The virtual colonoscopy conundrum


Good LA Times piece: "Virtual colonoscopy at center of policy debate: Will Medicare pay for the procedure even though there's no consensus about its effectiveness?" Excerpts:

In an extensive, year-long, review of virtual colonoscopy, Medicare officials scoured medical journals, convened doctors and health policy experts and reviewed more than 400 opinions submitted in two public comment periods. colo-ct-082.jpg

Though many urged Medicare to cover virtual colonoscopies, others counseled caution.

"You have to be really, really careful when it comes to preventive services because you are starting with asymptomatic people who appear to be healthy," said Dr. David Shih, senior director of medical affairs at the American College of Preventive Medicine.


On Feb. 11, the federal agency drew a simple conclusion: "The evidence is inadequate." It recommended Medicare not cover virtual colonoscopy.

The move sparked an immediate backlash.

"There are those who believe we have to have absolute gold-plated evidence to OK a procedure," said Dr. Len Lichtenfeld, deputy chief medical officer at the American Cancer Society. "But the fact is that we are not getting the job done when it comes to colorectal screening. . . . We have an obligation to give the benefit of the doubt to Medicare beneficiaries."

Working with a Washington lobbying and public affairs firm, interest groups organized a briefing last month for lawmakers in the Capitol.

More than 50 members of Congress mounted a letter-writing campaign to the Medicare agency.

To some health policy experts, that kind of political pressure is one of the reasons the nation's healthcare system has become so inefficient. Few expect it change, however. .

"The issue is: Who is going to make the decisions about what we do and what we don't do in medicine," Lichtenfeld said. "Let's not kid ourselves: That is a political question."


Do you happen to know where we can find out what congressmen have signed onto this rather inappropriate use of their power so we can apply the necesary pressure from the other side?

There seems to be only limited circumstance where these precedures are necesary,that being when the colonoscopist cannot traverse the entire colon for technical reasons.

Congressional signers of a draft letter can be seen in a pdf file available at:

The Publisher

We live in a world of evidence-based medicine, but there are some studies that will never get done because of ethical reasons and others that may never have enough substantial evidence for other reasons. We must rely on a combination of evidence and sound reasoning when we make policies that impact public health.

It's an interesting debate. What is the cost of involved for a medicare backed procedure for preventive care on those who may not need it? I expect there's no escape politically since we're ultimately moving towards a government run health care system.

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This page contains a single entry by Gary Schwitzer published on April 20, 2009 10:38 AM.

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