New medical developments are often pursued for both marketing and medical reasons. Large medical institutions will spend mightily for the latest high-tech robotic laser shooting burger-flipping tumor ray gun, even if (especially if) the competitor across the street already has one. Here in Cleveland, I suspect we have a mind numbing duplication of medical services in a very tight geographic reason. Since availability correlates with usage, I surmise that we are a model of overtesting and overtreatment. I am not assigning blame. Indeed, I need to be reeducated as much as anyone since we all practice medicine in a culture of excess.
The prism that should be used to view new medical development is if it serves the greater good. Many folks, however, define the greater good to be any outcome that coincides with their own parochial concerns. Conversely, if a particularly group is threatened by a medical advance, then it will be alleged that the greater good will surely suffer.
To a gastroenterologist, 50 is a milestone year. This is the age that we pounce upon you to scour your colon to remove cancers-in-waiting. While we champion this test, and sincerely believe in its worth, it is not ideal. Here are some drawbacks.
- The pre-colonoscopy cathartic cocktail
- Discomfort (no it’s not always painless)
- Risk of complications
- High rate of negative results
- Loss of a day’s wages or personal enjoyment
- Need for a driver
The above vignette is not a futuristic hypothetical creation. I suspect that colonoscopy and CAT colonography will be properly forced out during my own career as colon cancer screening techniques. Colonoscopy will still be performed, but only when some kinder and gentler screening test indicates that an individual has a high probability of harboring polyps. It will no longer be wielded in a buckshot fashion. The number of colonoscopies being performed will be decimated.
When that happens, it will not be good news for the Kirsch family. But, it will be greater good news for everyone else’s family.