CAT scans screen the healthy and wealthy

BEVERLY HILLS (Reuters) -- Money can't buy you love, but some doctors say it can buy peace of mind about deadly heart disease or lung cancer and maybe a few more years with your loved ones.

They are marketing quick and painless, but costly, CAT scans to even their seemingly healthiest patients as a way to detect certain diseases long before any telltale symptoms.

In Los Angeles, a city rife with health-conscious big spenders, one group of doctors is offering a screening program using an advanced computed tomography scanner they call InsideTrac. The machine spirals around the body for several minutes, creating detailed three-dimensional images of internal organs and systems by measuring tissue density.

"Managed health care has created a lot of fatigue and frustration for people who want to know why they have to get sick before anything gets done," said Dr. Stephen Koch, chief of neuroimaging at Access Medical Imaging in Beverly Hills and medical director for InsideTrac.

"We can find things that a doctor would never be able to see, or hear with a stethoscope, during a routine physical exam and you get an answer within an hour," he added.

Nevertheless, insurance companies are wary of footing the bill for CAT scans to screen patients with no symptoms or early signs of disease, although many will pay at least some of the cost if a doctor recommends the scan.

The argument is that unnecessary tests waste money, can cause undue worry and strain vital health care resources.

"It's like looking for a needle in a haystack and there are questions about what the information can do for you," said Mitchell Sugarman, director of technology at Kaiser Permanente, the largest U.S. non-profit health maintenance organization.

He said Kaiser commonly uses CAT scans as a tool to diagnose patients suffering from disease symptoms but does not use the machines for general screening.

At InsideTrac, which has a center in Beverly Hills and will soon open another in the San Fernando Valley, a coronary artery disease screening will run you $395, a 3-dimensional full body scan $795 and a full scan plus a "virtual colonoscopy" $1,325.

"We let the patient deal with any insurance reimbursement. A lot of people do have the means and are proactive in their approach to medical care," Koch said.

He said he finds something that needs to be dealt with in about 1 in 30 of the patients he scans. But he concedes that the technology has its limitations.

"MRIs (magnetic resonance imaging) are still the gold standard for differentiating organs and scanning the brain," he said, but the machines do not replace procedures like mammograms for breast cancer screening or ultrasound for pelvic exams.

There is controversy as well about the usefulness of a CAT scan in diagnosing coronary artery disease since the pictures do not show how narrow any plaque has made the arteries.

"If you have known heart disease, you are wasting your time with us," Koch said. "But for an individual walking in off the street, it can be very valuable to at least take a look. I know I'm glad my score was a zero."

Dr. Bruce Brundage, a spokesman for the American Heart Association, said there is a wealth of data to support the idea that scans are the best tool for determining who has the highest risk of heart disease.

Still, the advice for a patient found to have minimal to moderate calcium deposits in the arteries is the same as it is for anyone else: Exercise and improve your diet.

"There is no other active intervention. A doctor is not going to go in there and get the plaque out," Sugarman said. "And what about people that have no signs of disease? They may decide to keep eating those eggs and bacon."

InsideTrac also promotes what it calls virtual colonoscopy as a viable alternative for people who find the prospect of a traditional colon exam, using a flexible fiber-optic tube, embarrassing and uncomfortable.

A CAT scan can closely examine the interior of the colon without anesthesia or lab work, but the patient must still prepare by drinking a concoction that clears out the digestive tract and the bowels are inflated prior to the exam with air pumped through a tube inserted in the rectum.

Lung scans are far less complicated. "No one even bothers with chest X-rays anymore," Koch said.

Yet Sugarman, an ex-smoker who had a CAT scan of his lungs, questioned the value of the procedure for a healthy person. In his case, the scan showed a very small nodule, but no treatment or action, other than repeated follow-up scans, was recommended. "I wish I'd never done it," he said.

Identification of noncancerous growths could lead to more people getting biopsies -- risking infections or even death -- without a real reason, Sugarman said. "If we eventually discover a real benefit, we'll be the first on the block doing it. Until then, it's like opening Pandora's box."

Copyright 2000 Reuters. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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