Colonoscopy or Cologuard? Which is Best for You?

 

Colon cancer is the third leading cause of cancer in the United States in both men and women. When identified in the early stages it is curable. But if it has already metastasized, the prognosis is grim. Therefore, screening for colon cancer is vitally important.

If you’re over the age of 50, you’ve probably already had a colonoscopy to screen for colon cancer. But lately, you may have heard about a new screening test, called Cologuard. No unpleasant bowel preparation; no trip to the doctor’s office, no IV sedation, no anesthesia hang-over, no colonoscopy! Sounds great. No more colonoscopy, right?

The Cologuard advertisements report 92% effectiveness in identifying colon cancer. You simply provide a stool sample in the privacy of your home, place it in the kit provided, and mail it in using UPS, shipping costs prepaid. It’s certainly easier than colonoscopy but how does it compare to colonoscopy or other screening methods?

Chris Conover, Duke University economist, recently studied this question for personal reasons and summarizes his findings:

Screening Methods

  • Colonoscopy – the best life expectancy per decade. Required once per 10 years.
  • Cologuard – loses 5.5 – 9.5 days of life expectancy per decade compared to colonoscopy. It is required every 3 years.
  • Sigmoidoscopy – a shorter version of colonoscopy requiring less bowel preparation but still invasive and (hopefully) involving sedation. It is required every 5 years instead of the 10 years for colonoscopy. Statistically, it loses 3.7 – 7.0 days of life expectancy per 10 years compared to colonoscopy.
  • Annual Fecal Tests – These come in two varieties; FIT– fecal immunochemical test and qFOBT– guiac based fecal occult blood test. Either test means 9 more trips to the doctor’s office and loses 3.7 to 6.9 days of life per decade compared to colonoscopy.

 

Cost Effectiveness

You may not care much about cost-effectiveness but the federal government certainly does. Cologuard is actually the least cost-effective of all the screening methods as this graphic shows:

Cologuard, however, is cost effective when compared to no screening at all. In a recent study, Cologuard cost $923 more per person per ten years than no screening. But it yielded an additional 28.9 days of life expectancy for the average senior. This means the cost per added year of life for Cologuard relative to no screening is $11,639. If Cologuard were the only screening test available, this would be extremely cost effective. But given that there are other screening methods that achieve greater benefits in life-years gained (colonoscopy), Cologuard at its current level of technology and price is actually cost-ineffective.

This tells us that the average ten-year cost of using Cologuard is about $1200 higher than for colonoscopy. Currently, both are available and paid for by most health insurance including Medicare. But if we ever go to a socialized medicine, government-controlled, single-payer system, (like Medicare for All) you can be sure the government will eliminate more costly methods of screening.

For now, the gold standard for detecting colon cancer is colonoscopy every ten years. I’ve done colonoscopy and Cologuard and there is no comparison when it comes to patient convenience and comfort. However, the best recommendation for detecting early colon cancer is both; Cologuard every 3 years and colonoscopy every 10 years. Be happy you have a choice now to do both because the time may come soon when you don’t.

 

The Inconvenient Truth About Red Meat

 

One of the tenants of liberal orthodoxy is that red meat is bad. The pressure to stop eating red meat has gotten so pervasive that even Burger King and McDonald’s are now selling “hamburgers” that have no meat at all. Vegans of the world are celebrating.

But now an inconvenient research study has declared the long-held belief that red meat is bad questionable. The Annals of Internal Medicine just published a study by a team of international researchers who reviewed more than 130 articles and a dozen randomized trials and concluded that the evidence linking red meat to cancer, heart disease and mortality is flimsy.

The Wall Street Journal editorial board says most studies discerned weak associations between red meat and poor health, but other variables could have tainted the results. For instance, people who eat more hamburgers may also consume less nutritious diets. Maybe the artery clogger isn’t the meat but the combination of cheese, salt, secret sauce, soda and French fries. Could it be possible that those who eat more red meat also exercise less?

Few public health trials have actually been done on red meat and the researchers found that the most credible one still produced “low certainty” evidence “that diets lower in red meat may have little or no effect on all-cause mortality.”In other words, the evidence linking red meat to disease is very weak and should be viewed with skepticism.

This change of scientific conclusions regarding diet is not unusual. Thirty years ago the American Heart Association advocated low-fat diets believing they would reduce heart disease. But scientists now have concluded this was bad advice and may have contributed to the diabetes epidemic by causing people to eat more carbohydrates.

Unfortunately, this doesn’t comport with the liberal narrative about red meat. Therefore, rather than change their narrative they are challenging the scientific research even calling for the research to be shut down. The Physicians Committee for Responsible Medicine (an oxymoronic name at best), which promotes plant-based diets, has filed a complaint with the Federal Trade Commission against the journal that published the research. (Seriously!) Not to be outdone, Harvard’s T.H. Chan School of Public Health warned that the conclusions could “erode public trust in scientific research.”

The WSJ says Harvard health gurus also complained that the researchers should have studied the environmental impact of red meat in their review because “climate change and environmental degradation have serious effects on human health” and thus are “important to consider when making recommendations.”

In other words, when the scientific research doesn’t support your political narrative, shut it down!

(I suggest you stop feeling guilty when you occasionally enjoy red meat.)

Medicaid Fraudulent Enrollment

 

ObamaCare expanded eligibility for Medicaid – but not for everybody!

We have already discussed the unintended expansion of Medicaid to people who already had private health insurance (Medicaid Expansion Woes). This unintended consequence of ObamaCare is costing states billions of taxpayer dollars. In Louisiana alone it is estimated this practice will cost taxpayers between $900 million and $1.3 billion over five years.

But now we learn there is rampant fraudulent enrollment in Medicaid. A study published by the National Bureau of Economic Research finds that in several Medicaid-expansion states most people who gained coverage have enrolled in Medicaid regardless of their income. ObamaCare has become a new entitlement for the middle class that was never intended.

Brian Blase and Aaron Yelowitz, writing in The Wall Street Journal, say the authors of that study used data from U.S. Census Bureau’s American Community Survey to assess coverage changes from 2012- 2017 in nine states that expanded Medicaid vs. 12 states that did not. Their results identified a huge problem.

In 2017 alone, in those nine states, “around 800,000 individuals . . . appeared to gain Medicaid coverage for which they were seemingly income-ineligible.”

For review, Medicaid eligibility was expanded by ObamaCare to households with incomes below 138% of the federal poverty line (FPL), or nearly $36,000 for a family of four in those states that accepted the expansion. In the nine states studied, Arkansas, Kentucky, Michigan, Nevada, New Hampshire, New Mexico, North Dakota, Ohio and West Virginia, the authors found that among households with incomes 138% to 250% of FPL (about $65,000 for a family of four), some 78% that gained coverage were improperly enrolled in Medicaid. That was also true of 65% of the population above 250% of FPL that gained coverage.

What’s more, the problem is getting worse with time. It was found to be two to three times more prevalent in 2017 than in 2014, the first year the plan was implemented. When you recognize that people tend to minimize rather than maximize income information, the amount of fraud identified here is staggering. Furthermore, the nine states in the study represent only about 20% of the total population living in Medicaid expansion states.

Blase and Yelowitz say, “ObamaCare has turned out to be a giant welfare program, with millions of working and middle-class Americans improperly receiving Medicaid – a reflection of the unpopularity of the exchange policies and incompetence of government oversight.”

Those states that opted out of the Medicaid expansion program under ObamaCare have fared much better in preserving their private insurance coverage. Employer-sponsored coverage has steadily grown in these states with virtually no growth in expansion states.

It is no surprise that millions are gaming the system for their own benefit. What is surprising, and unacceptable, is the level of incompetence, perhaps even malfeasance, in government workers responsible for proper enrollment of new Medicaid patients. Medicaid needs to be protected and taxpayer dollars preserved for the disabled and low-income children, pregnant women and seniors, for which it was originally intended.