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FULL-BODY SCANS, VIRTUAL COLONOSCOPY, AND FANCY LUNG SCANS - WE HAVE HEARD THE HYPE, NOW THE NEGATIVE REPORTS ARE COMING IN

(February 2003)

In medicine and health, frequently the initial reports about a new drug, treatment, or technology are wildly enthusiastic. Then reality often sets in as more studies are published. Sometimes, the original enthusiasm is confirmed, more often, it is not. Healthful Life has consistently been skeptical of new technologies, such as full-body scans or virtual colonoscopy, because they are not based on evidence, they will result in large numbers of false positives, and there is a lack of evidence that they save lives.

At the annual meeting of the Radiological Society of North America held in December 2002, a report of full-body scans performed on 1,192 patients by for-profit imaging centers was presented. It is a preliminary study, but, it is a red flag.

Despite its superficiality, the study strongly suggests that full-body scans are largely a waste of money for persons under age 40, and for those over 40, the positive findings are likely to be false-positives requiring needless additional studies that are often invasive, expensive, cause anxiety and sometimes unpleasant physical complications that can, occasionally, be severe and rarely fatal.

The lead investigator is quoted as follows: "they get pushed to the public before any of the research was done. They are saying do it for your peace of mind, do it for your wellness, for your family. Nobody is saying that half the time we are going to find things you are going to worry about" - usually needlessly.

Another new heavily-advertised scan is helical computed tomography of the lungs (helical CT).

A cost-effective analysis of helical CT appeared in the Journal of the American Medical Association in January 2003. The proponents and entrepreneurs say it is a technique for detecting lung cancer in early stages, but it has not yet been shown to save lives, is expensive, and detects a lot of abnormalities that look like, but are not, cancer (false positives). Work up of the false positives can be expensive, involve invasive procedures, and be potentially dangerous.

The authors used a modeling technique on 100,000 hypothetical heavy smokers and calculated potential benefits, harms, and costs.

Here is what they said and concluded "direct-to-consumer marketing and media coverage of the helical CT trials has encouraged demand for lung cancer screening despite the lack of evidence. Early dissemination of a screening technology raises concerns such as consequences of false positive and false negative results, harms from invasive diagnostic tests, surgery, and considerable societal costs....given the current uncertainty of benefits, the harms for invasive testing, and the high costs associated with screening, direct-to-consumer marketing of helical CT is not advisable."

A proper study is underway to determine just how effective a helical CT is (or is not). That will take years to complete. Meanwhile, the hype and promotion by proponents and by entrepreneurs who can make a lot of money will continue. The scans will be costly. They will neither help nor harm most of those who get them; some could be helped; some will be harmed, and rarely will be killed.

The value of full-body scans, virtual colonoscopy, and helical CT scans of the lungs have not been adequately documented for health promotion-disease prevention in people without specific indications. Healthful Life will not include them in our health promotion-disease prevention program until there is good evidence showing they actually do more good than harm, and until it is shown they are worth the high cost.

As expected, these technologies are being heavily promoted by for-profit centers (and they are very profitable).

In New York, advertisements by one imaging center offer the public a special bargain, well off the usual price - a full-body scan and virtual colonoscopy together for a cut-rate price of a little less than $1,000; and, of course, the implication is clear - take advantage of the tests now while they are at bargain basement prices.

You would think they were selling vacuum cleaners or television sets or refrigerators.