It wasnt about the twist. It is about the everending scorsese theme of sin and redemption. That's why the ending is so brilliant. I think this is where Scorsese was at with this one. Ofr course the twist was obvious, I think it was a choice he made, a huge gamble.
"Only on Horrordvds.com could a well intentioned get well thread turn into an infomercial about the propensity for testicular perspiration".