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Prevention or Profit?

Prevention or Profit?In a Boston Globe op-ed, Tufts' Dr. Jerome P. Kassirer questions the motive behind two groups pushing for the use of CT scanning as a preventative maintenance tool.

Boston [02.15.08] If an ounce of prevention is worth a pound of a cure, then why do most in the medical realm disagree with the idea of utilizing Computer Tomography(CT) scans, which use X-Rays to make detailed pictures of structures inside the body, for disease prevention screenings?

In a recent op-ed appearing in The Boston Globe, Dr. Jerome P. Kassirer, professor at Tufts School of Medicine and former editor of the New England Journal of Medicine, argued that it is the motivation behind these screening recommendations that might take away from the sensibility of the process.

"In medicine, not everything that makes sense is sensible," Kassirer wrote in the Globe. "More screening machines invariably lead to more tests;more tests yield more false positive results, more risk to screened patients, and more expense."

Kassirer references two separate works: a proposal titled the Screening for Heart Attack Prevention and Education guidelines and a study by the International Early Lung Cancer Action Program.

According to Kassirer, despite a lack of support from larger organizations such as the American Heart Association and the American Cancer Society, two self-appointed groups formed-one made up of cardiologists and another composed of radiologists- to advocate preventative screening practices. These groups published a proposal and a study indicating the practice had exceptional life and cost saving capabilities.

Despite these apparent positive results, Kassirer said the initiatives failed to receive the backing of major professional organizations. One major problem was that the study was uncontrolled. Another was that screenings often turn up clinically insignificant lesions, leading to unnecessary invasive procedures.

Pushing beyond the negative feedback, the two organizations went further. One group went to a Texas state representative seeking a mandate reimbursement for testing. According to Kassirer, the Lung Cancer Alliance went even further by declaring that an ongoing controlled, blinded clinical trial of screening at the National Institutes of Health was unethical, an accusation which prompted an investigation by the House Committee on Energy and Commerce for financial conflicts. The investigation proved the accusations to be unfounded.

"Why all the fuss?" Kassirer wrote. "Why were the organizations pushing so hard, not only bucking the recommendations of major organizations, but going directly to legislatures to get their policies implemented? Why not go through the usual channels in their own professional organizations, offering their evidence and opinion and getting official policies changed?"

Though Kassirer noted that there was the possibility that the groups were looking out for the greater good by avoiding the "snail's pace by which physicians often change their practices," he also remained skeptical on their motives.

"Given the expansion of privately owned CT scanners in the country, and the possibility of a reimbursement bonanza for such procedures, another more sinister explanation is possible, namely a profit motive," he wrote, when a reporter found that "two lead investigators of the lung cancer study held 27 patents on procedures for CT screening and lung biopsy procedures," while a set of guidelines were sponsored by a company likely to benefit from the use of its drugs.

With the possibility of a money motive, the Tufts professor feels that any positive statistics presented by these organizations become less valuable.

"[Organizations] must appoint guideline committees that are not influenced by how much their colleagues make or how many pills the companies sell that pay them to speak or consult," Kassirer wrote in the op-ed. "We are nearly at the limit of our expenditures on medical care;we don't need more expenses for tests that have been tainted by possible financial bias. We must remember who will pay for all these additional tests: you and me."

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