Self Referred Whole Body CT Imaging: Current Implications for Health Care Consumers

Department of Medicine, Stanford University Medical Center, 701 Welch Rd, Stanford, CA 94304-5748, USA.
Radiology (Impact Factor: 6.87). 08/2003; 228(2):346-51. DOI: 10.1148/radiol.2282021083
Source: PubMed


To conduct an empirical analysis of self-referred whole-body computed tomography (CT) and develop a profile of the geographic and demographic distribution of centers, types of services and modalities, costs, and procedures for reporting results.
An analysis was conducted of Web sites for imaging centers accepting self-referred patients identified by two widely used Internet search engines with large indexes. These Web sites were analyzed for geographic location, type of screening center, services, costs, and procedures for managing imaging results. Demographic data were extrapolated for analysis on the basis of center location. Descriptive statistics, such as frequencies, means, SDs, ranges, and CIs, were generated to describe the characteristics of the samples. Data were compared with national norms by using a distribution-free method for calculating a 95% CI (P <.05) for the median.
Eighty-eight centers identified with the search methods were widely distributed across the United States, with a concentration on both coasts. Demographic analysis further situated them in areas of the country characterized by a population that consisted largely of European Americans (P <.05) and individuals of higher education (P <.05) and socioeconomic status (P <.05). Forty-seven centers offered whole-body screening; heart and lung examinations were most frequently offered. Procedures for reporting results were highly variable.
The geographic distribution of the centers suggests target populations of educated health-conscious consumers who can assume high out-of-pocket costs. Guidelines developed from within the profession and further research are needed to ensure that benefits of these services outweigh risks to individuals and the health care system.

4 Reads
  • Source
    • "Of course this is an argument that may be made of other unproven treatments performed only in the private sector. However the targeted marketing of CT screening to the asymptomatic, economically comfortable and educated health conscious consumer [45] as well as the prima fasciae logic embedded such a test should the benefits and risks not be adequately explained, brings the potential for a huge number of "worried well" presenting to publicly funded surgical outpatients clinics. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There has been a recent growth in the use of whole body Computerised Tomography (CT) scans in the private sector as a screening test for asymptomatic disease. This is despite scant evidence to show any positive effect on morbidity or mortality. There has been concern raised over the possible harms of the test in terms of radiation exposure as well as the risk and anxiety of further investigation and treatment for the large numbers of benign lesions identified. A healthy 64 year old lady received a privately funded whole body CT scan for her birthday which revealed an incidental mass in the right iliac fossa. This was investigated with further imaging and colonoscopy and as confident diagnosis could not be made, eventually excised. Histology demonstrated this to be a benign ancient schwannoma and we believe this to be the first reported case of an abdominal wall schwannoma in the English literature Ancient schwannomas are rare tumours of the peripheral nerve sheaths more usually found in the head, neck and flexor surfaces of extremities. They are a subtype of classical schwannomas with a predominance of degenerative changes. Our case highlights the pitfalls of such screening tests in demonstrating benign disease and subjecting patients to what turns out to be unnecessary invasive investigation and treatment. It provides evidence as to the consequences of the large number of false positive results that are created by blind CT scanning of asymptomatic patients i.e. its tendency to detect pseudodiesease rather than affect survival rates. Should the number of scans increase there may be an unnecessary burden on NHS resources due to the large numbers of benign lesions picked up, that are then referred for further investigation.
    BMC Surgery 01/2010; 10(1):1. DOI:10.1186/1471-2482-10-1 · 1.40 Impact Factor
  • Source
    • "Patients should be referred for screening from their primary care physician, who has discussed their understanding of and expectations for screening. The physician's referral, combined with thorough follow-up of results, is particularly important in light of recent data from Illes and colleagues indicating great variability in the manner and extent to which results of self-referred CT screening examinations were communicated with physicians and patients (Illes et al. 2003). "
    [Show abstract] [Hide abstract]
    ABSTRACT: During the past decade, screening tests using computed tomography (CT) have disseminated into practice and been marketed to patients despite neither conclusive evidence nor professional agreement about their efficacy and cost-effectiveness at the population level. This phenomenon raises questions about physicians' professional roles and responsibilities within the setting of medical innovation, as well as the appropriate scope of patient autonomy and access to unproven screening technology. This article explores how physicians ought to respond when new screening examinations that lack conclusive evidence of overall population benefit emerge in the marketplace and are requested by individual patients. To this end, the article considers the nature of evidence and how it influences decision-making for screening at both the public policy and individual patient levels. We distinguish medical and ethical differences between screening recommended for a population and screening considered on an individual patient basis. Finally, we discuss specific cases to explore how evidence, patient risk factors and preferences, and physician judgment ought to balance when making individual patient screening decisions.
    The American Journal of Bioethics 05/2009; 9(4):3-14. DOI:10.1080/15265160902790583 · 5.29 Impact Factor
  • Source
    • "These codes should be discussed within the neuromarketing community with the advice of independent academic researchers working in the area of neural correlates of decision-making, social behavior, and consumer preferences, as well as neuroethicists and professionals in marketing industry ethics. Proactive development of such guidelines within the professional community will provide credibility and garner greater acceptance than those that may be imposed upon the field by regulatory bodies, especially if they arise in response to adverse events (Illes et al., 2003). Timeliness in this effort is critical given the rapid pace of advancements in the field. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Neuromarketing is upon us. Companies are springing up to offer their clients brain-based information about consumer preferences, purporting to bypass focus groups and other marketing research techniques on the premise that directly peering into a consumer's brain while viewing products or brands is a much better predictor of consumer behavior. These technologies raise a range of ethical issues, which fall into two major categories: (1) protection of various parties who may be harmed or exploited by the research, marketing, and deployment of neuromarketing and (2) protection of consumer autonomy if neuromarketing reaches a critical level of effectiveness. The former is straightforward. The latter may or may not be problematic depending upon whether the technology can be considered to so effectively manipulate consumer behavior such that consumers are not able to be aware of the subversion. We call this phenomenon stealth neuromarketing. Academics and companies using neuromarketing techniques should adopt a code of ethics, which we propose here, to ensure beneficent and non-harmful use of the technology in consideration of both categories of ethics concerns. Copyright © 2008 John Wiley & Sons, Ltd.
    Journal of Consumer Behaviour 07/2008; 7(4‐5):293 - 302. DOI:10.1002/cb.252 · 0.75 Impact Factor
Show more