Tag Archives: colonoscopy

Rethinking Colonoscopy

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Colonoscopies Fail to Reduce Colorectal-Related Deaths

Analysis by Dr. Joseph MercolaFact Checked
October 20, 2022 

STORY AT-A-GLANCE

  • A landmark study published in The New England Journal of Medicine found the “benefits” of colonoscopies are not as great as they’re made out to be
  • After 10 years, those who were invited to get colonoscopies had an 18% lower risk of colorectal cancer than the unscreened group
  • There was no statistically significant reduction in the risk of death from colorectal cancer in the group invited to screening compared to those who were not screened
  • Colonoscopy may, in practice, reduce colorectal cancer risk similarly to other less expensive, and less invasive, screenings, including fecal testing
  • Colonoscopies can cause serious adverse events, including death, bleeding after removal of a precancerous polyp and perforation

The U.S. Preventive Services Task Force recommends adults between the ages of 45 and 75 be screened for colorectal cancer every 10 years.1 As a result, about 15 million colonoscopies are performed every year in the U.S.2 The procedure, which involves extensive preparation and comes with considerable risks — include the risk of death — is touted as a key way to prevent colorectal cancer deaths.

However, as noted in a landmark study published in The New England Journal of Medicine, “Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear.”3 The researchers set out to determine if the benefits of colonoscopies are as great as they’re made out to be — and found that they’re far from it.

Even study author Dr. Michael Bretthauer, a gastroenterologist with the University of Oslo in Norway, stated, “[W]e may have oversold the message for the last 10 years or so, and we have to wind it back a little.”

Study: Colonoscopies Don’t Reduce Cancer Deaths

The Northern-European Initiative on Colon Cancer (NordICC) study — a randomized trial involving 84,585 adults between 55 and 64 years of age — assigned participants in a 1-to-2 ratio to receive an invitation to undergo a colonoscopy or to receive no invitation or screening. None of the participants had gotten a colonoscopy previously.

After 10 years, those who were invited to get colonoscopies had an 18% lower risk of colorectal cancer than the unscreened group.4 However, there was no statistically significant reduction in the risk of death from colorectal cancer in the group invited to screening. The researchers intend to follow the participants for another five years to see if anything changes, but according to the study:5

“The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group … The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 … The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group.”

There were some limitations to the study, including a low uptake rate for those invited to get a colonoscopy. Only 42% of those invited to do the procedure actually did so. When the researchers analyzed the results based only on those who received colonoscopies, the procedure reduced the risk of colorectal cancer by 31% and reduced the risk of dying from colorectal cancer by 50%.6

Still, speaking with STAT News, Dr. Samir Gupta, a gastroenterologist who was not involved with the study, noted, “This is a landmark study. It’s the first randomized trial showing outcomes of exposing people to colonoscopy screening versus no colonoscopy. And I think we were all expecting colonoscopy to do better. Maybe colonoscopy isn’t as good as we always thought it is.”7

Colonoscopy ‘Not the Magic Bullet We Thought It Was’

According to the American Cancer Society, in 2022 there will be 106,180 new cases of colon cancer diagnosed and 44,850 new cases of rectal cancer.8 The two types are grouped together — collectively known as colorectal cancer — since they have many of the same characteristics.

The rate of people being diagnosed with either colon or rectal cancers has gone down since the 1980s. The American Cancer Society (ACS) attributes this to changes in lifestyle as well as more people getting screened.9 The death rate from colorectal cancer has also decreased over several decades — a decline that ACS again attributes to screening, as well as colorectal cancer treatments.

“One reason is that colorectal polyps are now being found more often by screening and removed before they can develop into cancers,” ACS notes.10 However, the featured study makes it clear that colonoscopies’ benefits may have been overstated. Bretthauer told STAT News:11

“It’s not the magic bullet we thought it was. I think we may have oversold colonoscopy. If you look at what the gastroenterology societies say, and I’m one myself so these are my people, we talked about 70, 80, or even 90% reduction in colon cancer if everyone went for colonoscopy. That’s not what these data show.”

Bretthauer suggested colonoscopy may, in practice, reduce colorectal cancer risk by 20% or 30%, which is close to reductions offered by other less expensive, and less invasive, screenings, including fecal testing. Bretthauer told STAT News:12

“That raises an important point for policymakers … Colonoscopy is more expensive, more time-intensive, and more unpleasant in preparation for patients. Many European countries balked at putting public health dollars towards a large, expensive program, he said, when the fecal testing was cheaper, easier, and had greater uptake in certain studies.

‘Now, the European approach makes much more sense. It’s not only cheaper, but maybe equally effective.’”

Do the Benefits Outweigh the Risks?

In 2019, the BMJ published clinical practice guidelines13 for colorectal cancer screening using a stool test — known as the fecal immunochemical test (FIT) — a single colonoscopy or a single sigmoidoscopy. A sigmoidoscopy is similar to a colonoscopy but less extensive and less invasive. During a colonoscopy, your entire large intestine is examined, while a sigmoidoscopy only checks the lower part of your colon.

The practice guidelines recommend physicians use a tool to estimate an individual’s potential risk for developing colorectal cancer in the next 15 years. The team recommends that only those who have a risk of 3% or greater should undergo screening tests, choosing from one of four screening options.

This included a FIT done every year or a FIT done every two years depending on risk factors. Patients may also choose a single sigmoidoscopy or, the weakest recommendation from the team, a single colonoscopy.

However, the team determined that the risks associated with colorectal cancer screening outweighed the benefits in many cases. For instance, the risk of death from a colonoscopy from one source was 1 in 16,318 procedures evaluated.14

In the same analysis, the researchers also found 82 suffered serious complications. Another analysis found a death rate of 3 per 100,000 colonoscopies, along with serious adverse events in 44 per 10,000, “with a number needed to harm of 225.”15

Colonoscopies Carry Significant Risks

For any medical procedure, the benefits must outweigh the risks to the patient. But depending on your risk factors, it’s possible that colonoscopy could cause more harm than good. Aside from the risk of death, additional concerning risks include perforation and bleeding after removal of a precancerous polyp.

A systematic review and meta-analysis found the risk of perforation after colonoscopy was about 6 per 10,000 while the risk of bleeding was about 24 per 10,000 procedures.16 However, the risks can vary significantly depending on where the procedure is performed.

The risk of perforation at Baylor University Medical Center, according to one study, was 0.57 per 1,000 procedures or 1 in 1750 colonoscopies.17 In a report published in Baylor University Medical Center Proceedings, it’s explained:18

“The frequency of complications is dependent on the skill of physicians doing the procedure, on safeguards that are in place within the laboratory where the procedure is carried out, and whether colonoscopy is done for screening or for diagnostic or therapeutic indications.

Major complications include adverse sedation or anesthetic events including aspiration pneumonia, post-polypectomy bleeding, diverticulitis, intraperitoneal hemorrhage, and colonic perforation.”

Improper Equipment Sterilization Is Dangerous

Download Interview Transcript | Video Link

Another risk factor that varies from clinic to clinic has to do with how well the equipment is sterilized. David Lewis, Ph.D., and I discuss this in the short video above. One issue is the inability to thoroughly clean the inside of the scope.

One common issue is that, during the examination, the physician may be unable to see through the scope and is unsuccessful in the attempt to flush it using the air/water channel as it is clogged with human tissue from a past exam. The scope must be retracted and another one used. Since endoscopes have sensitive equipment attached, they cannot be heat sterilized.

Unfortunately, manufacturers have not been made to produce a scope with the ability to be heat sterilized. As Lewis points out in the video, “We can put a Rover on Mars, surely we can build a flexible endoscope that we can put in an autoclave.” These expensive tools are not disposable but require sterilization between each patient.

Lewis reports that up to 80% of hospitals are sterilizing the flexible endoscopes with glutaraldehyde (Cidex). On testing, he finds this has complicated the process as it does not dissolve tissue in the endoscope but rather preserves it.

When sharp biopsy tools are run through the tube, patient material from past testing is scraped off and potentially carried into your body. This is why it’s important to find a clinic or hospital that uses peracetic acid to thoroughly sterilize the equipment by dissolving proteins found in the flexible endoscopes. Before scheduling any endoscopic examination call to ask how the equipment is sterilized between patients.

Most Colorectal Cancer Cases Are Related to Diet

Aside from skin cancer, colorectal cancer is the third most common type of cancer in the U.S., as well as the third leading cause of cancer-related deaths.19 It’s wise to take steps to reduce your risk, and lifestyle changes can be quite effective. In fact, lifestyle factors, including dietary choices, play a major role in the occurrence and progression of colorectal cancer,20 with only an estimated 20% of cases caused by genetic factors with the remainder due to environmental factors.

Up to 70% of colorectal cancer (CRC) cases are believed to be related to diet, leading researchers with the University of South Carolina School of Medicine to state:21

“As such, bioactive food components offer exciting possibilities for chemoprevention due to their potential to target many factors associated with the development and progression of CRC. Furthermore, the ability of bioactive food components to elicit tumoricidal effects without displaying the high toxicity exhibited by standard pharmacological interventions may translate to improved quality of life and survival in patients with cancer.”

For instance, emodin, which is found in Chinese rhubarb as well as in aloe vera, giant knotweed, the herb Polygonum multiflorum (tuber fleeceflower) and Polygonum cuspidatum (Japanese knotweed), may help prevent colorectal disease due to impressive therapeutic effects, including anti-inflammatory and antitumor properties.22

Fermented foods are also gaining recognition as an important dietary anticancer adjunct. The beneficial bacteria found in fermented foods have been shown particularly effective for suppressing colon cancer. For example, butyrate, a short-chain fatty acid created when microbes ferment dietary fiber in your gut, has been shown to induce programmed cell death of colon cancer cells.23

Other strategies to help prevent colorectal cancer include eating more fiber, optimizing vitamin D, avoiding processed meat, maintaining a normal weight and controlling belly fat. In a larger sense, researchers have demonstrated that cancer is likely a metabolic disease controlled in part by dysfunctional mitochondria.

You can optimize your mitochondrial health through cyclical nutritional ketosis, calorie restriction, meal timing, exercise and normalizing your iron level. All of these lifestyle factors play a role in keeping your body healthy and disease-free.

from:    https://articles.mercola.com/sites/articles/archive/2022/10/20/colonoscopies-carry-significant-risks.aspx?ui=f460707c057231d228aac22d51b97f2a8dcffa7b857ec065e5a5bfbcfab498ac&sd=20211017&cid_source=dnl&cid_medium=email&cid_content=art2ReadMore&cid=20221020&cid=DM1269224&bid=1625169157

Drugs, Medical Tests, Infections, etc.

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Hospital-Acquired Infections, Dangerous Tests and Other Medical Cover-Ups

By Dr. Mercola

March 08, 2016

Story at-a-glance

  • 1 in 4 patients in the U.S. end up contracting some form of infection while in the hospital, and 205 Americans die from hospital-acquired infections every day
  • Hospitals that accept Medicare tend to be riskier than others in this regard, but the FDA does not release the names of hospitals where infections are reported
  • Non-disposable flexible medical scopes can transmit infections between patients, due to the fact that they cannot be properly sterilized. If you must get a colonoscopy, make sure they clean the scope using peracetic acid

Hospital-acquired infections are a significant problem. According to 2011 statistics, 1 in 4 patients in the U.S. end up contracting some form of infection while in the hospital, and 205 Americans die from hospital-acquired infections each and every day.

In just one year (2011), an estimated 722,000 Americans contracted an infection during a stay in an acute care hospital, and about 75,000 of them died as a result of it.

The most common hospital-acquired infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections, and clostridium difficile infections.

Contaminated Medical Scopes Implicated in Spread of Superbug Infections

Last year, Dr. Jeffrey Tokar, director of gastrointestinal endoscopy at Fox Chase Cancer Center, and a paid consultant for a medical scope manufacturer, wrote an article1 discussing strategies to improve patient safety in light of superbug outbreaks traced back to contaminated medical scopes.

Now, Kaiser Health News points out that Tokar’s own cancer center was ground zero for at least three cases in which patients were infected with drug-resistant bacteria.

According to the article:2

“In accordance with federal rules, the hospital reported the possibility to the manufacturer … But the public was none the wiser.

The information only came to light … when a U.S. Senate committee unveiled the results of a yearlong investigation into scope-related infections that sickened nearly 200 patients across the country from 2012 to 2015, including those potential cases at Fox Chase in Philadelphia.

The incident in Philadelphia illustrates a larger problem, experts say: a lack of public disclosure when medical devices are suspected of posing a risk to patients …

[S]aid Lawrence Muscarella, Ph.D., a hospital-safety consultant … ‘Hospitals don’t realize the more transparent they are, the more infection risks would decrease. It looks like important information was missing from this paper.’ …”

Unfortunately, there’s no easy way for patients to determine where these kinds of infections are occurring, and whether your local hospital might be a hotspot.

According to the 2011 Health Grades Hospital Quality in America Study,3 Hospitals that accept Medicare tend to be far riskier than others in this regard, but the FDA does not release the names of hospitals where infections are reported.

Asking the Right Questions Could Save Your Life

Download Interview Transcript

Last December, I interviewed David Lewis, Ph.D., a retired microbiologist, about how non-disposable flexible scopes such as sigmoidoscopes and colonoscopes can transmit infections between patients, due to the fact that they cannot be properly sterilized. Their design simply does not permit it.

Lewis was the microbiologist that uncovered the fact that dentists were spreading HIV by not properly sterilizing their equipment in the 1990s. When he uncovered the problem with scopes however, rather than being rewarded he was fired.

If you’re having a colonoscopy or any other procedure using a flexible endoscope done, you can significantly reduce your risk of contracting an infection by asking the hospital or facility how the scope is cleaned, and which cleaning agent is used.

Some esophagoscopes and bronchoscopes have sterile sheaths with disposable air-water and biopsy channels, but many others do not, and must be cleaned between each use.

If the hospital or clinic uses glutaraldehyde, or the brand name Cidex, cancel your appointment and go elsewhere. About 80 percent of clinics use glutaraldehyde because it’s a less expensive alternative, however it does not do a good job of sterilizing the equipment.

If they use peracetic acid, your likelihood of contracting an infection from a previous patient is very slim.

So making a phone call or two before scheduling your appointment, asking what kind of scope will be used; whether it’s fully disposable or must be cleaned, and what they use to clean it with, could be a lifesaving strategy.

The ultimate long-term solution would be to create flexible scopes that can be autoclaved (heat sterilized). But manufacturers have not been pressured to come up with such a design. As noted by Lewis, it really boils down to federal agencies failing to take the contamination issue seriously enough.

Canadian Experts Dissuade Patients From Colonoscopies

While contamination risk was not cited as a reason for Canada’s updated recommendation to not use colonoscopy as a screen for colon cancer, it’s certainly a consideration that needs to be taken into account, no matter where you live.

Canada’s Task Force on Preventive Health care now recommends4 using guaiac fecal occult blood testing (gFOBT) or fecal immunochemical testing (FIT) when testing for colon cancer in adults over the age of 50 who have no symptoms of cancer and who are not in a high risk category.

According to Reuters:5

“Opposition to colonoscopy as a primary screening test for colon cancer stems from the lack of evidence showing it to be any better than other screening methods, the Task Force says …

These recommendations differ from those published by the U.S. Preventive Services Task Force in 2008, which support the use of FOBT, flexible sigmoidoscopy, or colonoscopy for colon cancer screening in adults aged 50 to 75.

‘Regardless of age, primary care providers should discuss the most appropriate choice of test with patients who are interested in screening, considering patient values and preferences as well as local test availability,’ the [Canadian] recommendations conclude.”

Antibiotic Resistance Likely to Reach Epidemic Proportions Worldwide

In the CDC’s 2013 report “Antibiotic Resistance Threats in the United States,” no less than 18 superbugs were identified as “urgent, serious and concerning threats” to humankind.6

The majority of these dangerous bacteria are in the gram-negative category, because that variety has body armor that makes it extremely resistant to the immune response.

Most disturbing of all, an increasing number of bacteria are now exhibiting “panresistance” — meaning, resistance to every antibiotic in existence. One of the latest multi-drug resistant bacteria gaining ground is Carbapenem-resistant Enterobacteriaceae(CRE), which produce an enzyme that breaks down antibiotics.

Hospitals are the most common source of this infection, which is lethal in about 9 percent of all cases. When the CRE infection affects your blood, the death rate jumps to 50 percent.7

In January, Canadian researchers issued a warning saying that antibiotic use in farming must be stopped if we’re to gain the upper hand against antibiotic-resistant disease. Canada recently began a surveillance program covering all Canadian hospitals, following reports that China had discovered a drug-resistant gene (MCR-1) with epidemic potential in animals, meat, and human patients.

MCR-1 is a gene mutation that makes bacteria resistant to a last-resort antibiotic called colistin, and the rate of transfer of this genetic mutation between bacteria is exceptionally high.

While colistin has not been used much in human medicine in recent decades, it is widely used in China’s agriculture industry. This heavy use may have triggered the acquisition of MCR-1 by E. coli and other bacteria. As a member of the Antibiotic Resistance Action Center at George Washington University said in a National Geographic interview, “It’s real world, empiric evidence that this thing can spread very widely. It’s almost like it possesses a universal key.”8

As noted by CBC News,9 “scientists in England and Wales, Denmark, Thailand and Laos, among others, have published similar findings.” Canada has also found the gene in three human cases. According to Michael Mulvey, Ph.D., head of antimicrobial resistance at the National Microbiology Laboratory in Winnipeg, “It’s the first such finding of the gene in North or South America, which confirms its global dissemination.”

Antibiotic Resistance Is Not the Only Cover-Up in Medicine

As reported by STAT News,10 “the regulatory system for reporting side effects caused by prescription drugs is producing its own kind of side effect — incomplete information about injuries that patients may have suffered.”

According to an analysis11 published in Pharmacoepidemiology and Drug Safety, drug companies frequently fail to file comprehensive reports on side effects, thereby preventing the U.S. Food and Drug Administration (FDA) from assessing the scope of the threat to consumers.

Doctors and consumers can report drug side effects to the FDA’s Adverse Event Reporting System (VAERS), and drug makers are required to not only report but also investigate side effects associated with their drugs and medical appliances. However, while drug makers file the vast majority of reports of serious or fatal side effects, compared to those filed by doctors and consumers the majority of their reports do not include key data.

As noted by STAT:

“For this reason, one of the study authors contends there are still wider implications … The analysis found that in 2014, the FDA received 528,192 new reports of a serious or fatal side effect, of which 4.7 percent were filed with the agency directly by doctors and consumers. Of those, 86 percent included complete information about four important data points — patient age and sex, the date the side effect occurred, and a specific medical term to describe the problem.

By contrast, drug makers filed 95.3 percent of side effect reports, but most were incomplete … nearly 38 percent lacked the patient’s sex and age, and 47 percent did not have the date when the problem occurred. Overall, reports involving patient deaths offered the least amount of complete information for all of the key data points…

‘With increasing pressure for the FDA to approve drugs fast but with less clinical testing, it is a major concern that postmarket surveillance has major problems that are not being addressed,’ said Thomas Moore, a senior scientist the Institute for Safe Medicination Practices …‘It is time for the FDA, the medical community, and industry to start work on a badly needed modernization’ of this ‘critical tool’ for monitoring safety.”

How Drug Ads Fool Consumers

Drug makers are also required to inform consumers about potential side effects in their ads. In another article,12 STAT News discusses how drug narrators “take the scariness out of side effects.” If you think about it, how is it that so many people voluntarily take, let alone ask their doctor for a drug that has very serious and in some cases lethal side effects?

“[T]he actors paid to deliver these warnings … say there’s an art to it. ‘We use the same approach medical professionals do, telling a patient calmly: ‘We’re going to perform this surgery and there’s a 60 percent chance you won’t live,’’ said Joey Schaljo, who has worked as a voiceover actor on drug ads and who has a knack for narrating endless lists of side effects …

Some ads use one narrator to talk about the benefits of the drug and a different actor to recite the risks — in a less engaging voice. Or the warning section may be written with more complex sentence structures, to make it harder for viewers to absorb …

Another common trick: Keep the voice actor who talks about risks off screen. Research has found that consumers absorb the most information when they can see people speaking rather than just hearing them … ‘There’s a shift in how the voice is used to make it easier to understand the benefits and less easy to understand the risks,’ said Ruth Day, a cognitive scientist at Duke University who has studied drug ads for more than a decade.”

Drug Companies Siphon Tax Dollars for Dangerous, Useless, Overpriced Drugs

As if it wasn’t enough that you pay with your health for the drug industry’s lackadaisical approach to side effects — both by their downplaying the risk of death or serious injury in their ads, and by their filing adverse event reports that are useless for predicting risk to other patients — you also pay for their crimes with your tax dollars.

Sovaldi, a hepatitis C drug made by Gilead was under investigation for 18 months by the Senate Finance Committee. In the end, the Committee decided that the price of the drug — $1,000 per pill, or $84,000 per treatment — “did not reflect the cost of research and development and that Gilead cared about ‘revenue’ not ‘affordability and accessibility,’” the Epoch Times13 writes.

In 2014 alone, Medicare and Medicaid shelled out more than $5 BILLION for Sovaldi and another hepatitis C drug called Harvoni.

Writing for the New York Times,14 columnist Nicholas Kristof notes that in the year 2015, the drug industry “spent $272,000 in campaign donations per member of Congress … to bar the government from bargaining for drug prices in Medicare. That amounts to a $50 billion annual gift to pharmaceutical companies.”

“But Gilead is far from the only drug company camping out on our tax dollars,” Epoch Times reports. “Drug companies have devised elaborate schemes for drug sales to states … In 2008, the Texas attorney general’s office charged Risperdal maker Janssen (Johnson & Johnson’s psychiatric drug unit) with defrauding the state of millions ‘with [its] sophisticated and fraudulent marketing scheme,’ to ‘secure … Risperdal, on the state’s Medicaid preferred drug list’ …

The Department of Veterans Affairs spent $717 million on … Risperdal to treat post-traumatic stress disorder (PTSD) in troops deployed to Afghanistan and Iraq only to discover after nine years that the drug worked no better than a placebo …

In Texas, a Medicaid ‘decision tree’ called the Texas Medical Algorithm Project was instituted that mandates that doctors prescribe the newest and most expensive psychiatric drugs first. The program was funded … by the Johnson & Johnson-linked Robert Wood Johnson Foundation … Another tactic that drug companies use is ‘helping’ states buy their own brand name drugs …

One such program sends registered nurses to the homes of patients who are on expensive brand drugs to ensure ‘compliance’ — that they have not stopped taking the drugs.”

To Protect Your Health, Avoid Antibiotics — Both in Medicine and Food

The conventional medical system has in many ways created just as many, if not more, problems than it has solved. Drugs are vastly overprescribed and misused, and this is particularly true for antibiotics — more than 80 percent of which are used in agriculture to fatten up livestock.

This routine practice has resulted in a manmade scourge of antibiotic-resistant disease, which is already rendering previously treatable infections lethal, and may soon turn even minor surgery into a dangerous proposition.

So what can you do to protect yourself? Regarding antibiotics, avoid using them unless absolutely necessary, and remember they don’t work for viral infections. Also opt for organic grass-fed and grass-finished meats, to avoid antibiotic residues and, more importantly, antibiotic-resistant bacteria that could kill you. This is a serious issue, so if you chose to eat meat, make sure it’s clean.

Strategies That Could Save Your Life If You’re Hospitalized

to read the rest of the article, go to:    http://articles.mercola.com/sites/articles/archive/2016/03/08/hospital-acquired-infections-superbug-cover-ups.aspx