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Solving the colonoscopy controversy

Do you know whether heartburn pills are safe for long-term use?

No doubt you’ve seen the latest on colonoscopies, from the New England Journal of Medicine.  The bottom line, so to speak, is that they don’t do anything…or do they?

It was a large, multiyear randomized control trial, which would normally be considered the Gold Standard.  And it concluded that the rate of colon cancer cases was not much lower in the invited group than in the control group, while the all-cause death rates were almost identical. It was good enough for the leading medical journal in the world, so shouldn’t it be good enough for us?

However, the subset of the invited population that actually got the colonoscopies did enjoy a much more noticeable reduction in cases and all-cause death rates.

But as we’ve learned in wellness, comparing participants to a reference or “passive control” group is not valid, because participants always outperform non-participants.

And we can credit Ron Goetzel’s brilliant analysis for that. He proved that participants will even outperform non-participants when there isn’t a program to participate in, as noted below, where the groups were separated in 2004 but the program didn’t start until 2006…at which point the participants had already dramatically outperformed the reference group.

And yet, this time the rebuttalists may have a point. Unlike in wellness, where there is clearly a state-of-mind difference between people who want to participate in a program and people who don’t, it’s hard to imagine that same amount of difference in a decision to get a colonoscopy. Some people just don’t want them, even if they are otherwise conscientious about patrolling their health.

Needless to say, Quizzify has deconstructed the pro and con arguments. You can read about that here in Part One of our series on colon screening.

Or you can cut right to the chase and see our elegant solution here in Part Two. You’ll see in Part Two that our solution has, in the immortal words of the great philosopher Zero Mostel, something familiar, something peculiar, something for everyone. It’s…

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