HEART SCANS: GOOD OR BAD?

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?

8 responses to “HEART SCANS: GOOD OR BAD?

  1. This is interesting Rdoc. But as a consumer, I would like to know when a patient should go in for a CT scan?

  2. Nita:
    Do read the NYT article. The CT is largely pushed towards screening/detection of heart disease in asymptomatic individuals, or those with some changes in the resting ECG….

  3. I read the article too, and the trend towards recommending CT scans as an automatic procedure even if there is no chest pain, and the doctor just wants a confirmation that there is plaque build up, is just another symptom of the increasing commercialization of medicine.

    The other problem is that patients are never really given an option. Nobody tells the patient what the risks are with a scan. If you had physicians explaining their reasons for a scan and the risks, a patient with no symptoms(say someone who had just come in for a routine annual check up) may decide to skip the scan.

  4. R-Doc:

    Do you think this is as rampant in India as in the US where a doctor’s malpractice insurance premium probably exceeds his/ her mortgage payment each month?

  5. Shefaly:
    No, this is much smaller than the US market….

  6. Doc – So should a scan really cost that much of money? I know it is fairly sophisticated technology – but a part of me is still suspicious. I mean I am skeptical it is *that* sophisticated. The kind of skepticism I see when I find an ATM transaction charge of $2.50 to $3 😉 ! – Yes I know it isn’t child’s play, but I have fair idea, and I ask – $3 a transaction? Who are we kidding?

    So who is *making* (not breaking even) the most out of these equipment and procedures? What are the margins? I would guess that they are fat margins – as the medical industry is usually a superbly healthy one.

    But if I attempt to answer it more seriously (or fairly) – I think the answer may be hard to find out – hospitals buy new equipment which they need to “pay for” – so procedures on old equipments that are paid for already still are expensive etc. etc. The same song and dance with drug companies.

  7. I am not qualified to talk about the harm caused by radiation due to the 64-slice ct scan but is it as good as angiography. I was told that 64-slice scan is nearly as good as angiography to detect any blockages in the heart. This scan is non invasive and is thus not painful.
    //patients who are being scalped or milked by the system// of late I have observed that patients who are taken for angiography get their angioplasty done there and then in case of blockage. This could be misused by some greedy doctors. Once the patient is inside the OT the relatives or the patient himself has no choice but to go according to the doctors advice.

  8. Very thought provoking
    Lekhni is right – rarely do the patients ever question the doctors and the doctors – they wont mind getting their work reduced .

    There was a recent case of a child dyeing of complications after multiple route canals done by a bds of a relatively prominent dental clinic having a website and also an office in lokhandwala in mumbai.

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