Physician, Sell Thyself AmeriScan's Craig Bittner wants consumers to take health care into their own hands with his high-tech medical scans. But how does an MD balance an oath to heal with a promise to pay back his creditors?
By Andy Raskin

(Business 2.0) – It's hard to miss AmeriScan. I first notice it while standing in a Pottery Barn at San Francisco's Embarcadero Center. Across the street, draped in front of a conservative blue storefront, a large banner says, "Call 1-866-4 MY SCAN." There's also a sign that proclaims, "Now Open! No Doctor's Referral Needed." Pictures of mature, active couples wearing comfy sweaters and offering testimonials are in the window. "My full body scan was the best gift my wife ever gave me," reads the caption on one.

The following day, listening to the radio, I hear a similar pitch. "How important are your plans if you happen to have an early cancer, heart disease, or some other problem ... and you don't even know it? Hello, I'm Dr. Craig Bittner, founder and medical director of AmeriScan." Some days later, I see an ad in the San Francisco Chronicle. It says AmeriScan can save my life.

Unable to resist, I visit the AmeriScan store. Inside, there's Bittner again, in a video that promises to "make you the captain of your health-care team." At the reception desk, leaflets describe a full menu of medical-sounding services. Some smack of infomercial-style hype ("Detect over 100 life-threatening diseases in less than 10 minutes!"). The virtual colonoscopy brochure does for a noninvasive intestinal exam what the J. Peterman catalog does for a braided horsehair belt ("A small soft rubber catheter ... gently puffs air into the colon").

It'll be a few years before I hit the demographic sweet spot for such a come-on, but I ask the woman behind the counter how much a body scan costs.

As consumers, we spend our days trying to make choices that will better our lives. Growth stocks or value stocks? Regular fit or relaxed fit? Tall, grande, or venti? And now there is this question, posed by the AmeriScan receptionist: "That depends--do you want it with IV contrast or without?"

Thanks to an aging populace, a panoply of health scares, and tighter control on expenses by insurers and HMOs, retail scanning is experiencing a miniature boom. No longer does anyone with a family history of cancer have to wait for their doctor to order a scan. Now, at more than 200 "stores" nationwide, virtually any adult can buy a computed tomography (CT, formerly known as CAT), magnetic resonance imaging (MRI), or electron beam tomography (EBT) workup. Most of the purveyors are mom-and-pop, or doc-and-doc, operations, promoting scans as a kind of high-tech checkup. No doctor's referral needed; patients foot the bill.

It sounds like a simple business: All you have to do is attract enough customers to pay down the lease on your million-dollar imaging machines. But most of the companies that announced plans to establish a national brand in the space have failed. Last spring HealthScreen America shuttered its flagship store in Jacksonville, Fla., the only one it ever opened. CT Screening Intl., based in Irvine, Calif., which used to pay Howard Stern for on-air endorsements, had 12 locations nationwide when it ceased operations in December.

CTSI ultimately lost, ex-employees say, because its marketing efforts produced uneven results across territories. According to former director of East Coast operations Rob Mackey, the company spent about $250 on average to acquire a customer, but in some regions the figure was several times higher. "For every star like Newport Beach," Mackey says, "we had a dog like Beverly Hills."

No wonder, then, that AmeriScan CEO Bittner, 35, acts like the Ronald McDonald of preventive health care. He cites as role models companies known for consistent marketing execution: Southwest Airlines, Gateway, and, yes, the fast-food giant. "They have McDonald's University," he says, referring to how the hamburger chain indoctrinates managers with its standardized business model. "We're building AmeriScan College."

With 12 centers from San Jose to Scarsdale, AmeriScan is now the industry's largest national player, and after securing a credit line worth $30 million (from Siemens, his equipment supplier), Bittner plans to open 10 more locations in 2003. Given his position, such optimism isn't surprising. But the marketing savvy with which the Johns Hopkins-trained radiologist expresses it sometimes is. "There will be 500 AmeriScans," he says, "if this hits the tipping point."

Perhaps because AmeriScan was born at the tail end of the dotcom boom--its first "body-imaging center" opened in the Scottsdale, Ariz., Fashion Square mall in June 2000--the company has its own version of the Founder's Epic. In the AmeriScan story, Bittner is a radiology fellow at Stanford University Hospital in 1999, when the British medical journal Lancet publishes a landmark finding: Helical, low-dose CT scans can detect early-stage lung cancer far better than a chest X-ray. Hopeful San Francisco Bay Area smokers bombard Stanford's radiology lab with phone calls, only to be turned away for lack of a physician's referral. Smelling opportunity, Bittner quits his job, drives with his wife "in a U-Haul across the desert" (to Arizona, where his parents live), and scrapes together $1.5 million in startup cash.

This is health care AmeriScan-style: Consumers--armed with information about medical innovation--wrest control of their medical destinies from their doctors. Pharmaceutical manufacturers began buying into this vision long ago. According to research firm Verispan, drug companies spent $3.1 billion (25 percent of their overall marketing budgets) on consumer marketing in 2001, up from $732 million (12 percent of total marketing) in 1996.

But unlike with pharmaceuticals, you don't have to get a prescription to get a scan. That's why AmeriScan can offer procedures that detect not only cancer but also heart disease, aneurysms, and arthritis, by way of toll-free numbers and mall-based offices. In fact, AmeriScan and its competitors have to sell direct: Most insurance companies reimburse only imaging procedures ordered by doctors (in other words, if a doctor won't say you need it, you don't need it), and most physician groups have yet to endorse scans for presumably healthy people. The American College of Radiology says that unless a patient's family medical history dictates otherwise, the value of the tests hasn't been shown to outweigh their costs and the worry associated with false positives. Others question whether entrepreneurs should be dispensing medical advice. "If you're going to make a truly informed choice," says Richard Roberts, a family practitioner and past president of the American Academy of Family Physicians, "wouldn't you want somebody that didn't have a conflict of interest in selling you the test?"

When I call AmeriScan's Scottsdale headquarters to ask about meeting Bittner, director of marketing Stephanie Darcy proposes an interview at the King of Prussia Mall outside Philadelphia, where AmeriScan recently opened up a center between a Cheesecake Factory and a Morton's steak house. Darcy is clearly practiced at playing up the "mall doctor" angle, baiting me with lines like "You can clog your arteries next door, and then see us to check them out."

It turns out that Bittner is planning a visit to San Francisco, so we meet on a crisp Friday in February at the center I first spotted. He's 6 foot 4, with all-American good looks and the confident, easygoing demeanor you want in someone who's about to probe your internal organs. The store has been operating for a month, though its grand opening was delayed because the MRI machine "quenched"--that is, its superconducting magnets unexpectedly shut down and it vented helium coolant through the roof. A sewage backup cost more time and forced Bittner to buy new carpeting.

Despite the setbacks, he says San Francisco is the perfect location for AmeriScan, thanks to the Bay Area's tech-friendly, "wellness aware" population. He admits to buying demographic data from Claritas--the same company that helps auto dealers choose locations--but his most trusted site-selection insights have come from mall developers. "I just ask them how much revenue their Nordstrom does," he says. "If they do well, we'll do well."

The first thing he points out in the center is the color of the walls. "We call these our Sonoran desert colors," he says, "which we use in all our sites." I agree with him that the palette produces a relaxing, spa-like effect, as do the soft leather chairs. "We have plastic surgeon friends who go in for that Elizabethan stuff," he adds. "That's not our feel."

"Feel" comes up a lot. For example, Bittner says he has had to retrain doctors (AmeriScan contracts the work of evaluating scans to freelance radiologists) to be more approachable: "I have to remind them, 'Don't say cholelithiasis, say gallstones.'" Receptionists need a tougher skin, since Bittner says doctors sometimes walk in off the street and angrily accuse the staff of running a scam. "Our people have to stand up and say, 'Here are the medical references that you might want to look at,'" he tells me.

As Bittner leads me back to the examination rooms, I mention the radio ad. He says he tailored the narration to appeal to his target audience--homeowners 45 to 64 years old. "If you were doing a car sales ad," he says, "you might push 190 words in 60 seconds. We try to keep it under 165." Sensing my amazement that he knows this stuff, he reveals that his mother was once a top Lincoln-Mercury salesperson and was its first female fleet sales manager. (His father was a "one-man plumber.")

In the exam rooms, Bittner shows me the Siemens Sensation 16, which he praises as "the atomic bomb of CT scanning." It's an uncharacteristically poor choice of words, since radiation is one reason doctors don't endorse unnecessary CT procedures. I also get a look at the temperamental $1.5 million MRI machine, a 3-foot-long cylinder with a small opening through which patients slide. Bittner says that last year, when he had only four centers, he did just under $10 million in sales. He's hoping that an expanded menu of zero-radiation MRI services will push per-center revenue to $3 million or more. It will also leave AmeriScan less vulnerable should the FDA decide to prohibit CT scanning without a physician's referral, which, given radiation concerns, Bittner thinks is a real possibility.

On a shelf along the wall, I spot pink paper bags, which turn out to contain gift-with-purchase souvenirs for the $1,695 MRI BreastScreen. I already know from Bittner's radio ads that his mother is a breast cancer survivor, and that X-ray mammography missed her tumor. He says reputable studies show that MRI detects nearly all breast cancers, though he admits that the claim doesn't make him popular at medical conferences. "I go in front of big radiology boards all the time and say, 'Guys, when you tell people mammography is the gold standard, you're killing women,'" he says. "I know it's not the party line, but I took a Hippocratic oath to do no harm. And withholding technology that saves lives is doing harm."

Famished, we head to an Italian restaurant in the mall. Along the way, Bittner shows me little things he does to preserve his own health. He makes sure we walk up the stairs rather than take the escalator, and promises to order "something with sausage, but not in a cream sauce." At our table, he tells me AmeriScan has the potential to get people thinking about their bodies the way he does, because once someone sees inside the temple, they're more likely to revere it. In fact, he wonders why big pharmaceutical companies haven't already invested in AmeriScan. "Take Merck," he says. "The average age that a patient starts on statins"--cholesterol-reducing drugs like Merck's Zocor--"is in the early 50s. We could lower that by a decade."

He anticipates my next question.

"There are those who say I'm peddling paranoia. They have it all wrong. The issue is, How do you get people to stop smoking, to quit buttering their bread? You do it by saying, 'Bob, here's a picture of your heart. Put it up on your fridge.' That's how they see they're screwing themselves. And we're talking, at most, $2,000 for the whole shebang, so to speak."

Choosing a scan isn't easy. do I want the "Complete Cardiac Evaluation" or the "Executive Health Evaluation"? On the advice of the AmeriScan operator, I opt for the "Zero Radiation MRI Full Body With Head," which costs $1,160 and comes with a Windows-compatible CD-ROM of my images. She fails to tempt me with a half-price special on a virtual colonoscopy.

On the day of my appointment, a video in the window advertises Baby SneakPeak, a high-resolution MRI of a child in utero for $495. Baby SneakPeak is to ultrasound what high-definition TV is to an old black-and-white console. The digitized baby in the window is Bittner's unborn son, Max.

The scanning takes 10 minutes. Less than half an hour later, Helen, a nurse practitioner, is showing me--slice by slice--my own brain. We fly through my lungs, kidneys, and liver, and watch a three-dimensional movie of my heart, all on a PC display. Not to brag about my own tissue, but seeing these things is so incredible that I almost pass out. Helen asks if I'm OK and then uses the mouse to measure my prostate. "39.05 millimeters," she says. "Normal."

A week later the radiologist's report, signed by Bittner himself, arrives in the mail. Happily, it's a clean bill of health. It concludes by recommending additional scans for "optimal health screening and protection."

Sound advice, or opportunistic cross-sell? Without a second opinion, it's hard to say. But if Bittner succeeds where others have failed, perhaps it's because, like every great marketer, he truly believes he's offering both.

Andy Raskin (araskin@business2.com) is a senior writer at Business 2.0.