What Lies Within

Two

years ago, when dr. gabby Freilich became chief radiologist at a company offering whole-body scans direct to the public, he encouraged some of his friends to come and be zapped. One of those was a 47-year-old dentist, "Don," who felt well. He worked hard and played tennis, and really couldn't be bothered getting scanned. "But Gabby was a pest," recalls Don, who finally relented. Returning to his car after the procedure, he found it vandalized. Right then he wouldn't have given Freilich the time of day.

That night at home, Freilich studied his friend's X rays. Clients of Total Health Screening, in Sydney's east, are scanned from head to pelvis by a $A1.4 million computed tomography (CT) machine. A procedure that takes about 40 sec. produces 870 images of the internal organs. Freilich analyzes the images for signs of illness, specifically heart disease, spinal abnormalities and cancer. One X ray of Don's left kidney stunned Freilich. "What the hell is that?" he said aloud. Freilich had spotted a tumor that, at the press of a key, he measured at an enormous 8 cm in diameter. Freilich phoned his friend. "Would you like to come over and see your pictures?"
"No."
"You should. They're interesting."

Don soon afterward had his cancerous kidney removed. Checks since then suggest he's in the clear.

Don's scan quite possibly saved his life. Freilich is convinced he has helped save many others in the past two years. So what do health authorities think of precautionary whole-body CT scans? They'd be all for them, right? Wrong. In fact, numerous medical bodies oppose them, and the New South Wales government, which recently brought down stringent regulations for operators, shares their skepticism. Partly as a result, Total Health Screening is the only place in the state (indeed, in Australia or New Zealand) known still to be offering the service. Business is slow, raising the possibility that whole-body scans may soon be unavailable in this part of the world. The question is, should we care?

It would be hard to believe that there is, anywhere, a more passionate advocate for whole-body scanning than Freilich. A 44-year-old dynamo, he defends his work in the manner of a debater with a brilliant speech who's just heard the one-minute bell - a legacy, perhaps, of being booed and heckled at conferences. In a country where adults can have liposuction, facial cosmetic surgery and penis and breast enlargements, he says, health authorities portray whole-body scanning as "some nefarious activity undertaken by grubby business people . . . charlatans who advertise." The facts, Freilich says, are that since August '02 he's analyzed the scans of more than 5,000 people. One in 20 had abnormalities needing "immediate follow-up," including more than 100 cancers. He could make more money in a standard radiography practice, he adds, "but it so happens I've become addicted to this."

Opponents make three broad arguments, the simplest of which concerns radiation. In its just-published position paper on whole-body scanning, the Australasian College of Physical Scientists and Engineers in Medicine estimates that subjects receive between 10-20 millisieverts of radiation per scan - a "non-trivial" dose, especially if the person has regular scans. (Nuclear facility workers are limited to an annual radiation dose of 30-50 mSv.) N.S.W. licensing laws require operators to explain to patients that "persons under the age of 50 years are more at risk of developing cancers as a result of the procedure."