The American Cancer Society (ACS) recommends a colonoscopy for everyone age 50 and older. The purpose of the screening procedure is to look for existing colorectal cancer or signs that the disease may develop. Thereafter, additional colonoscopies are recommended at 10-year intervals, assuming no problems are discovered. On the ACS website, the procedure is called “inconvenient and invasive” and suggests that “someone drive you home after the procedure.” Colonoscopy prep requires a “bowel cleanse” using a special diet and laxatives for a day before the procedure. There are several potential complications associated with a colonoscopy, including perforation, bleeding, and death, again according to the American Cancer Society. The most common complication is perforation, which occurs about once every 1,000 procedures, according to a 2009 review published in “Genetics in Medicine.” Death occurs in every 12,500 procedures.

There are other less invasive options for colorectal cancer screening, including virtual colonoscopy and stool tests such as fecal immunological tests or fecal DNA. Of course, these are not what American doctors call “the gold standard.” A colonoscopy is the gold standard.

A colonoscopy involves the insertion of a thin, tube-like instrument equipped with a tiny camera called a “colonoscope” (what else, a periscope?). This mini-dildo-like device is inserted into the rectum where it passes through the entire colon. The colonoscope allows visual diagnosis of any early colorectal cancer and biopsy and removal of suspicious lesions. If no lesions are found, suspicious or not, two things happen before the device is removed while the patient is still under sedation: 1) The doctor who performed the procedure has enough time to get out of town and start a new life under a government program similar to witness protection; and 2) When the medication wears off and the patient is fully recovered, an expert counselor says something like this to the patient: “Sorry, we didn’t find anything wrong with you. You really didn’t have to go through this. Your colon It’s okay. Come back and visit us again in ten years. We’ll do this to you again.”

No, I’m just kidding, I made it up because here’s the really amazing truth of the matter: the patient has been prepared for this highly probable eventuality! And he did, anyway. He is not shocked to learn that it was in vain; he would have been fine if he skipped the whole thing. All he has is some assurance that he does not have this particular disease or that he is likely to have it soon. There are still hundreds of others lurking in the wake of time. How many more tests will he have to learn that he doesn’t have one of them? In any case, this is what you really expected to be told about your colonoscopy results. At this point, not only is the patient NOT expected to grab the throat of the doctors who did this to him, but instead, he has been programmed to be happy about everything. So you’re likely to say something like this: “Oh, thank you so much. Thank you, thank you. I’m so delighted. You guys are the best. I can hardly wait until they do it to me again in ten years.” .”

I have never paid much attention to what the ACS or other medical organizations recommend regarding one test or another. I have distrusted medical tests, check-ups, preventive exams, risk assessments and all those medical imprecations. There is too much of this. Such activities have been part of the medicalization of health for at least half a century. I became aware of the problem as a health planner beginning in the late 1960s. I was immersed in medical research and policy for five years before moving into my current role as a wellness advocate. I have a doctorate in health and public policy. I saw up close and personal the reality and wasteful, often dangerous consequences of our bloated and dysfunctional medical system. I have written a lot about it.

The health problem that becomes a medical problem has only gotten worse. In a recent Progressive Policy Institute (PPI) report, Peter Orszag, director of the Congressional Budget Office, is quoted for his estimate that 5 percent of the nation’s gross domestic product — $700 billion per year – is intended for tests and procedures that do not actually improve health outcomes. He believes that the “unreasonably high cost of health care in the United States is a deep-seated problem that must be attacked at its root.”

Doctors say that colonoscopies are the gold standard of preventive medicine. Well, maybe, but who really needs the gold standard? Everyone over 50, every ten years? The jury is out. What’s more, if you’re 50 or older (or someday that is), you may want to do some checking to see if the jury has returned a sufficient verdict on colonoscopies and the many other routinely performed tests and procedures.

In 2008, the American Cancer Society considered colonoscopy the preferred test. Medicare pays for colonoscopies, and the new health reform law (PPACA) requires insurance companies to cover them.

However, I have reasons to resist this procedure, in addition to the general awareness that the medical system is riddled with unnecessary tests, some of which can be dangerous to health and wealth. For example, a colonoscopy is three to four times more expensive than a simpler test, a sigmoidoscopy. This involves only a partial “test” that lasts only a few minutes. There’s no sedation, no need to stop exercising or working, no pitcher of laxatives or awful emptying of the colon the night before, and perhaps no need for a gastroenterologist; your family or primary care doctor can often perform the procedure). Best of all, the risk of complications – infections, bleeding, incontinence or, in the worst case, death – is seven times lower than for the great ordeal of Full Monte.

And here’s the tweezer: The inventor of the colonoscopy, Al Neugut, wrote an editorial in JAMA this summer stating that he regrets inventing the colonoscopy. Neugut said, “If we were today where we were in 1988, I would not institute colonoscopy based on current evidence.”

As one joker put it, the gold standard of preventative medicine can only be gold from the point of view of physician salaries.

All of this is personal. I am almost 74 years old and have never had one. Many of my friends find this appalling. My wife and son have been behind me to do it. And, one of my best friends, a person whom I hold in the highest esteem for half a dozen different reasons, has done almost everything in his power to persuade me to give myself over to the colon body, otherwise drastic measures will be taken. , including unmasking. I have a false prophet of wellness.

Charlie Chaplin said: “Life is a tragedy up close, but a comedy from a wide angle.” In weighing the pros and cons of this procedure, I continue to struggle with a decision to go or not. I have consulted my Ouija board, birth chart and prayer book. Still, the arguments for and against having a colonoscopy seem balanced. (Yes, of course I’m kidding about the birth chart and the prayer book.)

I admitted that, in weighing the two options, I started and continue to be biased in favor of the “pass” option. To paraphrase Mr. Chaplin, when seen up close, the prospect of suffering this indignity seems tragic. However, I suspect that if I were to go ahead and discover that the test results allow me to remain on the planet’s surface for quite a while longer, my hesitation would seem comical, in retrospect.

Influential people in my life have been behind me for many years to have this procedure. This influential group includes my primary care physician, my son, and my wife. Your well-intentioned concerns are of course greatly appreciated and appreciated. However, I suspect that they are influenced by an excess of caution about lurking future problems combined with too little concern about the unpleasantness of the whole process and the high probability that it will prove unnecessary. Unfortunately, the pressure not to resist anymore, to just do it, has been almost unbearable.

The latest attack started about a month ago during training. A bicyclist friend and champion athlete my age whom I’ll call “Sandy” asked me if he had had a colonoscopy lately. I told him no. After further questioning, I had to admit that I had no plans to have one anytime soon. I thought that was the end. not so Later that morning, I received a long email from him. He stated that as a “wellness guru,” my audience expects me to take an interest in my own health, too. He claims that modern colonoscopies (as opposed to those performed by doctors in the Middle Ages) are quite simplistic and that, in my old age, I easily grow things (other than nose hair). By this, he meant that there is a high probability that one or more polyps will be found in my colon. He called me “a stubborn old goat.” But he softened it by adding that “those of us who admire and love you will be sad if my resistance proves fatal. He ended by warning that if I don’t have a colonoscopy and colon cancer causes my death, he will boycott my funeral and stop reading my weekly newsletter.” of wellness.

All of this was very effective and motivating, especially the parts involving praise. I asked a few associates, including several medical friends, for their thoughts on the matter. About half suggested it was unnecessary; the rest said it’s a good idea. The latter, however, did it for reasons that amounted to this: “he will make everyone who has his best interests at heart feel good if he does it.”

I realized that if I had this test, it would be to please my son, my wife, my doctor, Sandy, and others who are big fans of colonoscopy. All of these people prefer a little discomfort now to be sure.

However, a doctor friend in Perth pointed out that some medical groups, including the Preventive Services Task Force, have set 75 as the age to stop routine colon cancer screening. His opinion is that those (like me) who eat a high-fiber diet and otherwise live wisely probably don’t need the procedure. He also pointed out that colonoscopies are neither promoted in Australia nor covered by Australia’s universal health insurance system. Basically not recommended. Many others expressed a similar position, some quite strong given this country’s history of excessive testing, which can be dangerous and costly to society.

Well, I’m still on the proverbial fence. I made an appointment with a highly recommended doctor for early February. I plan to bring my doubts and concerns. Maybe the good doctor will help me see the light. Maybe not.

Needless to say, at this point, I am not recommending for or against colon testing for anyone else. However, I recommend that you do what I did: read through the pros and cons and collect all of your concerns and questions and discuss them with a trained health professional. If necessary, get a second or third opinion. This is a good idea when considering any type of invasive medical test or procedure. Then do what you think is rational. Do not submit to tests or anything else to please family or friends. Even if they threaten to boycott your funeral.

Okay.