Me, from Topto Bottom

Exotic medical scanning technology is now available off the shelf. Is that healthy, or wise?

med0302scan_A.gif

SEE CHEESE?
Six CT scan views of the writer, from his new photo album.

Inevitably, medicine in America has come to this: newspaper ads offering discounted body scans. Clip the coupon and bring it on down, for a digital gaze at your own guts. Act now for early detection of cancer, heart disease, tumors, and other time bombs.

So I did act, offering my 41-year-old body for a session of neck-to-pelvis computerized tomography (CT) at a clinic in Boca Raton, Florida, that pitches the scan as "a great gift idea." And I am not alone in being seduced by the prospect of pay-per-view medicine. Imaging centers catering to the self-referred (and generally asymptomatic) crowd are, notes Mitch Goldburgh of research firm IMV, opening up by the dozens. Neither the government nor the medical community measures the trend, but thousands of people are bypassing their doctors and lining up for scans, which run from $800 to $1,300.

A hypochondriac's dream come true? Maybe, but your insurance company won't cover it, since a doctor didn't order it. Many physicians question whether the tests are as effective at early detection as is claimed, and it's hard to know because there have been no rigorous studies of voluntary CT scans. The American College of Radiology, the governing body of sorts in this area, only notes that there isn't enough evidence to justify CT scans for patients with no symptoms, and expresses concern about undue "patient anxiety" and "wasted expense."

None of these people will come to my funeral, however, and I have spent $800 on more foolish things, most recently on a series of golf lessons that failed to produce a swing that even consistently hits the ball. A CT scan is, save for the cost, the sort of painless procedure that appeals to my curious but, when it comes to medicine, cowardly nature.

Sure, it feels a bit reckless to select a healthcare provider based on a newspaper ad. I'm more careful about where my car gets serviced. But these labs are run by doctors and, perhaps naively, I trust that a physician with X rays of my body wouldn't lie with the greasy dexterity of a mechanic manning the diagnostic gear hooked up to my Porsche.

After certain formalities involving my Visa card and a brief medical survey, the procedure takes about 20 minutes. Naked inside the always tricky hospital gown, I hop onto a narrow table and rest my head upon a soft pillow. The scanner-a $1.2 million GE Lightspeed Plus-stands at my feet, a low, squarish device with a patient-sized hole in the middle. The table moves through the scanner, snapping 3-D images of bones and internal organs from all angles. Non-invasive doesn't necessarily mean comfy, however. I'm not permitted to move, or even breathe, at certain points. I have to tuck my arms narrowly above my head so I can fit through the circular opening without losing an elbow.

As I move through the scanner, it speaks, telling me to inhale and hold my breath for up to 30 seconds. (Note to self: Does the fact that I find this difficult in itself say something about my health?) The machine works with the same whirling flashes of light and high-pitched whine that we have come to expect since Bones scanned Kirk on the old "Star Trek."
I went in unworried, survived the scan intact-and then spent three days considerably anxious. The results, when they come, consist of 172 black-and-white cross sections of my body on a CD-ROM disc, and a written report. On my PC, the pictures play like a low-budget horror flick, a moving Rorschach image of the guts of me. Fascinating, but they could be leftover autopsy photos for all I know. Wading into the medical jargon of the report, I learn that the scan finds my heart's pathways open, my lungs and sinuses clear, my spine and bones normal, and my liver, kidneys, spleen, and pancreas all in surprisingly good shape. (Never trusted that spleen.) Then I find mention of "several nonspecific nodes scattered throughout the neck." Nonspecific?

The next day's doctor-patient chat is reassuring. The physician tells me that the nodes in my neck don't present a problem, and are likely the result of an old throat infection or even dental problems. With a heart like mine, "You can eat steak tonight." By the way, I ask him, do you ever find anything bad with the self-scan patient? "We find two or three tumors a week," he says.

All of which leaves me physically fine but philosophically uneasy. Are we taking charge of our healthcare here, or being played by the medical marketing machine? Both must be true. No doubt these scans save lives, at least occasionally, and Americans won't stand for any system that denies us access to technology. But most of us will live long and prosper without full-body scans, and we'd probably be better off just seeing the doc once a year and cutting back on the french fries. But hey, can you even put a pricetag on health, or at least on seeing your healthy spleen?