So-tell-me-everything-you-told-the-nurse-5-minutes-ago-Funny-medical-picturesShoving a large fiberoptic device where the sun don’t shine has become one of those hated rituals that we are all told to do in the interest of “prevention”. Well, first it is most definitely NOT prevention but rather earlier “detection” of cancers that have likely been brewing for years based on our understanding of the nature of colorectal cancer growth.

The colonoscopy industry — and it is indeed an industry — is the gravy train of gastroenterology with clinics set up as fiberoptic factories to service the dutiful patients who spread their cheeks for small remuneration. It would be wrong to mock this practice too much as there are data that do indeed suggest that many cancers are caught “early” and “cured” with ongoing surveillance presumptively planned to make sure that no other cancers are ever allowed to grow in our lower GI tracts. But, the actual performance of a colonoscopy is based on standards. Standards that, apparently, are not being met nearly as often as the patient public might think. In a very large study done at Kaiser Permanente in California involving thousands of patients, the so-called “adenoma detection rate” or ADR standard was not met very often by physicians performing colonoscopy. Almost 1/3 of physicians doing this procedure were actually deficient. How would you like to know that you had a one out of three chance of flying in an airplane with a pilot who did not meet standards for flying it?

 

In all, 67% of examiners met the gastrointestinal society guidelines for ADRs in male patients, and 68% met guidelines for female patients, the researchers found. But ADRs among the examiners ranged widely – from 7.7% to 61.5% for male patients and from 1.7% to 45.6% for females, the investigators said. Adjustments for patient demographics and family history of colorectal cancer cut the variation from 8-fold down to 3-fold for male patients, and from 27-fold to 5-fold for females. However, physicians’ absolute rankings among their peers remained similar before and after controlling for patient case mix. (Clin Gastroenterol Hepatol. 2015 Apr;13(4):739-46. doi: 10.1016/j.cgh.2014.10.020. Epub 2014 Oct 25. PubMed PMID: 25445767; PubMed Central PMCID: PMC4369190)

This brings up, of course, the issue of whether or not you are actually getting the product that you think you are getting from the healthcare system when they strongly encourage you to do certain things like take certain drugs for cholesterol, have a so-called “annual physical”, or even get certain vaccines. All may not be what it seems to be.

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