Friday, October 18, 2013

Colonoscopies With Propofol. A Surprising Endorsement From The LA Times

By now we've all heard about the controversy of paying for anesthesiologists to give propofol during colonoscopies. The usual bias is that the procedure doesn't require the heavy sedation that is achieved with propofol. Colonoscopies in most parts of the world are performed with little if any sedation. If every colonoscopy in America suddenly needed an anesthesiologist to provide sedation, the country will be driven even more quickly into bankruptcy.

Yesterday, the LA Times consumer reporter, David Lazarus, penned a surprisingly accommodating article about using propofol for lower endoscopies. In the story, he criticizes the practice of health insurer Anthem Blue Cross in denying reimbursements to anesthesiologists who administer propofol to patients which the company deems are not medically necessary. Mr. Lazarus quotes one patient named Michael who says, "I can't imagine going through that procedure without anesthesia."

Mr. Lazarus goes on to accuse Anthem and other health insurance companies of being penny wise and pound foolish. He interviews Dr. Eric Esrailian, co-chief of the Division of Digestive Diseases at UCLA who defends the practice. Says Dr. Esrailian, "Colon cancer is a preventable cancer. Screenings are the key. We should do whatever is necessary for society to be screened." He states he would use propofol for all his colonoscopies if it weren't for having to deal with insurance company reimbursement problems.

The reporter goes on to list the potential down sides of using moderate sedation instead of propofol. He quotes a letter from Alister George, medical director of the Digestive Health Center in Thousand Oaks, CA. In the letter that is sent out to patients, Mr. George describes the side effects of moderate sedation, including, "The pain experienced while undergoing conscious sedation may be very unpleasant for some patients. The drugs used for conscious sedation may cause side effects such as prolonged drowsiness, low blood pressure, nausea and vomiting. Compared to propofol, the recovery time for conscious sedation is considerably longer."

Mr. Lazarus chastises the insurance companies for not reimbursing anesthesiologists who provide propofol for colonoscopies as being extremely short sighted. If people understood how propofol can make colonoscopies virtually painless, then more would probably get screened, preventing thousands of colon cancers from forming and saving the insurers billions of dollars. Studies have even shown that colonoscopies performed with propfol sedation yields a higher success rate of detecting colonic polyps vs. ones done under conscious sedation.

This is the kind of reporting that the ASA should be actively seeking from news media all around the country. While doctors may grumble and write letters to insurers defending their practices, nothing gets the companies more defensive than having the the general public, and hopefully politicians, breathing down their necks at their callousness in denying comfort to patients who need and want it.

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