Excerpts - Chapter 3

WHY NOT JUST GET A TOTAL BODY SCAN?

In this high-tech age, there surely must be a better way to make medical diagnoses than pretending to be solving puzzles. High tech scans have arrived, and they must surely be able to pick up lurking infections in the body!

Total body scans miss many diagnoses….

Unfortunately, they don’t. There is no single test which will find all abnormal conditions in one’s body. In fact, total body scans are least likely to help diagnose a chronic low-grade smoldering infection in one’s system.

Nonetheless, high tech full-body scans are widely promoted these days to persons desiring more than the customary information about the state of their health. For some very good reasons, however, routine use of these scans is not endorsed by public health agencies such as the American Cancer Society, the American College of Radiology and the Food and Drug administration, and are usually not covered by insurance and Medicare. Patients often ask physicians whether they should pay out of pocket to have one of these scans.

The answer is not a simple yes-or-no. The issue is not whether such a scan might pick up unsuspected diagnoses, but rather, will it do so reliably? Those who are basically healthy without any symptoms or problems, generally expect reassurance from the scans that they are indeed completely healthy. If so, they won’t get what they are hoping for (take the case of our patient with shingles.) In the case of heart conditions, while certain of the scans are rather good at identifying coronary artery disease, one can walk away from a totally normal body scan or heart scan, and drop dead of cardiac arrhythmia (sudden death,) which the scan will not predict. A scan interpreted as normal can also overlook a leaky heart valve, which may require taking preventive antibiotics every time one has dental cleaning. One could also have a totally normal scan, yet have extremely high blood pressure, diabetes, AIDS or leukemia. In fact, the scans almost never pick up chronic infections such as syphilis, the hepatitis virus, stomach ulcer bacteria, early cancer of the cervix, a low-grade bladder infection or many other chronic smoldering infections.

Alternatively, some with certain symptoms hope that the scan will give a conclusive answer to a problem. They may be disappointed. A person experiencing severe pain in the neck and shoulders may be told that the scan shows a bone spur or a partially slipped disk. Yet the actual reason for their pain may not be the spur or the disk. Instead it may be an inflammatory muscle condition called polymyalgia rheumatica. All the scans in the world will miss this very important diagnosis with potentially serious consequences, unless the doctor orders one specific blood test (Erythrocyte Sedimentation Rate test - not usually included in routine blood testing – see also Section 6) to diagnose it.

Even though scans miss a multitude of important conditions, the proponents suggest that their importance may be in finding otherwise unsuspected cancer. Unfortunately, there, too, the test is wanting. Early cancer of the cervix won’t be identified by a scan, only by a Pap smear. Skin cancer such as melanoma won’t be discovered by the scan, only by inspection of the skin. Cancer of the blood, such as leukemia, won’t show up, only by blood test. Even small growths in the colon may not reliably be found by a scan, only by a sigmoidoscopic or colonoscopic examination. Furthermore, a normal scan today doesn’t guarantee that a person won’t have a newly formed cancer of the pancreas by next year. Even if one decides to have such a scan, it is unclear how often the scan should be repeated, at what age should one begin, and at what age the scans are no longer useful.