RadSafe ] Re: CT screening of symptomless persons

[John Jacobus]

Dr. Parthasarathy,

I guess it is nice to see that India is becoming a
rich country where people can afford to buy into the
commericalization of medicine for profit.  The
advertisement you posted is very similar to what we
had in this country.

My impression is that the "boutique" clinic phenomenon
has passed.  I live in the Washington/Maryland area,
and I have not heard a radio advertisement or seen a
newspaper advertisement in the last few years. 
However, I am not sure what the story is in California
or orther parts of the country.  As you note, our FDA
and professional societies spoke out against this
program.  May be they had an affect.  Or people
realized that it was not worth the expense.

Regarding your questions:

"1. Has this clinical tool reached a stage now where
it can be used routinely to diagnose symptomless
patients."

First, I am assuming that you are referring to the use
of CT scanners.  Yes, it is possible for CT scanners
to diagnose asymtomatic patients.  Generally, what
happens is that a finding is made when a study is
being performed for another reason.  However, the
issue is the applicaiton of radiation for an intended
purpose rather than as a screening tool for
asymptomatic individuals.  Prior to the 1960s, mobile
x-ray units were used to screen for tuberculosis prior
to the current skin testing process.  For last several
years, screening mammography has been used to detect
occult breast cancers.  There are values in mass
screening.  However, I do not see self-referral as
being in this category.  The problem is that if a
suspect finding is identified, the customer will want
followup medical studies.  (If your have ever read a
radiologist's report, it is an list of "could be" and
"likely."  Beyond the evalution of the suspected
condition, they write down everything they see.) This
puts a drain on health resources, for both the
individual and the public health care programs.  In
one case, all reports of "suspecious liver" were found
to be negative after further tests that cost time and
money.  It is important to also remember that some
conditions do not require treatment.  There are many
80-year-old men who die with untreated, undiagnosted
prostate cancers that did not causer the death or
affect the life of the individual.

As noted at the CDRH web site
http://www.fda.gov/cdrh/ct/
"At this time the FDA knows of no data demonstrating
that whole-body CT screening is effective in detecting
any particular disease early enough for the disease to
be managed, treated, or cured and advantageously spare
a person at least some of the detriment associated
with serious illness or premature death."

2. Many professional associations including The
American Heart Association, American College of
Radiology, HPS and AAPM are against using CT on
asymptomatic patients. US FDA has also advised
physicians against such over use. The professional
associations in India  are not taking a stand 

As I noted above, many of our governmental and
professional organizations did come out against CT
screening.  The position of the FDA was well
publicized.  Whether they had any impact on the
decline of CT scanning, I do not know.   

I should mention for clarity that I am not a doctor,
medical or academic. I would like to get a PhD, but
only time will tell.

--- parthasarathy k s <ksparth at yahoo.co.uk> wrote:

> Dear Dr. Jacobus,
>  
> This is a query on " CT screening of symptomless
> persons"- a service provided by many CT scan centers
> which accept self referrals to carry out the tests.
> What is the current status in this practice which
> was not supported by many professional associations?
> Gina Kolataof the NYT reported that the bubble of
> commercial screening bursted. I am making this query
> in light of a recent development in India. 
>  
> Recently, a medical diagnostic center in India have
> invited patients to their institutions by publishing
> the following  advertisement in a leading daily in
> mumbai:
> 
> " 50% of the people who die of heart attacks have no
> previous history of cardiac problems. This is
> because heart disease is a silent killer, and is not
> usually not detected until it is too late. But now
> you can change that with a short visit.(....Clinics
> name..) has new state -of- the- art equipment  that
> can evaluate your heart vessels in 8 secs.....This
> technology is completely nonsurgical, and can detect
> blockages in the blood vessels and timely
> intervention can help prevent a heart attack. 
> 
> If you or your loved ones are affected by any of
> these risk factors, ask your doctor or visit us for
> a check up
>  
> 
> * smoking
> * stress
> * Diabetes
> *Obesity
> *high blood pressure
> *family history of cardiac illness
> *Erratic lifestyle(long working hours, pressure
> etc.)
> 
> Act now and ensure the health of your heart'
> 
> This advertisement contained colorful pictures of
> heart and blood vessels. One of the advantages
> stated was "regular monitoring or check up possible,
> being nonsurgical", there by encouraging periodic
> scans! The  word "nonsurgical" appeared fourtimes in
> the ad!!
> 
> Also the hospital has included "stress" and "erratic
> life styles" (whatever that may mean!) which are
> "universal" as risk factors thereby extending the
> tests to all.
> 
> I shall be very grateful to you if you kindly send
> responses to the following questions:
> 
> 1. Has this clinical tool reached a stage now where
> it can be used routinely to diagnose symptomless
> patients. 
> 
> 2. Many professional associations including The
> American Heart Association, American College of
> Radiology, HPS and AAPM are against using CT on
> asymptomatic patients. US FDA has also advised
> physicians against such over use. The professional
> associations in India  are not taking a stand .
> 
>  
> 
> What can be done under the circumstances?
> 
>  
> 
> With best regards
> 
>  
> 
> K.S.Parthasarathy Ph.D
> 
> (formerly, Secretary, Atomic Energy Regulatory
> Board)
> 
> Raja Ramanna Fellow
> 
> Department of Atomic Energy
> 
> Room No 18
> 
> Ground Floor, North Wing
> 
> Vikram Sarabhai Bhavan
> 
> Mumbai 400094
> 
> E-mail ksparth at yahoo.co.uk
> 
> 91+22 25555327
> 
> 91+22 25486081
> 
> 9869016206 (mobile)
> 
>  
> 
>  
> 
>  
> 
>  
> 
>  
>  
> 
> 		
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On Oct. 5, 1947, in the first televised White House address, President Truman asked Americans to refrain from eating meat on Tuesdays and poultry on Thursdays to help stockpile grain for starving people in Europe. 

-- John
John Jacobus, MS
Certified Health Physicist
e-mail:  crispy_bird at yahoo.com


	
		
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