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[cdn-nucl-l] Rapid Rise and Fall for Body-Scanning Clinics
Very interesting article in New York Times.
It shows "the power of dissuasion by professional societies."
"The reports came to the customers, not their doctors." -- doctors not
January 23, 2005
Rapid Rise and Fall for Body-Scanning Clinics
By GINA KOLATA
For a brief moment, Dr. Thomas Giannulli, a Seattle internist, thought he
was getting in at the start of an exciting new area of medicine. He was
opening a company to offer CT scans to the public - no doctor's referral
necessary. The scans, he said, could find diseases like cancer or heart
disease early, long before there were symptoms. And, for the scan centers,
there was money to be made.
The demand for the scans - of the chest, of the abdomen, of the whole body -
was so great that when Dr. Giannulli opened his center in 2001, he could
hardly keep up. "We were very successful; we had waiting lists," he said. He
was spending $20,000 a month on advertising and still making money.
Three years later, the center was down to one or two patients a day and Dr.
Giannulli was forgoing a paycheck. Finally, late last year, he gave up and
closed the center.
Dr. Giannulli's experience, repeated across the country, is one of the most
remarkable stories yet of a medical technology bubble that burst, health
care researchers say.
It began as a sort of medical gold rush, with hundreds of scanning centers,
with ceaseless direct-to-consumer advertising, and with thousands of
Americans paying out of pocket for the scans, which could cost $1,000 or
It ended abruptly with the wholesale shuttering of businesses.
CT Screening International, which scanned 25,000 people at 13 centers across
the nation, went out of business. AmeriScan, another national chain, also
closed. So, radiologists say, did another company that put scanners in vans
and traveled to small towns in the South.
The business's collapse, health care researchers say, holds lessons about
the workings of American medicine.
It shows the limits of direct-to-consumer advertising and the power of
dissuasion by professional societies, which warned against getting one of
these scans. The tests, they said, would mostly find innocuous lumps in
places like the thyroid or lungs, requiring rounds of additional tests to
rule out real problems, and would miss common cancers, like those of the
It also shows the workings of the medical market - when insurers refused to
pay, requiring customers to dig into their own pockets for the tests,
scanning centers found themselves cutting prices to compete. Within a year,
some centers said, prices fell to less than $500 from $1,000 or more.
And when the flow of patients began to slow, the combination of low prices
and reduced business spelled doom. It turned out that the assumption by
radiologists - that people would be willing to pay for early detection by
scans and that there was a huge market waiting to be tapped - were not true.
The scans were something new in American medicine - not like traditional
screening scans, mammograms or colonoscopies, for example, in which patients
are overseen by their doctors. People requested these scans on their own.
They paid on their own, with no hints that insurers would start picking up
the bill. And the reports came to the customers, not their doctors.
Some proponents said the scans would enable people to take their health care
into their own hands. Critics said the scans were medical nightmares, a
powerful medical technology gone out of control.
But few anticipated the precipitous reversal of fortune for the scanning
In Seattle, Dr. Scott Ramsey of the University of Washington got a federal
grant to study patients at nine centers, expecting to enroll 1,500 patients.
Last year, when he was ready to begin, only two centers were left, and he
enrolled just 50 patients.
He also hoped to do a study with a company, ScanQuest, on the scans'
effectiveness. "We were in negotiations when they suddenly stopped returning
our phone calls," Dr. Ramsey said. It turned out that ScanQuest had gone out
"I've never seen a market for a medical technology collapse so completely,"
Dr. Ramsey said.
Whole body scans erupted onto the national scene in 2000, helped in large
part by Dr. Harvey Eisenberg, the owner of HealthView, a scanning center in
Newport Beach, Calif. Oprah Winfrey, scanned there, featured him on her
show, and his competitors watched with interest as he got attention on
morning shows like "Good Morning America" and "Today" as well as in
newspapers and magazines like USA Today and Men's Health. Soon, HealthView's
waiting list grew to eight months.
The HealthView Web site quoted Whoopi Goldberg ("The most comprehensive
health exam that exists. I love them.") and William Shatner ("I'm sending
everyone I know."). And the site told how the concept worked: a person could
call and make an appointment and have a simple 15-minute scan, while lying
fully clothed on a table.
The powerful X-ray scanner could look inside the entire body, "from the neck
to the pelvis," the advertisements said. "Almost all diseases uncovered at
asymptomatic stages can be modified, reversed, or cured," HealthView
promised. Those whose scans found nothing amiss could have peace of mind.
Soon, competitors opened their own center, CT Screening International, just
across the street. Dr. Michael Brant-Zawadzki, a radiologist who was medical
director there, remembers those heady days after the center opened in 2001.
"The place was jammed," Dr. Brant-Zawadzki said. "We had a waiting list, and
we were competing with the poster boy of whole body scanning."
In just two years, CT Screening International had grown to a national chain.
"It was a very big operation, and it was an enormously rewarding operation,"
said its chief executive, Dr. Richard Penfil.
The business also appealed to radiologists who normally send reports to
doctors but have little contact with patients. At the scanning center,
though, Dr. Brant-Zawadzki sat down with patients and discussed their scans.
"It was very pleasurable," he said, adding that "it also promoted the value
of radiologists to those patients."
Dr. Carl Rosenkrantz, a radiologist in Boca Raton, Fla., said the business
had another appeal - it promised radiologists a good living without being on
call at a hospital and even without necessarily being present at the
"The goal in life seems to be to try to figure out some way where you don't
have to go to the hospital, where you don't have to take calls," Dr.
Rosenkrantz said. "Radiologists saw this as a cash business and a way out."
Academic medical centers also got into the business, including Beth Israel
Deaconess Medical Center at Harvard, which opened Be Well Body Scan. The
center is owned by the Beth Israel Radiology Foundation, a nonprofit
organization that supports the hospital's radiology department.
Dr. Max Rosen, medical director of the scanning service, says he has saved
lives, finding a lung cancer at a stage when it could be removed, he says,
and a heart problem that led to a bypass operation.
At Yale, Dr. Howard Forman, an associate professor of diagnostic radiology
and management, said he had felt pressure from hospital administrators to
explore the possibility of offering whole body scans to healthy people. He
could see why. "From a profitability standpoint, you would go in this
direction." But he and his colleagues resisted. "There is no evidence that
the scans are good medicine," Dr. Forman said.
Dr. Barnett Kramer, director of the National Institutes of Health's office
of disease prevention, said: "For every 100 healthy people who undergo a
scan, somewhere between 30 and 80 of them will be told that there is
something that needs a workup - and it will turn out to be nothing."
The same arguments were made by the American College of Radiology and the
Food and Drug Administration.
Radiologists at scanning centers protested. It may not be proven that scans
save lives, but on the whole, they said, the benefit of finding something
like cancer early outweighs the problem of finding harmless nodules and
having additional tests to rule out disease.
But that is not how the scans were portrayed by professional societies, the
scanning center doctors say.
"We were perceived as charlatans, bilking the population," Dr.
Brant-Zawadzki said. He was chagrined, he said.
"Did I see it coming?" Dr. Brant-Zawadzki asked. "No, obviously, I didn't."
Dr. Edmund Lundy, director of the Health Test Scan Center in Boca Raton,
says his center is one of the few in his area still in business. The trick,
he said, is to market to doctors, persuading them to send him patients. When
doctors do the referring for diagnostic purposes, health insurance often
pays, he adds.
So Dr. Lundy sponsors seminars for doctors and hired former drug company
representatives to visit them.
"I think there's a real place for doing this," Dr. Lundy said of the scans.
"And I think there's a population that wants to have it done. It's a
question of who's going to pay for it."
Be Well Body Scan at Beth Israel has also stayed in business, even though it
sees just 25 patients a week, not nearly enough to make a profit, said Dr.
Rosen, its director.
"We don't want to lose money, but we don't have stockholders; we don't have
investors," Dr. Rosen said. When he is not using the scanner to screen
patients, he said, he uses it on patients who need diagnostic radiology.
Dr. Eisenberg, the man who scanned Ms. Winfrey, has a new company, Body Scan
International. These days, instead of seeing patients in an office, he takes
the scanner to them, operating out of a van that, on a recent day, was
parked in a rundown parking lot beside a runway at John Wayne Airport in
Dr. Eisenberg was unavailable for an interview, but one of his employees,
Don Ark, said that since last May, the van has gone to two sites, an Indian
reservation and an electrical workers' union.
As for Dr. Giannulli, he has moved on to other things. He founded a company,
CareTools Inc., which sells software for medical record keeping to doctors'
offices. That, he says, is the new frontier in medicine.