Full-body disagreement

[Susan L Gawarecki <loc@icx.net>]

Perhaps of interest to the list....



--Susan Gawarecki



 Full-body disagreement 



 Harvard doctors offer scans that many in medical establishment spurn



 By Liz Kowalczyk, Globe Staff, 6/28/2002 



 The country's top medical agency couldn't be clearer: full-body scans,

it warns on its Web site, are

 unproven and possibly harmful. Partners HealthCare, Massachusetts'

largest hospital network, tells

 doctors to use them only in unusual cases. And insurance companies

won't even consider covering

 them. 



 So Boston's medical community was stunned when a group of Harvard

doctors decided to sell

 full-body scans as a way of detecting disease - and advertise the

super-fast high-powered X-rays on

 the radio. 



 Until now, the full-body scan craze that began in California has been

the province of entrepreneurs,

 not academic physicians. The Harvard doctors - the radiology department

at Beth Israel Deaconess

 Medical Center - have embraced a procedure considered suspect by many

physicians but popular

 with consumers, underscoring one of the biggest divides in medicine and

signaling that full-body scans

 may be more than a fad. 



 The group opened a full-body scan center in Chestnut Hill last month,

charging $900 a scan. The

 group has done more than 150 scans so far. The doctors say they will

conduct rigorous research on

 whether scans improve health and help prolong life, data that is in

short supply. And they will provide

 scans in a serious medical atmosphere; board-certified radiologists

will review results with patients. 



 ''People are a little flabbergasted,'' said Dr. Daniel O'Leary,

chairman of radiology at New England

 Medical Center, which does not provide full-body scans. ''Academic

radiologists have not tended to

 be overly entrepreneurial. On the other hand these centers are

springing up all over the country.'' 



 People lie inside a computed tomography, or CT, machine, which

resembles a giant doughnut standing

 on one end, for 15 minutes. The CT sends X-ray beams through the body,

collecting internal pictures

 from neck to pelvis. Full-body scan supporters say the machines can

discover potentially cancerous

 nodules in the lungs, hardened arteries in the heart, and possibly

malignant polyps in the colon. 



 Doctors agree that the scans pick up unusual spots on organs and

calcification in arteries. The

 controversy is over the large number of false positives - abnormalities

that turn out to be nothing

 serious but that nonetheless lead to expensive follow-up scans, risky

biopsies, and even surgery. It's

 also unknown whether detecting tiny cancerous nodules in the lungs

earlier improves one's chances of

 surviving lung cancer. The Food and Drug Administration, meanwhile,

warns that radiation from a

 full-body CT scan, which is hundreds of times that of a traditional

X-ray, may slightly increase the

 chances of radiation-related cancer. 



 ''It's remarkable to me without any scientific validation whatsoever

people are walking in and paying

 $1,000 for this test, which does not even diagnose three of the top

four cancers that people get,'' said

 Dr. James Thrall, chairman of radiology at Massachusetts General

Hospital, which belongs to

 Partners. ''We're waiting for scientific data before marketing these

services.'' 



 But Dr. Max Rosen, a radiology professor at Harvard Medical School and

medical director of the

 new center, Be Well Body Scan, said this is exactly the point -

thousands of Americans are paying for

 scans at less reputable centers without consultation with a physician.

The Beth Israel Radiology

 Foundation Inc. and its 40 radiologists established Be Well and will

use the profits to fund research

 and teaching for the group, he said. The hospital is not helping fund

the center. Rosen would not

 disclose how much the doctors spent on the center - the scanner alone

costs more than $1 million -

 but said it won't be profitable for several years. 



 ''The point wasn't to make money; it really was to expand the role of

radiology in health care,'' he

 said. 



 Rosen sees three types of patients: Healthy adults who eat right,

exercise, and want to know

 everything about their bodies. Patients with a nagging worry that

doctors have failed to address. One

 woman had a lump in her side ever since surgeons removed her

gallbladder; her doctors said it was

 nothing. The scan showed a hernia, which required no medical

intervention. 



 The third group is people who smoke or have a family history of heart

disease and have real reason to

 fear lung cancer or a stroke. Rosen is starting a study of whether

patients who view their own lung

 scans quit smoking as often as those who enroll in traditional stop

smoking programs. 



 ''We want to use these images to get people to change,'' he said. 



 Hall of Fame slugger Mickey Mantle got a full-body scan in 1995 to

determine if his liver cancer had

 spread - an event that was widely publicized. His scan did not pick up

anything unusual, but three

 months later doctors discovered the cancer had invaded his lungs. 



 But it was Dr. Harvey Eisenberg who popularized the full-body scan -

with help from Oprah Winfrey.

 Eisenberg, a former Harvard and UCLA professor with a longtime interest

in preventive medicine, in

 1997 founded HealthView, a body scan center in Newport Beach, Calif. He

had little money to

 promote his business, so he sent 2,000 letters to physicians offering

them free scans. Thirty accepted

 and many referred patients to him. 



 But his biggest boost came in fall 2000 when Winfrey received a scan at

his center. She invited

 Eisenberg on her show to project images of her internal organs on a

huge screen. The scan found

 plaque on a coronary artery. Winfrey called the procedure miraculous,

according to newspaper

 reports, leading one doctor to comment that she did the same for

full-body scanning that her reading

 group did for book sales. 



 Now about 100 scanning centers have opened across the country. And many

can provide patients

 who say their lives were saved because a scan discovered a dangerous

tumor or impending coronary

 calamity. 



 A woman who had just turned 50 came in to see Rosen earlier this month.

Her scan revealed a

 10-centimeter mass in her pelvis that her doctor did not feel during

her physical. The woman must

 have surgery to remove it - the only way to determine if it's

cancerous. If it's benign, the woman, who

 has no physical symptoms, will have had surgery at a cost to the

health-care system and risk to her.

 But Rosen said that doesn't mean it's unnecessary; surgery would have

been required had the mass

 been detected by her physician. 



 The scans sometimes raise questions that cannot be answered

immediately. Rosen recently saw a

 man in his late 60s whose scan found three lung nodules. The frequency

of lung nodules varies by

 region, and in New England one-quarter to one-half of all people will

have such an abnormality on

 their lungs. Most are harmless. But some are not, so Rosen wants the

patient to have a biopsy. The

 patient's doctor disagreed but referred him to a pulmonologist for a

second opinion. 



 Peter Laurendeau, 72, of Sudbury, came for a full-body scan last week.

A snowboarder and

 windsurfer who eats carrots and cantaloupe for breakfast, he likes to

have the latest tests. 



 ''I'm not nervous, I'm curious,'' he said before changing into a white

bathrobe. He wanted to know if

 his arteries are clogged and if his bones are sturdy. 



 Laurendeau lay on a long table, arms over his head, as the machine

slowly moved him through the

 scanner. The CT produced 400 images, which Rosen took 20 minutes to

review. The images came in

 2.5 millimeter slices of Laurendeau's body from neck to pelvis. 



 It turned out that his artery calcium score was low - in the 15th

percentile for his age and gender. But

 Rosen did spot a nodule on Laurendeau's lungs, although he suspected it

was benign because the

 margins were smooth. Still the finding means more scans for Laurendeau

at six months, one year, and

 two years to make sure the nodule hasn't grown - a cost health

insurance will now pick up. 



 Nevertheless, he was happy with the results. ''I feel like I've won the

lottery,'' he said. 



 Liz Kowalczyk can be reached at kowalczyk@globe.com. 



 This story ran on page A1 of the Boston Globe on 6/28/2002. 

 © Copyright 2002 Globe Newspaper Company. 

--

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