This story is an advocacy statement wrapped in a news report’s clothing.
The physician-reporter led his report by saying the Medicare decision “was big disappointment to many advocates,” and then proceeded to provide a platform for those advocates, while excluding those who supported the decision.
Viewers of this story would probably be surprised to learn that Medicare produced a 30-page Decision Memo that summarizes the evidence the agency considered and responds to the public comments it received as it considered whether or not to cover virtual colonoscopy screening. Certainly viewers of this TV story did not get an objective description of the process or its results in this report.
Indeed, based on what’s shown in this story, viewers are likely to conclude that virtual colonoscopy is just as good as traditional colonoscopy, that coverage would increase the number of people who get screened appropriately for colon cancer, and that public subsidy of this technology would save more lives. However, not only is the available evidence comparing the technologies still evolving, the questions about screening rates and health outcomes have not been addressed by high-quality studies.
While the story states that virtual colonoscopy costs about $800 and traditional colonoscopy costs $700 to $1500, it fails to note that virtual colonoscopy should be performed twice as frequently as traditional colonoscopy according to many recommendations, thus the statement that “Traditional colonoscopy usually costs at least twice as much” is not an accurate comparison.
The st ory notes concerns about overall colon cancer screening costs increasing because any growths found during a virtual colonoscopy are removed through a traditional colonoscopy procedure, but then he dismisses that concern by stating that “advocates say reaching more people is worth the added expense.” The claim that virtual colonoscopy “reaches more people” is not supported by any evidence.
This story portrays virtual colonoscopy as being equivalent to traditional colonoscopy, even though that question is still being studied. The story also gives support to untested claims that covering virtual colonoscopy would boost screening rates and save lives.
The story does not make any mention of the consequences of repeated radiation exposure, perforation of the colon, the inability to spot small polyps, or other harms and limitations of virtual colonoscopy. There is no discussion of questions about the quality of training and equipment of virtual colonoscopy providers.
Since virtual colonoscopy also captures images of areas outside the colon, it is common for the scans to see things that raise more questions and often lead to further tests and interventions.
The story says virtual colonoscopy is “non-invasive” without pointing out that people have to go through the same restricted diet and laxative regimen as with traditional colonoscopy. In addition, during the scan a tube is inserted through the rectum so that gas can be pumped into the colon to inflate it. Many people would hardly consider that part of the procedure to be “non-invasive.”
Throughout this segment, the reporter and anchor make bold statements that reach far beyond the available evidence.
The story’s assertion that questions about the efficacy of virtual colonoscopy “have been laid to rest” is stunning, since (as the Medicare coverage decision noted) “No published study has evaluated survival following participation in CRC [colorectal cancer] screening with CT colonography.”
Although several professional associations supported the Medicare decision not to pay for virtual colonoscopy until more information is available, the two on-air people act as if all the questions have been settled.
No overt disease-mongering of the seriousness or prevalence of colon cancer But this story uses fear to push public subsidies of virtual colonoscopy by claiming it would save more lives than covering just traditional colonoscopy, despite a lack of evidence to support that conclusion.
This story quotes only an advocate of public subsidies for virtual colonoscopy. It gives short shrift to opposing views, not even mentioning the expert panels, professional medical associations and others who support the decision by Medicare to not cover virtual colonoscopy until more information is available about its value.
It is notable that although the physician-reporter is a member of the American Society for Gastrointestinal Endoscopy, he failed to mention that it is one of the groups that support the decision not to cover this screening test until more is known.
As a practicing physician who specializes in this area, that reporter is not a disinterested observer. He should have declared his own conflicts of interest.
Although this story compares different technologies for colonoscopy, the statement by the reporter that “for somebody who’s thinking about getting a traditional colonoscopy but is ducking it because they’re afraid of the procedure, a virtual colonoscopy is a lot better than doing nothing,” ignores the options of flexible sigmoidoscopy or tests for blood in a person’s stool.
We rate this as unsatisfactory because the story failed to mention concerns that not all providers of virtual colonoscopy are adequately trained or may not be using appropriate devices. Numerous studies say poor quality virtual colonoscopy can lead to unnecessary follow-up testing or missed cancers.
Not applicable in this case
We can’t be sure of the extent to which the segment may have relied on a news release. We do know that only one source’s quotes were used on the air.