New Wave of Scanning Centers Sparks Medical Debate by Larry Luxner Entrepreneur Barry Blank has been self-employed since the age of 19. A native of Pikesville, Md., heís already launched two businesses in his careeróa 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 didnít 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 Germanyís Siemens. When the scan is done, a radiologist interprets the results and a physician discusses them with the p atient. Since the procedure isnít covered by health insurance (unless thereís 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 more than $75,000 a year and money to spend on full-body scans, Well-Screenóalong with area competitorsócould soon find themselves with more business than they can handle. "My concept is not to have one center, but 20 centers," said Blank, who plans to open a Bethesda clinic within the next four months. "We decided that we donít want radiologists at each site. Weíre going to do it through tele-radiology. As we open up other centers, weíll 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. Itíll be much easier to open other branches more quickly." So how does all this help the patient? "We find that 15 percent of the people who come here think theyíre fine, then come back with some kind of findingónothing necessarily life-threatening, though we did catch someone with pancreatic cancer," said 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, itís typically too late." He added: "Typically, radiologists are anot 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. Thatís why we want clinical physicians dealing with them." Blank said there are only 15 centers like this in the United States, but 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 thereís something wrong with you. The radiation youíre 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. Thereís nothing that can go wrong. Weíre not using anesthesia, and weíre not putting any needles in patients. "The technology has improved substantially over the past year," said Mark Adams, southeastern cardiac CT product sales manager for Siemens Medical Systems Inc. in Atlanta. "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 positivesóproblems which arenít really problemsóor donít have real medical value. Dr. Dan Marder, CT specialist at Washington Radiology Associates, said these scans "have been oversold, in the way theyíre performed at many of these centers," which also includes Millennium Scan and Virtual Physical. "While the virtual colonoscopy, cardiac scoring and the lung screening are useful, the full-body scan is not," he said. "There havenít been any scientific studies showing that itís an effective test. Because of that, major medical organizations have not endorsed it." Marder conceded 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, itíll pick up diseases which you canít tell if theyíre serious, and these people will need to go on to additional testing, worry and expense, all to find out that itís 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. "Theyíre not being recommended by the American Cancer Society. No reputable organization is recommending them. Theyíre 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, said the public may not realize that false positives almost always appear in commonly accepted medical screenings such as mammography, amniocenteses and conventional colonoscopy. For those reasons, Lederer urges physicians to "take another look" at the procedureóespecially 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," said 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." "The biggest negative from the medical community is that it will cause people to do testing they might not otherwise have done," added Blank.. "Theyíre not thrilled because itís a new technology. Theyíre opposed to anything against the status quo, but I think this will end up becoming a gold standard in years to come." Larry Luxner is a contributing writer for The Washington Diplomat. He can be reached via email at larry@luxner.com.