First RCT of Colonoscopy ever- NordICC is a Negative Trial! Implications, Interpretation & More
Vinay Prasad, MD MPH; Physician & Associate Professor
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12 year Endoscopy nurse here. I’ve circulated in hundreds of colonoscopies, and my hospital just finished construction on a 3 story GI center. Here’s what I’ve noticed through the years: 1) Our GI patients with upper and lower issues are getting younger. Having teens/young adults as patients used to be rare, not any more. 2) When GI symptoms aren’t answered through endoscopy, congratulations, you’ve won a CT scan and prescriptions. 3) In my experience, a positive Cologuard usually results in nothing, or a polyp or two. 4)I asked most of our GI physicians which part of the fancy GI center was going to be dedicated to diet/nutrition counseling for better GI health, they all acted like I was crazy. 5) The aforementioned younger patient base have terrible diets, drink 8 Red Bulls a day, and wonder why they don’t feel good. Many are on anxiety meds and are hoping to be granted disability benefits. 6) When the recommended age for first screening went from 50 years of age to 40, I asked the GI Dr’s if we’ve been getting young patients with detected tumors on my days off because I must be missing the reason, they looked at me like I was crazy again. I left GI/Endoscopy a few months ago, I felt like a factory worker cramming as many patients on the assembly line as I could in a day so the hospital can make as much money as possible, while ignoring preventative care/lifestyle issues. I will say, if you have a family history of colon cancer/polyps, it’s important to be screened regularly. Oh, and I wish fecal occult tests differentiated between tumor bleeding and hemorrhoidal bleeding. Almost everybody over 30 has hemorrhoids. I can go on and on, I’ve become extremely disillusioned with “health” care. Oh, one more thing, I’ve never worked with a Dr that couldn’t get to the cecum, unless a large tumor prevented them from advancing the scope.
I live in South America. My doctors here - where the medical care is superior - no longer look to the US as they do to Europe. The FDA has lost all credibility and the world knows it.
Mammography, because of its risk of inducing cancer is not recommended in healthy women in Switzerland as preventive screening
Great video. Preventative medicine is such a contradiction in the US and Canada. We're way too polite over these backwards incentives and pretending we're all evidence based practices.
"early screening saves lives." But what they really mean is that early screening improves five-year survival. Of course it does, but that doesn't mean you lived longer than you would have, you just knew about the cancer longer.
I've had 4 colonoscopies over the past 30 years. The first one cost about $600 and the price went up each time. Four years ago my doctor wanted to do another one but I refused because of the price which varied from $3,000 to $6,000 depending upon the hospital. My guess is the reason for the current big push for colonoscopies is…drum roll please…money! The procedure takes very little time to perform, consumes a minimum amount of medical supplies, and results in a large profit. Best thing since sliced bread for hospital profits…real pain in the rectum for the rest of us!
Lord this made me have flash backs to statistics in college! Had a doctor about 10 years ago that it was time for my colonoscopy. I said no thanks. He said I could not be his patient if I refused. He is no longer my doctor. In fact, I have no doctor. All they do is run tests on you till they find something.
The same thing happened to me. The doctor was about to send me down a long road of tests for chest pain. The nurse yelled across the office, “There’s nothing wrong with that girl, but GERD.” She knew intimately that my bloodwork was perfect over several years. Solution: I lost 30 lbs, and the acid reflux and chest pains magically disappeared. Smdh, thank God for nurses! 🙏🏾
Tremendously intelligent and refreshing commentary by a intellgent, balanced and sober person who has no other motivation than to be guided by what the data actually shows and not the money, speciality bais, or the politics. I'm sure the GI docs will begin to petition to have this man band from KZread for daring to go against the orthodoxy of the absolute benefit of colonscopy based screening.
45? That is such BS!
My mother had early stage colon cancer, probably from poor eating after my dad’s death. She did 6 weeks of radiation which caused terrible burns on her abdomen. These burns went untreated, and my mother suffered terribly. Ultimately, she was so weak that she fell one day at home, hit her head on the dresser. Over the next few days she complained (which was rare) about horrible headaches, so we took my mother to the emergency center at the major hospital downtown Fort Worth. My sister explained every detail of her cancer, radiation, the burns and mostly the headaches from hitting her head on a dresser! The hospital concentrated on her burns ignoring the headaches. Inside of a week my mother was dead, due to a brain bleed that had been neglected. Over all my mother received terrible care….careless care. The colon cancer, radiation, all about the money not really care. Her burns going untreated. Supposedly they did get rid of the cancer, but the lack of care ultimately killed her. I do not trust doctors, I feel they are money hungry glorified drug pushers. Every doctor I go to gets upset over me challenging the prescribed drugs or procedures they recommended. They also don’t appreciate my pre diagnosis before I come to the appointment. But if one goes to the doctor with out any prior information, one winds up taken advantage of or perhaps given poor care and won’t know it.
Contaminated equipment is also a risk of colonoscopy.
My dad had his requisite Colonoscopies every year past age 62 until they perforated his colon. He was so sick, hospitalized but they insisted it had noting to do with the Colonoscopy he had a week prior. That was in. He never went back. My dad lived to be 91 and died from complications due to dementia.
My mother had 2 colonoscopies. Both times within a month she suffered blockage and ischemic colitis. It was not until the 2nd time did I realize it was likely the colonoscopies that were the cause. Unfortunately, that 2nd emergency caused her colon to die and an emergency iliostomy had to be performed. Of course the doctors refused to acknowledge the connection saying that colonoscopies were very safe. 😕.
Here's a thought. Instead of saying "We could have spent it on this." or "We could have spent it on that." Why do we have to spend it at all? If I decide a Disney+ subscription isn't worth the money, it doesn't mean I need to go to a movie theater to offset that decision.
Thank you for this! Fight the good fight against overscreening, overdiagnosis, and overtreatment!
Has anyone studied the effect of "cleaning the colon" for testing and what it does to the microbiome? It can't be a healthy thing to do. I would like evidence that it's not disruptive to gut flora that we're starting to understand have such a huge role in overall health. I've never seen that addressed.
You actually care about people. You aren't just going through the motions. You have courage.
Great comment you made, “screening turns healthy people into patients.”
Thank you.