Have you had a whole body MOT? Probably not, if you’re Professor Nicholas Wald, director of the Wolfson Institute of Preventive Medicine, who has criticised the fashion for giving people body scans as birthday or Christmas presents. They “generally miss most cases of the disease for which they are carried out and there is always some harm.” Not everyone would agree. Step forward Birmingham City’s MD Karren (sic) Brady, who wrote an article in the Guardian under the snappy headline “I was terrified I could die any minute”.
“I had an allergic reaction, probably to nuts, and wanted to get to the bottom of it so I went to a private company that offers state-of-the-art screening, including a full-body MRI scan”. This unusual investigation for nut allergy certainly yielded results. “The next day I was at my desk when they called to say the radiologist had discovered a brain aneurysm - a potentially fatal weakening in a brain artery that could rupture at any time”
Ms Brady then paid to have her aneurysm clipped and, five and a half hours of risky neurosurgery later, she concluded that her whole body scan had saved her life, a small price to pay for the £2,750 fee. But the last thing Ms Brady needed was an MRI scan of her brain. Up to 1 in 20 adults have an unruptured aneurysm, only 1 in 15 of these aneurysms ever bleeds, and very few of the others cause any symptoms at all. Screening is sometimes undertaken when two or more first-degree relatives are affected by a bleed from a brain aneurysm in one family, but even then age and other illnesses may make screening inappropriate.
In a consumer society, anyone foolish and rich can have as many unnecessary and potentially harmful body scans as they like, but their uncritical endorsement in the press is lamentable. The Times ran an article entitled “Inside David Baddiel”, a report on his freebie whole body MRI scan. This was normal, but he concluded; “I have no doubt that, if you can afford it, a body scan every two years is a good thing to do.”
I’m on the side of Professor Wald. Screening is only ever a good thing to do if you are trying to prevent a specific condition, and there is good trial evidence that testing will pick it up accurately, at an early, treatable stage, and improve the quality of your life or longevity. This does not exist for whole body MRI scans, and the risk of haemorrhage and stroke caused by Ms Brady’s neurosurgery is significant.
Just as damaging is the stress and anxiety caused by identifying vast numbers of body wide shadows, cysts, spots and blips on increasingly detailed MRI and ultrasound scans. These are almost certainly of doubtful significance but you can never be completely sure, and many patients are left in limbo with no treatment offered to assuage the doubt that they might have cancer or there might be something wrong with their unborn baby. The best you can do is keep repeating the scans, which does little more than elevate the stress.
This epidemic of “innocent pathology” and “incidentalomas” lead consultant neurosurgeon Richard Hayward to coin the acronym VOMIT (Victims of Modern Imaging Technology)1 . But it applies to all investigations. The PSA test for prostate cancer is not very specific or sensitive, and the evidence that you live longer from treating the cancer is patchy at best. Which is why doctors refer to it as Promoting Stress and Anxiety. The media and internet does this best of all, with so much time now taken up with journalism induced angst that patients who are actually sick can’t get seen. Time to launch CAMRA – the Campaign for Real Ailments.
- BMJ 2003;326:1273
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