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Sigmoidoscopy: The colonoscopy’s cheaper, equally effective predecessor

Posted Aug 23 2010 2:47pm

Physicians claims that colonoscopies are the gold standard of preventive medicine.  In 2008 the American Cancer Society deemed the colonoscopy as the preferred test and the health reform law (PPACA) will compel insurance companies to cover colonoscopies.  But does the sigmoidoscopy–the colonoscopy’s predecessor–offer less expensive, less invasive, equally effective preventive care?

[The sigmoidoscopy] looks at only half the colon. In that test, there’s no sedation, no day off from work, no jug of laxatives the night before and maybe no gastroenterologist. Your primary care doctor could probably do the procedure himself…

Colonoscopy is three to four times more expensive than the simpler sigmoidoscopy test. And the risk of complication is seven times higher. Still the idea caught on. And as it did, it transformed the profession of gastroenterology. We went from too many specialists to a national shortage.

In fact, the inventor of the colonoscopy, Al Neugut, wrote an editorial in the JAMA this summer stating that he regrets inventing the colonoscopy.  On Marketplace, Neugut said “If today, we were where we were in 1988, I would not institute colonoscopy based on the current evidence.”

The gold standard of preventive medicine may only be golden from the point of view of physician salaries.

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