Do-It-Yourself Diagnosis
A CT scan can send a powerful message. So what's wrong with this picture?
The irony of virtual colonoscopy is that while scanning centers promote it as easy and comfortable, bowel cleansing is still a hated part of the routine, as with a regular colonoscopy. The day before, patients must swallow pills or several quarts of liquid that tastes like seawater, followed by frequent opportunities for bathroom reading. When 696 patients who had a virtual and a regular colonoscopy on the same day were asked whether they would repeat the exam annually, according to a survey in the latest Radiology, the percentage who said they would more than doubled if offered the possibility of no bowel prep. The patients also said ordinary colonoscopy wasn't so bad, and no more uncomfortable than virtual colonoscopy.
Peter Cotton, a gastroenterologist and medical director of the digestive disease center at the Medical University of South Carolina in Charleston, is no fan of virtual colonoscopies. With about a 30 percent chance that something will be found, he says, a biopsy must be done, so a follow-up conventional colonoscopy will be necessary anyway. "When they discover that," he says, "a lot of people figure, what the hell, I'll just go ahead." The only arguments favoring virtual colonoscopy, say experts, are the tiny possibility--1 in 750 or smaller--of perforation in the regular procedure, which can have fatal consequences, and that occasionally the cecum, a pouch at the beginning of the colon, can't be inspected.
Negative publicity for scanning centers has led some states, such as Pennsylvania and Texas, to claim they prohibit self-referral centers. State press releases even boast that they have closed offending centers. Complying with state law, however, usually requires nothing more than a referral slip that can be written by any physician--even if employed by a center. Short of a bad economy or a skeptical public, scanning centers seem poised to continue to reap profits from the worried well.
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