Appeal to Barack Obama,
President Of The United States

by Konstantin Monastyrsky

Customarily, it takes years to reach a “scientific” consensus before stopping a harmful medical treatment, even though tens of thousands of people are getting killed or injured while the deliberation takes place. In the case of screening colonoscopy, the rate of death and injury is estimated at 200 otherwise healthy Americans each and every day. There is, though, one person who can put an end to this tragedy faster. For this reason alone I am addressing this appeal to Barack Obama, President of the United States.

Mr. President,

Each year an estimated fourteen million [1] Americans over age fifty are being screened for colorectal cancer on presumably a scientific premise and implied promise that screening colonoscopy will cut their risk of getting colon cancer up to ninety percent! [2]

Of these 14 million, five in one thousand, or an estimated 70,000 [3] otherwise healthy people are killed or injured by colonoscopy-related complications. This “collateral damage,” Mr. President, is 22% higher than the total number of annual deaths from colon cancer itself. [4]

And these seventy thousand reported casualties do not include a considerable number of unreported deferred complications related to colon preparation and general anesthesia. The most common among them are kidney failure, stroke, heart attack, pulmonary embolism, pneumonia, intestinal obstruction, and acute diverticulitis. [5]

Even if you take at face value the claim that screening colonoscopies have reduced colorectal cancer mortality by 5% [6], or about 2,500 lives annually, it means 28 [70,000/2,500 — Ed.) healthy people have been needlessly killed or injured to save just one single life.

It also means, Mr. President, that the direct cost of saving that one life ranges from a staggering $8 to $12 million, because the overall cost of screening colonoscopy is estimated at $20 to $30 billion annually. [7] The cost of the ensuing medical care for unreported complications is also in the billions.

And none of it, Mr. President, is actually big news. It has been known for a long while that colonoscopy screening increases mortality from all other causes. The Telemark Polyp Study I [8] demonstrated a 157% relative increase in mortality among screened patients vis-à-vis unscreened controls as far back as 1996.

But these deaths, complications, and wasted billions, Mr. President, are peanuts next to the outcome of abdominal CT scans, known as “virtual colonoscopy.” Each scan exposes the unsuspecting patient to 5 to 10 millisieverts of x-ray radiation. According to our very own Food and Drug Administration, “This range is not much less than the lowest doses of five to twenty millisieverts received by some of the Japanese survivors of the atomic bombs.” [9]

In turn, this exposure increases one‘s lifetime risk of any cancer to one chance in five, or 20%, while the initial risk of colon cancer for most people is under 5%. [10] In other words, Mr. President, a single virtual colonoscopy increases one‘s risk of any cancer four to eight times over the initial risk of colon cancer itself. [11]

Moreover, since virtual colonoscopies are now recommended every five years [12], tens of millions of Americans are expected to die needlessly from all other radiation-induced cancers. Just imagine the future costs of mopping up this “collateral damage.”

And consider these, to say the least, startling facts:

● The actual effectiveness of screening colonoscopy has never been studied. According to the American Cancer Society, up until now “…There are no prospective randomized controlled trials of screening colonoscopy for the reduction in incidence of or mortality from colorectal cancer.” [13] This means that that often-cited 90% risk reduction is pure fiction.

● Next, the effectiveness of cancer-causing virtual colonoscopies has never been studied either. According to The National Cancer Institute: “…it is not yet known for certain whether colonoscopy can help reduce the number of deaths from colorectal cancer.” [14]

● Next, Mr. President, a truly large-scale investigation of colonoscopy screening demonstrated its complete futility. The 18 years long, Minnesota Colon Cancer Control Study included over forty six thousand patients between the ages of 50 and 80. It demonstrated only a 0.62% reduction in the incidence of colorectal cancer [15]. Statistically speaking, this difference is even less than the chance outcome of one thousand coin flips.

● And it also has been known for a while that the removal of polyps — a primary goal of all screening colonoscopies — does not actually prevent cancers. According to the widely published reports back in 2006, the screened patients “developed cancers in the next few years however at the same rate as would be expected in the general population without screening” [16], even though doctors removed all found polyps.

● Adding insult to injury, up to a third of all colonoscopies ­– conventional and virtual alike – routinely miss polyps and even cancerous tumors [17]. And according to the recently published research one hundred percent of all polyps are missed in the right colon, and that many cancers start without any detectable polyps. [18]

Not surprisingly, despite the tens of millions of screening colonoscopies performed in the last eight years, colon cancer incidence is up by 30,000 more cases [19], and the deaths remain practically unchanged. If the colonoscopy screening was, indeed, 90% effective, with close to half of all Americans over age fifty screened, we should have seen at least a 40% percent reduction in mortality, not just a statistically-unrepresentative 5%. [6]

Mr. President, when you accepted your party‘s nomination last year, you pledged to “protect us from harm.” [20] Well, if 70,000 killed or injured by conventional screening colonoscopy, and millions more exposed to cancer-causing radiation by virtual colonoscopy, does not constitute horrendous harm, then what does?

Therefore, Mr. President, I respectfully appeal to you to request your Attorney General and the Secretary of Health and Human Services to review this matter as quickly and as thoroughly as possible.

With this request coming from you, Mr. President, their review will be swift, unbiased, and objective. How can it be otherwise, Sir, when an estimated two hundred Americans are being killed or injured every day, and thousands more exposed to irreversible cancer-causing radiation? And it is all for nothing, except for the enrichment of few.

Thank you, Mr. President, for reviewing and considering my appeal.

I wish you and your family lots of health and good luck!

***

Cover Letter To President Barack Obama

The President of The United States The White House 1600 Pennsylvania Avenue NW Washington, DC 20500 March 23, 2009 Dear Mr. President, Congratulations on becoming the President of the United States. Your election has become a tremendous source of inspiration to me, and the catalyst to become a public health advocate. Your intention to transform our healthcare system has motivated me to challenge one of the most deadliest of medical dogmas — the necessity, safety, and alleged efficacy of screening colonoscopies. This challenge is difficult to accomplish on my own because it adversely affects the reputations, careers, and the immense profits of influential individuals and entities in the mass media, business, and medicine that have been built on promoting colorectal cancer screenings. For this reason I‘ve decided to appeal to you publicly, and ask for your intervention in this matter. All of the facts presented in my appeal are no more farfetched or improbable than the recently disgraced screening test for prostate cancer, even though the independent experts were warning us about its appalling potential for harm over many years. You yourself, Mr. President, are just a few years away from your first screening colonoscopy. Your well-meaning doctors may erroneously advise you that your colorectal cancer risk is “higher than average” because of your African heritage. This erroneous assumption is derived from analyzing the morbidity and mortality of African-Americans, who, on average, have higher rates of obesity and diabetes — major predisposing risk factors for colorectal cancer — than white Americans. Hopefully, your review of the facts and recommendations presented in my appeal will spare you from taking unnecessary medical risks that may irreversibly compromise your health, future, and longevity. Your attention to this grievous situation will also help all Americans to learn the true facts about the dangers of screening colonoscopies, reduce related morbidity and mortality, and save or redirect tens of billions of dollars to critical services for children and the uninsured. Thank you in advance for reviewing and acting upon my appeal. Respectfully yours, Konstantin Monastyrsky, medical writer   Submitted on WhiteHouse.gov website March 23, 2009 [link]

Citations and References

Click the [link] to view the source site or document in the new window (when available). The references for this page were compiled in March 2009. Some of the links may not match at a later date because publishers may revise their web sites. In this case, try searching cached pages on Google, or contact the respective publishers.

1. Seeff LC, et al.; How many endoscopies are performed for colorectal cancer screening? Results from CDC's survey of endoscopic capacity. Gastroenterology. 2004;127: 1670-1677. [link]

2. The National Colorectal Cancer Research Alliance, Don't end up saying "if only." Get tested." [link]

3. T. R. Levin, et al.; Complications of Colonoscopy in an Integrated Health Care Delivery System  Ann Intern Med 2006; 880-886. (The 70,000 estimate is derived by multiplying 14,000,000 by 0.5% complications rate sited by the authors of the above report. [link]

4. According to the Centers for Disease Control and Prevention, 54,040 men and women died from cancer of the colon and rectum in 2005 [link, the latest available data]. The casualty rate related to colorectal screening (above) is 70,000.

5. K. Monastyrsky; Why Screening Colonoscopy Increases Mortality; Multiple sources; [link]

6. 5% reduction claim is made by Ms. Couric in her television commentary without providing her sourcing for actual data. Most likely it's based on the National Cancer Institute's mortality estimate. I discuss the reason why this number doesn't reflect true mortality statistics here.

7. The $20 to $30 billion estimate of the total cost of screening colonoscopies is based on 14 million screening colonoscopies performed annually at the cost ranging from $1,500 to $2,000. The $8 to $12 million estimate of “cost per live saved” is derived by dividing estimated total cost by the number of estimated “lives saved”, or 2,500.

8. Thiis-Evensen E, et al.; Population-based surveillance by colonoscopy: effect on the incidence of colorectal cancer. Telemark Polyp Study I.; Scand J Gastroenterol. 1999 Apr;34(4):414-20. [link]

9. What are the Radiation Risks From CT?; U.S. Food and Drug Administration; Center For Devices and Radiological Health; August 6th,2008; [link]

10.  Update on Colorectal Cancer; Am Fam Physician. 2000 Mar 15;61(6):1621-2, 1628 [link]

11. An estimate that “a single virtual colonoscopy increases one‘s risk of any cancer four to eight times over the initial risk of colon cancer itself” is based on dividing 20% (any cancer increase risk from virtual colonoscopy) by 2.5% and 5% — the initial range of colorectal cancer risk for American population.

12. American Cancer Society, Health Groups Issue Updated Colorectal Cancer Screening Guidelines; American College of Radiology [link]

13. Levin, B., at al.; Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology CA Cancer J Clin 2008 58: 130-160 [link]

14. Colorectal Cancer Screening; National Cancer Institute; Oct 2008; [link]

15. Mandel, J, at al.; The Effect of Fecal Occult-Blood Screening on the Incidence of Colorectal Cancer; N Engl J Med 2000 343: 1603-1607 [link]

16. Study Questions Colonoscopy Effectiveness; The New York Times; G. Colata; Dec 14, 2006; [link]

17. Colonoscopic Withdrawal Times and Adenoma Detection during Screening Colonoscopy Barclay, RL., et al.; N Engl J Med 2006 355: 2533-2541 [link]

18. Virtual Colonoscopy Misses Nearly One Third of Lesions; The proceeds of the 68th annual scientific meeting of the American College of Gastroenterology; Oct 15, 2003; [link]

19. The incidence of colorectal cancers in the United States has increased from an estimated 129,400 new cases in 1999 (Rudy, D, et al.; Update on Colorectal Cancer; American Family Physician; March 15, 2000; [link]) to 158,410 in year 2007; Cancer Facts & Figures, 2007; Atlanta: American Cancer Society; 2007, page 4 [link])

20. Transcript “Barack Obama‘s Acceptance Speech,” August 28, 2008, The New York Times; [link]