Wednesday, December 8, 2010

Turning over stones

That's not me to the right, for which I'm grateful given what looks like a huge mass in the patient's left lung. This is an image that was recently generated by an experimental technology that combines PET and MRI primarily for use in oncology. My immediate reaction: Great. Another blockbuster (and budget busting) imaging device that may be only marginally better than existing scanners for diagnosing and staging cancer. Just what we don't need: further distraction from the kind of cancer care in which patients matter most and doctors don't obsess over superfluous information. I'm deeply skeptical of anything that abrogates a doctor's responsibility to be a healer first and not just a body technician. This technology seems to lead us further down the wrong path.

But it's early days and it's possible an integrated PET/MR scanner might be a good thing. I've already been scanned by PET/CT many times, and have come to the reluctant conclusion it's a better early warning system for cancer recurrence than plain-vanilla CT or stand-alone PET. The ability to superimpose two data sets so that metabolic activity revealed by PET can be precisely located anatomically within a CT (or MR) image is a technically brilliant achievement. Unfortunately, there's scant evidence that these studies affect the health outcomes of patients with advanced melanoma. I've read that PET/MR looks especially promising in breast cancer, so perhaps it will have redeeming medical value. Given our inability to justify the cost of high-tech medicine as things stand, another expensive imaging modality had better be diagnostically superior by an obvious margin. If it's not, it's adoption will represent another victory of medical marketing over clinical need.

I had the pleasure yesterday of submitting to the lowest-tech exam someone in my position is likely to have: a visual skin check by my dermatologist. I'm covered with moles. many of which could be likened (unkindly) to barnacles on a whale. These are called seborrheic keratoses, which may sound dangerous but which are totally benign. I visit Dr. O'Hare every six months or so because my history puts me at elevated risk of additional primary melanomas. While my bigger concern are the subcutaneous mets that continue to plague me, an occasional skin check is still a wise precaution. If you haven't had one yourself, ask for it from Santa. It's the cheapest insurance you can buy against the risk of all types of skin cancer. I was happy to learn yesterday that the doc saw nothing suspicious.

I remain vigilant in my search for small mets just under the skin. There are no medical specialists nor imaging technologies dedicated to finding these little bastards, so the curious and unsavory exercise of looking for them falls to me. It seems there may be a business opportunity here for someone. Despite what we'd like to believe, our bodies remain largely a wilderness in which danger often goes undetected to the naked eye. This, of course, helps to account for the enormous emotional appeal of machines like PET/CT. We attribute power to them they don't possess. I'm predicting that PET/MR will eventually exert its magic just as other devices have previously. Knowing that potentially a stone remains unturned is a temptation that few doctors or patients can resist.

1 comment:

Anonymous said...

I don't remember your hips being that big either.