The LA Times  reports on a new strategy that should encourage more people to get screened but may further increase our expenditure on health care.
12 thoughts on “The Laxative Free Virtual Colonoscopy”
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Everyone is entitled to his own opinion, but not his own facts. Founded by Mark Kleiman (1951-2019)
The LA Times  reports on a new strategy that should encourage more people to get screened but may further increase our expenditure on health care.
Comments are closed.
As it happens, I am reading Dr. Nortin Hadler’s outstanding book “Rethinking Aging,” (which reminds me, now THAT is a guy who should be writing for the RBC) and he absolutely demolishes most screening tests, including colonoscopies. As with his book “The Last Well Person: how to stay well despite the health care system,” Rethinking Aging” is an astringent and invigorating treatment of the corruption that has come to dominate the health care system, the search for the almighty dollar in a corporate-ruled system. Hadler is no DFH wearing beads and calling for single payer, but his honesty forces him again and again to tote up the staggering costs that produce a mouseful of benefit, and he is especially good at pointing out the hidden costs, the diminished lives that result from all this screening, which is the first step to turning people into profitable patients.
Of course, in health terms, there are millions of things we could do more useful than this gimcrack device, but then folks like GE wouldn’t profit, and then where would we be?
Thanks for the tip. I looked at it on Amazon just a few minutes ago and decided to purchase…
If it’s worth doing medically – and having lost a spouse to bowel cancer I’m inclined to give GE the benefit of the doubt – it should also save money, right?
A great deal of the high cost of scans in the USA (here, page 8) is down to high labour costs and general price-gouging and inefficiency along the chain. The machines sold by GE and its competitors are the same everywhere. In 2008 an MRI scan cost on average $1200 in the USA, $824 in Canada, $567 in the Netherlands, and $179 in the UK public sector.
Where does the extra money go? The radiologist? The technicians? The imaging facility? Do we know?
I knew a man who was in the business of buying and selling MRI’s. He guaranteed a facility a certain number of scans a month, for which he paid $600 each. He then sold them for $1100. And yes, he did have a reliable source of customers.
If it’s worth doing medically – and having lost a spouse to bowel cancer I’m inclined to give GE the benefit of the doubt – it should also save money, right?
I don’t think so, for two reasons.
First, the cheapest diseases for the medical system are the “we can’t do anything about it” kind. “We didn’t find out about it yet” are almost as good. (Note, here, that for the medical system is key; being sick, or dying, can cost society but not the medical system.)
Second, if a fairly-expensive screen identifies a treatable condition fairly accurately, the screening costs themselves can easily drive up total spending.
Your first point is true enough; but if medicine can’t do anything about the condition, then there’s no medical justification for finding out. This isn’t the case with many cancers, including those of the bowel.
On the second: bowel cancer survival rates do depend SFIK on how early the diagnosis is made. Early surgery – removing polyps by endoscopy – must be cheaper as well as more effective than the removal of a fully established tumour through the abdomen. If and when the cancer returns, the patient faces gruelling and expensive chemotherapy.
I don’t see the pathway to Matthew’s cost-raising scenario for this particular invention. It used to be the case that cancer (cheaply fatal) was the health insurer’s friend. Not any more.
As somebody who get his colonoscopy every five years, I wonder about people’s reluctance to undergo this procedure. Is it the laxative regimen? Or the fear of penetration? Or the loss of a workday?
My reluctance is solely due to the laxative regimen (was completely sedated for the procedure), which may be due to individual sensitivity issues. I never use laxatives, and felt very ill for about a week afterward, hardly able to eat, very nauseated. It was like the result of a very bad bout of food poisoning, to the degree that it was difficult to remain standing (blood pressure drop?) and I didn’t come close to finishing the dose I was assigned–I saw a lot of undissolved material at the bottom of the laxative jug, felt so debilitated that I dumped it down the drain rather than continue, and still was awarded the “excellent prep” description in my report.
I’m due for another one and am procrastinating, thinking: why can’t they improve this awful process? It’s good to know that maybe they have, but there has been other similarly optimistic progress reported over the years. I hope that this time they’ll get it right.
I know that this is a terrible disease if it isn’t caught in time, but it isn’t easy to subject myself to what I know is a quite disagreeable experience, especially as I wonder about how they landed on their recommended time intervals. One more month? Why not two? Six? And so on…
On the other hand, my father sailed easily through the whole thing and afterward his only question was “what’s for lunch?”
My reluctance is solely due to the laxative regimen
Me too, though I didn’t have as bad an experience as Kathleen.
By the way, a barium enema is worse, since it involves the same prep, but the procedure itself is unpleasant and painful. If your doctor wants you to have one, make sure it really is necessary.
Byomtov – Would I ever concur with your eval of the barium enema! I will never have another without general anesthesia; I’d rather die.
True, I had other issues that added to the pain of it (endometriosis) but the jerk just proceeded onward rather than cancel the test due to what he considered “discomfort”–yeah, right, “discomfort” that caused me to literally pass out from pain. Before passing out I actually saw stars—and still remember noting with amazement that this really happens! My experience was sufficiently torture-like that I wrote a formal letter of complaint afterward, and never even received a reply, let alone an apology.
I shudder even thinking about it, several decades later, although it was interesting on an intellectual level to learn how much pain it takes to cause me to lose consciousness.
Another vote for the laxative regimen. The procedure was a piece of cake, but the prep cost me most of three days of work. (Which, by the way, doesn’t get counted in most measurements of medical costs. So add $400-$1500 to the list price of the current procedure.)