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September 14, 2008

Re "The high cost of precision," Sept. 7

By overstating the growth of CT scanning, The Times' article paints an inaccurate picture of how physicians use this lifesaving technology.

The Government Accountability Office statistics used to demonstrate an increase in CT scans are misleading. The GAO's report did not use 2007 data, which show that medical imaging's growth has actually decreased.

The article also presents biased information as fact in order to claim CT over-utilization. Insurance companies are motivated to reduce healthcare costs, including imaging, and have created a cottage industry, called radiology benefit managers, with the sole purpose of refusing coverage for scans. By citing subjective insurance-company-generated analysis of how many scans are "inappropriate," readers are presented with a skewed view of how and why physicians order scans.

The larger issue is ensuring that patients have access to the right scan at the right time. That's why it is vital to ensure that healthcare decisions remain between physicians and patients. The recent Medicare bill embraces this through accreditation and appropriateness criteria. These approaches help ensure that each scan is appropriate and effective without denying access.

Maureen Zilly

Arlington, Va.

The writer is the director of government relations for the Medical Imaging and Technology Alliance.

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I want to congratulate The Times for educating the public about the risks of CT scanning, particularly in children. As a pediatric surgeon, I have spent the last seven years educating my colleagues, as well as future physicians, about these risks, and pleading with them to use CT scanning more judiciously.

Unfortunately, outside scattered islands of excellence, American medicine is becoming an increasingly corporate affair, where assembly-line care is practiced and clinical acumen and judgment are giving way to routine and chaotic use of technology. In such an environment, patient benefit and professional ethics often take a back seat to financial profits. Our nonsystem of healthcare is desperately sick, and your article describes one of its many symptoms.

We can initiate the recovery of our healthcare system by banning the practice of physician self-referral and enacting policies that restore medicine as a service, not a business.

Sherif Emil, MD

Irvine

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