Gastroenterologists bash CT colonoscopy in letter to President Obama

News that President Obama received a clean bill of health from a virtual colonoscopy several days ago rubbed influential gastroenterologists the wrong way.

On Monday the American College of Gastroenterology (ACG) fired off a letter to Obama stating that “while a ‘virtual’ exam is better than no exam, for most people, colorectal screening by colonoscopy is the preferred strategy.”

Signed by ACG president Dr. Philip O. Katz, the letter states that “our 11,000 physician members are concerned that you missed an important opportunity to set an example of the power of prevention by taking the test proven to prevent colorectal cancer by polyp detection and removal.”

Not only has the president done a disservice to the nation, Katz asserts, he has particularly hurt African Americans, “because evidence reveals that African Americans are diagnosed with colorectal cancer at a younger age, and African Americans with colorectal cancer have decreased survival compared with other racial groups.”

Dr. Perry Pickhardt, who nearly a decade ago set up the CT colonography program at Bethesda Naval Hospital where the President underwent CT colonoscopy, called the letter “unbelievable.” Pickhardt, now a professor of radiology at the University of Wisconsin in Madison, said he thinks the ACG is trying to bash virtual colonoscopy to protect “its cash cow.”

Pickhardt’s former colleague at the Bethesda Naval Hospital, Dr. Michael Puckett, said he believes the college might have “felt they had to say this.” The two men say ACG’s fears are misplaced.

Puckett, now a diagnostic radiologist at San Diego Imaging, which supports four hospitals and two imaging centers, works closely with gastroenterologists in the San Diego area. He provides virtual colonoscopy to patients who cannot complete optical exams, as well as to those who, for one reason or another, prefer a less invasive approach.

“Almost all my patients are referred by gastroenterologists,” Puckett said. “They have come to know me and know what I can do.”

Pickhardt says he has performed 7000 virtual colonoscopies since he came to the UW seven years ago and demand for optical colonoscopy “has only gone up.” CT colonography, he said has “been complementary.”

Collaboration was not on Katz’s mind, however, when the leader of the gastroenterology world scolded the leader of the free world for his poor choice of diagnostic procedures, stating: “We hope that any healthcare reform policies endorsed by the White House will be informed by the best clinical science and the best economic evidence—which clearly demonstrates that colonoscopy has the power to both save lives and save healthcare resources in the long run.”

Katz does not mention that the American Cancer Society recommends both conventional and CT colonoscopy. Instead the page and a half letter to Obama refers to optical colonoscopy as the preferred test for detecting colorectal cancer.

The answer to the implicit question—preferred by whom? —is clear when Katz notes in the letter that “The American College of Gastroenterology recommends colonoscopy as the preferred colorectal cancer detection test.”