The RCT clearly shows we do not fully understand all of the factors impacting overall mortality. The non-significant difference in colon cancer death is particularly telling - how could this be? Is it possible that the procedure accelerates this outcome in a similar fraction of patients as it prevents? To improve either the procedure its…
The RCT clearly shows we do not fully understand all of the factors impacting overall mortality. The non-significant difference in colon cancer death is particularly telling - how could this be? Is it possible that the procedure accelerates this outcome in a similar fraction of patients as it prevents? To improve either the procedure itself, or overall care, this should study should be viewed as a challenge to find the answer.
Very good point. All-cause mortality is the key. And we know that in the elderly population, competing causes of death are such that it's often impossible to clearly assign a person's demise to a single factor.
As to Dr. Cifu's defense of colon cancer screening, my own take is that 'screening' is a marketing term. A promotional term. A term that is reassuring for patients. The medical industry knows this.
Thus millions of people literally buy the idea that colonoscopies, PSA tests, covid tests, mammographies, bone density tests, etc. will provide 'peace of mind', or 'catch it early'. And insurance companies tend to string along.
The whole medical landscape might be different If doctors and medical associations ditched the 'screening' motif, and, talked bluntly about true benefits and true risks, without sweetening the messages and promoting the products.
For example, re colonoscopies a doctor might simply point out
- A colonoscopy doesn't guarantee that you won't die of colon cancer. In fact, it doesn't guarantee anything.
- It is an intervention that will occasionally be harmful or even fatal for a patient.
- And statistics indicate that people who have colonoscopies don't live longer than people who never get colonoscopies.
But usually, all a patient gets is reassuring words from the doc, plus a fine print legal document absolving the doc from responsibility if anything goes wrong.
Of course, I'm all for patients making their own decisions about treatments and interventions. Thus if a patient is so worried about colon cancer that they want a colonoscopy, fine. It's their choice.
But hey, let's not try to bring everyone into the net, and let's not give everyone false ideas about the ultimate efficacy of this or that treatment or intervention.
The RCT clearly shows we do not fully understand all of the factors impacting overall mortality. The non-significant difference in colon cancer death is particularly telling - how could this be? Is it possible that the procedure accelerates this outcome in a similar fraction of patients as it prevents? To improve either the procedure itself, or overall care, this should study should be viewed as a challenge to find the answer.
Very good point. All-cause mortality is the key. And we know that in the elderly population, competing causes of death are such that it's often impossible to clearly assign a person's demise to a single factor.
As to Dr. Cifu's defense of colon cancer screening, my own take is that 'screening' is a marketing term. A promotional term. A term that is reassuring for patients. The medical industry knows this.
Thus millions of people literally buy the idea that colonoscopies, PSA tests, covid tests, mammographies, bone density tests, etc. will provide 'peace of mind', or 'catch it early'. And insurance companies tend to string along.
The whole medical landscape might be different If doctors and medical associations ditched the 'screening' motif, and, talked bluntly about true benefits and true risks, without sweetening the messages and promoting the products.
For example, re colonoscopies a doctor might simply point out
- A colonoscopy doesn't guarantee that you won't die of colon cancer. In fact, it doesn't guarantee anything.
- It is an intervention that will occasionally be harmful or even fatal for a patient.
- And statistics indicate that people who have colonoscopies don't live longer than people who never get colonoscopies.
But usually, all a patient gets is reassuring words from the doc, plus a fine print legal document absolving the doc from responsibility if anything goes wrong.
Of course, I'm all for patients making their own decisions about treatments and interventions. Thus if a patient is so worried about colon cancer that they want a colonoscopy, fine. It's their choice.
But hey, let's not try to bring everyone into the net, and let's not give everyone false ideas about the ultimate efficacy of this or that treatment or intervention.