Total Body Scans Not Recommended

I never recommend the full body CAT scans for healthy people. You've seen the advertisements. They tell you to come in, get a scan of your entire body, pay your thousand dollars and find out what's wrong with you before you have symptoms.

CAT scans of the body are high-speed, highly sensitive X-rays that can find tiny tumors, weak spots on blood vessels that make them bulge out like balloons, and calcified areas that may be indicative of heart disease. As a result of intense competition, prices are dropping, from $1,000 or more to a few hundred dollars. New centers are springing up in cities and strip malls across the country. They advertise in newspapers, on the radio, on billboards and in fliers sent by mail. There are even mobile units that travel from state to state in huge buses, make contacts with churches and other groups and then charge a reduced price of $200 to scan any of three regions of the body, or $500 for all three.

However, most of the radiologists that I know, who have no interest in making money from these scans and are not influenced by personal gain, tell me that they are a waste of money and time. They tell me that a careful look at most CAT scans shows that almost everyone will have some abnormality. Scanners can find lumps smaller than a millimeter, or four-hundredths of an inch, and most of these lumps are harmless. So you follow up the cat scan with several thousand dollars worth of other tests only to find out that you are normal and you have been upset for the sole reason that you took a test that picked up an a normal finding in most healthy people.

Furthermore, many people are fooled by the medical profession into thinking that early treatment results in cures for everything, when the truth is that early treatment often offers nothing but worry. For some cancers, early treatment has not been proved to have any effect on their course. "We've sold ourselves the myth that getting everything early is always good," said Dr. Larry Kessler, the director of the office of surveillance and biometrics at the Food and Drug Administration.

CAT scans are relatively safe, however. Since these CAT scan tests are usually not covered by insurance, you will have to pay for them and the odds are overwhelming that they will find nothing or that they will find something that is harmless. They then may cost you more money for many other tests, and loss of sleep before you find out that you do not have a tumor or any other serious disease.

On the other hand, those who provide the scans say they are a real service. The radiologists who do them are delighted with them. They offer a huge rate of profit. Since the patients pay out of pocket, there are no insurance companies to haggle with. What would you say if you had a CAT scan and they found nodules in your liver, kidneys and lungs. Your family practitioner will tell you that half of all normal people over 50 have cysts in their liver or kidneys. However, an abnormal full body CAT scan upsets your doctor who knows that if he misses a cancer, you will sue him. So against his better judgment, he orders a liver biopsy and another doctor sticks a needle into your liver, removes a piece of your liver, and finally tells you that you are normal and have nothing to worry about. Total body scans can pick up hidden cancers, ballooning blood vessels and plaques in your arteries, but they will also pick up a host of things that will cost you thousands of dollars and lots of worry before you find out that most healthy people have these abnormalities. Weekly newsletter

Knee Surgery to Trim Cartilage Ineffective

In the United States, more than 650,000 knee surgeries called arthroscopic debridement or lavage are performed each year, at a cost of about $5,000 each. A report in the New England Journal of Medicine shows that knee surgery to remove cartilage is worse than doing nothing. The headline from Baylor Medical School, where the landmark study was performed, is "Study Finds Common Knee Surgery No Better Than Placebo." Patients with osteoarthritis of the knee who underwent placebo arthroscopic surgery were just as likely to report pain relief as those who received the real procedure. The researchers say their results challenge the usefulness of one of the most common surgical procedures performed for osteoarthritis of the knee. Lead investigator Dr. Elda P. Way states, "The fact that the effectiveness of arthroscopic lavage or debridement in patients with osteoarthritis of the knee is no greater than that of placebo surgery makes us question whether the one billion plus dollars spent on these procedures might not be put to better use."

In the study, 180 patients with knee pain were randomized into three groups. One group received debridement, in which worn, torn, or loose cartilage is cut away and removed with the aid of a pencil-thin viewing tube called an arthroscope. The second group underwent arthroscopic lavage, in which loose cartilage is flushed out. The third group underwent simulated arthroscopic surgery; small incisions were made, but no instruments were inserted and no cartilage removed. The people who did not have surgery on their cartilage did better than the people who had some of their cartilage removed.

The knee is just two sticks held together by four bands called ligaments. Bones are soft, so the ends of bones are covered with a hard gristle called cartilage. Cartilage serves as a padding to protect the ends of bones. Once cartilage is broken, it can never heal. And once you break a small amount of cartilage in your knee, your knee cartilage can never fit together properly, and every time you put force on the knee, you break off more cartilage.

When surgeons remove cartilage, they leave less cartilage than the person had before the surgery. Eventually the knee joint runs out of cartilage and when bone rubs on bone, it hurts all the time and a peson must have a knee replacement just to be able to sleep at night. Surgery to remove cartilage just hastens knee replacement. On the other hand, doctors can replace torn ligaments, which stabilizes the knee joint. They can remove a loose piece that is blocking the movement of the joint. People with loose cartilage have sudden locking of the knee when they walk or the cannot fully straighten or bend their knees.

Based on this study and my own impression from treating hundreds of damaged knees, I recommend that you do not get knee surgery unless you have a torn ligament that needs to be repaired or you have sudden locking of the knee during walking or you cannot fully straighten or bend you knee. Otherwise surgery is likely to hasten your need for another surgery, knee replacement. Journal reference for this article Knee replacement surgery