Letters to the Editor - Dec. 25, 2000

Many insurers won't pay for colorectal cancer screening - American Cancer Society guidelines reported incorrectly - U.S. Preventive Services Task Force guidelines also reported incorrectly - Add abortion to list of things a physician should not participate in

Many insurers won't pay for colorectal cancer screening

Regarding "Surgeons urge more attention to colorectal cancer screening" (Article, Nov. 13): Your cover story on colorectal screening guidelines was both motivating and disarming. In my internal medicin e practice, the single biggest obstacle to screening is insurance noncoverage.

The great majority of our patients do not have hundreds -- or even a thousand dollars in the case of colonoscopy -- to spend out-of-pocket for these services. While I have little doubt that physician compliance can stand to be improved, there is not a single reference in your story to the status of coverage for these tests in asymptomatic patients.

The prospect of malpractice litigation for failing to follow published guidelines (not all of which are identical) is chilling. Liability for failing to adhere to guidelines, which in turn are not covered by most insurance plans, must warm the hearts o f our malpractice attorney friends. Third-party payers, true to form, care less about doing what is medically sound than what is profitable to them. Pressure must be brought by organized medicine, the AMA among others, on insurance companies to pay for th e recommended screening tests.

--Glenn S. Ross, MD

American Cancer Society guidelines reported incorrectly

Your article on screening for colorectal cancer (Article, Nov. 13) seemed to have a glaring error. The current new recommendations for colorectal cancer screening by the American Cancer Society are for patients of average risk to have either an air-contrast barium enema or a colonoscopy every 10 years, or a fecal occult blood test yearly and flexible sigmoidoscopy every five years. I would think such information should be included in an article of this nature.

--James V. Ortman, MD Omaha, Neb.

U.S. Preventive Services Task Force guidelines also reported incorrectly

The second paragraph of your article on colorectal cancer screening (Article, Nov. 13) falsely states that the consensus is clear. In fact, the U.S. Preventive Services Task Force recommends screening with annual fecal occult blood testing, or sigmoidoscopy (periodicity unspecified), or both.

Colonoscopy may have greater risks than potential benefits when screening average-risk adults. Screening colonoscopy receives a "C" recommendation. (Defined as: "There is insufficient evidence to recommend for or against the inclusion of the condition in a periodic health exam, but recommendations may be made on other grounds.") There are certain risks involved when a patient is enrolled in a screening program, and recommended tests should be carefully considered.

Many times patients in my community are overscreened. For example, they continue to get rectal exams with FOBT during their annual gynecological exams in the years following their normal screening colonoscopy. A false-positive result may put them at ri sk of a complication from an unnecessary repeat colonoscopy. I appreciate the need for more attention to colorectal screening. Underscreening, as well as overscreening, needs to be addressed. More research and better dissemination of accurate information are the best solutions to this problem.

--Anthony Pesce, MD St. James, N.Y.

Editor's Note: Drs. Ortman and Pesce are correct. We regret the errors.

Add abortion to list of things a physician should not participate in

Regarding "Suicides or executions: Physicians should not participate" (Editorial, Dec. 4):

In your editorial there is a blatant blind spot in lethal activities that physicians should not be involved in. Laws and a medical profession in this country that permit partial birth abortion are a dangerous compromise to the notion of "first do no ha rm." As with suicide and execution, when a physician kills an infant in abortion, indeed something (as the editorial states) "is being borrowed, not to be returned -- the integrity of the medical profession."

It's a sad commentary on how far down the ethical slippery slope we've gone when we condone infanticide in the form of abortion under the guise of "medical care."

--David H. Clymer, DO Mount Union, Pa.