Yesterday’s USA Today reports that Barack Obama had coronary C-T angiography and a virtual colonoscopy to evaluate the status of his coronary arteries and to screen for colon cancer.
This is truly distressing. There is good evidence that using CT scans to screen for cardiac disease finds coronary disease but does not improve outcomes – so why is our president getting this test? Colonoscopies are recommended for those 50 and over (Obama is 49), and virtual colonoscopy via CT scan is not recommended as an alternative to actual colonoscopy at this point. (It does not allow biopsy – and while it does not require insertion of a fiberoptic scope, it still requires the unpleasant preparation.) Both tests use CT scans – with nontrivial radiation exposure.
I’m sure the President’s physicians feel like they were offering Obama exceptional care. Doing more high tech “noninvasive” tests gives the ‘sense’ of decreasing uncertainty, although we often end up with more data that is difficult to incorporate into a plan of care. If we want to convince the public to accept the results of comparative effectiveness studies which might constrain future care, we should start at the top by not providing non-recommended care to our President.
