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Are colonoscopies worth it?

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Re: Are colonoscopies worth it?

#251

Post by matheusmoreira »

ramraj07 wrote: post #133
hermitcrab wrote: post #120

>3. It’s irresponsible to call colonoscopies “invasive” (as CNN did) since that might make people think they are unpleasant and not do them. LOL. It hard to imagine anything much more invasive than having a metal tube (with light and camera) shoved up your arse. It is definitely unpleasant. I speak from personal experience. That said, it is less unpleasant than bowel cancer. So don't be put off if you really need to…

It is invasive, as are most gynecological procedures. It sounds disingenuous to try and sugar coat this. My female acquaintances have long been lamenting the trauma of gynecologists especially in India telling them “please get a scan in the next room it’s a simple procedure” only to get a probing that’s not just invasive but even painful at times.

Yeah. It's definitely a simple procedure... To the doctors who do it all day every single day for decades. To the patient who's going to be examined, it's extremely invasive.

Re: Are colonoscopies worth it?

#252

Post by tptacek »

matheusmoreira wrote: post #243
tptacek wrote: post #220

Earlier quoted context omitted.

Doctors routinely washed their hands before Semmelweis, whose innovation was chlorinated hand washing; he ended up in a sanatorium because he went crazy (he likely had an advanced case of syphilis); the connection he made was that "cadaveric particles" were causing illness in hospitals, which is problematic because the phenomenon occurred in circumstances where no cadavers availed, but he was apparently absolutely hu…

> Doctors routinely washed their hands before Semmelweis The cringeworthy "gentlemen don't wash their hands" culture contradicts that. > he ended up in a sanatorium because he went crazy (he likely had an advanced case of syphilis) I see no evidence of this so called "craziness". Even the people who speculated about the cause included "emotional exhaustion from overwork and stress" as a possibility. That's the simple…

You can just go look this up instead of trying to rebut it through axiomatic derivation from a meme. Doctors washed their hands in Semmelweiss's time. There's a reason writeups of his contributions often include the recipe for his decontamination solution; that's the novelty, of antiseptic washes versus ordinary soap and water.

Similarly, you can just go look up Semmelweis' mental state at the time of his commitment.

The difference between Semmelweis's incorrect theory of what was causing childbed fever and reality is a big part of why his interventions were rejected (that, and the fact that he was apparently an unholy asshole) --- he was trying to convince his colleagues to disinfect their hands from particles that sometimes could not have existed, and the colleagues noticed that. If you're trying to evangelize a new medical intervention, don't get hung up on an explanation that can't possibly be correct, is one lesson to take from this.

Complicated dude. Read more about him than you have. It's interesting stuff. His story is more than just the airport bookstore management parable that it's become.

later

As a quick PS: the "gentleman's hands" thing came up on an AskHistorians thread I just read, and it's apparently a misquote. It's not "gentleman don't wash their hands"; it's "a gentleman's hands are clean". As in, doctors already keep their hands clean. What they didn't do was chlorinate the water they used (or clean all that hard).

That's obviously false! The contagionists and aseptics were right, the spontaneous generation people were wrong, and obviously aseptic procedure before Gordon and later Holmes and later Semmelweis was inadequate. I'm not defending the guy who said that. But he didn't say what you think he said.

Re: Are colonoscopies worth it?

#253

Post by timr »

vibrio wrote: post #235
timr wrote: post #127

Earlier quoted context omitted.

> One thing is clear: Screening works. If you’re of the appropriate age, please get screened. If your tubes are acting funny, please get screened without delay. The best method and the level of benefit are debatable, but we know it helps. 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 tr…

If i recall, it is important to note that the main analysis in the NORDICC trial was on patients invited to receive screening. As an intent to treat study, not all received screening. There was a subgroup analysis on those that actually received screening, which showed a decent improvement in hazard ratio. The question I had (and will look for when I’m off mobile) is was there a demographic bias in those invited who…

Yes, this is the main, common counterargument that the OP addresses. This does a pretty good job of showing why that argument is overstated (if not entirely in bad faith), so I direct you back to it.

> There was a subgroup analysis on those that actually received screening, which showed a decent improvement in hazard ratio.

I can't emphasize this enough: read the article. Per-protocol analysis (what you're describing) is incredibly biased. OP shows that it's an overestimate of true effect, and I'd go so far to say that it's completely useless (in general; not just for this paper).

People who argue that NORDICC was wrong because per-protocol showed a bigger effect size should be ignored with prejudice. They don't know how to read or interpret scientific studies, and have a poor understanding of statistics.

Re: Are colonoscopies worth it?

#254

Post by timr »

Mistletoe wrote: post #228
timr wrote: post #127

Earlier quoted context omitted.

> One thing is clear: Screening works. If you’re of the appropriate age, please get screened. If your tubes are acting funny, please get screened without delay. The best method and the level of benefit are debatable, but we know it helps. 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 tr…

I really wish the trial included stool testing. I suspect it would perform very favorably to the colonoscopy, which seems to have very modest benefits to begin with. And the stool test is infinitely easier (and cheaper on a healthcare system). >The sensitivity of detection of carcinoma is a remarkably acceptable comparison. The multi-targeted stool DNA test is 92% sensitive for finding cancers, which is almost equal…

Me too. It would be good to see an RCT between the approaches for asymptomatic people who seek screening.

Re: Are colonoscopies worth it?

#255

Post by rexpress »

tonnydourado wrote: post #205

I'm still flabbergasted that anyone in the face of the planet even considers doing a colonoscopy without sedation.

I had it done twice, both times without sedation by choice. I did have analgesics, and a cannula in my wrist in case I changed my mind mid-way.

It was quite tolerable, just a few moments of short lived cramping pains (similar to diarrhea pains) as the endoscope turned the corners of my insides. My recovery was about half an hour of sitting up and having tea and toast, while those that were sedated slept off the drugs.

I'd do the same again if ever I get another one, and recommend it to anyone who can't have or doesn't want sedation.

Re: Are colonoscopies worth it?

#256

Post by matheusmoreira »

tptacek wrote: post #252
matheusmoreira wrote: post #243

Earlier quoted context omitted.

> Doctors routinely washed their hands before Semmelweis The cringeworthy "gentlemen don't wash their hands" culture contradicts that. > he ended up in a sanatorium because he went crazy (he likely had an advanced case of syphilis) I see no evidence of this so called "craziness". Even the people who speculated about the cause included "emotional exhaustion from overwork and stress" as a possibility. That's the simple…

You can just go look this up instead of trying to rebut it through axiomatic derivation from a meme. Doctors washed their hands in Semmelweiss's time. There's a reason writeups of his contributions often include the recipe for his decontamination solution; that's the novelty, of antiseptic washes versus ordinary soap and water. Similarly, you can just go look up Semmelweis' mental state at the time of his commitment.…

The incompleteness of the theory is completely irrelevant. He published results and reproduced his findings. He correlated a rise in mortality to the time the necropsies started, and he demonstrated a decrease in mortality after implementing his hand sanitization method twice. That's more trustworthy than quite a bit of what passses for science even today. Doesn't matter how much of an asshole he was, when faced with that undeniable evidence clearly showing that women were dying less the last thing those scientists should have done was dismiss it out of hand and condemn women to death for their negligence. To me it sounds like they deserved every bit of denouncing they got and then some.

Re: Are colonoscopies worth it?

#257

Post by hermitcrab »

Supermancho wrote: post #237
hermitcrab wrote: post #120

>3. It’s irresponsible to call colonoscopies “invasive” (as CNN did) since that might make people think they are unpleasant and not do them. LOL. It hard to imagine anything much more invasive than having a metal tube (with light and camera) shoved up your arse. It is definitely unpleasant. I speak from personal experience. That said, it is less unpleasant than bowel cancer. So don't be put off if you really need to…

Let's discuss what "invasive" means. Putting something in the body and getting it back out without tearing, is not invasive. Eating and vomiting would be categorized as invasive, in context. A colonoscopy/endoscopy is internal and dangerous, which is not the same thing as being invasive, so the term "minimally invasive" is sometimes used as a happy middleground, which has then been sensationalized.

The first relevant definition I found online was:

"(of medical procedures) involving the introduction of instruments or other objects into the body or body cavities."

YMMV

Re: Are colonoscopies worth it?

#258

Post by landemva »

bojan wrote: post #192
scruple wrote: post #87

Earlier quoted context omitted.

I've had the experience that... I was told when I was separating from the military, at 25b(I don't know why and I didn't ask...), to expect a colonoscopy. It didn't happen. I mentioned it to my GP a couple of years later, he said probably between 30 and 35... Now I'm in my 40s. It's perpetually a couple of years away. I get the sense from this, and from other anecdotes in life, that preventative maintenance, of all f…

In the Netherlands they begin with preventive colonoscopies when you turn 55. Then you get one every 5 years. The newest science says they should even begin at 45.

> The newest science says

I was speaking with my Dr. about these exploratory procedures and asked if early diagnosis extends life. He responded with general recommendations. Every procedure has a risk.

I have no symptoms, so what science studies with control groups show extending life?

Re: Are colonoscopies worth it?

#259

Post by tptacek »

matheusmoreira wrote: post #256
tptacek wrote: post #252

Earlier quoted context omitted.

You can just go look this up instead of trying to rebut it through axiomatic derivation from a meme. Doctors washed their hands in Semmelweiss's time. There's a reason writeups of his contributions often include the recipe for his decontamination solution; that's the novelty, of antiseptic washes versus ordinary soap and water. Similarly, you can just go look up Semmelweis' mental state at the time of his commitment.…

The incompleteness of the theory is completely irrelevant. He published results and reproduced his findings . He correlated a rise in mortality to the time the necropsies started, and he demonstrated a decrease in mortality after implementing his hand sanitization method twice . That's more trustworthy than quite a bit of what passses for science even today. Doesn't matter how much of an asshole he was, when faced wi…

All of this matters. You write as if he provided a succinct record of a series of experiments he conducted; in fact, he infamously wrote ponderous and impenetrable litanies on the precise cadaveric origin of the particles he thought he was combating. I understand the message board rhetorical strategy of trying to put me on the other side of the aseptic revolution, but (1) no and (2) that has nothing to do with what I'm writing. The bar you need to clear here is much higher than "Semmelweis was correct about chlorinated lime".

Re: Are colonoscopies worth it?

#260

Post by matheusmoreira »

tptacek wrote: post #259
matheusmoreira wrote: post #256

Earlier quoted context omitted.

The incompleteness of the theory is completely irrelevant. He published results and reproduced his findings . He correlated a rise in mortality to the time the necropsies started, and he demonstrated a decrease in mortality after implementing his hand sanitization method twice . That's more trustworthy than quite a bit of what passses for science even today. Doesn't matter how much of an asshole he was, when faced wi…

All of this matters. You write as if he provided a succinct record of a series of experiments he conducted; in fact, he infamously wrote ponderous and impenetrable litanies on the precise cadaveric origin of the particles he thought he was combating. I understand the message board rhetorical strategy of trying to put me on the other side of the aseptic revolution, but (1) no and (2) that has nothing to do with what I…

> he infamously wrote ponderous and impenetrable litanies on the precise cadaveric origin of the particles he thought he was combating

Which doesn't invalidate the fact that women provably died less after his methods of combating those particles were implemented and published. Faced with that evidence, they should have accepted the method even if they don't agree simply because you can't argue with results. They could have saved women and followed up with further study on the exact nature of the problem which would only become clear when Pasteur came along. They chose to institutionalize him out of embarrassment.

I'm not "putting you on the other side" of anything. I don't agree with your minimization of the guy's achievements nor with your characterization of him as "crazy".

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