The Brave New World of Health Testing

The "worried well" are doing whatever they can to uncover disease before it takes its toll. But does their detective work yield more questions than answers?

By Susan Ince
And if you’re going to be offered the same diet and exercise advice or be put on the same medication, does it really matter if your risk is established by one test or a dozen?So far the AMA and the FDA haven’t taken a formal position on direct-testing labs, but some physicians caution that, without having the numbers interpreted along with a medical history and a physical, you could be falsely reassured by a normal test or too anxious about one outside the normal range. Enter preventative and executive health centers, which offer a thorough physical and some pampering along with mega-testing.At the Kronos Optimal Health Centre in Scottsdale, Arizona, the standard battery includes more than 100 measures. "The tests we do have all been proven scientifically useful, but they may not be cost-effective so they usually aren’t recommended by your regular physician," says Susan Kaib, MD, who spends at least an hour performing a history and physical on each Kronos patient, then another 90 minutes going over their results.For super-achievers, Kronos offers a challenge: To pass, you have to be better than "normal," because they compare your results with a far narrower "optimal range" of values. And every patient leaves with custom-blended supplements and a new exercise and nutrition regimen. Like other facilities, such as the Mayo Clinic in Rochester, Minnesota, and the Canyon Ranch Health Resorts nationwide, Kronos also offers some serious coddling (for $4,000 or more, it had better!), with clients spending time between tests in amenity-filled private suites. A False Sense of Security?If you were offered the choice between a full-body scan and $1,000, which would you choose? According to a national telephone survey by researchers with Dartmouth Medical School and the University of Massachusetts, Boston, 73 percent of us would go for the scan, which provides a detailed look at one’s bones, muscles, organs, and blood vessels with computer-enhanced images generated by x-rays.Indeed, the popularity of full-body (or, more accurately, full-torso) CT scans has exploded in the past few years. Do a computer search under "peace of mind," and "CT scan" and you’ll find links to dozens of companies, such as Peace of Mind Scans in California and Your Peace of Mind, Inc., in Florida. It’s not that we’ve given up on traditional screening, but the idea of being able to get a quick once-over and spot potentially life-threatening problems — say, a tiny tumor or weakened blood vessel — is appealing. The possibility of getting an "all clear" is perhaps even more enticing.There is a growing body of evidence that CT scans, which have been used for years to evaluate possible tumors, vascular problems and kidney stones, can be beneficial for certain people. Specific scans are also available for those with an above-average risk of heart disease or colon or lung cancer. But an estimated 80 percent of aberrations found on full-body screening scans are harmless — old scar tissue or benign growths, for example."People need to realize that a scan may find something of unknown significance, and they may end up undergoing invasive tests that cause anxiety and carry their own risks," says Judy Illes, PhD, senior research scholar at the Stanford University Medical Center for Biomedical Ethics and Department of Radiology. It’s also possible to have a scan that doesn’t raise any red flags and suffer a stroke or be diagnosed with cancer soon after."On a public-health basis, the scans don’t even come close to making sense, but some people want it and in some cases it makes sense for them to have it," says Jeffry L. Huffman, MD, president and CEO of the University of Southern California Care Medical Group, where full-body scanning is offered as part of a new Executive Health and Imaging Center. "It doesn’t take finding too many incidental cancers in fortunate patients to make you happy they’re available."The DrawbacksOf all the health concerns of the wealthy worried well, cancer is preeminent. For years we’ve been told that getting screened is our best defense, and we’ve dutifully signed up for mammograms, colonoscopies, and the like. But if you think that a full-body scan is a good way to condense several screenings into one, think again.

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