As Paul Scott pointed out in this space last week, President Obama’s recent annual physical checkup stirred up some long-brewing controversy about the value of two medical screening tests: the computed tomographic (CT) scan for coronary calcium and the CT colonography (often referred to as a “virtual” colonoscopy).
President Obama underwent both tests.
On Monday, the controversy became a bit more heated with the online publication of an editorial in the Archives of Internal Medicine. In it, the editor of the journal, Rita F. Redberg, MD, expresses being “troubled” that the president’s physical exam included these tests, especially the CT scan for coronary calcium. (This test looks for the presence of calcium in the arteries and then, based on what it finds, provides you with a coronary calcium score. That score is supposed to indicate your risk of heart disease, but in many cases calcium deposits can be false-positives — invalid indications of heart disease.)
This screening test likely exposed Mr. Obama to significant radiation unnecessarily, increasing his risk of future cancer. A single electron beam CT scan is estimated to result in a lifetime excess cancer risk of 9 (range, 3-42) additional cancers per 100,000 persons for men. In light of this radiation risk, and the lack of proven benefit in low-risk persons, the U.S. 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.
The relevance of President Obama’s coronary calcium score “pales in comparison” to the fact that he continues to smoke cigarettes, notes Redberg. If he quit smoking, she says, his risk of having a heart attack or other cardiovascular event during the next 10 years would plummet by 72 percent.
Redberg also wonders why the 48-year-old president had a virtual colonoscopy:
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.
As Redberg points out, the use of these two controversial screening tests by the president’s doctors “reflects 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.