Undoctored: Why Health Care Has Failed You and How You Can Become Smarter Than Your Doctor by Davis William

Author:Davis, William [Davis, William]
Language: eng
Format: azw3, epub
Publisher: Rodale
Published: 2017-05-08T16:00:00+00:00

CAR BUYING, CT SCANS, AND CAVEAT EMPTOR

While the growing world of direct-to-consumer imaging is exciting with huge potential, it also has some potential hazards you should know about. Just as buying a new car means investigating the reputation of both the dealer and the car you are considering, so it goes with direct-to-consumer imaging services.

Be aware of what facility is offering the service and why. While most direct-to-consumer imaging services are offered by companies independent of hospitals in free-standing or mobile imaging facilities, even hospitals have gotten into the act, though they often view such services as “loss leaders” (i.e., low-cost services performed at no profit, even a loss, in the hopes that there is an abnormal finding that leads to further investigation and additional revenue). Doctors can also own imaging equipment, thereby double-dipping for both facility fees and professional fees, abuses that have sparked government and regulatory scrutiny. Be wary when a doctor recommends such testing.

Testing based on x-rays, such as CT scans, has the potential for radiation overexposure. This was one of the justifiable criticisms of the full-body scan, which was briefly popular a few years ago. The radiation required to scan the brain, neck, thorax, abdomen, and pelvis adds up to the equivalent of a thousand chest x-rays of radiation. Such radiation exposure adds to cancer risk, particularly on top of the other sources of medical and ambient radiation (e.g., flying in airplanes). Any radiation-based form of testing should therefore come with questions about radiation exposure. Radiation exposure is more important the younger you are, since activation of cancer generally requires decades to manifest. Newer technologies have also introduced methods that have dramatically reduced exposures, so it may pay to shop.

Medical imaging, whether applied conventionally or in our Undoctored approach, raises the issue of unanticipated incidental findings, the discovery of potential abnormalities that trigger further, often costly, sometimes invasive, investigation. This is among the most criticized aspects of all forms of medical imaging. I have personally interpreted tens of thousands of CT heart scans, a simple test to measure calcium in the coronary arteries that indirectly quantifies the atherosclerosis present. In the typical heart scan image, the cross-sectional image shows the heart in the center and the lungs on either side of the heart. While the scan is designed to focus on the heart, it is not uncommon to see small masses in adjacent lung tissue in as many as 50 percent of people scanned. The vast majority of these are benign—scars from prior viral or fungal infections, etc.—with less than 1 percent representing early cancer. As a practical matter, any mass less than 4 millimeters in diameter is nearly always benign; a mass larger than 1 centimeter is more likely to represent a cancer.5 This rule is often ignored, however, and many people are advised to undergo additional testing, such as a full CT scan of the lung (the different settings of this form of scanning expose you to the equivalent of approximately 300 chest x-rays of radiation, compared to 8 to 10 for the screening CT heart scan), or even a lung biopsy.

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