Canadian radiologists have started debating the ethics and efficacy of using full-body computed tomography (CT) scanning as a screening tool.
In the February issue of the Canadian Association of Radiologists Journal (CARJ, www.cma.ca/carj), Dr. Harald Stolberg of McMaster University questions the utility, ethics and cost-effectiveness of the scans, and raises safety concerns. Drs. Bruce Forster of the University of British Columbia and John Mayo of the Vancouver Hospital present the counter-argument.
In “Yuppie scans from head to toe: unethical entrepreneurism” (CARJ 2003;54[1]:10-3), Stolberg says potential harm far outweighs potential benefit in most cases.
“The only known benefit of this marketing ploy is the financial advantage to the radiologist or the organization providing the CT screening,” says Stolberg.
And even though the scans are purchased without public funds, he argues that the publicly funded health care system will be left to deal with any false-positive results. Stolberg concludes that “extolling the possible benefits of computed-tomography screening without knowing the potential for harm exploits people's trust and is unworthy of any physician.”
In their response, Forster and Mayo contend (CARJ 2003;54 [1]:14-7) that the scans are acceptable if done in a “scientifically principled, ethically based and patient-focused manner, with clear disclosure of the limitations of our current knowledge.”
CARJ Editor Craig Coblentz praised the authors “for going mano-a-mano” on the topic. “Open and frank discussion such as this is necessary,” he wrote.
Full-body screening is already offered throughout the US and is available at a handful of private Canadian clinics. In the US, online advertisements include invitations to “bring a friend and receive $50 off both scans.”
In March, 1 American company was offering $50 discounts for “virtual colonoscopies,” which are “just as accurate as conventional colonoscopy … without passing an endoscope through the colon.”
Normand Laberge, CEO of the Canadian Association of Radiologists, says most of the clinics are operated by “entrepreneurs,” not physicians.
Dr. Dale Vellet of Canada Diagnostic Centres, one of the few Canadian companies that still offer full-body scanning, says his patients must be more than 40 years old and have a physician's referral. The company also offers heart, lung, colon and bone scans, with costs ranging from $800 to $1200.
Laberge says there are no regulations governing full-body screening here, and American companies are lining up to access what they consider an untapped market. — Jim Donnelly, CMAJ
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