Expensive, exclusive clinic promotes uncomfortable and unproven medical exam.
by Gillian Steward
Could Calgary be the colonoscopy capital of Canada?
That’s certainly the impression that is emerging as a public inquiry into queue jumping in the public health-care system reveals all sorts of interesting data about a state-of-the-art colon cancer screening clinic associated with the University of Calgary’s medical school.
According to testimony at the inquiry, patients who were clients of a boutique private clinic, a privilege for which they paid $10,000 a year, were booked for screening colonoscopies almost instantaneously. Other patients usually waited two to three years for the widely promoted procedure.
Not fair but not exactly a surprise either. The private clinic is in the same university building as the publicly funded screening centre and it’s not unusual for physicians to negotiate with each other to get preferential treatment for certain patients.
What’s far more interesting about this brouhaha is the information that is emerging about the overwhelming demand for the invasive, uncomfortable and expensive screening colonoscopy. The first year of operation the clinic had 15,000 people on its waiting list. Five years later it performs 18,000 colonoscopies a year.
“Where is the evidence that this kind of screening is effective? What other programs have been cut to pay for this apparently overzealous use of a screening procedure?”
Alberta Health Services, the über body that is responsible for all public health care in Alberta, is confident that because the procedure can find cancers and potentially precancerous polyps that wouldn’t be detected otherwise, fewer people will suffer from the disease and have to be treated in hospital or cancer care facilities.
It sounds like a fine idea in theory but raises all sorts of questions about the consequences and costs of such a mass cancer screening program.
“It seems to be preferential access for well people while the sick suffer,” says Wendy Armstrong, a researcher with the Consumer Association of Alberta, which has intervenor status at the public hearings. “Where is the evidence that this kind of screening is effective? What other programs have been cut to pay for this apparently overzealous use of a screening procedure?”
In his book Seeking Sickness, Alan Cassels of the University of Victoria points out that colon cancer screening by stool sample or colonoscopy only reduces deaths from 8.83 per thousand to 5.88 per thousand, or about 3 per thousand.
The colonoscopy is now considered the gold standard for colorectal cancer screening and in Calgary it’s easy to get one. Family physicians refer almost everyone over 50 whether they have symptoms they should be worried about or not. And you don’t need to have taken the Fecal Occult Blood Test (FOBT) beforehand, either.
That relatively simple home test is much less expensive than a colonoscopy and has no adverse side effects. In many parts of the country you can’t get a colonoscopy unless you have a positive FOBT but it’s an icky process so most people don’t want to do it.
Instead they take what seems like gallons of purgatives to clean out their systems (everyone takes the same amount no matter their age or size) and then a gastroenterologist uses a million-dollar computerized probe to examine their insides from the bottom up. The whole event takes about three hours, after which patients are sent home groggy but cleansed and thoroughly examined.
The clinic was established after two wealthy Calgarians — John Forzani and Keith MacPhail — donated $2.7 million for pricey technology, the U of C donated some space in a brand-new building, and the health region (medicare in other words) committed to $70 million worth of funding.
Billed as the largest colonoscopy clinic in Canada, it boasts six pre-assessment rooms, six endoscopy rooms, 24 recovery beds and is staffed by 55 health professionals. The centre also promised to serve as a key research facility that would evaluate current and potential techniques for screening as well as population health research focusing on colorectal cancer.
Alberta Health Services now covers the entire cost of the Forzani-Macphail Colon Cancer Screening Centre but any research that is being done there does not appear to be publicly available. And so far there is no data to show the screening program has reduced the incidence of colon cancer in the Calgary region.
There’s no question that for some people a screening colonoscopy can mean the difference between suffering through colon or rectal cancer and avoiding it all together.
But for most people it seems like too much medicine when less will do.
About Gillian Steward
Gillian Steward is a Calgary writer and journalist, and former managing editor of the Calgary Herald.
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