The New York Times has carried an excellent article on the rampant use of the CT scan for diagnosing coronary heart disease in patients. It gives a balanced picture of the pros and cons of a healthcare system which thrives on modern and expensive investigations.
The basic argument in favor of scanning your heart would be to detect the plaques (deposits of fat) in the coronary arteries and document any narrowing in the passage of blood supplying the heart muscles, thereby warning the cardiologist and the patient of the need for aggressive treatment like angioplasty or bypass surgery.
On the other hand, each scan costs a lot of money, causes radiation exposure equal to a thousand x-rays (thereby increasing the risk of cancers), and may not be as effective in helping detect the specific case of the cardio-vulnerable patient.
In India, all the premium city hospitals, led by the Apollo group, have procured the 64-slice CT scanners that cost nearly a million dollars. These hospitals aggressively position themselves to patients as leaders in preventive cardiac care, which is just an effective way of marketing the cardiac CT scan.
Additionally, they also position the CT-angio to doctors through CMEs, cocktail-dinner seminars, etc.
The ‘cardiac CT’ has taken center stage along with coronary angioplasty and bypass surgery as major revenue earners for these hospitals. The strategy is to screen patients through executive health checkups and diabetes and hypertension screening camps across the rural-urban divide (through peripheral clinics), get them referred to the center with the CT scan, and following the detection of some lesions in the CT, get the patients ready for the expensive angios and bypasses.
The entire delivery system is now well-oiled, and the number of procedures is rising every year, as are the revenues to these hospitals.
Patients are also benefitting, by and large, though there are (unspecified numbers of) patients who are being scalped or milked by the system. Isn’t it always so?