Marketing vs. medicine: Strong sales pitches worry doctors

Radiology used to happen only in hospitals behind doors marked "Do Not Enter."

Now the increasingly complex work of medical imaging can take place miles from the hospital, sometimes in strip malls and semitrailer trucks.

While radiologists still serve a vital role helping doctors diagnose and treat cases, their new visibility puts them ever closer to patients.

Even patients who aren't sick.

Customers with cash but no symptoms can learn whether they have early signs of heart disease or lung or colon cancer. Most of the metro area's larger radiology practices are offering heart and lung scans and virtual colonoscopies -- no doctor's referral required.

Retail scanning is a growing business for radiology. It helps offset the costs of the imaging machines, which can start at $1 million and go as high as $5 million each.

Radiology clinics also hope that the patients will become repeat customers when they need doctor-ordered imaging for kidney stones, back problems or other medical conditions.

But the clinics are taking some heat from physicians who warn that consumers and medicine aren't quite ready for this sophisticated technology to be available to anyone who can afford the $400 for a heart or lung scan and $875 or more for a virtual colonoscopy.

The idea of scanning healthy patients is so new that nobody knows whether it will allow people to live longer or healthier lives. It's also unclear whether such screening will drive up society's health care costs. Two fears are that scan results will cause healthy people unnecessary worry and make other patients overconfident about their health.

In the meantime, state regulators are scrambling to ensure that consumers are protected. Minnesota, with the support of the radiology industry, prohibits so-called full-body scans without a doctor's referral because unnecessary radiation exposure to the abdomen can cause harm.

Still, like cosmetic surgery and laser surgery for eyes, scanning is advertised on television, radio, magazines and newspapers.

When St. Paul Radiology opened its Woodbury imaging center in September, the company brought in Vikings coach Mike Tice for the grand opening ceremony. Two grand prizes were given away: a health scan and a football autographed by Tice.

LifeDiagnostics Imaging Center, a new $2.9 million radiology clinic in downtown Minneapolis, carefully used interior design to recruit patients, portraying itself as "soothing" and "spa-like," as well as "futuristic."

The clinic's designer said he was told to make the clinic look like the fictional Starship Enterprise or a ride at Universal Studios amusement park. The clinic, which also opened in September, needs to attract patients from other radiology clinics to be successful, its owner says.

Decorative touches include pulsating lights that ring the room containing the 5-ton MRI scanner. They "can produce every color of light to man's eye," said designer Steve Stokes of FreemanWhite Inc., based in Charlotte, N.C. "It can be theatrical. It will move, flash, however you program it."

While the clinic might seem like a diversion for owner Hennepin Faculty Associates, the staff doctors at Hennepin County Medical Center, it is part of a strategy to strengthen the radiology program at the hospital.

If successful, the clinic will give chief of radiology Dr. Chip Truwit more resources for the doctor's group and the hospital at a time when payments from insurers and government programs have been tight.

The clinic expects retail scanning to be 10 to 15 percent of its business. Other radiology groups said that retail scanning is never expected to become a major revenue component.

However, United Imaging in Bloomington hoped to make money in retail scans alone. One of its slogans was "Look Inside Your Heart. It only takes 5 minutes to save your life."

Minnesota Health Department regulators initially refused the center permission to scan customers last year. The company had not filed paperwork about radiation levels emitted by its CT scanner.

It also was going to send each person's scan electronically to a radiologist in northern Minnesota, who would interpret the results and send them back to the clinic near the Mall of America.

"We did not think that was a good way to manage patient care," said Sue McClanahan of the Health Department, whose guidelines require that scans be interpreted on-site.

United Imaging later received the necessary approvals after making changes. But after losing several medical directors, a clinic manager and safety officer, the center was sold to a group of radiologists.

It now has a new name, Minnesota Radiology, and no longer has nonphysician investors. Manager Roxanne Tryba hopes the company can better compete for retail scanning customers.

Scanner on wheels

One investor-owned company, CATscan 2000, based in Clearwater, Fla., brings an imaging clinic to the patients using a mini-radiology lab on wheels.

Painted in large letters on CATscan 2000's semitrailer truck is the toll-free number: 87-R-U-AT-RISK.

It offers $199 heart, lung and abdominal scans, or $567 for all three. The company typically parks the trailer in nonmedical locations. When the trailer visited 17 Wisconsin towns in October, it stopped outside churches and Moose Lodges.

CATscan 2000 wants to bring its trailers to Minnesota. McClanahan, who is reviewing the application, said the company will be required to read consumers' scans at the trailer, rather then phoning them in to a radiologist at the Florida headquarters.

Minnesota regulations won't allow the trailer to offer abdominal scans, she said.

In Wisconsin, the state's Medical Society and consumer protection officials advised people not to use the service.

"Marketing such a service to the general public borders on unethical," said Dr. John Beasley of the Medical Society.

Dr. Gordon Mosser, executive director of the Institute for Clinical Systems Improvement, a medical think tank in Bloomington, said retail marketing of scanning is "a snake-oil story again just in a high-tech version.

"Virtually everyone in the American population has a couple of [calcium] plaques, but they die of something else. Should we be promoting this test? To what end?" Mosser said.

The American College of Radiology and the U.S. Food and Drug Administration oppose full-body scans. Health organizations generally don't endorse heart and lung scans for healthy people, saying more research is needed to determine whether such screening is beneficial.

Insurance companies do not pay for the screening tests, saying their value is unproven for otherwise healthy consumers.

Doctors' advice

Family physicians, including Dr. Tim Komoto of Bloomington Lake Clinic, are getting more inquiries about the tests. Doctors rarely recommend them.

Komoto, for example, asks patients who are interested in the heart scan whether they would eat better and exercise more if a simple blood test showed their cholesterol was high.

"If the answer is yes, then why do you need a $300 test?" he said.

Yet advocates of scanning are evangelistic about its value.

"If we can decrease the number of people who die of heart attacks . . . we might make a very big difference," said Dr. Geoffrey Bodeau of Minneapolis-based HeartScan Minnesota, the first to offer retail scans in Minnesota. "It is going to change the way medicine is performed."

In Bodeau's view, to wait for symptoms is flawed, because the first sign of cardiac disease for some people is a heart attack that could kill or disable.

"The population that comes for a test like this . . . are motivated and interested in making healthy changes," he said.

Follow-up surveys conducted by Bodeau's clinic found that 38 percent of those who had a scan said they made lifestyle changes afterward. Most of them were patients with scans that showed some coronary artery blockage.

But, conversely, a small percentage of patients admitted they stopped doing things, such as physical exercise, mainly because their test scores showed little artery blockage.

-- Staff writers Jill Burcum and Maura Lerner contributed to this report.

-- Glenn Howatt is at howatt@startribune.com.