Virtual colonoscopy: good enough for the president but not the American public?

On Feb. 28 President Obama was screened for colorectal cancer using CT colonography. The results from this exam, also called virtual colonoscopy, along with those from the rest of the president’s annual physical, which was done at the National Naval Medical Center in Bethesda, described the president as “fit for duty.”

Obama was a tad behind the curve clinically. African Americans should be screened beginning at age 45. But he’s way out in front on the technological curve. Virtual colonography is beyond the reach of many Americans, not because physicians don’t have access to it but because most insurers refuse to pay for it.

Dr. Perry Pickhardt, who set up the virtual colonoscopy program at the Naval Medical Center before joining the radiology faculty at the University of Wisconsin in Madison, says virtual colonoscopy is as effective diagnostically as conventional colonoscopy; it presents less risk of complications to the patient. And it is more cost-effective. Yet Medicare and many national third-party payers, such as Aetna, do not reimburse for virtual colonoscopy as a routine screening tool.

“It is still being viewed as a lesser test even though, for those in the know, it is the preferred test in almost every way,” said Pickhardt, who led the study done at the Bethesda Naval Hospital and published an article in the New England Journal of Medicine in 2003 that put virtual colonoscopy on the medical map.

Conventional colonoscopy was an option for Obama in his physical last weekend. It was chosen, in fact, several years ago by his predecessor, George W. Bush, who temporarily handed over executive powers to the vice president because of the needed sedation.

Obama might have wanted to avoid having to make such a transfer. But it’s doubtful that the president’s physician would have opted for an exam if it were not a reliable clinical test to screen for cancer. No worries there, says Pickhardt. Polyps as small as 6 mm are evident on CTC, he said, making the technology at least as good as optical colonoscopy.

Pickhardt hopes that the presidential endorsement raises questions in the public mind about the virtual colonoscopy. If it’s good enough for the president, he asks, why isn’t it good enough for Medicare beneficiaries?

A few months ago, questions about elitism entered into the debate on Capitol Hill over healthcare reform, when antagonists of the administration’s reform efforts questioned whether the American public deserved the same quality of healthcare coverage given those in Congress. The president’s recent CT colonography adds fuel to that argument, as do the virtual colonoscopy exams routinely, and quietly, given members of Congress at Bethesda Naval Hospital.

“When I was at the Bethesda Naval Hospital, we did a lot of members of Congress and other VIPs inside the Beltway,” Pickhardt said. “I think the general public doesn’t realize the true advantages of virtual colonoscopy.”