The Age of AmeriScan: Entrepreneurial or Unethical?

Physician's Money Digest, June15 2003, Volume 10, Issue 11

Some believe it helps to move medical carefrom reactive to proactive. Others feel ittakes medicine into a strange realm ofmoney, marketing, and paranoia. Whatever youropinion, AmeriScan and its Body Imaging Centers(866-469-7226; www.ameriscan.org) are poppingup across the country. With 12 locations, and 6more to open soon, the centers offer high-techmedical screenings using computed tomography(CT) and magnetic resonance imaging (MRI)—without the need for a physician's referral.

For those concerned or curious about theirhealth and who have the money to pay for it, a fullrange of services is available. They include: thezero radiation full body scan; full body scan; scansof the head, heart, and lungs; a complete cardiacevaluation; an MRI BreastScreen; and an MRIJointScreen. Prices range roughly from a few hundreddollars to just under $2000 for most services.

A patient simply schedules an appointment.Then immediately following the scan, the patientis given a personal consultation with a clinicianand a visual "tour"of their body—including atake-home CD-ROM of the images. Later, board certifiedradiologists review the images and providethe patient with a personal health summary.

Business 2.0

AmeriScan isn't the only game in town—thereare about 200 "stores"of this type across thenation—but it is the "industry's largest nationalplayer,"according to . AmeriScan isdetermined to succeed, and that means the medicalcommunity has a new, and controversial, elementto consider. AmeriScan—and centers likeit—generate mixed reactions. The tests can bepractical, proactive, and very effective at convincinga patient to make lifestyle changes. At best, theycan be life saving. But some medical professionalsworry about false positives, the validity of CT scansdone without IV contrast, and the ethical issues ofmarketing medical tests to consumers for profit.

Physician's Money Digest

The founder and medical director of AmeriScan, Craig Bittner,MD, is a board-certified radiologisttrained at Johns Hopkins UniversityMedical School, UCLA Medical Center, and theStanford Hospital. He recently talked candidly to:

•Why break from the traditional route?

I was working in the radiology center atStanford, listening to receptionists take calls fromfamily members of patients who were sick or whohad died from various diseases. After seeing thetechnology used to diagnose diseases, these familymembers would call and ask if they could bescanned. I would hear, "Not until you are sick."Ithought, "This is backward."Here I am, a physician,prolonging the lives of seriously ill patients.While they were living longer, it was not an optimalexistence. AmeriScan's goal is to allow patients tolive as healthy as possible for as long as possible. It'seasier, less painful, more cost effective, and obviouslymore successful to prevent disease than it isto cure it.Traditional medicine tries to fix what isbroken. Patients should be able to use technologyto prevent disease. We provide that option.

•Are there any statistics on the benefits?

AmeriScan has screened over 30,000 patients.Two of 10 present some form of pathology or condition.One in 10 has a serious condition developingin their body. AmeriScan has saved thousandsof lives and given thousands more the opportunityto protect their health. A full body scan willchange people. When a smoker sees what is goingon inside their lungs, they quit smoking. Taking ahigh-tech look inside your body can reaffirm yourcurrent healthy choices, or it can provide the necessarymotivation to make changes. Seeing theinside of your body will change your perspective.

•How do fellow physicians react?

Honestly, when I started doing this in 1999,fellow physicians called me a few choice names.But, once they began to see that we are actuallysaving lives, their attitudes began changing. Now,I'm receiving calls from physicians across thecountry supporting us. Proactive health care is thefuture of medicine. Traditional medicine has beensaying for years that early detection is the best curefor disease. Now, they're finally embracing theconcept. People deserve better screening tools.

•How do you address criticisms?

The criticisms of whole body scanning haverevolved around 3 issues: false positives, radiation,and price. AmeriScan's false-positive rate isbetween 4% and 5%. Obviously, no medical test isperfect. And I think many physicians have forgottenthat other regularly performed tests, like thePSA or mammography, have false-positive ratesupwards of 40%. Whole body screening providesaccurate and reproducible results. AmeriScan nowoffers whole body MRI scans in all our markets forthe same cost to the patient as CT Full BodyScans. But the MRI bypasses the issue of unnecessaryradiation and is a more accurate screening.

The cost-related criticisms are ridiculous. Theinsurance industry states that it's too expensive forthe public and therefore not a good test. But, thecost effectiveness of a screening should have nothingto do with its value to the patient. We charge$450 for a lung scan. Ask patients with late stagelung cancer what a new, healthy lung is worth tothem and they're going to say it's priceless. Theycould have had the world's best early lung cancerscreening—that could have saved their life—for$450 at AmeriScan. Patients are paying out ofpocket because they realize that their health careshouldn't be dictated by what their insurancecompany deems financially viable. The publicdeserves to know the accuracy of the new technology.The ethics in question are those of physicianswho sell only what insurance companies will payfor and withhold information from patients.

•Consumers are used to marketing inmany industries but not necessarily inmedicine. What are your thoughts on marketingin the medical industry?

We market directly to patients. As we say herein the office, AmeriScan works directly for thepatient and we gear our message directly to themin a way they can understand. A patient isn't goingto understand the dynamics of a 16-slice CTmachine vs electron beam technology. But they dounderstand a guarantee about their health. Westand behind our technology and our service in away that the insurance company or a doctor thatworks for the insurance company cannot.

•Is the business financially rewarding?

Yes, but I don't know of any doctors who wouldsay they got into medicine because of money. Ibecame a physician because I am committed tohealth care. AmeriScan offers a service that saveslives and allows families to have a future. The financialrewards are secondary. Each center averagesbetween $3 and $5 million in annual revenue. Butthe true valuation and reward from leading thewhole body CT or MRI screening revolutioncomes from seeing the public change their perceptionof health care. They are smarter and betterinformed now. They realize that the choices theymake can influence their health. And that they cantake control when it comes to prevention. Societywill always have a need for treatment-based medicine,but hopefully, not as much.