Colonoscopies Are Overpromoted, Overprescribed and Overpriced – Consumers Should Resist and Rebel

Introduction: A Few Questions to Set the Stage

Should you trust your doctor? Is the medical system organized and controlled by modern equivalent of highway robbers? What can we learn from the way colonoscopies are promoted and priced in America? What is the single most important takeaway lesson from a brief exploration of these questions?

Here are short answers to the first three of these rhetorical queries. I’m saving a response to the last question (i.e., recommended course of action) until the end.

  1. No, don’t trust your doctor, if you are fortunate enough to have ready access to one or more medical practitioners. Instead, be wary and verify, do independent checks on the pertinent issues and obtain other qualified opinions. Doctors and other provider are not your enemies but they’re definitely not your friends, either. They are highly trained professionals who function in a complex dysfunctional system oriented to profit. Most want to do the right thing but pressures brought to bear can lead even ethical practitioners to justify action courses not be in your best interest. In this essay, I’ll make the case that your interests and the public interest take a back seat to a higher power of sorts – the profit motive.
  2. Yes, the medical system is highway robbery, circa 21st century.
  3. Plenty can be learned from a close look at the colonoscopy industrial complex. The procedures being performed can serve as canaries in the American medical system coal mine. Pay attention, be alarmed and do what you can to save yourself before it’s too late.

Colonoscopies, Medical Providers and Free Enterprise Run Amuck

Colonoscopies are the most expensive routine screening test in this country. A report by the Commonwealth Fund revealed that this procedure is billed at rates ranging from $6,385 to $19,438. (See Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality, May 3, 2012, Volume 10.) These figures are retail rates for the uninsured; insurers usually negotiate prices down to about $3,500. Americans fortunate enough to have employer-based insurance often assume that medical care is basically free, despite rising co-payments and deductibles, but it’s not. Seniors on Medicare make the same mistake, often because they are exhaustipated (i.e., too tired to give a crap).

Like the high costs of our wars in Iraq and Afghanistan, everyone pays in the end, no pun intended.

In other Western countries, the price tag for a colonoscopy averages out at a few hundred dollars. Contrast this with the U.S. experience:

Americans pay more for almost every interaction with the medical system… A list of prices compiled by the International Federation of Health Plans found that medical services are more costly in every categories – by a huge margin.

We lead the world in medical spending, though numerous studies have shown we do not receive better care and we are less healthy than people in nearly every other Western nation.

Forms of Highway Robbery in America’s 4th Century

In case you have been on the moon or otherwise out of touch for several years, here’s a summary of why so many experts believe the U.S. medical care system is out of control:

  • Doctors prescribe expensive procedures. However, the high price tag of ordinary ones accounts for our $2.7 trillion annual medical care tab – 18% of GNP. ((Source: Elisabeth Rosenthal, Paying Till It Hurts: A Case Study in High Costs, New York Times, June 1, 2013.)
  • Doctors promote too many tests. According to the CDC, more than ten million Americans each year undergo colonoscopies (at a cost of $10 billion annually). One motive for so much testing is defensive medicine. America is as litigious as it is religious. Doctors are required (or pressured) by insurance regulations or their employers/partnerships/professional associations to prevent lawsuits, rather than to patient impoverishment or even bad health outcomes.
  • Pharmaceutical companies saturate the media with direct-to-consumer merchandizing. The saturation ad campaigns for drugs for whatever does or could ail you distorts patient judgements. Consumer appetites for quick fixes are encouraged. Patients are motivated to pressure providers for overpriced, overrated products.
  • Greed rules. So-called non-profit hospitals, insurance companies, device makers and other players in the medical industry are focused on generating the highest possible profits they can legally justify. The quest for maximum returns is by far the number one objective in the American medical system.
  • High tech, drug-focused treatments dominate. A disproportionate amount of medical care and expense is lavished on chronic conditions in later life, leaving fewer resources for prevention, education and acute care.
  • Cost/benefits take a back seat. Substantial medical care is lavished on ministrations that simply extend the dying process.
  • There are too few incentives to act sensibly. Overlooked in studies to explain the high costs and poor return on medical investments relative to other industrialized countries is a disturbing reality: Americans are overly fond of guns, gods, demigods and drugs. They are too little committed to reason and critical thinking, exercise, whole food plant-based dining and the art of shaping supportive environments for themselves and others.

Colonoscopies As Coal Mine Canaries

The colonoscopy gets my vote as the biggest scam in modern medicine. We should stop using the term colonoscopy – colonoscamy is much more descriptive and appropriate. The biggest scam distinction is no small honor or rather dubious distinction, given the abuses that could and have been documented about the U.S. health care system. Colonoscopies are marketed by fear tactics, not unlike religions. The high possibilities of horrific torment and premature death from colon cancer are sometimes described with almost wicked delight by colonoscopy counselors.

A year ago, I reluctantly agreed to sit for a pep talk by a renowned proctologist. The topic was why I should have a colonoscopy, despite no risk factors save old age. I consented to the interview only after years of get a colonoscopy badgering by friends, family members and varied medical practitioners, including even my dentist! The graphic descriptions of dire consequences of failing to detect a polyp would have done Hieronymus Bosch proud. I was reminded of the visions drawn by nuns 65 years or so ago at St. Barnabas Parochial School. The eternal hell-fires were described in such fine and vivid detail anyone would have been convinced the nuns had been there. I think all this fright was designed to insure that I never missed a mass on Sundays. (For a while, I didn’t, though I did arrive as late as possible so that my being there still counted.) So I listened to the colorful colonoscopy pitch – and still decided not to do it. (I even wrote an essay about the interview experience.)

Colonoscopies are billed as quasi operations. What a short time ago was a simple office procedure has morphed into a more complex booming business. Now there are surgery centers where lucrative colonoscopies are prescribed and performed in excess of medical guidelines. The goal is to maximize revenue; lobbying, marketing and turf battles among specialists, plus huge profit margins, account for the high costs. Other tests for colon cancer are less invasive, cheaper and equally effective.

Australia does not even pay for colonoscopies as a standard screening procedure and it is not common in other western nations, either.

The American Free Enterprise Anomaly

In this country, the government, unlike in any other industrialized nation, does not regulate or otherwise intervene in medical pricing, other than setting payment rates for Medicare and Medicaid. Other nations view health care as a right for all and regulate hospitals and the rest of the delivery system as public utilities. What conservatives like to call a free market is not so free for consumers.

Imagine if you went to a restaurant and ordered your meal with no clue what the dinner would cost. Imagine the anxiety waiting for the waiter to arrive with the check. Or, apply the medical care model to other normal purchases, large and small. What if the supermarket groceries you loaded up, took home and consumed were added up and recorded in your account, but you did not see the bill for days or weeks, well after you processed most of what you carried off! Such transactions are ridiculous, of course and yet that’s how it is in the medical system. I sometimes receive bills for medical procedures rendered a year earlier, after the hospital or medical practitioner has given up on negotiations for full or good enough payment from the Medicare insurer). It’s bizarre, irrational, unfair and intolerable.

Summary and the Promised Takeaway Lesson

Ask yourself, Do you have to be passive and tolerate this state of things? Consider that you do not.

First, with regard to colonoscopies, know that for most people, regular testing for blood in the stool is sufficient. Unfortunately for unwary, easily intimidated patients, settling for this low cost option is difficult. Such resistance to colonoscopies will be mightily resisted by medical counselors involved with the procedure. Stool testing is not a high revenue producer for this industry.

What can you do to avoid spending more for lower quality medical care while becoming less and less well? You have three options: Die, move or adopt a REAL wellness lifestyle. Stick with the latter until you do move or die. Personally, I’m going with the REAL wellness lifestyle. With regard to the colonoscopy issue, I favor a whole food plant based diet, plenty of exercise and lesser methods of cancer detection over the unpleasant, costly and dubious invasive procedure. Life is full of risks – and the flesh is heir to more slings and arrows than there will ever be costly medical tests to detect and treat early on.

Getting back to the three options (die, move or adopt a RW lifestyle), I go with the latter as well because the few countries I’d want to call home (Australia, New Zealand, Canada and El Dorado) might not have me. But of course I really and truly favor this choice because REAL wellness is a richer way to be alive. It’s the only way to fly, or live, in my opinion, even if it did not save money and grief on all kinds of chronic medical problems I’d surely have to endure if I were obese, sedentary, bored or ornery – and I’m definitely not fat, sedentary or bored.

Real wellness is my suggested takeaway from this precautionary tale of the colonoscamy in America.

Why I Love the Chinese Army

I love the Chinese Army, but why? I am a Quaker, so am a pacifist who actively dislikes military engagement and military thinking. Collaboration is the way. Is it that I am biased in some way? Perhaps. I love Tai Chi, Chi Gung and Chinese medicine, but that surely is not enough?

Ah, then again I have my eldest son; now that strikes nearer the heart. My first wife was Thai, but ethnically Chinese, so I have blood that is Chinese, and he has three children, so that’s an even deeper level of commitment. But to love the Chinese Army? What have they ever done for me?

To be precise: nothing. You see it’s like this. Two years ago I went into hospital with a near fatal cancer. I had at the time a terrible dream where I was trapped and being dragged down to my doom – and when I suddenly awoke I knew something bad was happening or going to happen to me. In hospital they cut the tumour out but it was malignant. But what has this got to do with the Chinese Army?

Well, the other night I had another strange dream, only this felt very different. I dreamt I was in a large square, or rather grand rectangular area, like one in a city centre (Tiananmen? I have no idea) and there were hundreds, maybe thousands of people, and I was one of them. Suddenly I became aware of this massive and aggressive disruption. As I looked I could see these strangely dressed Chinese people, but in large overcoats and furred hats, and the coats had a strong bluish tint and the tail-ends were reddish. They were causing mayhem and they seemed to have weapons, although in the dream I could not make out what the weapons were.

I knew I was in danger myself, certainly I if were to approach near to them, so I hid back amongst the crowd of other panicking bystanders who were rushing off in all directions. Then all might have been lost, but out of nowhere an army appeared, a Chinese army. And they were all in order, phalanxed and disciplined. They faced the disrupters and called out for them to surrender; but they weren’t going to. However, the presence of the soldiers seemed to inhibit them; they neither seemed so numerous or so dangerous now. The phalanxes surrounded them – their number, their order, their sense of purpose intimidating and curtailing the excess in front of them.

Then, as one, the army paused, or seemed to pause, but simply placed their rifles vertically and attached bayonets. I knew what they were going to do, but was not permitted to see it in the dream. Without words, they closed in and bayoneted the rioters to death – they went in and in, jabbing and doing their grisly business relentlessly till it was done. And I watched them from afar.

Somehow I had to hold back and not rush in to see the carnage, which I knew was there, but I knew in my heart of hearts that the job was done. The Chinese Army had entirely destroyed these looters, these freeloaders, these rioters, this rabble of destruction and I awoke and was so glad. This was necessary. This was not like the dream before.

For I realised at some deeper level what this dream was about. The Chinese Army is my – and your – immune system. And mine had been sluggish and ineffective for far too long. Now it had been activated and it had spotted those tumour cells – those rogue anarchists who seek to undermine the realm, the kingdom of myself. But the army – millions of them – were now back in action and they were deadly, as they should be. What were these tumours compared with the Red Army, my red army?

So as I go forward into 2014 I bless the Chinese Army, confident in the belief that my tumours are dead, and that this metaphor is a lesson for us all. We need to mobilise or own inner resources, and powerful metaphors are a key.

Immediate Release – Fiber and Diverticular Disease: Stop the Pressure Stop the Pain

No, no, everyone sit down and stop applauding. It may not be quite as exciting as you think.

In the world of digestive disorders, fiber is probably the most controversial subject. There is a lot of true and a lot of false information about this subject.

Let’s start with what everyone agrees on. In a healthy person, fiber is good. Most people get too little fiber in their diet. A diverticulitis diet, one rich in fiber, will assure you you’re taking positive steps toward your own recovery.

The real problem with lack of fiber is low volume in the intestines, a direct link to diverticulosis; here too, a diverticulosis diet is one of the keys to good health. It might help to think of your intestines, and especially your colon, like a tube of toothpaste. When you get down to the last toothpaste in the tube, it is a lot more work to push it out of the tube. This is the danger too low fiber and too low residue eating has on your system. Eating a diet low in fiber is much harder on your intestines than a higher fiber diet would be to “move things along.”

I do have to tell you, however, once you already have diverticulitis or colitis, adding a lot more fiber suddenly is not necessarily a good idea. Consider for a moment you have a much damaged colon. If you have pain, diverticula, fistulas, sores, wounds, and tears to begin with, then you’re already on a road with a sign at the end, reading “Watch out.” Here’s why. Your colon like the contents in a tube of toothpaste is weak, injured and may even have small tears in it. Suddenly adding a large volume of anything can actually cause complications and lots of pain. When the “tube” is weak you don’t want to add to the physical pressure it is under. Again a diet for diverticulosis is one of the closest remedies you have in your control to rectify a life of bad eating habits.

Only you and your doctor can assess whether or not you have open wounds and tears. Most people with colitis or diverticulitis are not at this level of crisis. If you know your colon is sound, gradually adding fiber is healthy and very tolerable for nearly everyone. When you increase your bulk by adding fiber to your diet, you move material through your colon much like you squeeze toothpaste through a tube of toothpaste. You make it easier for your colon to move the material through successfully. This process of movement is called peristalsis. Think of peristalsis as the motion of your hand squeezing the toothpaste tube. Lots of toothpaste makes it easy to dispense, while smaller amounts of toothpaste makes it difficult to move out of the tube, and the tube gets traumatized in the process of forcing the small amounts through it. This analogy is not far from the truth.

If you don’t eat at least 25% to 50% of your diet from the produce section of the grocery store or from your garden, you probably have a low fiber diet. A diverticulitis diet can treat or prevent diverticulitis. Some good examples of diverticulitis foods are canned or cooked fruits without skin or seeds, and vegetables such as green beans, peas and potatoes (without the skin). The less fresh produce you eat, the more you should add fiber back to your diet. In the meantime, supplement your fiber with something from the grocery store or health food store. I don’t like naming brands, but concentrate on healthier fiber choices. They all help. The one thing I recommend against is choosing a fiber source which is loaded with sugar, or worse yet contains artificial sweetener. I know it is annoying to listen to me sometimes telling you why “nearly everything is bad,” but my first passion is telling you the truth. I am not going to tell you what you want to hear instead of telling you the truth.

If you won’t listen to this advice, here is simple list to give you “best, better, good, and bad” choices.

Best: When your colon health is decent (no wounds or tears), gradually increase your fiber intake with fresh produce until you have at least one substantial movement per day and preferably two to four times per day (although they may not all be substantial). Once you get use to a diverticulitis diet, it’ll become easier for you to make the right food choices for you.

Better: Same as above regarding colon health, but gradually increase your fiber intake by taking a supplement such as a psyllium seed, psyllium husk or psyllium powder. Flax seed (crushed or powdered) is also a great fiber choice and includes some omega oils and nutrients as well. When choosing your fiber, avoid too much sugar and avoid all artificial sweeteners. In my opinion, they are toxic.

Good: Same as above regarding colon health, but take any type of fiber you can tolerate well, sugared, artificial sugar, pills, tablets, etc. Do something to improve your volume and it will still benefit you.

Bad: Keep doing what you are doing now and pretend you are going to get better. It is true, the program alone will cure diverticulitis and colitis, but the volume of stool moving through you is always going to be a factor in your internal health.

One definition of insanity is: Keep doing the same thing you have always done, but expect or hope for a different result.

Fiber is good for us for other reasons as well. The shape and non-softening nature of fiber makes it an internal “scrub brush” as it moves through us. It is the most effective internal cleanser we can use. If you look at people as a machine, such as a car for example, the internal dirt and buildup needs to be addressed periodically. In a car, this is handled with the 3,000-mile oil change. In people, especially in the UK, Australia, Canada and the U.S., we no longer fast (go without food periodically). We are rich enough and food is accessible enough we have come to think of missing a meal or two as some type of plague which has us “starving.”

Because we no longer get enough fiber, and we almost never fast for a 24-hour period (a natural cleanse), we are never getting cleaned out. As a group, our plumbing is filthy inside. Please consider adding some fiber to your diet. When you take in fiber you also need to drink a full glass of water, per dose (except produce fiber), above and beyond what it takes to mix the fiber. This is because you want to make the material moving through your tubes the consistency of toothpaste, and not the consistency of a brick. Add fiber, add water, and get healthier. Adopt a sound diet for diverticulosis and you’re on your way to a healthier, happier lifestyle.

Please do what it takes to get over this horrible disease.