3 ms·

>"Risks? The risks of a colonoscopy are crazy low though." Not at the statistical level. Death rate from complications is about 1 in 10,000: https://www.endosc

>"Risks? The risks of a colonoscopy are crazy low though." Not at the statistical level. Death rate from complications is about 1 in 10,000: https://www.endoscopy-campus.com/ec-news/risk-of-death-from-colonoscopy-in-a-fit-positive-program/ https://www.endoscopy-campus.com/ec-news/risk-of-death-from-...

panarky 5mo ago
The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000, significantly higher than the roughly 3-5 per 10,000 annual chance of actually having colorectal cancer for low-risk groups. My doctor says that since Cologuard catches a large percentage of those 3-5 per 10,000 without any of the colonoscopy risk, the marginal benefits from colonoscopy really aren't justified since FIT+DNA testing is almost as good, at least for low-risk cohorts. Very few things in medicine are zero risk. I wish more doctors would help balance the risk of doing A vs. the risk of doing B vs. the risk of doing nothing. It's all Bayesian conditional probabilities, considering your own individual risk factors, and considering the false positive rate and false negative rate of each test.
- bonsai_spool 5mo ago
  > The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000 What's your reference for this? That's incredibly (read, unbelievable) high for a routine procedure.
  - genewitch 5mo ago
    not who you asked but the perforation is 3-5 per 10,000; cardiovascular issues is 52 per 10,000, polyp removal carries risks of bleeding or perforation, and underlying patient physiology. RESULTS Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias. just ask any AI, i don't got time to play tic-tac-toe with the NIH.gov website gating me behind click bus images for 10 minutes
    - bonsai_spool 5mo ago
      You are hardly describing "serious complications" ('bleeding', and 'respiratory events' are very non specific, and the fact that this is an uncited meta-analysis across nations makes the whole enterprise suspect), even less so since your source averages 24 countries while we are speaking about US colonoscopy recommendations. My source is not seeing one perforation each week at work. > just ask any AI These do not give reliable answers, as I am sure you know
      - genewitch 5mo ago
        they give citations which i was going through and literally copied and pasted the CITE to you, not the AI. i only answered the specific question of where the number "48" or the range 40-80 came from. my cite even shows perforations are 3-5 per 10000 so i don't know what you're on me about
        bonsai_spool 5mo ago
        > they give citations which i was going through Yes, I am sure. Do send the actual citations. > my cite even shows perforations are 3-5 per 10000 An implausible number for humans who have actual, non-LLM experience in this area
        genewitch 5mo ago
        my EXPLICIT SOURCE was 10.14309/ajg.0000000000003429 do you require other ones, or do you wanna keep harping on the fact i used LLM as a fucking search engine? https://jamanetwork.com/journals/jama/fullarticle/2779987 https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000 take it up with JAMA and the AJG. do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL? because there's a difference. And it has nothing to do whether i use google.com or chat.whatever.com to find that out.
        bonsai_spool 5mo ago
        > do you wanna keep harping on the fact i used LLM as a fucking search engine? You didn't give me a source before now, so I unfortunately had no other source to challenge except the LLM! > https://jamanetwork.com/journals/jama/fullarticle/2779987 https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000 Different source, friend. Please note that they say 3.1, not 3.5. That is at about 25% less than 4 (and even less than 5, let alone your previous assertions). And if either you or your LLM troubled yourself to read the article, even this is a confounded number in that we cannot determine whether low-volume, 'community' operators are worse than high-volume settings. > do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL? We are talking about screening—once you have a target to remove, you are looking at a high-likelihood-of-cancer population. I am fully aware of this, so I don't understand why you are bringing up this difference which has not yet figured into our discussion. Is this something your LLM suggested to you? --- I think the thing to take away is that LLMs do not yet replace human understanding and discretion.
- BobbyTables2 5mo ago
  The real risk is getting a doctor that is more interested in money than medical care. These seem to be more like 3000-5000 per 10000.
bonsai_spool 5mo ago
>>"Risks? The risks of a colonoscopy are crazy low though." > Not at the statistical level. Death rate from complications is about 1 in 10,000: THAT IS NOT what this paper says. Please avoid commenting about things that you do not understand! Here is the actual article: https://www.cghjournal.org/article/S1542-3565(20)31076-4/fulltext https://www.cghjournal.org/article/S1542-3565(20)31076-4/ful... First, the study looks at people who had a positive screening Cologuard/FIT test. These are not normal people! Second, the test looks at DEATHS WITHIN THIRTY DAYS of the procedure. In fact, the article goes on to say that there are ZERO deaths related to the actual procedure. ZERO.
m3047 5mo ago
This is funny. I've had an unbelievable string of bad doctors / clinics... almost as though something is wrong with medical care around here. Couple of years ago the latest doctor who I fired started talking colonoscopies. I asked some basic questions like how do they get paid? How much do they get paid? Who inspects their facilities? He took great umbrage at the notion that the doctors were getting "bounties" for nipping pieces of tissue for lab review, refused to discuss that. (Tell me you know something without telling me you know something.) He also took umbrage at the notion that his clinic wasn't "clean" and that it was inspected regularly... didn't say by whom. So here's the deal. Here in Washington State, USA his clinic gets a "wet work" inspection, just like a slaughterhouse or restaurant, as part of the occupancy / doing business license. But there is no ongoing inspection, and fuck no there is no "safe to eat here" poster in the window of his clinic. It gets more interesting when you start looking at the datasets an inquiry like that turns up. Like: how many deaths / hospitalizations are there per 1K procedures? Actuarily we have a number. Now clinics, at least the ones doing things on a regular basis, have to report adverse events leading to hospitalization: the reporting rate is impossibly lower than the actuarial rate, complications leading to hospitalization are not being reported. But.. there's more! The State collects "foreign contamination" stats from pathologists; you can look at this by pathologist, if they do enough of them. The majority of pathologists scoring colonoscopy samples report ZERO foreign contamination; among the pathologists actually reporting, the rate for presence of foreign contamination is around 25%.
- kelvinjps10 5mo ago
  What is your point?
  - deleted 5mo ago
    [deleted]
- boppo1 5mo ago
  What an interesting and obvious approach, wish I'd thought of it. Tell me more about your inquiry for the answers the doctor avoided.

panarky 5mo ago

The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000, significantly higher than the roughly 3-5 per 10,000 annual chance of actually having colorectal cancer for low-risk groups. My doctor says that since Cologuard catches a large percentage of those 3-5 per 10,000 without any of the colonoscopy risk, the marginal benefits from colonoscopy really aren't justified since FIT+DNA testing is almost as good, at least for low-risk cohorts. Very few things in medicine are zero risk. I wish more doctors would help balance the risk of doing A vs. the risk of doing B vs. the risk of doing nothing. It's all Bayesian conditional probabilities, considering your own individual risk factors, and considering the false positive rate and false negative rate of each test.

bonsai_spool 5mo ago
> The risk of serious complications like major bleeding or perforation is closer to 40-80 per 10,000 What's your reference for this? That's incredibly (read, unbelievable) high for a routine procedure.
- genewitch 5mo ago
  not who you asked but the perforation is 3-5 per 10,000; cardiovascular issues is 52 per 10,000, polyp removal carries risks of bleeding or perforation, and underlying patient physiology. RESULTS Among the 30,818 records identified, 82 population-based studies from 24 countries were included, involving a total of 38.5 million colonoscopies. The estimated incidence per 10,000 colonoscopies was as follows: gastrointestinal AEs, including perforation (5.15; 95% confidence interval [CI] 4.19-6.34, I2 = 99%), bleeding (18.39; 95% CI 13.53-24.99, I2 = 100%), and splenic injury (0.61; 95% CI 0.43-0.85, I2 = 93%); nongastrointestinal AEs, including cardiovascular events (52.11; 95% CI 18.67-144.59, I2 = 100%), respiratory events (4.26; 95% CI 0.73-24.99, I2 = 100%), and deaths related to colonoscopy (0.18; 95% CI 0.10-0.34, I2 = 74%). Subgroup analyses yielded partially divergent findings. The majority of the included studies exhibited a low to moderate risk of bias. just ask any AI, i don't got time to play tic-tac-toe with the NIH.gov website gating me behind click bus images for 10 minutes
  - bonsai_spool 5mo ago
    You are hardly describing "serious complications" ('bleeding', and 'respiratory events' are very non specific, and the fact that this is an uncited meta-analysis across nations makes the whole enterprise suspect), even less so since your source averages 24 countries while we are speaking about US colonoscopy recommendations. My source is not seeing one perforation each week at work. > just ask any AI These do not give reliable answers, as I am sure you know
    - genewitch 5mo ago
      they give citations which i was going through and literally copied and pasted the CITE to you, not the AI. i only answered the specific question of where the number "48" or the range 40-80 came from. my cite even shows perforations are 3-5 per 10000 so i don't know what you're on me about
      - bonsai_spool 5mo ago
        > they give citations which i was going through Yes, I am sure. Do send the actual citations. > my cite even shows perforations are 3-5 per 10000 An implausible number for humans who have actual, non-LLM experience in this area
        genewitch 5mo ago
        my EXPLICIT SOURCE was 10.14309/ajg.0000000000003429 do you require other ones, or do you wanna keep harping on the fact i used LLM as a fucking search engine? https://jamanetwork.com/journals/jama/fullarticle/2779987 https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000 take it up with JAMA and the AJG. do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL? because there's a difference. And it has nothing to do whether i use google.com or chat.whatever.com to find that out.
        bonsai_spool 5mo ago
        > do you wanna keep harping on the fact i used LLM as a fucking search engine? You didn't give me a source before now, so I unfortunately had no other source to challenge except the LLM! > https://jamanetwork.com/journals/jama/fullarticle/2779987 https://jamanetwork.com/journals/jama/fullarticle/2779987 3.5 per 10,000 Different source, friend. Please note that they say 3.1, not 3.5. That is at about 25% less than 4 (and even less than 5, let alone your previous assertions). And if either you or your LLM troubled yourself to read the article, even this is a confounded number in that we cannot determine whether low-volume, 'community' operators are worse than high-volume settings. > do you do SCREENING or DIAGNOSTIC/POLYP REMOVAL? We are talking about screening—once you have a target to remove, you are looking at a high-likelihood-of-cancer population. I am fully aware of this, so I don't understand why you are bringing up this difference which has not yet figured into our discussion. Is this something your LLM suggested to you? --- I think the thing to take away is that LLMs do not yet replace human understanding and discretion.
BobbyTables2 5mo ago
The real risk is getting a doctor that is more interested in money than medical care. These seem to be more like 3000-5000 per 10000.

bonsai_spool 5mo ago

>>"Risks? The risks of a colonoscopy are crazy low though." > Not at the statistical level. Death rate from complications is about 1 in 10,000: THAT IS NOT what this paper says. Please avoid commenting about things that you do not understand! Here is the actual article: https://www.cghjournal.org/article/S1542-3565(20)31076-4/fulltext https://www.cghjournal.org/article/S1542-3565(20)31076-4/ful... First, the study looks at people who had a positive screening Cologuard/FIT test. These are not normal people! Second, the test looks at DEATHS WITHIN THIRTY DAYS of the procedure. In fact, the article goes on to say that there are ZERO deaths related to the actual procedure. ZERO.

m3047 5mo ago

This is funny. I've had an unbelievable string of bad doctors / clinics... almost as though something is wrong with medical care around here. Couple of years ago the latest doctor who I fired started talking colonoscopies. I asked some basic questions like how do they get paid? How much do they get paid? Who inspects their facilities? He took great umbrage at the notion that the doctors were getting "bounties" for nipping pieces of tissue for lab review, refused to discuss that. (Tell me you know something without telling me you know something.) He also took umbrage at the notion that his clinic wasn't "clean" and that it was inspected regularly... didn't say by whom. So here's the deal. Here in Washington State, USA his clinic gets a "wet work" inspection, just like a slaughterhouse or restaurant, as part of the occupancy / doing business license. But there is no ongoing inspection, and fuck no there is no "safe to eat here" poster in the window of his clinic. It gets more interesting when you start looking at the datasets an inquiry like that turns up. Like: how many deaths / hospitalizations are there per 1K procedures? Actuarily we have a number. Now clinics, at least the ones doing things on a regular basis, have to report adverse events leading to hospitalization: the reporting rate is impossibly lower than the actuarial rate, complications leading to hospitalization are not being reported. But.. there's more! The State collects "foreign contamination" stats from pathologists; you can look at this by pathologist, if they do enough of them. The majority of pathologists scoring colonoscopy samples report ZERO foreign contamination; among the pathologists actually reporting, the rate for presence of foreign contamination is around 25%.

kelvinjps10 5mo ago
What is your point?
- deleted 5mo ago
  [deleted]
boppo1 5mo ago
What an interesting and obvious approach, wish I'd thought of it. Tell me more about your inquiry for the answers the doctor avoided.