Several years ago I got a full-body CT scan. It found a spot on my liver that was “statistically unlikely” to be anything serious. It also found something else that was just a typical anomaly and told me my coronary arteries were in great shape for my age. I don’t recall what else it found but it wasn’t something that changed my life. A few years earlier a relative got a full-body CT scan because of pain in his side that his doctor wasn’t taking seriously. It found kidney stones. Someone else I know got his & her body scans. What all these scans have in common was they were all direct-to-consumer, with no input from their doctors. They were also all paid for in cash.
Are direct-to-consumer diagnostic scans a good idea? It all depends on your perspective. Doctors do not recommend them in asymptomatic patients. The New Yorker magazine had an article on full-body scans and explained why doctors don’t like them.
When doctors screen healthy people with highly sensitive tests like MRIs, they tend to turn up a barrage of ambiguous findings. Is that an aneurysm waiting to burst, or a harmless vascular variant? Is that a deadly cancer, or just a blob of fibrous tissue? “You pick up some incidental finding and get put on the surveillance train…
Health experts worry about a “cascade of care,” where a benign finding leads to more testing that leads to even more testing and unnecessary care. Direct-to-consumer diagnostic imaging firms like to trot out life-saving anecdotes. The New Yorker wrote about a man whose scan found renal carcinoma early and possibly saved his life. He is the exception rather than the rule, however.
Crownholm is an unusual patient. He is wealthy enough to afford, and eager to use, a wide variety of optional care; he’s drawn to experimental technologies, whether or not doctors recommend them. He also had a dangerous tumor at a key stage: large enough to appear clearly in a full-body scan, but small enough to be asymptomatic and removable. In all of these ways, he was an ideal patient for Prenuvo. The company ultimately recruited him to appear in a promotional video, and he became a kind of MRI evangelist.
Anomalies can lead to over treatment and medical costs searching for the cause. Here is what the writer said in The New Yorker:
As a doctor, I approached Crownholm’s story with caution. No professional medical society in America endorses whole-body MRIs as a proactive screening tool. The American College of Preventive Medicine argues that they “waste money and healthcare resources,” while the American College of Radiology, which theoretically stands to benefit from more imaging, said in a statement that “there is no documented evidence that total body screening is cost-efficient or effective in prolonging life.” Doctors tend to think that if it ain’t broke, don’t MRI it; for every case like Crownholm’s, there are many more that result in false positives, additional scans, needless biopsies, avoidable anxiety, and excess costs.
I support direct-to consumer medical businesses because they are competing for customers on the basis of price. That is rare in health care. Prices tend to be low and transparent. Prenuvo charges about $2,500 for a full body MRI, whereas the CT scan I got was less than half that. Superior Body Scan, a company in Fullerton, CA only charges $425 for a CT scan. The firm claims it’s the most affordable body scan in the nation! A New York based startup named Ezra, just received FDA approval for an AI-assisted technology that speeds up the process of getting a scan and shortens the time patients need to be under the scanner. The firm hopes to ultimately get the price of an MRI down to $500.
Full-body MRI scans are different from CT scans in two key ways: they don’t subject people to potentially harmful radiation, and they are better at surveying the soft tissue of our internal organs, where cancers commonly arise. The other complaints, however, still seem to apply. MRIs are sensitive enough to pick up subtle abnormalities that can be clarified only with further tests, and sometimes those tests cause harm: pain, radiation, infections, financial and psychological distress.
The writer notes something else:
Their growing popularity suggests that our relationship to medicine has continued to evolve. Increasingly, patients are not passive recipients of care, but active customers. Trust in medical leaders keeps falling…
More active health care consumers are a good thing. Besides body scans and walk-in lab tests, consumers we need more cash doctors and specialists who will offer cash discounts.
The entire article is worth reading, especially if you are considering a DTC body scan. The New Yorker: Will a Full-Body MRI Scan Help You or Hurt You?