Thursday, March 5, 2009

Scanning For Dollars

Are Doctors Irradiating You So Their Kids Can Go to Private School?

As I reported yesterday, Reuter's put out a story about a relatively important subject: X-ray exposure during Diagnostic Imaging examinations (mainly CT and Nuclear Medicine).

The Reuter's story was fabricated off of this release from the NCRP (National Council on Radiation Protection & Measurement).

Reuters took a straight-forward statement of the facts, talked to a few doctors who implied that "self referral" was an issue in imaging, and came up with this stew:

"The findings... add to already mounting evidence that doctors are ordering too many diagnostic tests, driving up the cost of health care in the United States and potentially harming patients."

This Reuterian conclusion (Reuterian is from the Greek for "stupid head") is at best a deductive error, but really is just a fabrication meant to draw readers, which they did, with 201 subcategory stories on this topic listed on Google by noon yesterday.

Ordering "sophisticated expensive tests" is a common refrain in the corridors of the health care reform hotel, where we are all staying until Obama can bail us out from this health care crisis by "completely overhauling" our horribly broken health care system (that's the one Kennedy chose for his brain cancer treatment when he had the financial options to go anywhere in the world).

The idea is that when those sophisticated and expensive tests are taken away from you and rationed (as they are in Canada where Kennedy DID NOT fly his jet to for treatment), you will be told it's for your own good, because you cannot trust your greedy doctors to order the tests. It is much better that a nurse sitting at a desk in Roanoke Virginia make that decision over the phone, when she gets back from her lunch break and finishes handing out her Secret Santa gifts and goes through the seven hundred requests before yours that are lying in her desk.

You Want the Truth?

Why are so many CT scans ordered? Yesterday I mentioned that the main reason is that the scans are so good -- we want to see them. When you have a pain in your head do you want someone to flash a light into your eyes and stare at your pupils and say "Hmmm...looks good!" Or, do you want a photograph of what's going on inside your skull obtained by a professional on a fabulous (Nobel-winning) machine and then interpreted by an expert? Tough choice.

Why are CT's so good? Because they are computers, that's why. At the top of this page is my first computer. It was a Kay-Pro. It had no hard drive, about 64K of RAM and two huge floppy disks which held about 16K each. That was 1983.

The "C" in CT scan stands for "Computerized." A CT scanner in the 1980 had no processing power and no memory. However, in the 29 years since 1980, CT scanners have advanced their imaging capabilities in a perfectly parallel course with chip processing and memory power. Make sense?

So today -- as opposed to 1980, or even 1990, or 2000 -- the images generated by CT are spectacular and we now can do 3D fly-throughs of your colon (virtual colonoscopy) and stop your heart for a look at your coronary arteries (64/128 slice CT angiography).

Now lets look back at the first sentence in the Reuters article from yesterday:

Americans are exposed to seven times more radiation from diagnostic scans than in 1980, a report found on Tuesday...

And the next line in my report would have been: because the evolution of imaging technology has made it so accurate and valuable that we cannot live without these tests; but, Reuter's next line was:

"as experts said doctors are overusing the tests for profit and raising health risks for patients."

Sin is behovely.

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