Obama's Preventive Care Pitch

Last night, President Obama made a pitch for preventive care in his address to a joint session of Congress on health care:

And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies - because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

As a doctor who has held the hands of patients dying from totally preventable illnesses, I couldn't agree more. The largest number of deaths in the United States are caused by two preventable causes -- tobacco smoking and high blood pressure -- killing an estimated 467,000 and 395,000 people respectively in 2005. The list goes on and on, including obesity, physical inactivity, and poor diet.

When I was working in the emergency room as a medical resident, it was heartbreaking to see a patient with poor routine medical care roll into the emergency room with a devastating stroke that could have easily been averted with regular office visits and blood pressure medication -- both relatively inexpensive compared to the cost of caring for the stricken patient.

We're not preventing enough deaths by the types of cancer screening tests mentioned by President Obama. One reason is the technology is still not good enough. We need to develop better screening tests that pick up problems early but don't lead to an unacceptable number of unnecessary biopsies, procedures, and further tests. And not enough patients are screened. Only about about 60 percent of women get mammograms and about 50 percent of men and women get routine colonoscopies.

Lack of insurance coverage is certainly a big reason why some patients don't undergo screening. Another reason is patient fear and misunderstanding. In order to educate the public about the risks of colon cancer and the benefits of screening exams, Katie Couric underwent a colonoscopy on national television in March, 2000. Three years later, researchers at the University of Michigan found that colonoscopy rates jumped by 20 percent across the country following Katie's procedure, calling the rise the "Katie Couric Effect."

It's almost 10 years later and we're still not screening enough patients. Although the death rate from colon cancer has dropped in recent years -- likely mostly because of screening efforts -- colorectal cancer still strikes almost 150,000 Americans every year and kills about 50,000.

As a gastroenterologist, I have seen patients' lives saved by the removal of polyps and early cancers found by colonoscopy. I have also taken care of patients whose colon cancers were found too late to save them. Over the years, I must have heard every excuse for ducking a colonoscopy. The top four (and my answers):

• I have no symptoms (most colon cancers start small and have no symptoms until they grow larger.)


• I have no family history of colon cancer (that's true in about 70 percent of patients with colon cancer.)


• I'm afraid it will hurt (that's why we use sedation and, if needed, anesthesia.)


• I can't do the prep (we'll figure out a way to clean out your colon that you can tolerate. And even if you have a tough night, it sure beats chemotherapy.)

For this week's CBS Doc Dot Com, I follow Katie's lead and undergo a colonoscopy with cameras rolling in an attempt to remind people that a screening colonoscopy can save your life. I had the benefit of a house call the night before by my office nurse, Debbie Fitzpatrick, who held the video camera and offered advice and encouragement as I had a taste of my own medicine: the colon cleanout solution. The colonoscopy was performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. For more information about the Jay Monahan Center, click here.

For more information about screening for colon cancer, click here.

To watch my colonoscopy, click below:


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Comments

[JDShipley]

I've procrastinated, too, but on Tuesday had my exam. One polyp was removed and found clear of cancer. The colon cleansing isn't any joy but the peace of mind is.

@ddktt: All procedures have risks and cynicism leads us nowhere.

@placebostudman: You diss on preventive medicine in one post and then support prevention through education in another. No doubt many illnesses are self-imposed but that doesn't argue against preventative health care and screenings such as discussed here.

[bannorhill]

Prevenitive care saves lives but does NOT save money. It should be part of health care.

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/31/AR2009083103854.html

[PlaceboStudman]

Preventative medicine is a joke. Everything that is called preventative medicine is in fact not medicine, but lifestyle choices. Everything from high blood pressure, cholesterol, diabetes, and even colon cancer can largely (no not completely) be controlled by eating right, not drinking alcohol, smoking, exercise, etc.

When are we going to start talking about prevention of REAL diseases and disabilities, like MS, MD, CP, CF, ALS, SIckle Cell Anemia, and the millions of other diseases and disabilities that are not preventable, because their cause is not known, therefore a cure can not be developed for them

When we start talking about real prevention of real disease, and not these side effects of gluttony and an instant gratification meccas of McDonalds and Starbucks, THEN we'll be discussing prevention

[lastpost]

“We need to develop better screening tests that pick up problems early”

For example: Olfactory detectors which function in that that spectrum of reality beyond the meagre range encountered by humans. Sensing scent particles emitted from cancerous growths. An experience hitherto confined to the awareness of those creatures equipped with appropriately refined systems.

[PlaceboStudman]

“We need to develop better screening tests that pick up problems early”

How about, instead, we invest in better education so that people don't develop those problems in the first place. Fewer problems, less money needed for those who need health care the most. As it is, most disease that we are focusing on is a matter of lifestyle choices or environmental factors. Eliminate those, and you dramatically reduce the need for health care, and give more money for research for things that can not yet be treated or cured

[AntiClast]

I am fortunate to have good health insurance so money is not an issue. I have to have my 2cd colonoscopy next month and I'm not looking forward to it. The last one consumed 3 days of my life. Maybe it gave me many more years, maybe the polyps would have turned cancerous.
I used to do the hemocult and my doctor would check the last 10 inches of my intestine, where he said most of the cancers are.
Now I have to spend a day preparing (within 10 feet of the bathroom), a day for the check, and another day getting over the anesthesia. It is a very intrusive test.

My question is: how many more cancers are being found now than with the earlier, easier, cheaper tests?

[RonTompkins]

I am a year past colon cancer. I was lucky because I knew the symptoms. Intertwining this with the insurance issue, my cancer is a pre-existing condition. Any cancer survivor with private health insurance is locked with their present provider and whatever rates they choose, currently $2,300 a month for family, due to his or her pre-existing condition, unless five years of litigation is your preference to insurance, five years being the duration of the litigation and the benchmark for cancer survival. The insurance companies wish to cherry pick their insureds from low risk groups, if they can. It is a matter of conscience that we make our entire nation one risk pool. I was foolish enough to prefer to be either healthy or dead without coverage and was inadvertently insured by the kindness of strangers and my wife, who is strange but not a stranger. Without single payer, which is adminstratively more cost effective than private insurance, the rest of the plan will not work. I give O'Bama's speech a 101 on a scale of100. We'll see how it goes. BY the way, you are in moredanger from not washing your hands than you are from a colonoscopy, folks.

[Clzwld]

"Dr. La Pook's insurance probably covers the test and the treatment."
Maybe he knows a doctor and can get a deal. (J)
The mystery of the medical? how much does it cost?
A little Google for a simple answer and and and not.
It would help if we could find a price and pay for it? Maybe save up for ? 6 months or so.
Maybe if I go to each hospital to check the menu and find the price schedule.
What no insurance Out out with you. We don't take those pennies.

[csavage]

My grandfather died of colon cancer when I was 6. He died 6 months after he retired and never once got to go on a trip with his wife, my grandmother. I still remember seeing my dad take the phone call when grandpa died. Tomorrow, I'm taking my husband to get his first colonoscopy. We have a HSA so we will be paying for the test out of pocket.
I've recommended thousands of colonoscopies to patients. I tell them that they won't remember the test and the prep is better than the alternative. Colon cancer is still the #3 cancer killer in this country and fiber's not a panacea-actually, the Masai tribe has the lowest rate and they drink cow's blood mixed with milk in their diet, blood being an excellent cathartic. Barring a blood and milk diet, be a little more proactive. I admitted plenty of people with GI bleeding due to cancer and it's really sad when you have to tell someone that their newly diagnosed cancer has already metasticized

[polarmaker]

I have insurance in Massachusetts. I pay $1000. for my husband and me with a $2000 deductible each and 20% co pay.. The colonoscopy my doctor ordered for me is not covered until deductible is met. Making $55,000 a year, we can't afford to pay $1000 for the test and also pay the monthly premium for insurance that won't pay for the test. Ironically, maybe something will go undiagnosed and I'll need surgery and then the insurance company will have to pay a whole lot more. Screening tests should NOT be subject to the deductible. My doc really wants me to get the test but if I use the money to pay for it, I can't pay the premium that month and it will be cancelled. Then, if something is found and I need surgery, I'll have no coverage!
This system is so unfair....and stupid!

[bannorhill]

Then go buy a different insurance policy.

I have not had those problems with my insurance carrier.

[livingecology]

if you eat fiber and mix in a good, strong probiotic, you won't have to worry about colon cancer, period; the problem is that most people's colons are rotting sewers instead of a functional, 24-hour composter it was meant to be

[PaiaGirl]

You are doing no favors by spouting this nonsense.

Yes you can MINIMIZE your chances. But not eliminate.

My dad died at 50 from undiagnosed colon cancer. I'd be dead today if it weren't for colonoscopies which started when I was 40. (Thank you Kaiser)

[zipowitz]

CBO says that Preventative care will actually raise costs not reduce them. Not that I don't believe in getting checked up on but they are right and Obama is incorrect. If he repeats their numbers in one sentence as fact then he can't deny them in another.

[wonketteRAWKS]

Exactly what I was thinking.

[dumboldfarmer]

Kudos to you for highlighting this. Unfortunately, last time I had one, recommended by my physician, I had to fight tooth and nail with my supplemental insurance provider (I am on Medicare) to get reimbursed even though it was pre-approved. It goes with the games they play. Their information even stated clearly that it was covered, yet they tried to deny. I appealed, and have to appeal nearly every bill submitted to them. That should not have to be done,

[noneIn2008]

Preventative care must make sure their are not pockets of illness that are hidden to grow. Undocumented workers must be covered, all people are people. If you exclude health care from the undocumented, you will increase pools of disease. Your place of birth should not make you a non-person in the USA.

[Thermodynamics]

The procedure costs $5000+. If you do it every 5 years that is $1000 per year.

For those of us on a limited budget, with crappy insurance that will not cover the test, this is too much. Most of us are already paying $3000+ for insurance.

Anyway, we probably can't afford the treatment if it does find cancer.

We have to make our dollars multi-task. Maybe it would be better to spend the $1000 on stuff like carrots and spinach to prevent colon cancer before it starts.

This illuminates the hidden issues that tell me we need lifestyle change, not just comprehensive insurance.

Dr. La Pook's insurance probably covers the test and the treatment.

[ddktt]

Amen. The way the system is set up now these tests are "mining for gold".

Ca-ching if they find something.

Too bad if they scare you to death with false positives and unnecessary procedures. I just heard of two catastrophes lately from this test resulting in perforated colons that resulted in infection. The people WERE healthy before the jumped onto the medical merry-go-round. Blue Cross doesn't want to cover the person who administers the anesthesia in CA--the m.d. is supposed to do both.

The patient's health is not the goal.

[PaiaGirl]

The treatment is done during the colonoscopy. If done every 5 years, the polyps are removed BEFORE they become cancer and require treatment.