None of my four jobs provides health insurance. Recently I purchased at my own expense a policy with a $10,000 deductible (not a typo) which I suspect will turn out to be like an umbrella that folds up as soon as it starts to rain, should I ever actually need it. The only reason I bought it was so that, in the event of a serious accident or illness, I could say I did everything right when I told my sob story to Mike Moore.
But the policy does provide certain benefits. When I turn fifty, less than two years from now, as part of my initiation into elderhood I will be offered a free colonoscopy.
Thanks, but no, thanks.
A recent study published in the Annals of Internal Medicine highlights the difficulties inherent in establishing the efficacy of screening for colorectal cancer (or any other kind of cancer, for that matter). Dr. Nancy Baxter and her colleagues examined the records of 10,292 patients in Ontario who died of colorectal cancer. Average age at diagnosis was 73. For each patient who died of colorectal cancer, 5 controls were chosen from the Registered Persons Database who did not. Controls were chosen to match case patients for sex, age, income level, and location. They found that case patients who died of colorectal cancer were less likely to have undergone colonoscopy than the matched controls. The authors concluded that people who had colonoscopies had a 69% reduction in the risk of dying of colorectal cancer compared to those who did not.
Wow, a 69% reduction in risk! You’d have to out of your mind not to get that colonoscopy, right?
Hold on, not so fast. Sixty-nine percent of what, exactly? According to the American Cancer Society, colorectal cancer kills 56,000 Americans every year. Since about 2.5 million Americans die every year from all causes, that means that about one death in fifty, or about 2% of all deaths, is due to colorectal cancer. Sixty-nine percent of two percent is 1.38%, or one in seventy-two. So using Dr. Baxter’s figures, we can deduce that for every seventy-two patients who are screened, one will be spared death from colorectal cancer while the other seventy-one will receive no benefits whatsoever (not to mention a small but measurable risk of a perforated colon).
I don’t think a one in seventy-two reduction in risk is worth bothering with. Maybe you do – but we’re not finished yet. With proper scientific caution, Dr. Baxter and her colleague stated the conclusion of their study thusly: “Colonoscopy was associated with fewer CRC [colorectal cancer] deaths.” They don’t say that early detection via colonoscopy caused the reduction in colorectal cancer deaths.
The whole idea of screening for cancer was based on the hope that there are cancers which are so fast-growing that by the time symptoms appear, it’s too late – BUT which are sufficiently slow-growing that, if detected earlier, by these new screening technologies, could be cured. There is no evidence such cancers even exist.
I would bet you any amount of money that people who take the trouble to get regular colonoscopies are also more likely to refrain from smoking and excessive drinking, and to exercise and eat sensibly – all of which have been shown to reduce the risk of colon cancer. So how much of the reduction in mortality from colon cancer was due to early detection and treatment – all of it, half of it, or none of it? The fact is, we don’t know.
But even that’s not the whole story. What difference does it make if you die of colon cancer at the age of 73 – or you die of something else AT THE EXACT SAME TIME? The only statistic that means anything to you as an individual is the OVERALL death rate. I emailed Dr. Baxter and asked her if she and her co-workers found any evidence that colonoscopy was associated with any reduction in the overall death rate. She very graciously replied to me that the study was not designed to answer that question.
Gilbert Welch, M.D., M.P.H. and author of Should I Be Tested For Cancer? Maybe Not And Here’s Why states that to reliably detect a one percent drop in overall death rate due to colorectal cancer would require a study involving over one million people.
It is worth quoting Welch at some length here:
”Many researchers involved in early cancer detection say simply, “It can’t be done”; “It’s just too big.” What they really are saying is, “We can’t be sure a strategy of early detection of cancer saves lives.” I don’t know what the right answer is, but I think we have one of two choices: either do the study or publicly acknowledge that we cannot be sure whether early detection lengthens, shortens, or has no effect on how long people live. And we should be clear that if it takes so many people to find out for sure, then the benefit must be, at best, small.”
Something I wish everybody involved in the health care debate would acknowledge: we all have to die. And we all get to be dead the same length of time, which is forever. So the only thing that matters is how you live while you are alive.
So my motto is: if it feels good, do it.
And nothing feels as good as having a powerful healthy body. Nothing else comes close.
In a world in which one-quarter of the population lacks safe drinking water, isn't our endless hypochondriacal obsession with cancer screening, cholesterol levels, and the like, a bit unseemly? Especially since most people can’t be bothered to do the simple, cost-free things which have been proven both to extend life and improve its quality – exercising, eating sensibly, and refraining from smoking and excessive drinking.
I exercise because strenuous exercise is more enjoyable than sitting on my ass watching other men play games. I eat sensibly because real food tastes better than processed garbage, and cold water tastes better than sugary soft drinks, or God forbid, diet soda. I refrain from excess drinking because I don’t enjoy feeling weak and stupid, and I don’t smoke because I watched my father die from his addiction to tobacco and it didn’t look like any fun at all.
Welch asks his readers a pertinent question: do you want to put your efforts into pursuing health, or into pursuing disease? I find this illness-centric, death-centric world view so many seem to have so…puny.
Photo via Wikimedia Commons