Rapid Rise and Fall for Body-Scanning Clinics

1. Rapid Rise and Fall for Body-Scanning Clinics By GINA KOLATA New York Times Published: January 23, 2005 http://www.nytimes.com/2005/01/23/health/23scans.html?hp&ex=1106456400&en=c80c40c9e3171a4a&ei=5094&partner=homepage

2. Demand for Scans • Dr. Thomas Giannulli, a Seattle internist, thought he was getting in at the start of an exciting new area of medicine. He was opening a company to offer CT scans to the public - no doctor's referral necessary. The scans, he said, could find diseases like cancer or heart disease early, long before there were symptoms. And, for the scan centers, there was money to be made. • The demand for the scans - of the chest, of the abdomen, of the whole body - was so great that when Dr. Giannulli opened his center in 2001, he could hardly keep up. "We were very successful; we had waiting lists," he said. He was spending $20,000 a month on advertising and still making money.

3. The Procedure • The HealthView Web site quoted Whoopi Goldberg ("The most comprehensive health exam that exists. I love them.") and William Shatner ("I'm sending everyone I know."). And the site told how the concept worked: a person could call and make an appointment and have a simple 15-minute scan, while lying fully clothed on a table. • The powerful X-ray scanner could look inside the entire body, "from the neck to the pelvis," the advertisements said. "Almost all diseases uncovered at asymptomatic stages can be modified, reversed, or cured," HealthView promised. Those whose scans found nothing amiss could have peace of mind.

4. Collapse of Demand • Three years later, the center was down to one or two patients a day and Dr. Giannulli was forgoing a paycheck. Finally, late last year, he gave up and closed the center. • Dr. Giannulli's experience, repeated across the country, is one of the most remarkable stories yet of a medical technology bubble that burst, health care researchers say. • It began as a sort of medical gold rush, with hundreds of scanning centers, with ceaseless direct-to-consumer advertising, and with thousands of Americans paying out of pocket for the scans, which could cost $1,000 or more. • It ended abruptly with the wholesale shuttering of businesses.

5. Criticisms • Dr. Barnett Kramer, director of the National Institutes of Health's office of disease prevention, said: "For every 100 healthy people who undergo a scan, somewhere between 30 and 80 of them will be told that there is something that needs a workup - and it will turn out to be nothing." • The same arguments were made by the American College of Radiology and the Food and Drug Administration. • Radiologists at scanning centers protested. It may not be proven that scans save lives, but on the whole, they said, the benefit of finding something like cancer early outweighs the problem of finding harmless nodules and having additional tests to rule out disease.

6. The Economics • Information - Professional societies warned against getting one of these scans. The tests, they said, would mostly find innocuous lumps in places like the thyroid or lungs, requiring rounds of additional tests to rule out real problems, and would miss common cancers, like those of the breast. • Market - When insurers refused to pay, requiring customers to dig into their own pockets for the tests, scanning centers found themselves cutting prices to compete. Within a year, some centers said, prices fell to less than $500 from $1,000 or more.