Stopping restless reg(ulator) syndrome

June 5, 2008

Click the video at the bottom of the American College of Radiology’s website, myradiologist.com, and a board-certified radiologist appears, explaining how radiologists are an important part of the medical team. The explanation begins with the cyber radiologist posing the question, “Did you know that radiologists are physicians?”

Click the video at the bottom of the American College of Radiology's website, myradiologist.com, and a board-certified radiologist appears, explaining how radiologists are an important part of the medical team. The explanation begins with the cyber radiologist posing the question, "Did you know that radiologists are physicians?"

In the year 2008, after 30 years of extraordinary technological progress in x-ray, nuclear medicine, and ultrasound, after the introduction and development of CT, MR, and PET, just the possibility, much less the likelihood, that a viewer might not answer affirmatively is mind-boggling.

What have we been doing? Obviously, not communicating very well with the public. ACR's website is a welcome step in the right direction, but it only underscores how far we have to go.

It is no coincidence that radiology has taken it on the chin lately from Congress and the Centers for Medicare and Medicaid Services, which have finagled ways to cut imaging reimbursements and plan to keep looking for more. Argue as some may that cuts are all but inevitable in a world of finite resources, let's not forget how well others in the medical industry have done at dodging fiscal bullets. Look no further than the pharmaceutical industry, which has embraced public information.

It wasn't very long ago that U.S. residents were buying prescription drugs by mail from Canada and other countries, a trend that was gathering steam. The insurance industry was in favor of it. The federal government, however, from legislators to White House administrators to regulators, was not. Patient safety was the reason. Ultimately, though, the group that succeeded in getting that message across was the one representing the drug companies.

It did not stop with just blunting this attack on their revenue streams. Pharmaceutical companies proved adept at not only protecting existing sales avenues but adding new ones through what medical pundits have dubbed "disease mongering."

An example is GlaxoSmithKline's Requip, a drug developed to combat "restless leg syndrome," a disease that many argue does not exist. Ditto for Pfizer's Lyrica, a drug the FDA approved to battle fibromyalgia.

The Wall Street Journal pushed back with a story entitled, "How Glaxo Marketed a Malady to Sell a Drug." The New York Times ran a similar story about Lyrica: "Drug Approved. Is Disease Real?"

We do not want to follow in these footsteps, which have led to the path of disinformation. But the degree to which the pharmaceutical industry has succeeded in getting its message across to both the public and regulators could serve as an example of what we should be doing.

Rather than having to sell medical imaging, we need only present a case for the good that it does. CMS backed off from its effort to restrict coverage of coronary CT angiography after arguments made by the medical community in favor of this application. Medicine is rife with cases in which medical imaging makes a difference in managing patients every day. There is virtually no end to the concrete examples that could come from oncology (MR and PET/CT), orthopedics (CT and digital x-ray), cardiology (nuclear medicine, echo, and cardiac cath), neurology (functional MRI), and trauma (CT ).

CMS isn't going to sit still, and Congress isn't going to stop looking for ways to trim Medicare costs. Radiology needs a heightened profile to stand up to the assaults that are sure to come.

Kudos to the ACR for creating myradiologist.com. Now it's time to go further, so we won't ever have to explain again that radiologists are M.D.s.