Are colonoscopies worth it?

How significant is reducing a small risk (1%) significantly?

(Base rate fallacy)

"The right graph compares those results to the observed outcomes for acceptors in our branch of the multiverse, where they did have colonoscopies. At the end of the trial, there’s a reduction of 37%. Unfortunately, data aren’t available to do this for mortality,..."

They are invasive, they are also unpleasant. It isn’t irresponsible to say those things it’s just true.

That's unfortunate, because it's a poor summary of the actual paper the article is discussing. If you bother to read the rest of the article, you'll see the actual summary of the trial, and it's pretty darned easy to interpret for yourself:

https://asteriskmag.com/media/pages/issues/04/you-re-invited...

to wit:

> The 18% reduction in colorectal cancer incidence was statistically significant, while the 10% reduction in colorectal cancer mortality and 1% reduction in overall mortality were not.

(Those reductions are relative risks, which are on very small baseline numbers.)

Then the article goes on for many pages about how American gastroenterologists do not agree...which isn't terribly shocking, considering the source of the argument. But a number of rebuttals are made, some of which are reasonable (i.e. colonoscopies are one of the few screening tests to actually do something to prevent disease, in the form of clipping polyps), and others of which are quite simply lies ("other studies have estimated larger benefits for colonoscopies" -- yeah, but those studies were bad, and this one was good, which is why we're talking about it!)

Note that American gastroenterologists do a lot of colonoscopies, mostly without good evidence. This was the first major RCT in decades to consider the question at all. The other screening methods have even worse evidence, and certainly no good evidence at the young ages we do them in the USA (currently 40 in men; the studies are all in much older age groups).

Overall, the NORDICC trial paints an incredibly ambiguous picture for the effectiveness of colonoscopy at preventing severe illness or death -- at the very least, the benefits are likely dramatically overstated. Discussing all of this, then turning around and claiming "it works" is an insult to evidence-based medicine.

(FWIW, I'm personally torn on the meaning of the study. I just think that "one thing is clear" line is a particularly odious bit of "journalism" -- not the least because it confuses symptom-free screening with doing something in reaction to symptoms. The rest of the article is pretty fair, IMO, but that line is substituting the opinion of the author for an actual summary of the data.)

Don't bother with the NHS, it's a carwreck. See this, for example: https://www.bbc.co.uk/news/health-67239548

Last month, after years of waiting, I got a letter again delaying my assessment for a growth on my neck, for the foreseeable future. It's a good job that I'd gone private a year ago, as it turned out to be extremely advanced, with neural invasion, requiring two rounds of surgery to be removed.

Nationalised healthcare ought to be means-tested to target help at the people who need it, and not delay others who can afford to pay their way. The population 'pyramid' as it stands can't support the health and social care model we're using, and the lack of market incentives means that we don't train enough medics.