Minichan

Topic: Benefits of colonoscopies quite minimal, risk of the procedure itself may be higher than the benefit

Anonymous A started this discussion 3 years ago #109,626

> Huge trial yields disappointing results on colonoscopy benefits
> Analysis suggests that the screening method cuts risk of colorectal cancer by only a modest amount.
https://www.nature.com/articles/d41586-022-03228-z
https://www.nejm.org/doi/full/10.1056/NEJMoa2208375

According to the study, if you receive a colonoscopy your risk of dying from colorectal cancer was 0.28% compared with a 0.31% risk if you didn't receive one. So a 0.03% excess mortality rate.

Colonoscopies themselves carry a risk serious complications: 1 in 200 (0.5%).

0.5% is over ten times higher than the excess mortality of receiving no screening at all.

So, for the overwhelming majority of people, these screenings may be doing more harm than good. That's what we get for pushing a screening procedure that had minimal evidence-based research backing it. Hoodwinked again!

(Edited 1 minute later.)

Anonymous B joined in and replied with this 3 years ago, 9 minutes later[^] [v] #1,223,915

Any time you shove something up your arse you're taking a risk. This is just common sense.

Anonymous A (OP) replied with this 3 years ago, 10 minutes later, 19 minutes after the original post[^] [v] #1,223,916

@previous (B)
If your common sense told you the risk of serious complications was 0.5%, riding beside a baseline excess mortality rate of 0.03%, then you should stop everything you're doing and become a medical researcher.

Common sense to me is not pushing an invasive medical procedure on everyone and attempting to guilt trip anyone who questions it before any studies are done supporting its efficacy.

Anonymous B replied with this 3 years ago, 6 minutes later, 26 minutes after the original post[^] [v] #1,223,917

@previous (A)

> If your common sense told you the risk of serious complications was 0.5%, riding beside a baseline excess mortality rate of 0.03%, then you should stop everything you're doing and become a medical researcher.

I already am a medical researcher.

Anonymous A (OP) replied with this 3 years ago, 8 minutes later, 34 minutes after the original post[^] [v] #1,223,918

@previous (B)
Oh, intriguing. What field are you in? What institution are you affiliated with?

Anonymous B replied with this 3 years ago, 9 minutes later, 44 minutes after the original post[^] [v] #1,223,919

@previous (A)

> Oh, intriguing. What field are you in? What institution are you affiliated with?

Hematopathology. I'm affiliated with Johns Hopkins University.

Anonymous A (OP) replied with this 3 years ago, 3 minutes later, 47 minutes after the original post[^] [v] #1,223,920

@previous (B)
Oh, no way! I did my MD and PhD there. Which lab are you a part of?

Anonymous C joined in and replied with this 3 years ago, 7 minutes later, 55 minutes after the original post[^] [v] #1,223,921

> if you receive a colonoscopy your risk of dying from colorectal cancer was 0.28% compared with a 0.31% risk if you didn't receive one.

So getting a colonoscopy reduces mortality by nearly 10%. (Divide 0.28% by 0.31%, don't subtract.)

> Colonoscopies themselves carry a risk serious complications: 1 in 200 (0.5%).

So I have a 99.5% chance of not dying.

Anonymous B replied with this 3 years ago, 4 minutes later, 59 minutes after the original post[^] [v] #1,223,922

@1,223,920 (A)
Sidney Kimmel Comprehensive Cancer Centre (Bayview Medical Centre).

Anonymous A (OP) replied with this 3 years ago, 4 minutes later, 1 hour after the original post[^] [v] #1,223,923

@1,223,921 (C)
> So getting a colonoscopy reduces mortality by nearly 10%.
Correct. That's more or less the relative risk.

> (Divide 0.28% by 0.31%, don't subtract.)
You provided an entirely different statistic. Neither is "right" or "wrong". It's the interpretation that matters.

Think of it like this, let's suppose we find a procedure to reduce your chance of dying from a lightening strike 10000x fold. That's an exceedingly large reduction in mortality!

What's the procedure? We just dip you in molten iron and make the entire outer shell of your body a Faraday cage. Your risk of having serious complications from this is only 999,999 in 1,000,000!

Relative risk, in itself, is not such a useful measure here or there without context.

Anonymous A (OP) double-posted this 3 years ago, 3 minutes later, 1 hour after the original post[^] [v] #1,223,924

@1,223,922 (B)
There's no such "Centre". Who is the PI of the lab you work with?

Anonymous B replied with this 3 years ago, 4 minutes later, 1 hour after the original post[^] [v] #1,223,925

@previous (A)

> There's no such "Centre".

What are you talking about? It's one of the main consultative hematopathology centres you dolt:

https://www.hopkinsmedicine.org/kimmel_cancer_center/locations/bayview.html

Anonymous A (OP) replied with this 3 years ago, 1 minute later, 1 hour after the original post[^] [v] #1,223,926

@previous (B)
There's not a single "Centre" affiliated with JHU.

Who is the PI of the lab you work with?

Anonymous B replied with this 3 years ago, 5 minutes later, 1 hour after the original post[^] [v] #1,223,927

@previous (A)

> There's not a single "Centre" affiliated with JHU.

Wait, to be clear, are you nitpicking over my British spelling? Or are you seriously saying you did an entire MD and PhD at Johns Hopkins and you've never heard of Sidney Kimmel/Bayview??

Anonymous A (OP) replied with this 3 years ago, 1 minute later, 1 hour after the original post[^] [v] #1,223,928

@previous (B)
Who is the PI of the lab you work with?

Anonymous B replied with this 3 years ago, 1 minute later, 1 hour after the original post[^] [v] #1,223,929

@previous (A)
Answer my question first and then I'll answer yours. Were you nitpicking over my British spelling or you really had never heard of it?

Anonymous A (OP) replied with this 3 years ago, 1 minute later, 1 hour after the original post[^] [v] #1,223,930

@previous (B)
I asked first, you answer first. That's how this works.

Anonymous B replied with this 3 years ago, 5 minutes later, 1 hour after the original post[^] [v] #1,223,931

@previous (A)
So you'd never heard of it? Lol, you dumbass. Anyway, PI is Professor Yan Xiaoqing.

Anonymous A (OP) replied with this 3 years ago, 2 minutes later, 1 hour after the original post[^] [v] #1,223,933

@previous (B)
Really? I did my PhD with her, but last I heard she quit to work at a doughnut shop in Louisiana. Did she come back?

Anonymous A (OP) double-posted this 3 years ago, 53 seconds later, 1 hour after the original post[^] [v] #1,223,934

@1,223,931 (B)
And, yes, I had heard of it. We just don't take kindly to the Queen's English in Baltimore.

Anonymous D joined in and replied with this 3 years ago, 43 minutes later, 2 hours after the original post[^] [v] #1,223,935

Oh gee! Two dolts arguing about who REALLY went to John Hopkins despite full knowing neither of them did.

Anonymous B replied with this 3 years ago, 1 minute later, 2 hours after the original post[^] [v] #1,223,936

@previous (D)
What are you talking about? I work there.

Anonymous A (OP) replied with this 3 years ago, 7 minutes later, 2 hours after the original post[^] [v] #1,223,937

@1,223,935 (D)
Are you mad that I got my degrees from JHU?

Anonymous E joined in and replied with this 3 years ago, 59 minutes later, 3 hours after the original post[^] [v] #1,223,938

Is it because people are more likely to have such a procedure if they already suspect sonething is wrong?

Anonymous A (OP) replied with this 3 years ago, 12 minutes later, 3 hours after the original post[^] [v] #1,223,939

@previous (E)
In the study I mentioned in the OP, the groups which did and did not receive screening were randomly assigned ahead of time, so, no, not in this case.

But what you mention is a problem for retrospective studies that use statistics of the general population. That's why randomized prospective trials are so important.

Anonymous E replied with this 3 years ago, 5 minutes later, 3 hours after the original post[^] [v] #1,223,940

@previous (A)
So some of these people got unnecessary colonscopies for this study?

Anonymous A (OP) replied with this 3 years ago, 15 minutes later, 3 hours after the original post[^] [v] #1,223,943

@previous (E)
They got them at the rate specified by various medical organizations. Although, those guidelines have not, with any level of seriousness, been based on rigorous studies or data. So I guess you could further argue that everyone getting colonoscopies that doesn't have a family history of colorectal cancer is getting them unnecessarily.

However, if the study had gone the other way couldn't one argue they were depriving the control group of necessary screening?

Point is, before the study no one really knew what was and wasn't necessary.

Anonymous E replied with this 3 years ago, 8 minutes later, 4 hours after the original post[^] [v] #1,223,945

@previous (A)
So one group got them based on advice from their doctors?

I feel like I'm missing something

(Edited 32 seconds later.)

Anonymous A (OP) replied with this 3 years ago, 4 minutes later, 4 hours after the original post[^] [v] #1,223,948

@previous (E)
Of the people that volunteered to participate in the study:

One group was randomly assigned to get them.
One group was randomly assigned to not get them.

I'm not sure what's confusing about this?

spectacles joined in and replied with this 3 years ago, 1 hour later, 5 hours after the original post[^] [v] #1,223,961

Unless you have cancer. Colon cancer is super common, and super treatable with early detection. I'd say it's probably best to take the advice of your doctor and if they say it's the best course of action -at any age, it's likely best to heed their suggestion and schedule a procedure with the gastroenterologist they refer you to. Since insurance pays for routine screenings and it can save you from ass cancer.

Which OP likely wouldn't care if you had. Which is weird, considering how about your ass this is. It's just kinda weird. U know?

Anonymous A (OP) replied with this 3 years ago, 4 minutes later, 5 hours after the original post[^] [v] #1,223,964

@previous (spectacles)
1. I am a doctor.
2. Your argument is an appeal to authority.

spectacles replied with this 3 years ago, 7 minutes later, 5 hours after the original post[^] [v] #1,223,968

@previous (A)
👁  👃👁
👄👂
☝️ -yes! An appeal to the correct authority. With a diploma I can see.

Anonymous A (OP) replied with this 3 years ago, 58 minutes later, 6 hours after the original post[^] [v] #1,223,974

@previous (spectacles)
Or we could act like adults and not rely on having other people tell us what to think, especially considering I've already handed you all the relevant information you need. I'd venture a guess and say the overwhelming majority or problems humans have gotten themselves into throughout all of history has been exactly this: outsourcing critical thinking to other people.

spectacles replied with this 3 years ago, 44 minutes later, 7 hours after the original post[^] [v] #1,223,976

@previous (A)
👁👃👁   to medical doctors, who's
 👄  👂 -entire lives are dedicated  
☝️      to being outsourced expertise
        trained specifically to know
        better than me what relevant 
        information I need, and that
        makes you redundant. You have
        handed me a waste of your time,
        and believe me, I've considered
        none of it. Have fun lying about
        being a doctor. In case you were 
        wondering, yes I don't believe you,
        no, that's not even the reason I
        wouldn't trust you to be well
        informed on issues related to 
        medical doctoring anyway. But,
        I still think you're full of shit,
        it just so happens that you lying
        about being a doctor is FITTING,
        prove me wrong, Dr.anonymous. you
        know so much about asses I'm sure
        you can pull a medical license out
        one in less time than it takes to
        Google "medical license.jpg." and 
        "How to photoshop false documents
         For idiots."

Anonymous A (OP) replied with this 3 years ago, 15 minutes later, 7 hours after the original post[^] [v] #1,223,980

@previous (spectacles)
Didn't read.

spectacles replied with this 3 years ago, 6 hours later, 13 hours after the original post[^] [v] #1,224,001

@previous (A)
—   __
👁👃👁  
 👄  👂🫱
🫱 - and you expect people to value your critical assertions over their own critical thinking which says you're likely not an expert or more that even modestly informed?

I already assume you don't read. You probably do tho. Lol

(Edited 1 minute later.)

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