Obama Passes on Colonoscopy: Oh, What Might Have Been!

Does anyone out there know why President Obama underwent a virtual  ‘colonscopy’ (VC) instead of a conventional colonoscopy earlier this year? In my gastroenterology practice, we do not offer colon cancer screening to 48-year-old individuals, unless special risk factors are present. Of course, maintaining the president’s health is in the national interest, so I understand why professional screening guidelines might not apply to him. For similar reasons, airline pilots are subjected to routine cardiac testing, not to protect the pilots' health, but to protect the passengers.  Stricter scrutiny of the president's health is proper.

So, if the national interest required that the First Colon be studied prematurely, then why didn’t the president choose the screening test that nearly every physician opts for when we turn 50?  I’m baffled.

It is inarguable that a colonoscopy is more accurate than VC and can remove polyps and obtain biopies at the time of the examination. In every instance that I recommend a colonoscopy, I present virtual colonoscopy as an alternative adventure of the lower bowel. Patients invariably reject it, despite its safety advantage, because they do not want to endure a VC laxative prep to discover afterward that they need a colonoscopy to remove a lesion.

VC also has radiation risk, which is belatedly capturing the attention of the press, physicians and the public. The FDA acknowledges that radiation exposure from VC is equivalalent to about 400 standard x-rays. We have been broiling too many patients for too long.  I am also concerned that VC, like all CAT scans, will discover incidental ‘abnormalities’ outside the colon, that will generate anxiety and a medical cascade chasing these faux lesions that are nothing more than radiographic curiosities.

Medicare has declined to cover VC for colon cancer screening, presumably as they have not been persuaded by available data.  Interestingly, ABC news reported last week that Julian Nicholas, a former FDA scientist (can I call him a ‘Whistleblower’?), stated in an interview that "there was an absence of sufficient, valid scientific evidence to conclude that the use of CT devices for colorectal cancer is both safe or effective." Nicholas alleges that after he declined to withdraw his objection to VC, he experienced a VT, a virtual termination. The FDA states that there was no retaliation against Nicholas for his dissenting view. Yeah, right. Sounds like the agency spokesman was engaging in some VS, or virtual spinning.

Perhaps, President Obama wanted to avoid the sedation that is administered before a conventional colonoscopy. Was he scared to transfer his presidential powers to the Vice-President? Did he fear that during these few hours, that Biden might go soft on Netanyahu, invite Jeremiah Wright to a White House prayer breakfast or simply start spewing ‘BFD', as he did in the president’s ear – and in ours- just prior to the signing of the health care reform bill?

What would I have done if I were the president’s gastroenterologist? I would have devised a solution that would have met two tests:

• Provide premier presidential colonic protection
• Permit the president to retain his powers

This is easy. I would have advised the president to undergo a traditional colonoscopy without sedation, as routinely occurs in many nations whose citizens do not have the expectation of comfort that we Americans do. In addition to receiving Cadillac colonic care, there would be a political dividend. The president, by shrugging off a few stomach cramps, would show the world his toughness. This would earn him deserved respect from his political adversaries here at home, and might induce some leaders abroad to reconsider their policies. While all of this is hypothetical, here are some headlines that might have followed a presidential colonoscopy sans sedation:

Nervous Ahmadinejad Invites U.N. Inspectors Back
Kim Jong-il Surrenders Nukes. Sends Obama Flowers
Chinese President Hu Demands Sanctions on Iran
Senator Mitch McConnell Supports Public Option
Hillary Clinton States, “Honored to Serve as Obama's #2”
Washington Monument Renamed the Obama Obelisk
Obama Promised Nobel Prize in Medicine 2011
Dick Cheney Invites President on Hunting Trip

Mr. President, your colon cancer screening choice had geopolitical ramifications. While this damage is done, there may be a way to restore some of our power and prestige. Find out when Biden is due for his next colon exam. If it's not due for a while, then declare it to be necessary now by executive order. Direct him to proceed without sedation, so the world can fear and respect the man who is a heartbeat away from the presidency. If he balks, tell him that he needs to take one for the team. Afterwards, at his bedside, let him know that his sacrifice was a 'BFD' for the nation.

Unsedated colonoscopy could become a new standard for political candidates. Their handlers would make sure that after the candidates kiss the babies, eat rubber chicken, acknowledge the local mayor and dignitaries, wear a hard hat and reject polling data; that they will jump on board the GI Colon Express with only a bullet to bite on for anesthesia.

Are you listening Mitt Romney? Here's your opportunity to vault ahead before this procedure becomes as politically required as eating at the local diner. Go for it, Mitt.  There will be light at the end of the tunnel.