Are gyms and spas safe spots for medical services?
Hospitals, clinics, doctor’s offices, and other traditional sites for medical care struggle mightily to safeguard patients. They do so by spending a lot of time, money, and other resources, and by using highly trained personnel. Still, despite their best intentions, patients can experience harm, injury, and death.
Knowing this, why are increasing numbers of Americans willingly subjecting themselves to risky procedures in places with no history or culture of patient safety? These include so-called med spas, hydration clinics, gyms, and fitness centers.
These outlets, claiming to boost customers’ health, well-being, and looks, fill their clients — by injection into muscles or veins — with purported vitamins, “fat melters,” hangover remedies, and more.
In some places, estheticians with basic cosmetology training and scant knowledge about best medical practices are administering powerful agents like the nerve toxin Botox. They do so under the purported supervision of doctors, who may or may not even be on site. This also may laser patients’ skin and employ harsh peeling agents.
NBC News reported that medical safety experts are expressing alarms about the once-novel but steadily expanding procedures that consumers, mostly women, undergo at med spas and hydration clinics.
“The number of med spas and hydration clinics has ballooned in recent years, turning into a $15 billion wellness industry offering a variety of services, from IV therapy to skin care and cosmetic procedures. Federal health officials and representatives of med spa owners warn consumers that, along with the boom, some facilities are using unlicensed workers to inject unapproved products in unsanitary conditions.
“It’s difficult to know how many people have been injured at med spas, because the infections often are not reported to local or state health departments. But some infectious disease and emergency room doctors say they are seeing more adverse reactions associated with the facilities.”
The Wall Street Journal reported that trendy gyms and health clubs — and soon to be copied by their mass-market counterparts — have catered to the wellness-, longevity -, and appearance-conscious with an array of medical-type services:
“Would you get blood work done at your gym? Longevity-focused treatments like IV vitamin drips, biological-age testing, and peptide injections — questioned by many doctors but embraced by a growing group of health enthusiasts —are coming to mass-market fitness centers. Some fitness brands are adding or investing in clinics that offer access to weight-loss drugs, too … Proponents say the new offerings are low-risk and fill a need for those frustrated with traditional medicine. Skeptics say some treatments are a waste of money at best and carry the potential for harm at worst. Many lack robust substantiation of their health claims, traditional doctors and researchers caution. The gyms’ moves are an attempt to capitalize on Americans’ growing interest in finding novel ways to live healthier for longer, industry professionals and analysts say.”
What proponents too often do not discuss, however, is what happens when treatments go awry. How substantial is the training, care, and follow-up by those who break the skin of customers or gym-goers for various treatments? It cannot be overstated how this increases the risk of infection and other serious, costly, and even fatal outcomes.
What happens when a customer or gym user has an adverse reaction to a procedure or substance? The facilities that so readily “treat” the public likely lack the needed medical resources in emergencies. Consider that even highly credentialed, experienced medical specialists, such as those who settled lawsuits in the death of comedian Joan Rivers after a cosmetic surgery procedure, have confronted major problems during office procedures — with tragic results.
Looking for longevity in all the pricey places
Chasing longevity is another way to set yourself apart and show everyone how special you are. If only the really expensive procedures worked, it would be great.
Take the full-body MRI scan, for example.
The idea is it will detect serious medical conditions long before traditional medicine might find them.
The problem is that these scans often find what doctors call “incidentalomas,” incidental odd little spots in the body with unknown significance for the patient’s health. Chasing down these incidentalomas takes a lot of time, expense, and risk of complications. And then they usually turn out to be nothing.
The price for a whole-body MRI is not that much, between $1,350 and $2,500, with one vendor selling five-year “membership” options (and repeat procedures) for $7,000. But that’s only the first price, before any further workup gets done.
As reported in the New Yorker magazine by Dhruv Khullar, an assistant professor at Weill Cornell Medical College and director of the Physicians Foundation Center for the Study of Physician Practice and Leadership, the scan fad can be traced in part to the influencer Kim Kardashian.
Besides Kardashian, others identified by Khullar with this procedure of the moment include supermodel Cindy Crawford, former Google chairman Eric Schmidt, and fashionable test participants like “designer Zac Posen, the model Lily Aldridge, and the editor Olivier Zahm.”
Doctors are skeptical, Khullar noted, recalling a celebrity hype for a similar type of scan:
“In 2000, demand for head-to-toe CT scans — essentially, three-dimensional X-rays — surged after ‘The Oprah Winfrey Show’ featured a Newport Beach doctor who offered them to the general public, without a physician’s referral. The scans weren’t covered by insurance and cost about $1,000 each. Whoopi Goldberg called them ‘the most comprehensive health exam that exists;’ William Shatner said, ‘I’m sending everyone I know’ … Medical societies, however, warned that the scans had high rates of false positives; they also delivered enough radiation to increase the risk of some cancers that they aimed to detect. Before government-funded studies could properly evaluate the scans’ effectiveness, most of the companies offering them collapsed.
“Full-body MRI scans are different from CT scans in two key ways: they don’t subject people to potentially harmful radiation, and they are better at surveying the soft tissue of our internal organs, where cancers commonly arise. The other complaints, however, still seem to apply. MRIs are sensitive enough to pick up subtle abnormalities that can be clarified only with further tests, and sometimes those tests cause harm: pain, radiation, infections, financial and psychological distress. Their growing popularity suggests that our relationship to medicine has continued to evolve. Increasingly, patients are not passive recipients of care, but active customers. Trust in medical leaders keeps falling; these days, a Kardashian post is worth a thousand academic studies.”
As NPR and the Pulitzer Prize-winning investigative news site ProPublica have reported, published research has estimated that in one year alone “more than 600,000 patients underwent a treatment they didn’t need, treatments that collectively cost an estimated $282 million.”
The American College of Radiology (ACR) is the leading organization of doctors who specialize in interpreting MRI scans and other imaging. If anyone had an incentive to promote widespread use of whole-body MRI scanning, this outfit would be it.
The ACR issued an official statement in April 2023 that threw a big bucket of cold water on the idea of whole body MRI scanning for patients without worrisome symptoms or history. They wrote that the ACR “does not believe there is sufficient evidence to justify recommending total body screening for patients with no clinical symptoms, risk factors or a family history suggesting underlying disease or serious injury. To date, there is no documented evidence that total body screening is cost-efficient or effective in prolonging life. In addition, the ACR is concerned that such procedures will lead to the identification of numerous non-specific findings that will not ultimately improve patients’ health but will result in unnecessary follow-up testing and procedures, as well as significant expense.”
Dr. Khullar’s story in the New Yorker has its own twist. He decides to get the scan, though he knows as a much-published researcher about the risks of over-testing and over- treatment.
Khullar is a fine reporter and writer, and his story is worth reading. No spoiler alert here about the story’s finale. Just the questions: Really? Why?