Do you think colonoscopy preps are messy? Well, you haven't seen anything until you see the fight that will occur over our collective colons. There is new evidence that the "virtual" colonoscopy may become an acceptable alternative to the regular colonoscopy. This super x-ray or CT of the colon still involves the good old clean-out the night before but there is none of that penetration action that patients have trouble getting past. The test is cheaper but any abnormalities still need to get removed via a regular colonoscopy. Medicare is considering paying for this as an alternative and that will get the managed care companies to jump on the bandwagon. The article in the USA Today, by the way, has quotes from people who have obvious conflicts of interest which is a little troublesome. So what's next? War. The gastroenterologists (GI) have to strike back. Do you know how much money they would stand to lose if the insurance companies buy into this? There is no way they are going to sit on the sidelines. I remember when I was in my first few years of practice in family medicine and we got the go ahead from my hospital employer to do flexible sigmoidoscopies in the office. They spent a ton getting our room ready and it took months. The flex sig unit was ready to go and we were starting to train our staff in assisting with the procedure. One morning I walked into the room and the flex sig unit was gone! I thought it was stolen and called the administration. I was told that they "donated" it to the local GI group who does procedures in both hospitals in town. That was it. No more explanation. We made the flex sig room into a nice lounge. End of story. Oh, there will be war my friends. Expect the higher ups of the GI world to be working on a plan right now to show why colonoscopies are the way to go. This time, however, I get to watch from the sideline as the radiologists battle with the gastroenterologists. Got to get me some popcorn.