Very interesting. I’m just a meager FNP PCP but if the question is why screen for colon cancer, I think the answer could plausibly be because there are so few cancers that can be detected through screening, this being one of them.
I am very interested in this, as someone who had some minor GI issues that got talked in to a colonoscopy a few years ago.
I was in an outpatient surgery center adjacent to a local hospital for the procedure.
I aspirated my stomach contents while under anesthesia. Woke up in the Recovery area gasping due to nonstop coughing and wheezing. My lungs, mouth and throat were burning with an intense pain I had never experienced before.
I begged for help, between coughs. The person looking after me, I assume a nurse, looked completely dumbfounded when I asked for an antacid to put out some of the insane burning pain. I also asked for an Albuterol Nebulizer treatment because I felt badly out of breath from the nonstop coughing.
I was told I had to wait until the Nurse Anesthetist finished with the patient getting a colonoscopy.
They left me coughing and wheezing for a full 45 minutes until the Nurse Anesthetist finally made her way in to see me. She strongly disagreed with my statement that I had aspirated my stomach contents while under anesthesia. She reluctantly agreed to order an Albuterol Nebulizer treatment, which took an additional 10 to 15 minutes to set up.
About halfway through the Nebulizer treatment my coughing and wheezing finally stopped, I got dressed and went home.
A few additional points. At no point while coughing and wheezing after the colonoscopy, did anyone take my vitals in any way, not even with a simple Pulse Oximeter on my finger.
Also, I didn’t have any prior history of Asthma/Reactive Airway Disease.
I had two very small, benign polyps removed, and still no help for the GI issues that brought me in initially.
To say I was disappointed by the care I received was an understatement. I contacted the Gastroenterologist clinic manager to pass on my feedback.
I am extremely leary of any future colonoscopies, especially with general anesthesia. My risk of severe side effects like aspiration wasn’t discussed before the procedure, and their handling of what could have become a respiratory emergency was sadly lacking.
Afterwards I looked up Aspiration Pneumonia following colonoscopy with anesthesia is in one study the one of the highest risk complications. And while my circumstance was rare, it was awful, and badly shook my faith in my doctors and their practice.
Sun exposure causes nitric oxide production and lowers blood pressure??? Really??? A strange chemical beast like nitric oxide (a free radical, after all) is important for controlling blood pressure? So I looked.
"UVA Irradiation of Human Skin Vasodilates Arterial Vasculature and Lowers Blood Pressure Independently of Nitric Oxide Synthase"
This article and related discussion is exactly why I'm such a huge fan of Substack. I very much enjoy the chance to engage with and debate these topics, as opposed to being force fed a narrative by corporate media. Imagine how much better off we would have been over the past 2 years if this was the norm, rather than the exception. Thank you to all the doctors and commenters involved for helping me to learn and pushing my thinking.
This is a fantastic letter, not only as it relates to the study but, in a broader context, as it describes the groupthink, the lack of nuance and seriousness applied to the subject by cheerleaders of profiteering medical institutions. I really want to applaud this doctor.
Pfizer COVID-19 vaccine studies showed a 95% relative benefit of taking the job. At the same time the absolute benefit was less than 1%. Side effects were not considered. Why the media only parroted the 95% benefit is another question we should all be asking.
Again and again and again, people cannot truly engage in informed consent because they are not being told the true COSTS and BENEFITS. It is all one-sided.
Enjoyed watching a lively discussion and debate by thoughtful people. One aspect that was not mentioned is the overall health of Europe vs the US I am especially thinking about obesity rates, diabetes and sedentariness. You have to spend about five minutes in those countries to see how much healthier they look and how much better they move. They are generally just healthier. We are missing the forest from the tree.
Traditional diets and appreciation of good food are one reason. I also have the impression that European physicians are more conservative than American docs. Or maybe we just have too much money. So far as I know routine colonoscopies are not done in Italy. I doubt their stats are worse than ours.
My comment ties this post in with another post by Prasad on medical education.
Decades ago, Mill's "On Liberty" was taught in high school in the US. Now, you might be able to find him taught in a few colleges.
This post points to a need for ethics in the world, which will impact both medicine and science. Strawman arguments are unethical (an ethical logician would argue against the best case by the opposition), as are ad baculum arguments like coercion and censorship.
While we are talking about ethics and science, let's discuss data transparency--or the lack thereof--which we have seen recently from pharma and pharma regulatory agencies as regards pharma's covid vaccines.
We might as well listen to the ancient Greek philosopher...again. We have so much need of his wisdom.
For some of us who are younger, this may be our first meeting with Plato, since we have been cheated by our "educators." So, should we return to requiring introductory philosophy in high school? Do we want a populace educated in liberty and ethics?
It does seem that looking at the absolute reduction in death from colon cancer is "tiny".
The NNT is over 400. But there are 160 million people in the USA 0ver over age 40. So if all these people got colonoscopy, the new study suggests that it would actually it would save over 400,000 deaths from colon cancer The issue is not efficacy, absolute or relative. The issue is cost.
At 160mm population over age 40, giving each one a colonoscopy once every 10 years at an average cost of $3000, our healthcare costs would be over $120000 for each life saved (if all 400000 were actually saved and if all cause mortality did not affect that number and if every patient lived an average of 80 years). Difficult number to absorb considering that in those remaining 40 years of life other medical challenges will present.
Yes. Of course you are correct. That is why most European countries screen with an inexpensive stool test which performs almost as well as a colonoscopy. The fact remains that physicians in the USA are reimbursed and graded and paid partially on whether their patients get the screening done. If what you say is true ( and I believe you are correct) why is the emphasis these days on "prevention" rather than cure. Prevention is much more expensive than treatment to cure particularly when doctors these days are supposed to address ( and fix?) the social conditions of health (poverty, racism, bad housing, illiteracy, poor diet, etc).However, from a strictly public health perspective, the. fact remains that number of lives saved ( at least for ten years). from colon cancer would be 400,000. It is about time we realize that this practice of trying to save these lives this way is unaffordable. And that is one of the reasons health. care in America is so expensive: the emphasis on prevention rather than cure.
" His comments are tough, and these days you could not say these things without professional reprisal."
This is unfortunate for medicine and for science and speaks to the need for doctors to be ethical as regards their colleagues and for doctors' speech to be protected from reprisal by employers and medical review boards.
Censorship and coercion are anti-science. Science thrives on liberty.
Also, yes, questioning the "settled science" is heresy, and not to be allowed.
An aside--as a pediatrician, not many of my patients need colonoscopies, but I'm getting closer to the screening age (mid-40s) and have been mulling this over for myself. There seems to be minimal discussion regarding the potential harms of the procedure itself, and I'm not just thinking perforations, etc. The microbiome is the powerhouse of our bodies, (immune health, metabolic control, mental well being, etc.), and we know some species are rather delicate and easily influenced, sometimes irreversibly. Is flooding the colon with gallons of polyethylene glycol really without consequences to our microbiome? Any long term data? No, there isn't (that I can find) and bringing this up to adult GI was met with sound dismissal. "Not a concern. May even be beneficial and can help patients with IBS." But what about those of us without IBS? What about the data?
Not only that, but I also don't think people understand the full risk of going under anesthesia. I'd personally never want to go under unless it's medically necessary.
I want the right to make medical decisions for my body. Emperor of all maladies helped convince me of the nuances of oncology, my instincts were skeptical of cancer therapy. Medical field has been hijacked by Rockefellers ect.. more than a century ago. Cholesterol fallacy still being perpetuated adds to my skepticism. As a scientist, Mercolas website opened my eyes 20 years ago to alot of inconsistent medical practices. The systems end result is more indebted customers. Why was vitamin d never on a public service announcement for viral respiratory infections or vit d analysis covered by Medicare?
Very interesting. I’m just a meager FNP PCP but if the question is why screen for colon cancer, I think the answer could plausibly be because there are so few cancers that can be detected through screening, this being one of them.
"It Is Difficult to Get a Man (or woman) to Understand Something When His Salary Depends Upon His Not Understanding It"
I am very interested in this, as someone who had some minor GI issues that got talked in to a colonoscopy a few years ago.
I was in an outpatient surgery center adjacent to a local hospital for the procedure.
I aspirated my stomach contents while under anesthesia. Woke up in the Recovery area gasping due to nonstop coughing and wheezing. My lungs, mouth and throat were burning with an intense pain I had never experienced before.
I begged for help, between coughs. The person looking after me, I assume a nurse, looked completely dumbfounded when I asked for an antacid to put out some of the insane burning pain. I also asked for an Albuterol Nebulizer treatment because I felt badly out of breath from the nonstop coughing.
I was told I had to wait until the Nurse Anesthetist finished with the patient getting a colonoscopy.
They left me coughing and wheezing for a full 45 minutes until the Nurse Anesthetist finally made her way in to see me. She strongly disagreed with my statement that I had aspirated my stomach contents while under anesthesia. She reluctantly agreed to order an Albuterol Nebulizer treatment, which took an additional 10 to 15 minutes to set up.
About halfway through the Nebulizer treatment my coughing and wheezing finally stopped, I got dressed and went home.
A few additional points. At no point while coughing and wheezing after the colonoscopy, did anyone take my vitals in any way, not even with a simple Pulse Oximeter on my finger.
Also, I didn’t have any prior history of Asthma/Reactive Airway Disease.
I had two very small, benign polyps removed, and still no help for the GI issues that brought me in initially.
To say I was disappointed by the care I received was an understatement. I contacted the Gastroenterologist clinic manager to pass on my feedback.
I am extremely leary of any future colonoscopies, especially with general anesthesia. My risk of severe side effects like aspiration wasn’t discussed before the procedure, and their handling of what could have become a respiratory emergency was sadly lacking.
Afterwards I looked up Aspiration Pneumonia following colonoscopy with anesthesia is in one study the one of the highest risk complications. And while my circumstance was rare, it was awful, and badly shook my faith in my doctors and their practice.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1666432
https://www.jwatch.org/na45026/2017/09/18/more-aspiration-pneumonia-with-propofol-colonoscopy
Cologuard is a possible test alternative.
Sun exposure causes nitric oxide production and lowers blood pressure??? Really??? A strange chemical beast like nitric oxide (a free radical, after all) is important for controlling blood pressure? So I looked.
"UVA Irradiation of Human Skin Vasodilates Arterial Vasculature and Lowers Blood Pressure Independently of Nitric Oxide Synthase"
https://www.sciencedirect.com/science/article/pii/S0022202X15368780
"Suberythemal ultraviolet exposure and reduction in blood pressure"
https://www.amjmed.com/article/S0002-9343(04)00308-0/fulltext
This article and related discussion is exactly why I'm such a huge fan of Substack. I very much enjoy the chance to engage with and debate these topics, as opposed to being force fed a narrative by corporate media. Imagine how much better off we would have been over the past 2 years if this was the norm, rather than the exception. Thank you to all the doctors and commenters involved for helping me to learn and pushing my thinking.
What a great discussion !
This is a fantastic letter, not only as it relates to the study but, in a broader context, as it describes the groupthink, the lack of nuance and seriousness applied to the subject by cheerleaders of profiteering medical institutions. I really want to applaud this doctor.
Pfizer COVID-19 vaccine studies showed a 95% relative benefit of taking the job. At the same time the absolute benefit was less than 1%. Side effects were not considered. Why the media only parroted the 95% benefit is another question we should all be asking.
Again and again and again, people cannot truly engage in informed consent because they are not being told the true COSTS and BENEFITS. It is all one-sided.
Enjoyed watching a lively discussion and debate by thoughtful people. One aspect that was not mentioned is the overall health of Europe vs the US I am especially thinking about obesity rates, diabetes and sedentariness. You have to spend about five minutes in those countries to see how much healthier they look and how much better they move. They are generally just healthier. We are missing the forest from the tree.
Traditional diets and appreciation of good food are one reason. I also have the impression that European physicians are more conservative than American docs. Or maybe we just have too much money. So far as I know routine colonoscopies are not done in Italy. I doubt their stats are worse than ours.
My comment ties this post in with another post by Prasad on medical education.
Decades ago, Mill's "On Liberty" was taught in high school in the US. Now, you might be able to find him taught in a few colleges.
This post points to a need for ethics in the world, which will impact both medicine and science. Strawman arguments are unethical (an ethical logician would argue against the best case by the opposition), as are ad baculum arguments like coercion and censorship.
While we are talking about ethics and science, let's discuss data transparency--or the lack thereof--which we have seen recently from pharma and pharma regulatory agencies as regards pharma's covid vaccines.
We might as well listen to the ancient Greek philosopher...again. We have so much need of his wisdom.
https://plato.stanford.edu/entries/plato-ethics/
For some of us who are younger, this may be our first meeting with Plato, since we have been cheated by our "educators." So, should we return to requiring introductory philosophy in high school? Do we want a populace educated in liberty and ethics?
Well said! Thank you for the links. 😊
It does seem that looking at the absolute reduction in death from colon cancer is "tiny".
The NNT is over 400. But there are 160 million people in the USA 0ver over age 40. So if all these people got colonoscopy, the new study suggests that it would actually it would save over 400,000 deaths from colon cancer The issue is not efficacy, absolute or relative. The issue is cost.
Again, you are missing the RISKS in the procedure itself.
Yes. There are risks which in this study were zero.
Impossible. All medical procedures have risks associated with them.
At 160mm population over age 40, giving each one a colonoscopy once every 10 years at an average cost of $3000, our healthcare costs would be over $120000 for each life saved (if all 400000 were actually saved and if all cause mortality did not affect that number and if every patient lived an average of 80 years). Difficult number to absorb considering that in those remaining 40 years of life other medical challenges will present.
Yes. Of course you are correct. That is why most European countries screen with an inexpensive stool test which performs almost as well as a colonoscopy. The fact remains that physicians in the USA are reimbursed and graded and paid partially on whether their patients get the screening done. If what you say is true ( and I believe you are correct) why is the emphasis these days on "prevention" rather than cure. Prevention is much more expensive than treatment to cure particularly when doctors these days are supposed to address ( and fix?) the social conditions of health (poverty, racism, bad housing, illiteracy, poor diet, etc).However, from a strictly public health perspective, the. fact remains that number of lives saved ( at least for ten years). from colon cancer would be 400,000. It is about time we realize that this practice of trying to save these lives this way is unaffordable. And that is one of the reasons health. care in America is so expensive: the emphasis on prevention rather than cure.
" His comments are tough, and these days you could not say these things without professional reprisal."
This is unfortunate for medicine and for science and speaks to the need for doctors to be ethical as regards their colleagues and for doctors' speech to be protected from reprisal by employers and medical review boards.
Censorship and coercion are anti-science. Science thrives on liberty.
Mill weighs heavily yet again.
https://plato.stanford.edu/entries/mill/#LibeFreeSpee
Agree fully with anonymous doc.
Also, yes, questioning the "settled science" is heresy, and not to be allowed.
An aside--as a pediatrician, not many of my patients need colonoscopies, but I'm getting closer to the screening age (mid-40s) and have been mulling this over for myself. There seems to be minimal discussion regarding the potential harms of the procedure itself, and I'm not just thinking perforations, etc. The microbiome is the powerhouse of our bodies, (immune health, metabolic control, mental well being, etc.), and we know some species are rather delicate and easily influenced, sometimes irreversibly. Is flooding the colon with gallons of polyethylene glycol really without consequences to our microbiome? Any long term data? No, there isn't (that I can find) and bringing this up to adult GI was met with sound dismissal. "Not a concern. May even be beneficial and can help patients with IBS." But what about those of us without IBS? What about the data?
DON'T QUESTION. THE COW IS SACRED FOR A REASON.
Not only that, but I also don't think people understand the full risk of going under anesthesia. I'd personally never want to go under unless it's medically necessary.
Have you read Mill or Plato in your education, either formal or self-taught?
Not formally since my undergraduate days! But interested, absolutely! Any primer you'd recommend to start?
I want the right to make medical decisions for my body. Emperor of all maladies helped convince me of the nuances of oncology, my instincts were skeptical of cancer therapy. Medical field has been hijacked by Rockefellers ect.. more than a century ago. Cholesterol fallacy still being perpetuated adds to my skepticism. As a scientist, Mercolas website opened my eyes 20 years ago to alot of inconsistent medical practices. The systems end result is more indebted customers. Why was vitamin d never on a public service announcement for viral respiratory infections or vit d analysis covered by Medicare?
.
This relative to absolute risk assessment reminds me of the same "false advertising" seen with statins.