Out-of-Pocket Health Screenings: Too Early to Tell

“Advertising is the art of convincing people to spend money they don't have for something they don't need.” - Will Rogers

My dad ran a dime store while I was growing up. When I wanted some spending money, I swept floors, priced merchandise, and restocked shelves. With a dollar in my pocket, my eyes widened as I approached the candy counter or walked down the toy aisle. Dad used these opportunities to teach me that I would be no happier or wiser if I made impulsive, poorly informed choices. As a result, I am still a bit of a cheapskate…and I remain skeptical of bright, shiny packaging.

Therefore, I was suspicious when I first heard a radio advertisement for out-of-pocket lung cancer screening with Spiral CT scans. My instincts were reinforced by a recent essay in the New England Journal of Medicine (2002; 346:529, 2/14/2002). Lee and Brennan paint Spiral CT’s (along with Electron-Beam CT for heart disease) as clinically unproven, financially irresponsible, and ethically suspect. The authors point out that until clinical trials demonstrate a real benefit, these screening tests potentially provide false hope, waste resources, and are no more sensitive than less expensive studies.

As physicians, we want to offer our patients cutting-edge care. We do well to remember, however, that Mesmerism, Phrenology, and Laetrile all had their proponents at one time or another. As a medical student, I was told that “half of what we will teach you is wrong. We just don’t know which half.” I suspect that is still true.

My dad sold his thriving Ben Franklin Store not long after a Wal-Mart opened nearby. That was all the evidence he needed that it was time to change. Similarly, it should take some strong evidence to convince us to recommend Spiral CT scans as a cancer screening test.

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.