CAMLAW: Complementary and Alternative Medicine Law Blog

Drop in Body Scan Market Suggests Possible Outcome for Complementary Therapies that are Disfavored and Unreimbursasble

The quick rise and fall of a medical technology called "body scans" suggests potential long-term, financial pitfalls in marketing CAM therapies that lack third-party reimbursement and general medical acceptance.

In "Rapid Rise and Fall for Body-Scanning Clinic" New York Times, January 23, 2005), Gina Kolata summarized the life and death of these clinics as follows: three years ago, a "medical gold rush, with hundreds of scanning centers, with ceaseless direct-to-consumer advertising, and with thousands of Americans paying out of pocket for the scans, which could cost $1,000 or more." The market "ended abruptly with the wholesale shuttering of businesses."

Reasons for the collapse?

Twofold. One: "the power of dissuasion by professional societies, which warned against getting one of these scans. The tests, they said, would mostly find innocuous lumps in places like the thyroid or lungs, requiring rounds of additional tests to rule out real problems, and would miss common cancers, like those of the breast."

Two: Insurance. "When insurers refused to pay, requiring customers to dig into their own pockets for the tests, scanning centers found themselves cutting prices to compete....And when the flow of patients began to slow, the combination of low prices and reduced business spelled doom."

Conventional medical doctors are demanding that CAM providers such as naturopathic physicians prove through evidence-based medicine that their therapies have efficacy. The counterarguments are that it may be difficult to test some CAM therapies, that it may take time before definitive results are in, that many CAM therapies are individualized and not amenable to standard research protocols, and that some kinds of results are more about balance and wholeness than conventional notions of efficacy.

From a business perspective -- apart from clinical research trials testing these arguments -- if the market for some CAM therapies is weak or collapses, then these therapies won't be available long-term anyway.

If the body scan story offers a lesson from technological medicine, it is the power of medical authority in combination with insurance reimbursement to create (or dissipate) the market for therapeutic services outside the conventional arena. Even when body scan proponents within mainstream hospitals tried to transfer power and authority away from the medical doctor and back to the health care consumer, the bubble this created rapidly burst.

Not even features on Oprah and other mainstream shows could save the marketeers.

As Kolata explains: "It turned out that the assumption by radiologists - that people would be willing to pay for early detection by scans and that there was a huge market waiting to be tapped - were not true." Warnings by professional societies of 'false positive' test results led to consumer distrust of the new machines.

"Radiologists at scanning centers" who were promoting the body scans in turn "protested" the conclusions of medical professional societies, reasoning thus: "It may not be proven that scans save lives, but on the whole, they said, the benefit of finding something like cancer early outweighs the problem of finding harmless nodules and having additional tests to rule out disease."

The market disagreed.

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