Back From the Brink

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Toshiba’s body scanner is used by Associated Radiologists of Clarkston. Illustration by Garth Glazier

There’s no better endorsement of a product than when it’s used by the president of the United States. When President Obama had his annual physical earlier this year, he was given a virtual colonoscopy on a CT scanner. The noninvasive procedure, the results of which were not made public, offers a high-tech solution to personal health-care needs.

Carl and Judy Gerhardt recently underwent similar medical body scans in Clarkston. The reason: Judy’s family has a history of heart disease and cancer, and the couple figured it would be a good investment to find out whether their doctor could detect any risks.

“We liked the idea of just having the security, so to speak, of knowing that we don’t have anything happening,” Carl says. “You hear these things all the time [about] people who are allegedly healthy and do the right things, then keel over dead with a stroke or a heart attack.”

The Gerhardts, who live in Milford, had ARC scans of their regular heart arteries and their carotid arteries, which cost a little extra but gave them added reassurance.

The couple understood that they would have to pay for the procedure out of their own pockets ($300 per scan) since, like most health-insurance policies, theirs doesn’t cover the service. But they saw it as a reasonable investment, considering the potential costs of suffering a problem they hadn’t anticipated.

For Carl, 66, and Judy, 63, the scans showed nothing unusual. They will most likely wait another five years before they go through the procedure again.

Still, the Gerhardts find it curious that most general practitioners don’t recommend that their patients get the scans done. (Doctors generally attribute that fact to the lack of insurance coverage for the procedure.)

With clean reports in hand, the Gerhardts say they’ll continue to be careful — if not fanatical — about maintaining good health habits. And they won’t have to waste time and energy worrying unnecessarily.

“It’s been a positive thing, and something of a comfort,” Carl says. “So if I want to have a big cheeseburger once in awhile, I’m not going to worry about it.”

The risk of developing serious medical conditions led to the widespread appearance a decade ago of early warning or “body scan” centers. Using state-of-the-art scan equipment, the centers were established to take images of patients’ internal organs, in an effort to detect unusually high levels of calcium and other potential problems that might create a higher-than-normal risk.

While the technology is no substitute for a traditional checkup, and its practitioners make no claim that it can uncover every conceivable problem, it does offer the ability to look inside the body and detect potential risks that more traditional measures can’t immediately spot.

At Associated Radiologists of Clarkston, where the Gerhardts had their procedures performed, Dr. Marc Kahn sits down with as many as three patients a day to explain the meaning of their scan results and to recommend the next steps, if any. A printed report, along with a CD containing the scan images, are provided to patients, so they can take them to their primary physicians to discuss what treatment might be needed. “For most of the population,” Kahn says, “the first sign of heart disease is death.”

Associated Radiologists and other scan providers haven’t experienced the kind of market many were expecting when the technology first became viable in 2000. At that time, it was widely anticipated that health insurers would readily reimburse their subscribers for taking such a proactive measure intended to help prevent heart attacks.

But the insurance companies decided otherwise.

“They don’t want to pay for something that has potential mass use,” Kahn says. He’s frustrated by the insurance industry’s position, but he’s realistic about the likelihood of it changing anytime soon. That’s one reason why body scanning only accounts for about 10 percent of what Kahn’s practice does — and why many others who provided the service in metro Detroit have come and gone.

“Ten years ago, when this all got started, it was insane,” Kahn says. “There was so much misunderstanding about what this was about and what this was going to do. Most people didn’t understand what the point of it was. Cardiologists didn’t like it because [they thought] other disciplines were [muscling] in on their action — which was hardly the case. But there was so much misinformation. And then, when everyone did an about-face and didn’t reimburse, if you wanted to stay in business you had to ask people to pay money out of their own pockets.”

Since then, Kahn says, the industry has faced the perception that the service must not be legitimate, because insurance companies won’t pay for it.

Perhaps the best example of a come-and-go center was the Auburn Hills-based Early Warning Healthcare Institute, which opened in May 2002 under the direction of Dr. Donald Bronn. Using Electron Beam Tomography connected to superfast computers that analyzed imagery, Early Warning looked to provide crucial, potentially live-saving information to thousands who might otherwise have no idea of the risks they faced.

Bronn, who now operates out of an office in Bloomfield Hills, says the closure of Early Warning was a bow to business reality — and also to his belief that body scanning may be rendered obsolete by the emerging practice of genetic profiling.

“We’re now moving from imaging to presumption medicine,” Bronn says. “There’s been such an explosion in the last five years of genetic information that we don’t need to scan people. We can do genetic testing. That’s probably going to be the future direction, in that you’re concentrating on an individual. If there’s a history of heart disease, you’d want to get a genetic profile to see if you’ve carried on the bad genes.”

 

When the Early Warning Healthcare Institute was operating, it performed CT scanning, virtual angiographies, and colonoscopies, although Bronn says they never really did general body scanning.

A more sustainable economic model might be represented by another scanning center, Royal Oak-based Central Medical Imaging, which offers scans to the public but doesn’t have its own radiologists on staff. Instead, CMI contracts out the reading of the images to Beachwood, Ohio-based Franklin & Seidelmann, whose radiologists conduct the service, provided they’re licensed to practice in the state where the scan was performed.

Dr. Mark Flyer, body- and cardiac-imaging specialist at Franklin & Seidelmann, says his organization works with scanning centers nationwide that are trying to rein in their costs against the backdrop of economic reality. “They may find it less expensive than hiring radiologists on-site,” he says, “and it gives them a greater expertise to offer.”

One of the most in-demand scanning services at Associated Radiologists is the heart scan, which checks the aorta for high concentrations of calcium and the resulting plaque. High concentrations of calcium and plaque can signal a heightened risk of heart attack, although it may not be imminent. And the people found to be at risk aren’t always the likeliest of suspects.

“There was a couple that came in yesterday,” Kahn says, “and [the woman] had been told she has high cholesterol, and she’d heard from friends about this test. She had almost no plaque. Her husband had no problem, or so he thought. But he had a score in the 75th percentile (at a very high risk of heart disease). Turns out he’s the one with the problem — not her.”

The couple provided an example, Kahn says, of why cholesterol readings don’t tell the whole story for many people, and why not everyone should be shooting for the same numbers on the cholesterol scale. While it’s always good to maintain your LDL, or “bad” cholesterol, at the lowest level possible, a person with little or no plaque can handle a much higher level of LDL than a person with high plaque.

Kahn wants people to know that the cost of a scan isn’t prohibitive. At Associated Radiologists, he says, patients are charged $300 for a heart scan. But in a society accustomed to the idea that health care that’s not covered by insurance is essentially unavailable, it’s hard to persuade people to pay out-of-pocket for a procedure that’s strictly preventive — no matter the potential impact of what might be found.

“If you want it, most people have the means to do it,” Kahn says. “Everybody isn’t a CEO of a business; they’re regular folks. Some people are motivated to be more proactive with their health, and that’s the thing that separates the people who do it from the people who don’t do it. For the heart scan, most people could spend a few hundred bucks every two years. When you spend what people spend on a sport coat or on Lions tickets, it isn’t the type of money that isn’t affordable.”

That seems to be reflected in the demand Kahn is seeing for the service, where at least one person asks almost every day for a scan. He says Associated Radiologists recently offered the service free to Clarkston firefighters — a group Kahn says is in a high-risk category for heart disease because of the stressful nature of their jobs.

“For the vast majority of these guys, there’s nothing serious going on,” Kahn says. “But there’s one gentleman, 49 years old, and his plaque is in the 98th percentile compared to the rest of the population. He had no clue.”

Kahn sits down with everyone who has a scan and explains the meaning of the results. For those whose findings signal risk, he recommends that they see their regular doctors, show them the results, and discuss possible steps to prevent problems for which the individual may be at higher risk.

“I tell people this isn’t to be done in lieu of a physical,” Kahn says. “I can’t diagnose high blood pressure. I can’t diagnose diabetes. This augments what is done traditionally. I do a better job of diagnosing colon cancer or heart disease than is maybe done in your primary-care physician’s office, but there are plenty of things we can’t diagnose with this. It’s an adjunct; it’s not a replacement tool.”

Kahn says another benefit of doing a scan is to find out who isn’t at risk, so they don’t take medications they don’t need, with unnecessary costs and side-effects as part of the bargain.

But persuading the public to spend money remains a challenge, even considering the potential costs for some of not doing so. While Kahn admits he’s glad he doesn’t have to deal with the insurance industry’s byzantine reimbursement process, he says that’s small consolation for anyone who might miss the evidence of a heightened risk for heart disease.

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