Here’s an article in the New York Times about a survey that was done to find out why some people won’t submit to screening colonoscopy.

According to the article, the primary reason people will not submit is fear – fear of the preparation, fear of the procedure itself, and fear of what they might find out. Other reasons were cited as well, such as lack of time, lack of good insurance coverage, or being “squeamish” or “procrastinating.”

Apparently no one answered, “Because I’ve looked at the evidence, and I’ve concluded that the negatives outweigh the positives.”

Those negatives include not just the discomfort and the cost, and they go beyond the small but measurable risk of a perforated colon. A diagnosis of cancer can ruin your life. It can bankrupt you, it can make you permanently uninsurable and unemployable. Being treated for cancer can even kill you.

Screening colonoscopy is an amazing phenomenon. Thousands of years from now, future historians will read about this ritual and shake their heads and wonder: What kind of people were these “Americans?”

Think about it. You drink that magnesium citrate and spend the day crapping your guts out, and then you go to the temple clinic and the high priest doctor slips you a roofie administers a sedative and then proceeds to sodomize you with a fiber-optic cable. Then there are three possible outcomes:

1) Almost certainly, the high priest absolves you of your sins doctor pronounces you cancer-free. You walk away feeling very good about yourself for being so prudent and responsible, and become a proselytizer for colon cancer screening.

2) You are diagnosed with colon cancer. After being subjected to the tender mercies of our cancer treatment industry (which may include any or all of the following: blasting the body with radiation, blasting the body with toxic chemicals, or mutilating surgery) you are pronounced cured. Maybe you would have done just as well had you waited for symptoms to appear. Maybe the symptoms never would have appeared at all before you died of something unrelated. You have no way of knowing. Nevertheless, you conclude that “a colonoscopy saved my life” and you become a proselytizer for colon cancer screening.

3) You are one of the unlucky tiny minority who really do have a nasty metastatic cancer, and despite the best efforts of the medical profession, you die from it anyway, and your surviving loved ones become proselytizers for colon cancer screening.

Do you get the picture? Any conceivable outcome is interpreted as evidence supporting colon cancer screening.

Oh, by the way, the aforementioned survey was funded by Salix Pharmaceuticals, manufacturers of OsmoPrep, which it bills as “The tablet prep for confidence in clear visibility of the entire colon.” The study was performed at the behest of the Colon Cancer Alliance, an alleged “patient advocacy group” whose own website expresses “special thanks” to Ethicon Endo-Surgery and Genentech for their “generous support.”

Ethicon Endo-Surgery is the manufacturer of the SEDASYS System, which it bills as “an investigational computer-assisted personalized sedation system…designed to enable gastrointestinal physician/nurse teams to safely administer propofol, a preferred sedative for minimal-to-moderate sedation in routine colonoscopy.”

Genentech is the manufacturer of the cancer drug Avastin, a drug which blocks angiogenesis, or the formation of new blood vessels, effectively starving tumors of the nutrients they need for continued growth. Currently the drug is approved only for treatment of late-stage cancers of the lung, breast, and colon. A couple of years ago, the company was blasted by some cancer researchers for the design of a study testing the efficacy of Avastin as a treatment for early-stage colon cancer.

The purpose of the study was to determine if administering Avastin for one year could help prevent the recurrence of colon cancer after surgery. (Chemotherapy administered after surgical extirpation of a cancer is called "adjuvant" chemotherapy.) Normal protocol is to test adjuvants for six months, not a year, leading researchers to wonder whether patients and insurers might end up footing the bill for a year's supply of Avastin, when six months might have done just as much good, at half the cost. It all turned out to be a moot point when the study failed to show any significant benefits, although the company’s chief medical officer vowed to continue efforts to develop the drug as a treatment for early-stage colon cancer.

Oh, by the way: for individuals with annual incomes of under $100,000, Genentech has capped the price for a year’s supply of Avastin at $55,000. That’s not counting markups by doctors and hospitals.

Letting these guys decide if you need a colonoscopy is like letting the Hummer salesman decide how big a car you need.

Where are the data that show that screening colonoscopy saves lives? I’m not talking about the data that show it is correlated with a tiny, barely measurable reduction in the chances of having colon cancer, as opposed to something else, listed on your death certificate as the cause of death. Where are the data that show it delays the DATE of your death?

 Screening colonoscopy has been around for forty years. This ought to be a slam-dunk for its proponents. But they can’t show us the data that screening colonoscopy saves lives because THERE AREN’T ANY.

I’m sure I’m going to get comments from people who will say something like, “I know that screening colonoscopy saves lives. I (or My Uncle Fred) had a colonoscopy and was treated for colon cancer and lived to tell the tale, and therefore I am (he is) alive BECAUSE of that colonoscopy." If, after forty years, the proponents of colonoscopy don’t have anything better to offer us than that kind of magical thinking, it’s time to move on.

Illustration via Wikimedia Commons