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 - 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,

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

    To watch my colonoscopy, click below:

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