By Dan Kennedy • The press, politics, technology, culture and other passions

Uncomfortable, yes, but ineffective, too

I read this story last night with the delight I normally reserve for accounts of casino-crazed former tribal leaders pleading guilty to federal corruption charges.

Only those with a childlike faith in the medical establishment could be surprised to learn that colonoscopies aren’t nearly as effective as had previously been thought. Of course, they are extremely effective in generating revenue, so no doubt we’ll continue to be told that everyone over 50 should get one every year blah blah blah.

Next time somebody feeds you that line, just ask a simple question: “Why?”

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  1. Peter Porcupine

    “Instead of preventing 90 percent of cancers, as some doctors have told patients, colonoscopies might actually prevent more like 60 percent to 70 percent.”That’s why.Last year, my sister-in-law balked at getting one. My brother scheduled one to show her how easy it was. They wheeled him from the examination room to the surgical theatre – although asymptomatic, he had multiple growths, so they removed a section of colon.He had cancer. He has just finished his chemotherapy, and promises to be alright instead of dead at 55. Had he not been showing off for his wife, he would never have been diagnosed.Is a dip in diagnosis rate a reason to skip the test? I’m glad they have found that the test only tells them so much, so they will not be over-reliant on it, but to say it is a surgical ATM goes too far the other way.

  2. Dan Kennedy

    PP: There are always going to be stories like that, and the story about your brother is wonderful.But the test was 90 percent effective on Monday and down to 60 percent effective by Tuesday. Want to take any bets about what direction it’s going to move in next?Unfortunately, much of modern medicine is a high-priced scam. How about statins for everyone?

  3. Steve

    I agree with PP (and yet, the Apocalypse refuses to come!). Are you really going to say, “Gee, it only finds 60-70% of cancers. I think I’ll wait until there’s a procedure that’s better!”Not me.BTW, my doctor (and also the doctor that performed my last colonoscopy) told me to have one in 5 years, *not* every year, now that I’m over 50.

  4. Jacquie

    I have to agree with Peter. As a medical professional, I recommend patient’s get colonoscopies at their yearly physical at the age of 50. I can’t tell you the number of people whose lives have been saved by growths being removed or cancer being found. It’s the most thorough test that is out there to help detect colon cancer early.What is high priced about medicine are the number of people that rip off the system using Mass Health and then work under the table…but that’s another whole discussion.

  5. Dan Kennedy

    I can’t tell you the number of people whose lives have been saved by growths being removed or cancer being found.Jacquie, according to the study cited by the Times, you’re not the only one!

  6. Jacquie

    Hey Dan…decided to put my 2 cents in once a saw the link on the CFO site (must be because you have casino mentioned at the beginning of your post).Although not related to the casino, it’s a nice break to blog about something different. Anytime you want to talk about the Medicaid scam, just let me know.The system is so abused (which causes our insurance rates to skyrocket)…hence the expensive healthcare.Truly ruins it for those that need the Medicaid.

  7. The Arranger

    My feelings about modern medicine are akin to Churchill’s on democracy: it’s the worst for of medicine, “except for all those other forms that have been tried from time to time.”Hard to see what’s to celebrate here. As profit- and CYA-driven as modern medicine is, what’s the alternative? I’m a scientific method man myself.Bob in Peabody

  8. Bill H.

    If the colonoscopy is the best test they’ve got, who doesn’t want the best test they’ve got? Given the choice of finding a malignancy 60% of the time, as opposed to not finding anything until later, after symptoms have appeared, who would choose to decline the examination?

  9. Dan Kennedy

    Bill: I’m sure you believed the 90 percent figure until this week. Why would you believe the 60 percent figure?Bob: Me too. The scientific method is now telling us that the colonoscopy considerably less effective than we had been led to believe.What do you suppose a follow-up study might tell us? Do they dare go there?

  10. Ron Newman

    A 60% effective test still strikes me as a test worth taking, especially since it’s recommended only every 10 years.

  11. NewsHound

    This is an old story, out last year from another study.The best doctors are darn good at this, observe better with less risk of puncture through the colon.The attendants at Mass. General couldn’t be nicer the way they accommodate the patient. And, the doctors there have an excellent reputation.The worst part is preparing for it the day before, darn near starving except for green popsicles and broth, and finding an escort so they don’t have to worry about you falling in the street from still being sleepy after the procedure.Getting undressed and wearing a johnny isn’t that much fun for some of us either.Finding a top notch colonoscopist is the key.

  12. Bill H.

    Yes, Dan, as someone who’s been examined from every–every–angle, I’m disappointed that the 90% effectiveness rate has been called into question. But let’s be clear: Are you saying that you will tell your physician that, absent symptoms, you decline a recommended colonoscopy? If so, that’s further than I’m willing to go, especially since I trust my physician.

  13. Neil

    I’d like to see stats on how many people they have to test to find anything in the first place. I think it’s pretty low (ie, they test a lot of people to find a little cancer). Also the difference between finding cancer pre-emptively vs. waiting until a patient notices symptoms. Testing everybody over 50 strains resources. So it’s a question of cost effectiveness–could the money be better spent elsewhere. Other countries who could afford to do this, like Sweden, do not.The science journalist John Horgan did exactly what Bill H. said–he will not have it done because statistically it’s not worth the bother.I have family history so had one a few years ago. Got to watch the trip through my own innards on the TV. Nicely doped up, it was like watching Fantastic Voyage, with Raquel Welch. If no family history I would have said no thanks.

  14. Mike F

    The article’s conclusion is that the tests are less effective than previously thought, though that may be based in large part on poor preparation and doctors who are not sufficiently skilled at performing the procedure, not that the test is ineffective. I think you’re seeing bogeyman where there aren’t any, Dan. As someone who holds your opinions in high regard I’m stunned to read your thoughts on this subject. And do you have a reason to believe a follow-up study will show the tests to be even less effective? Are you concluding that because the tests were shown (and by shown, I don’t mean conclusively) to be 20% less effective than had been thought, that they will eventually be proved to be ineffective?I’d like to find something to agree with you on here Dan, but my faith in your intelligence is being tested.

  15. Dan Kennedy

    Mike: I think you misread the story. Yes, it’s true that the test is more effective with better preparation, but no matter what they do, they miss the entire right side of the colon.Let’s say the test really is 60 percent effective. These folks have been swearing up and down that it’s 90 percent effective. Don’t you find that disturbing?This is typical of the medical establishment, right up there with recommending pasta as a weight-loss aid.

  16. O'Reilly

    I put up with the discomfort when my doctor examines my prostate gland. I suppose I can put up with the discomfort when he shoves a camera up my ass… as long as its the most effective diagnostic method to detect early-stage cancer or pre-cancer.Dan, you’re right to be upset about being misinformed by a professional that relies so heavily on scientific process. …but it’s time to get passed that and realize it’s the best way we have to detect colon cancer, which occurs frequently in men and is lethal.

  17. Mike F

    Well, as the article states, the cancers on the right side are more difficult to detect. That means patients are more likely to be negatively affected by inadequate preparation and the ability of the doctor performing the test, two things the study didn’t control for. I take your point in the sense that patients should be informed as to the possible limits of what the test may find so that they can factor in whether or not they feel the procedure is worth it due to costs and risks. And I also think people should be informed that you might want to have the procedure done by someone more expert than your general practitioner. That’s a long way from saying ‘why bother?’ And I’d also say it’s a leap to say that further studies will show a continued drop in effectiveness. Given that technology is greater today, would it be surprising if the level of effectiveness goes up?And are the people who did this study part of the medical establishment? I’m not asking that sarcastically, I’d really like to understand what people you’re criticizing here, because it seems to me that the field of medicine puts more emphasis on scientific study, peer review, and criticism than any other.

  18. Dan Kennedy

    Mike: In general, I think we get way too hot and bothered by all things medical. Health care is not the most important issue on earth. Let’s enjoy ourselves, eh?

  19. O-FISH-L

    What’s with these 50 something year-old Boston educated celebrities challenging modern medicine? Sheesh.”Unfortunately, much of modern medicine is a high-priced scam.”–Dan Kennedy, December 2008″There is a huge boom in autism right now because inattentive mothers and competitive dads want an explanation for why their dumb-ass kids can’t compete academically, so they throw money into the happy laps of shrinks . . . to get back diagnoses that help explain away the deficiencies of their junior morons. I don’t give a [bleep] what these crackerjack whack jobs tell you – yer kid is NOT autistic. He’s just stupid. Or lazy. Or both.”–Denis Leary, October 2008

  20. Ani

    I agree that our culture is too caught up in health care. We act as if, if we could only control our health, we would never die and we would be happy. I think the medical establishment needs more of the attitude of the hospice movement. And I agree with Mike F that doctors ought to do an individualized, and honest, cost-benefit analysis for each patient regarding whether a colonoscopy makes sense, including taking into account the toll the test takes on some individuals’ well-being due to underlying pre-existing physical conditions — I think they’re much too pushy about the test, as if there couldn’t possibly be any downsides to it. As a matter of disclosure, I will say that I’ve had 3 colonoscopies, by a reputable specialist at a reputable hospital, found them all excruciatingly painful, and felt unwell for days afterwards. I swore after the last one, I cannot put myself through this again.

  21. Rick in Duxbury

    Ani, you may want to think about a different doctor. I have the procedure every 3-5 years,(family history)and have had pre-cancerous polyps removed every time.Drinking the crappy lemonaid sucks and it’s an inconvenience to my wife to lose the day driving me. That said, I have never felt a thing during or after the procedure. If you find it “excruciatingly painful”, I would suggest getting a second opinion. The stakes are too high. Good luck.

  22. NewsHound

    Unfortunately, the test is annoying. It should not be painful. The best doctors who specialize in lower endoscopy have exceptionally high rates of finding problems if there are problems to find. Identifying one of the best colonoscopists who are good at safely detecting pre-cancerous cells is not necessarily easy. However, with the small chance there is a problem, and the greater chance the colonoscopist will detect it, the much greater the chance for success, and importantly, too, without too much inconvenience.With modern medicine, in almost all cases there is no need to suffer and/or die with colon cancer.Without early detection the risk is increased dramatically, not only for survival, but also for painful surgery, chemotherapy, radiation, and the possibility for needing a bag which can be a horrible daily chore for the rest of a patients life.With early detection most people can avoid becoming a prisoner to what can be a horrible illness and treatment procedure.One day every five or ten years with the cost picked up by insurance might be well worth it. Without insurance more people would avoid it, but the cost/risk/reward ratio does not warrant such economics and that is one reason insurance companies are willing to include this in most if not all plans.

  23. Neil

    Ani it shouldn’t be painful. Properly “medicated”, you should be having relaxing thoughts about this and this. Raquel is the one at the top in the first pic. She’s cutting your polyps away with tiny scissors. You are the guy in the bubble at the top of the ship, watching. Fun!To repeat, anybody have stats on total number of colonoscopies performed, vs cancer (or pre-cancerous polyps) found? The fact that insurance will pay for it doesn’t change the cost-effectiveness, in terms of a population-wide recommendation. Where’s the cost-benefit analysis.Which reminds me, local cops continue to perform a similar procedure on the taxpayers, in spite of the governor’s efforts.

  24. NewsHound

    Yes, indeed, the way things are going in this economy, and with the ever increasing cost of health care delivery, we will all be semicolons, sooner or later.

  25. Rockey

    So colonoscopies are only 60 to 70 percent effective in preventing colon cancer? While that may be less effective than previously thought, that’s good enough for me. No question we are probably the most over-medicated,over-tested, and over-therapied society on the planet but perhaps we ought not be so quick in this case to mock a simple diagnostic test that has probably saved thousands of lives.

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