Preventive Medicine using Imaging but at a High Price

Two days ago I had the privelege of shadowing a great endocrinologist in Austin. It was at his clinic that I was introduced to the idea of doing both ultrasound imaging and fine needle biopsy of the thyroid in-house.

What was far more interesting to me -- because it doesn't fall within "endocrinology" (e.g., diabetes/pancreas, thyroid and reproductive organs) -- was that the clinic sonographers can also take an ultrasound image of the carotid arteries and then tell you if there is too much thickening of the intima and media, the inner two most layers of the carotid artery, and thus determine one's risk of ischemic stroke.

Called CIMT (for Carotid Intima Media Test), this is a non-invasive procedure that takes less than 3 minutes. And the cost? $299, though the clinic is currently running a special for $199. Does insurance cover this screening test? No.

And there is another non-invasive imaging test called this review article.) Cost at the heart hospital in Austin? $199.

I believe focusing on preventive medicine is important for preserving or enhancing a patient's quality of life and for lessening the cost burdens on our healthcare systems as a large portion of complications can be averted.

However, in these cases the barrier is high cost. Only a small segment of Austinites can afford to get screened for the health of their carotid and coronary arteries. Which means for the most people this kind of preventive medicine is unavailable.

Still, this is a step in the right direction. And with most technology costs, it will fall in time so that more can afford it.

Time will also tell if these preventive measures help reduce stroke and heart attacks. If they are found to be effective and also become cheaper, then insurance companies and the government will more likely cover them in the future to the benefit of most Americans.

However, in time the promise of these imaging-based screening tools can prove false, as a recent study showed with CT screening for lung cancer. As one NY Times article judged it, based on the article published in JAMA in March 2007:

Lung cancer screening with CT scans does not appear to save lives and exposes people to serious risks of injury and even death from needless surgery, researchers are reporting today.

None of this is to say that we shouldn't keep trying to find effective screening tools that will prevent disease and death. We should, by all means. All this does is puts the promises of new untested screening tools in perspective.