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New Wave of Scanning Centers Sparks Medical Debate
The Washington Diplomat / November 2001

By Larry Luxner

Entrepreneur Barry Blank has been self-employed since the age of 19. A native of Pikesville, Md., he's already launched two businesses in his career -- a regional title company and a nationwide retail janitorial supply chain.

Now, at age 45, he hopes to strike it rich with his third venture: a chain of walk-in medical centers where patients can get full-body scans to detect illnesses they didn't know they had.

On Sept. 17, Blank opened his clinic, Well-Screen Inc., on the ground floor of an office building in Owings Mills, a suburb of Baltimore. Here, patients can choose from a full-body scan for $795, a full-body scan with virtual colonoscopy for $1,395, a heart scan alone for $525 or a virtual colonoscopy alone for $695.

Well-Screen uses a technology called computed tomography (CT), which uses radiation to obtain hundreds of images of the body in less than 10 minutes as the patient lies flat and motionless passing through a $1 million scanning machine manufactured by Germany's Siemens.

When the scan is done, a radiologist interprets the results and a physician discusses them with the patient. Since the procedure isn't covered by health insurance (unless there's an existing condition which warrants a CT scan), patients are expected to pay up front.

And with Americans more health-conscious these days, especially affluent ones with family incomes of over $75,000 a year and money to spend on full-body scans, Well-Screen -- along with area competitors -- could soon find themselves with more business than they can handle.

"My concept is not to have one center, but 20 centers," says Blank, who plans to open a Bethesda clinic within the next four months. "We decided that we don't want radiologists at each site. We're going to do it through teleradiology. As we open up other centers, we'll go through T-1 data lines. The only people in these centers will be a physician who will talk to the patient, a technologist, and an office manager. This office will support all the satellite offices. This is the central nervous system. It'll be much easier to open other branches more quickly."

So how does all this help the patient?

"We find that 15% of the people who come here think they're fine, then come back with some kind of finding -- nothing necessarily life-threatening, though we did catch someone with pancreatic cancer," says Blank. "This test can check for illnesses that your doctor doing your normal physical cannot. If you find it by the time the symptoms come out, it's typically too late."

He adds: "Typically, radiologists are not trained to deal with patients. Most of them are sitting in rooms, studying film on glass lights. We want to have the patients feel warm and fuzzy, and understand what the results are. That's why we want clinical physicians dealing with them."

Blank says there are only 15 centers like this in the United States, but that new ones are popping up all the time. Well-Screen is the latest entrant to a new industry that already includes rivals Millennium Scan, which opened in Washington about five months ago, and Virtual Physical, which has been operating in Baltimore since April.

Asked about possible risks from radiation, Blank had this to say: "The biggest risk is finding out if there's something wrong with you, The radiation you're exposed to with the machine is very slight. It compares to getting dental X-rays done. Other than that, there really is no other risk. There's nothing that can go wrong. We're not using anesthesia, and we're not putting any needles in patients."

Says Mark Adams, southeastern cardiac CT product sales manager for Siemens Medical Systems Inc. in Atlanta: "The technology has improved substantially over the past year. The instrument Well-Screen is using is in the same family of instruments being used by Johns Hopkins and the Cleveland Clinic. Physicians should consider revisiting the concept of CT because of these recent advancements in technology."

Yet many experts criticize screening CT scans, saying they identify too many false positives -- problems which aren't really problems -- or don't have real medical value.

Dr. Dan Marder, CT specialist at Washington Radiology Associates, says these scans "have been oversold, in the way they're performed at many of these centers," which also include Millennium Scan, which opened in Washington about five months ago, and Virtual Physical, which has been operating in Baltimore since April.

"While the virtual colonoscopy, cardiac scoring and the lung screening are useful, the full-body scan is not," he said. "There haven't been any scientific studies showing that it's an effective test. Because of that, major medical organizations have not endorsed it."

Marder concedes that CT scans "can certainly can pick up some diseases at an early stage, and for some people it will be very beneficial. But for many others, it'll pick up diseases which you can't tell if they're serious, and these people will need to go on to additional testing, worry and expense, all to find out that it's not really anything. And for some people, the tests will simply miss serious diseases."

Another skeptic is Dr. Alan Sheff of Bethesda.

"These scans have not been shown to be valid for early detection of anything," he said. "They're not being recommended by the American Cancer Society. No reputable organization is recommending them. They're being promoted based on an entrepreneurial model. It often shows us things that require surgery with some potential risk and no proven benefit."

Sheff recalled a patient whose scan revealed a lymph gland buried in her pancreas, but which showed up as a lump. "For three or four years, she lost sleep and was stressed, even thinking about her will. It turned out not to be serious at all."

But BethAnn Lederer, director of marketing at Well-Screen, says the public may not realize that false positives almost always appear in commonly accepted medical screenings such as mammography, amnioscentesis and conventional colonoscopy.

For those reasons, Lederer urges physicians to "take another look" at the procedure -- especially for patients with risk factors such as age, obesity, smoking and family history.

"At the very least, people are walking away with greater peace of mind or committed to making health-promoting lifestyle changes," says Lederer. "And sometimes, as has already been the case at Well-Screen, asymptomatic individuals are referred back to their primary-care physicians for further testing, based on our findings, which leads to medically indicated surgery. For those individuals, having a scan may have saved their lives."

Adds Blank: "The biggest negative from the medical community is that it will cause people to do testing they might not otherwise have done. They're not thrilled because it's a new technology. They're opposed to anything against the status quo, but I think this will end up becoming a gold standard in years to come."

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