Yesterday's post looked at the issues relevant to health-care reform raised by the fact of the president's recent annual physical, starting with the act of getting an annual physical exam in the first place. The U.S. Preventive Services Task Force (USPSTF) has long recommended that rather than a  lock-step, one-size-fits-all approach, periodic health screening be conducted according to individualized factors. 

"This year's examination focused on evidence-based screening prevention and primary care, targeted to the president as an individual and his occupation," the exam's final report stated. And indeed, the president, who is 48, was too young to warrant much in the way of screening, save for some standard blood work and the hands-on portions of the exam. He did receive a PSA test, which would not have been warranted at his age were he not African-American.

Perhaps the test most relevant to the developing rancor over evidence practices, however, was the news that the president received a virtual colonoscopy. Colon cancer is the poster child for preventive screening — it is the second leading cause of death by cancer in the United States and research shows it can be prevented if tumors are removed in their early stages. Screening is recommended after 50 and after 45 for African-Americans; options include fecal testing, two kinds of scope procedures and  the procedure undergone by the president, virtual colonoscopy. 

A three-dimensional reconstruction
Virtual colonoscopy is your basic Pixar stuff — a three-dimensional reconstruction of the interior of your nether regions created by sophisticated imaging software that spits out a high end gastroenterology video game allowing radiologists to surf your intestines like Raquel Welch at the helm of her microscopic sub in the "Fantastic Voyage." The patient needs only spend 20 seconds while prone in a scanner with his colon inflated, which is little more than how you or I feel upon reclining onto a queen size pillow-top after a big night at the burrito house. It is not invasive, requires no sedation, and carries none of the small risk of perforation required by colonoscopy. What's not to like, right?

Well, as of last summer, Medicare will not pay for it. (Cue pipe organ.)

The original decision is 30 pages long. For those seeking to test their GI terminology tolerance, it is here. But I can cut to the chase: It is written by a thuggish team of Obamacare henchmen, cold-blooded apparatchiks paid by the hour with the simple goal of taking over one sixth of the U.S. economy for their droll amusement. I know that, because I read all about it last summer on the Wall Street Journal editorial page. The editorial, which somehow managed to mention a crush of lobbying from the makers of imaging technology as a defense of the practice, left no Big Brother stereotype on the bench, referring to "the program's central planners," in referencing Medicare scientists and stating that "this is a preview of how health care will be rationed when Democrats get their way."

As Gary Schwitzer has recently reported, part of the uproar may have little to do at all with what works, but rather a turf war between medical specialties.

An argument for integrated medicine
The ruling pits radiologists against gastroenterologists, which if nothing else, is surely an argument for integrated medicine that rewards outcomes, rather than services. But as the New England Journal of Medicine reported at the time, the decision not to pay for fly-through colon exams was based on something far less territorial. It has not been sufficiently demonstrated to work in the population served by Medicare.

As for the president, perhaps he gets a pass for getting a high-tech colon exam. Simply putting him under sedation for a standard colonoscopy would have required the temporary swearing in of the vice president. There's going to be some new costs associated with that one. And the colon exam is one in which the task force is allowed to look at costs.

Freelancer Paul Scott of Rochester writes frequently about health and fitness for various media. Susan Perry will return March 8.