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Journal editor troubled by Obama's CT scan for coronary calcium & virtual colonoscopy

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Archives of Internal Medicie editor Rita Redberg writes:

“I was troubled to read that the President’s physical examination included an electron beam computed tomographic (CT) scan for coronary calcium. This screening test likely exposed Mr Obama to significant radiation unnecessarily, increasing his risk of future cancer. …In light of this radiation risk, and the lack of proven benefit in low-risk persons, the US Preventive Services Task Force (USPSTF) recommends against this test in men such as Mr Obama. In addition, the leading professional cardiology societies do not recommend coronary calcium screening for such men. …According to news reports, Mr Obama also underwent colon cancer screening, even though this screening is not recommended in his age group. Moreover, even when he reaches age 50 next year, the recommended colon cancer screening tests are either fecal occult blood test or colonoscopy. The USPSTF does not recommend virtual colonoscopy for screening, as performed on Mr Obama, owing to the lack of supporting evidence. This CT colonography test, like the electron beam CT scan, increased his radiation exposure and subsequent cancer risk.

Inadvertently, but perhaps fittingly, the reports of Mr Obama’s physical examination reflect some of the key challenges facing health care reform today–Mr Obama appears to have been administered 2 cutting edge, expensive diagnostic tests that exposed him to a radiation risk while likely providing no benefit to his care. Some might defend these tests on the grounds that the President, of all people, deserves the very best our health care system can provide, but that would miss the point: more care is not necessarily better care. If the tests have no proven benefit for patients like Mr Obama, then they have no benefit for Mr Obama himself. Worse, evidence shows that the performance of unnecessary tests is not limited to Mr Obama or some select few patients. On the contrary, Mr Obama’s case is multiplied many times over at extraordinary cumulative financial cost to society and personal cost to the individuals who receive tests with known adverse effects and potential harms but without benefits.

It is unlikely that Mr Obama will have a dispute with his insurance company over the costs of the tests performed at his physical examination, whether or not they were necessary, but it is a certainty that we all will have great disputes over the spiraling costs of health care for the rest of us.”

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Comments (6)

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Paul Scott

March 9, 2010 at 3:14 pm

I too saw the glaring irony of a fly through colon exam for the president (and beat her to this by a day or so over at Minnpost), but I think if you go by the colorectal surgeons guidelines he was OK getting screened at 48 (his being African American pushes it down to 45). Plus, his mother had cancer, so that could put him in a higher risk group. Finally, a colonoscopy would have required some general anesthesia, which is a transfer of power situation if I am not mistaken, so they might have had that excuse not to use the colonoscopy, but he would have set a real example by getting the cheap, effective, low tech, fecal blood occult test. I did miss that he had the calcium scan.

crf

March 19, 2010 at 5:45 pm

“This screening test likely exposed Mr Obama to significant radiation unnecessarily, increasing his risk of future cancer.”
Could she give a range of how much his cancer risk increased, with citation?
I understand that you’d want to reduce patients’ radiation exposures, but the argument is more understandable when presented as a population risk, rather than on a personal level. The risk from a scan (or even the cumulative effect of all exposures) is likely small for any one patient: probably hightly individualised, and hard or impossible to measure.

DoctorSH

March 26, 2010 at 9:15 pm

Utter B.S.
I have recommended calcium scores for a few years now. The radiation used has been shrinking as the scanners get more advanced.
As for the cost of screening, a calcium score of the heart is by far cheaper than a chemical cardiac stress test, and is there not radiation in a myoview stress test? And what about the risk of contrast media?
This is nothing more than docs trying to keep the income streams going to procedures they can do, and that others can not.