Virtual colonoscopy and the message President Obama sent

President Obama had a well-publicized routine health exam last week.

One of the more controversial issues was the virtual colonoscopy he received. It’s been well covered here that virtual colonoscopy doesn’t have the same diagnostic accuracy as a traditional colonoscopy, and in fact, is not covered by Medicare or most third party payers.

With the President obtaining one, does that send out the wrong message?

Of course, radiologists — who stand to benefit financially from increased use of virtual colonoscopies — are applauding his decision. Mark Klein, writing in The Wall Street Journal, says,”He and his physicians correctly recognized virtual colonoscopy as an excellent alternative to screen for colon cancer. Why undergo a traditional colonoscopy—a procedure that carries a risk of serious complication and requires sedation—when a safer screening method is available?”

Dr. Klein neglects to mention that virtual colonoscopies may miss smaller polyps, and exposes patients to radiation as well as the possibility of unrelated false positives that a CT scan can find. In fact, the USPSTF recommends against virtual colonoscopy as a way to screen for colon cancer.

Perhaps more interesting is the message it sends to millions of Americans during this tenuous time of health reform:

[Virtual colonoscopy] is not a covered service under Medicare and many third party payers . . . The president is receiving medical care that the average American cannot and probably should not receive, he is being treated in a way not recognized by many medical societies, and he is avoiding a test — colonoscopy — that millions of Americans are avoiding wrongly. Not a great way to lead by example.

Indeed.

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  • http://guidonps.com Michael LaChapelle

    The President’s primary reason for having a virtual colonoscopy was that it doesn’t require sedation and he wouldn’t have to invoke the the 25th Amendment and transfer power temporarily to Joe Biden. I think this is a unique situation that doesn’t necessarily say anything about the relative value of virtual vs. traditional colonoscopies.

  • christophil, MD

    obama, bored certified in Poli.Sci. has a better idea, don’t you know. God help us all.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Well, since he’s sending out the wrong message with the other end (using submissive white coats as props), it sounds par for the course that he’s doing the same thing with his colon.

  • http://drpullen.com Edward

    WIth the recent computer models about CT related cancer risks I wonder if Mr. Obama just ignored this information,

    http://drpullen.com/2010/02/16/ct-scanning-and-radiation-exposure-wow/

    I had considered a CT colonoscopy, but would not put myself at this longer term risk for an inferior test.

  • http://glasshospital.com Dr. John Schumann

    The colongraphy (i.e. virtual c-scope) is not advantageous in my view for 2 main reasons:

    1. the radiation exposure, already mentioned above.
    2. still requires prep, and insufflation of CO2.

    So why subject yourself to a test that might miss small polyps and lose the opportunity to have any resected under direct visualization?

    I’m a general internist; I am not an endoscopist in case I sound like I’m shilling for one group over the other.

  • http://www.futurewaredc.com Chuck Brooks

    To say nothing about the advice to lay off the sauce. Nothing about how that might relate to the 25th amendment.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Yeah, Chuck I saw that.

    It got a blip on DRUDGE and then disappeared – without any MSM “outrage”.

    But tell the truth, aren’t you kinda relieved power didn’t transfer to Biden?

  • http://blog.insweb.com Robert

    The guy got a physical checkup and we’re slamming him because his physician preferred one type of colonoscopy over another? Come on…

  • ninguem

    I’m no fan of Obama, but I have to enthusiastically support his decision in this case. Joe Biden as acting President? Think of the damage he could do in an hour. He might try to give a speech or something. The laughter alone, American healthcare would be inundated with a flood of herniorrhaphies.

  • Rod

    He was not started on statins for LDL of 138 and some groups were beating up that decision.With the amount of stress his job holds, I wonder what the guidelines should be.

  • Evinx

    Obama + health care are a bad combination. How is the public supposed to listen to an individual who keeps on smoking (breaks promises to stop), is told to drink in moderation, + now goes for the virtual colonoscopy with all its inherent disadvantages.

    Sedation is no excuse – even if Biden is a buffoon. How much could he screw things up in an hour or two?

  • http://thedoctorwriter.wordpress.com/ Leigh Ann Otte–TheDoctorWriter

    Yeah, it’s kinda strange that he had a virtual colonoscopy. I understand the idea of not wanting to transfer power, I guess … but it would only be for a couple of hours, right? And what’s that compared to your life? On the one hand, I think it’s his own business. But on the other, well, you make some good points, Kevin.

  • Mark E. Klein, MD

    Kevin-I was disappointed with your blog today. First of all, many studies have demonstrated that Virtual colonoscopy (VC) is at least as accurate for the identification of significant polyps as optical colonoscopy(OC). It is true that diminutive polyps can be confused with retained fecal material on a VC study,and therefore these are not routinely reported on VC studies. These polyps are rarely significant, and there is a good deal of data suggesting that too many small polyps are removed during OC, unnecessarily increasing the risk of OC. Recent studies have also shown that optical colonoscopy not infrequently misses frank cancers, especially those on the right side. Several studies have implied that VC is superior to OC for identifying right sided cancers, and once one becomes familiar with VC it becomes clear why that is. As for radiation dose, the president received 3 mSv of radiation from his scan, the equivalent of his residing in Washington DC for one year. Any radiation physicist will confirm that this is an insignificant dose, even assuming it will need to be repeated several more times in the president’s lifetime.
    The USPSTF did not recommend against VC. They gave it an indeterminate rating because of their concern for finding extracolonic findings. The incidence of significant non colonic findings is about 4%, and many of these prove to be important including renal cell cancers, lymphoma, lung cancers and aortic aneurysms.
    VC is a proven technique which allows more people to be screened for a preventable disease. One last point. It is insulting to state that radiologists only want to do VC studies because of the financial incentives, just as it is to assume that any physician is primarily motivated by money. While some no doubt are, in my experience this is a minority. Contrary to the picture painted in the media, most physicians remain focused on doing the best they can for their patients. I am passionate about VC because it is an excellent, proven test that, if performed well, will without questions save lives. If a patient prefers OC that is fine, but for those patients who refuse OC VC is an excellent alternative.

  • gary

    I had difficulty finding a place that would do my colonoscopy without sedation (I don’t need the amnesia and finding a ride home would be problematic). I found most gastros to be seemingly uncaring practitioners who use sedation to increase revenue (faster exams) rather than patient comfort. I didn’t consider VC since I knew that I had a polyp from an in office flex done by my NP. The unsedated colonoscopy was easy and I’m not sure why anyone would want sedation for this exam.

  • ninguem

    Evinx – “Sedation is no excuse – even if Biden is a buffoon. How much could he screw things up in an hour or two?”

    I tried putting my answer in a Zip file, but the E-mail handler still crashed.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Poor Biden! The President was scared to sign over to him even for an hour or so. I tell every pt sent to me for a colonoscopy about the virtual study, as I feel they are entitled to know about this alternative. I’ve had very few takers for the virtual. The thought of going through a 2nd prep is more than they can swallow.

  • Daniel D

    Virtual Colonoscopy has a 20% miss rate. If the president has no family history of colon cancer, then the study is not justified at all. If he needs a colonoscopy, the procedure of virtual colonoscopy is waistful and a poor example of unnecessary medical test for the rest of the country

  • Steph

    You all are kidding me. What a waste of conversation. Please show me an article on Bush, Reagan, Bush, of this magnitude, Just SHEER IGNORANCE.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Well, there was the time Reagan got shot . . .

    And Steph, the “blame it all on Bush” act is getting pretty stale. THIS President is trying to re-write American healthcare in his own socialist image. THIS President is trying to present himself as an expert on healthcare even though he thinks Pediatricians perform tonsillectomies for the money. THIS President parades compliant white coats behind him at press conferences while lawyers and politicians draft 2000(+)-page legislation that few have actually read or understand.

    There is this concept of leading by example . . .

    So. Not kidding you. And please do not lecture me on “ignorance”. Because I’m one of the folks who got a preview of what the President/his party has in mind during my stint in public service under the Clinton administration.

    You know, HIllary’s “village”.

  • Karen

    VC has a higher miss rate than optical (regular) colonoscopy, that’s a fact. And regular colonoscopy DOES NOT REQUIRE sedation, although many patients seem to want it (until they experience side-effects) or are coerced into sedation because it make the exam easier, faster and more profitable for the gastro. The perforation risk drops dramatically when colonoscopy is performed unsedated; the patient usually feels pressure (from say looping) long before perforation occurs. Try comparing VC with unsedated regular colonoscopy, the latter is much better and more cost-effective.

  • http://www.MDWhistleblower.blogspot.com Michael Kirsch, M.D.

    Karen, regarding, “coerced into sedation because it make the exam easier, faster and more profitable for the gastro”, kindly explain. Our practice receive no $ for sedating patients for colonoscopy, which we do routinely. Do you wish to amend your comment?

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