The Price of Colonoscopy, NY Tiimes Letter to Editor

February 22, 2011
http://www.nytimes.com/2011/02/23/opinion/l23colon.html?_r=1&ref=opinion&pagewanted=print

To the Editor:

“States Aim Ax at Health Cost of Retirement” (front page, Feb. 14) describes steps taken by cities and states to control employee health care costs. One city, Wauwatosa, Wis., requires its employees to undergo “colonoscopy at age 50, to help forestall cancer and potentially high treatment costs,” you report.

Colon cancer screening with colonoscopy — viewing the entire colon — has almost completely replaced more limited sigmoidoscopy, which costs as little as one-tenth as much. Yet studies have repeatedly failed to show that colonoscopy reduces the risk of death from colon cancer more effectively than sigmoidoscopy.

Indeed, two national multidisciplinary task forces state that sigmoidoscopy is just as effective. Nonetheless, the American College of Gastroenterology recommends colonoscopy over sigmoidoscopy, and national health care legislation mandates that new coverage include screening colonoscopy.

And therein lies a clue to controlling health care costs. To do that, we need the discipline to apply scientifically based medical knowledge, without commercial interference.

John Abramson
Ipswich, Mass., Feb. 15, 2011