Scan or Scam?

Today in any large city in the UK, you can walk into a clinic and book yourself in for a total body CT scan – without a referral from your doctor. In some clinics, (many which are souped-up beauty parlours) you can get your Botox injections and fillers done at the same time. Never mind that the scan is probably unnecessary and will give your body a large dose of harmful radiation.

Self-testing is a huge and growing industry but at the moment it is largely unregulated. While companies get rich marketing meaningless tests, no one is looking out for the interests of the growing armies of worried well who spend up to £2000 a time to have their health scrutinised. Full body MOTs, well woman testing, DIY testing tests bought over the counter; you don’t need to be sick to get these tests. In fact, more and more they are now being aimed at people in excellent physical health, who are prepared to pay for peace of mind.

It sounds like a great idea – taking proactive steps to safeguard your future health.

But are these wellbeing tests really a positive step towards preventative healthcare or a clever ruse to get the worried well to part with their money? Worse, could these tests even cause long-term harm? As the health and wellbeing test market grows at record rate – it is now worth over a hundred million a year in the UK alone – serious concerns are being raised about the way these tests are being evaluated and regulated. Anyone can set up shop marketing tests, and they might have little clinical benefit at all. Labels are littered with ‘mights’, ‘maybes’ and the perennial get- out clause, ‘if in any doubt, consult your doctor.’ There is often little in the way of counselling before a test, which may give you information that causes you significant anxiety and distress. Afterwards, if you are lucky, you may be able to call a helpline to talk the results through.

It seems to defy all medical codes of practice, but there are clinics that offer you a fake tan session, Botox injections, – and scans that can detect brain tumours, lung lesions and potentially fatal aneurysms. Others promise to analyse a sample of your blood and work out your chances of getting cancer, heart disease or even mental illness. And they’ll send you a report in the post, or perhaps give you a telephone consultation to talk it through.

‘There’s a growing industry of selling tests direct to the general public and it does seem to be unregulated at the moment,’ says Professor Peter Furness, former president of the Royal College of Pathologists. ‘There is a lack of quality assurance and some of these tests have been questionable validity.’

Take for example the total cholesterol test. Yes, it measures your cholesterol levels, but this is meaningless unless the test differentiates between good and bad cholesterol. ‘We all have cholesterol in our bodies – our brains are largely made up of cholesterol – but what matters is the levels of bad HDL cholesterol.’ Says Dr Andrew Green, a GP based in Yorkshire. ‘These tests are meaningless unless they look at the problem in context.’

‘Most doctors are not opposed to people being able to take tests that may point to health problems,’ says Dr Andrew Green.

Most experts agree that for people who are already well and showing no symptoms of disease, only a small number of screening tests are worthwhile.

The tests can often show false positives, or suggest that there may be a problem in the future, creating a potential army of the worried well. One of the classic tests that means very little unless it is done in context is the PSA test for prostate cancer. In many cases, elevated levels of PSA have nothing to do with prostate cancer, instead showing someone is overweight, or even just has a urinary infection. A total cholesterol test is meaningless unless it is taken in context of other risk factors for heart disease, and cholesterol comes in different guises, good and bad versions. You really need to know your levels of HDL and LDL cholesterol to get any idea of your risks.

Much more worryingly, some tests can actually cause harm and should only be done when there is a genuine clinical need. Studies show that CT body scans, which emit X-rays in order to create the 3D image on the screen, cause fatal cancer in one in 2000 people who undergo them for purely diagnostic purposes. Mammograms may be useful in detecting breast cancer for women over the age of 50, but their use of younger women is highly controversial.

But if you are prepared to pay the fees, there is nothing to stop fit people having these scans multiple times. You are buying peace of mind but there is a cost.