The president may be "in excellent health and 'fit for duty'" according to his doctors, but that did not stop physicians around the country from scrutinizing Barack Obama's medical exam results after their release Sunday.
Some gastrointestinal experts questioned the decision to give the president a "virtual" colonoscopy rather than the more accurate -- but more invasive-- conventional screening. Several cardiologists suggested that Obama's rising cholesterol levels would warrant a decision to put him on cholesterol-busting statins. Still, many doctors felt that the recommendations Obama received were appropriate -- namely, stub out his cigarette habit, and eat a bit healthier.
They were recommendations that White House press secretary Robert Gibbs reiterated to reporters Monday.
"The bad cholesterol measure was slightly elevated from where it had been previously," Gibbs said. "Obviously, he's a few years older from when it was last measured." But he later added that Obama has likely been indulging in more desserts than he should have over the past year.
"He's just got to use a little bit more presidential restraint," Gibbs said.
A virtual colonoscopy uses X-rays, while a conventional colonoscopy involves the insertion of a flexible tube into the colon while the patient is under anesthesia. A White House spokesman said on background that the president's doctor had his reasons for recommending the virtual procedure -- not the least of which was the fact that the virtual approach would not require the president to be sedated, thus sidestepping possible transfer-of-power issues.
"In this case, the doctors believed that all things were equal," the spokesman said. "And it seemed fine to do the virtual colonoscopy. The team there gives top-notch care, and they do this virtual procedure often."
Still, some gastrointestinal experts said that for cancer detection, the conventional option is still the best choice.
"Conventional colonoscopy is widely considered superior to virtual colonoscopy for detection of small polyps, while the two are about equivalent for larger polyps," said Dr. Douglas Rex, director of endoscopy at Indiana University Hospital in Indianapolis.
Additionally, Rex said that the U.S. Preventive Services Task Force has declined to recommend virtual colonoscopy for screening based on the frequency of false positives associated with the test, as well as the fact that it exposes patients to a certain degree of radiation, which he said is "more relevant to younger [patients] like President Obama, as they have a longer life expectancy and a greater chance to experience risk, especially from repeated testing."
Dr. Blair Lewis, clinical professor of medicine at Mount Sinai School of Medicine in New York, said he was "surprised and a bit miffed" at the choice.
"[Virtual colonoscopy] is not a covered service under Medicare and many third party payers. It has also come under fire recently due to the varying doses of radiation used and the long-term health risks," Lewis said.
"I am concerned this sends the wrong message to millions of Americans in several ways. The president is receiving medical care that the average American cannot and probably should not receive, he is being treated in a way not recognized by many medical societies, and he is avoiding a test -- colonoscopy -- that millions of Americans are avoiding wrongly. Not a great way to lead by example."