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Presidential Screening

President Obama had a virtual colonoscopy earlier this month—apparently, against the recommendations of the U.S. Preventive Services Task Force (USPSTF). Rita F. Redberg, MD, editor of the Archives of Internal Medicine, published an online editorial about Obama’s 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.”

My first reaction to Redberg’s editorial centered on the fact that the rules are different for the president of the United States. News reports about the presidential virtual colonoscopy noted that he was awake for the procedure and thus did not have to temporarily relinquish presidential powers, as would have been the case if he had been sedated for standard colonoscopy. That seemed reasonable to me.

Some pundits and advocacy groups seized the opportunity to note that Medicare would not cover the president’s virtual colonoscopy. While I thought that was funny, the rules for this nation’s commander-in-chief are different. I don’t know the details, but I’m sure that Obama has excellent health insurance coverage with liberal coverage for all kinds of exams, lab tests, and experimental treatments—even if they’re not necessarily supported by clear clinical evidence. Being the leader of the free world should offer some perks.

Then it occurred to me that when it comes to healthcare, people in this country expect the same kind of treatment the president receives—preferably at taxpayer expense, too. And just like in Washington, people only want the data driving decisions if they happen to agree with the data’s conclusion. Like many things in medicine, screening is about much more than the scientific data supporting or opposing a given screening test. Even if the data were overwhelming, the combination of emotion, advocacy, anecdotal experience, politics, and financial implications routinely win out over data.