Healthy Skepticism?

You surely have heard the hype from the neighbors and the local media about whole-body MRI or CT screening for individuals with no symptoms of disease. CT screening became all the rage a few years ago as healthy people bet on the powers of medical imaging to detect occult cancers and diseases or write them a clean bill of health.
In this issue’s interview with Dr. Henry N. Wagner, the father of nuclear medicine, he prescribes that new advances in medicine should be tempered by a dose of skepticism. Does this mean the industry should write off the idea of whole-body MRI or CT screening as just another fad for making a quick buck? Ads that encourage you to ‘find cancer before it finds you’ are compelling, but where is the proof that whole-body image screening is effective?
According to a recent full-body MRI study by University Hospital of Essen in Germany conducted on nearly 300 asymptomatic patients, 21 percent of the subjects had signs of atherosclerotic disease, another 12 percent had peripheral vascular disease, and screening detected 12 colon polyps, nine pulmonary lesions, two cerebral infarctions and one myocardial infarction. Despite these promising results, researchers in the study emphasized that while the screening can detect a number of diseases in a variety of organs, it is very difficult to evaluate the risks and benefits.
Caution certainly prevails among most physicians when discussing the pros and cons of whole-body screening. “It may have value in certain clinical settings if a person had an occult cancer of some kind. But I don’t think that there’s any evidence right now that it has value for screening asymptomatic patients,” said K. Amrami, M.D., head of the body MR imaging practice at Mayo Clinic in Rochester, who is currently developing clinical applications on 3T MRI. “It eventually would be really improved at 3T because one of the issues with doing whole-body screening is doing it rapidly. Now you can screen the whole body in about 30 seconds with 64-slice CT scanner, but what does it mean?” It is hard to say considering it remains a statistically unproven methodology. Dr. Amrami points to additional problems from false positives detected by CT and MRI, and the huge costs associated with chasing exams that turn out to be completely inconsequential.
The FDA’s case against it is simple, stating that there is no evidence demonstrating CT screening of patients without symptoms provides greater potential benefit than harm.
So with all of this skepticism in the air, why are some insurers having a change of heart? Two large international insurance companies are looking at screening in a new light — as a risk management tool — and they are prepared to reduce premiums following the logic that proactive health management will reduce overall claims. Recent studies by BUPA Wellness have indicated that 98 percent of people feel assured after a whole-body screening and nearly 75 percent made subsequent lifestyle changes. Perhaps those eager consumers lining up, wallet in hand, ready to fork out between $800-$1,500 per scan are on to something? Or are they just paying for another false positive?
The debate goes on and will continue until there is enough evidence that demonstrates the effectiveness of whole-body screening of asymptomatic patients and shows the benefits outweigh the risks. Meanwhile many physicians will not recommend it, the FDA will not endorse it and most insurance companies will skirt the issue of covering it. Could we just write it off as healthy skepticism?