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Are colonoscopies worth it?

asteriskmag.com

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Re: Are colonoscopies worth it?

#41

Post by [deleted] »

plugin-baby wrote: post #18
tedunangst wrote: post #12

Article doesn't actually answer the question? Certainly interesting information about the topic and efficacy, but it doesn't really explain how the current situation came about. Why is my neighbor driving around on a donut? I could write 3000 words on the history of tires, the assorted trade offs of trunk storage vs spare diameter, the geographical distribution of potholes, etc., but none of that explains why the don…

> Why is my neighbor driving around on a donut? Complications from a colonoscopy?

[deleted]

Re: Are colonoscopies worth it?

#42

Post by gumby »

methou wrote: post #40

My uncle had one, it almost killed him when the probe breached his colon causing an internal bleeding. It was done with anesthesia, which according to him could be a major contributor to the incident.

> It was done with anesthesia, which according to him could be a major contributor to the incident.

The article suggests his reasoning could be well founded.

Re: Are colonoscopies worth it?

#43

Post by all2 »

woleium wrote: post #35
Barrin92 wrote: post #30

Earlier quoted context omitted.

This is a large, randomized control trial, so obviously you should value this significantly higher than whatever doctors are doing to themselves. (history has more than a few examples of doctors practicing medicine that didn't make a whole lot of sense).

If only Semmelweis wasn’t such a strange chap, we’d have been much more further forward now.

I don't know what this means. Can you expand on your statement? Who is this person? What would we be farther forward to?

Re: Are colonoscopies worth it?

#45

Post by riku_iki »

haldujai wrote: post #29
LarsDu88 wrote: post #5

Colonoscopies come with potential for complications. There are actually a number of companies which have either released or plan to release non-invasive colorectal cancer screening based on blood dna sequencing. GRAIL, Freenome, and Guardant all have tests out or coming down the pipeline.

Sure but procedural complications are actually quite rare, as alluded to in this article. Misses from operator error, suboptimal bowel prep, or inability to complete the examination are more common and where we have the most potential for benefit from novel screening tests.

> Sure but procedural complications are actually quite rare, as alluded to in this article.

article actually says that perforation (requires emergency surgery as per article) is between 1 to 100 and 1 to 20000 base on some studies, which sounds very high if it is not mistake.

Re: Are colonoscopies worth it?

#46

Post by raverbashing »

nwellinghoff wrote: post #19
joshuaheard wrote: post #16

My doctor recommended Cologuard, a test of your stool sample for cancerous DNA, instead of a colonoscopy. I can't imagine taking a colonoscopy now.

Colonoscopy has a big advantage in that they are already in there. If they see anything forming that is pre-cancerous they can take it out before it turns into a problem that would show up on a Cologuard test.

And the big disadvantage that to get there your need to book 2 professionals (?) and take pretty much one day off, and there are risks associated with anesthesia and the procedure itself

I don't think it scales

(Not to mention the interests of doctors of suggesting things that make them more money)

Edit: now I see TFA mentions risk of perforation and that the risk is smaller without anesthesia

Re: Are colonoscopies worth it?

#47

Post by woleium »

all2 wrote: post #43
woleium wrote: post #35

Earlier quoted context omitted.

If only Semmelweis wasn’t such a strange chap, we’d have been much more further forward now.

I don't know what this means. Can you expand on your statement? Who is this person? What would we be farther forward to ?

https://en.m.wikipedia.org/wiki/Ignaz_Semmelweis

He had very sensible ideas about hand washing a hundred years before it was accepted by most doctors. He was a bit weird though, and ended up being ignored.

Re: Are colonoscopies worth it?

#48

Post by IcyWindows »

labster wrote: post #21
eastern wrote: post #14

The sad thing about the article is that skirts around mentioning the possibility that the American disease industry hates this trial because it will reduce their income. The good thing about the article is that it has a colonoscopy joke that also involves (bonus for the HN crowd) Bayesians.

Did you read the whole article? It definitely mentions cost and financial interest in the discussion section.

It didn't mention the bias from those that don't want to pay for the procedure which was a little unbalanced, perhaps.

Re: Are colonoscopies worth it?

#49

Post by Nevermark »

re wrote: post #28
refurb wrote: post #8

This is actually a nice summary of how a clinical trial is more than just "did it have a positive or negative result?". Every single trial introduces some bias through the way it's designed. Good trials try to minimize bias or at least limit it to things we know don't introduce bias. The article does a nice job at digging into the nuances of the trial design and how it may influence (or not influence) the results. Th…

Yeah, I thought the discussion of how you couldn't just directly compare people that accepted the colonoscopy invitation with the control group was really interesting, and non-obvious (at least to people like me that don't design studies). It reminds me of the fundamental problem that all surveys have in terms of the bias introduced by being limited to "people who agree to take surveys".

Any self-selection where higher risk individuals opt-in more, increases benefit/cost ratios.

That seems like a pro invitation argument. (I.e. pro treatment for the invited + opt-in cohort.)

Re: Are colonoscopies worth it?

#50

Post by eastern »

labster wrote: post #21
eastern wrote: post #14

The sad thing about the article is that skirts around mentioning the possibility that the American disease industry hates this trial because it will reduce their income. The good thing about the article is that it has a colonoscopy joke that also involves (bonus for the HN crowd) Bayesians.

Did you read the whole article? It definitely mentions cost and financial interest in the discussion section.

Did you read my comment?

I'm saying that the Americans want colonoscopies to remain unchallenged because they make money out of it. This has little (or nothing) to do with the cost-benefit trade-off that the article discusses.

I didn't find this (self-evident) idea anywhere in the article.

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