Lately, I have been inundated with radio, tv, and print advertisments heralding an exploding plethora of locations doing whole body CAT scans on healthy individuals. This seems to be the stupidest idea since pet rocks. Ok, you take a healthy individual, find some possible abnormality, send them for further diagnostic workup and end up with an uncomfortable, disabled, or dead patient. My guess is that the number of healthy people being made ill is much greater than the number of sick people made well. Attempts at research are to no avail, as there is no hard medical data concerning this screening exam.
I thought CAT scans were pretty much harmless. What is it that makes them harmful?
What makes them harmful is finding an equivocal abnormality that must then be worked up in a more invasive manner, with resulting risks and complication is what was previously a healthy patient. And in general, it seems that when a patient does not need a drug or procedure every complication that can occur will, whereas, if the medical intervention is needed everything will work out find. I am against making the healthy sick.
Well, you don’t necessarily make a healthy person sick, but I understand the argument that this may make a healthy person believe he might possibly be sick, resulting in potentially unnecessary diagnostic tests.
In the absence of symptoms and a specific indication (personal or family history of a disorder) of a need for such testing, it appears to me to be a misuse of the system. However, in fairness, AFAIK these are rarely covered by insurance plans in that case, so if there’s money being “wasted” it’s the person’s own money.
People can do what they want in this regard, but I do agree it’s kind of pointless for most of us.
CAT scans use x-rays, and you get quite a big dose from one.
You’re probably thinking MRIs, which use huge magnets.
IIRC there is a place in Phoenix - my former city before I became an east-coaster again - that did this for $700 or $900 bucks a pop.
I think the OP is concerned about a healthy person suddenly finding out they have a dibilitating disease prior to the onset of symptoms.
To me I’d say “Hey thanks, now I can take the proper precautions and live alonger healthier life because I caught the illness early enough”
In my opinion, the OP’s fear, is warrented to a degree, but in rational terms it has a strawman holding up the argument.
Philosphr,
No, that is not what I am saying at all. Any diseases caught in an early, pre-symptomatic stage is a very good thing. But, do to the nature of interpreting x rays, probably 90% of what looks “funny” is totally normal, but has to be worked up. You get the study, you are really, truly healthy, but the radiologist thinks your pancreas looks a little plump. You go for ERCP, where they stick a garden hose down your throat, take a look-see and inject some contrast. The contrast causes acute pancreatitis, and you are deathly ill for weeks. But before you started this mess you were, and would have remained healthy.
Or you have a cardiac artery calcium score of over 1500. They squirt you and your arteries are normal. But you develop a retroperitoneal bleed and are in the hospital for weeks.
The NEJM had a few good articles about bad outcomes on people with abnormal findings on screening tests who then get caught in a diagnostic cascade and become injured or ill.
And don’t tell me about the neighbor who had one, and eventually underwent a bypass and is now alive and kicking. There is no medical evidence that bypass surgery prolongs life.
Maybe not, but evidence is emerging that angioplasty and stenting does prolong life, and that would be the far more common procedure to perform after discovering an occult stenosis. There is a role for focused testing of otherwise healthy individuals with the correct risk factors.
However I do agree with your main point. Total Body Scanning of otherwise healthy individuals is not something I would recommend. The cascade of complications you describe is what we know as a “therapeutic adventure” and makes me think fondly of that oh so true novel The House of God.
Is there medical evidence that it doesn’t? Come on, now, are you saying bypasses are NEVER helpful? My husband absolutely would be dead now if not for one. It was not found by one of the whole-body scans that are the subject of the OP, but via an angiogram after classic pending heart attack symptoms. When your main coronary artery is mostly blocked, and it’s fixed, and you’re still around 12 years later, I’d say that life has been prolonged. I know that’s just one anectodal piece of evidence, but you implied they were NEVER life-prolonging, and that’s just not true.
MLS, on the whole, the jury is still out as to whether it’s better to bypass an asymptomatic patient who has blocked arteries found on screening tests, or to treat them medically. Earlier studies have shown that these types of patients who get bypasses live no longer than people treated with medications alone. It does appear that angioplasty with or without stenting may be the best way to go for these types of individuals.
This does not apply to patients in your husband’s situation. There is a bucket of evidence that bypass surgery is better than medical management for people with unstable angina or acute heart attack if they fit certain criteria.
Frankly, that’s why I try my best to avoid making sweeping statements such as was made here. Too many exceptions to the rule. And even the cardiologists and cardiac surgeons are arguing over the outcome data.
I blame the media. They take a nice, controlled little study applicable to only a very small group of patients with specific diseases or risk factors, and generalize it to everyone, on the front page of the paper.
QtM, MD
Fascinating, KarlGauss! BTW, check your email! I sent you a note a few minutes ago! What a small internet it is!
Thank you, Qagdop. My point exactly. IANAD, but it’s been my observation that one-size-fits-all is rare in medical situations. When somebody says “never” or “always” it’s usually a time to question the premise.