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Is a Colonoscopy More Effective in High-Def?

Rating

4 Star

Is a Colonoscopy More Effective in High-Def?

Our Review Summary

More outside sources, hard analysis of the data, use of absolute (not relative) data and better specifics about costs could have made the story even better.

 

Why This Matters

Ever since Katie Couric broadcast her colonscopy in 2002, the procedure has become an unlikely media darling. Stories like this one lower the hype volume and give readers a fuller picture of this evolving technology. Newer isn’t always better. But for some reason, the story still ignored one of the old tried and true – fecal occult blood tests – the only screening test for colon cancer showed by randomized clinical trial to decrease colon cancer mortality and incidence. Sure it has limitations, but so do these more highly covered media darlings, and so FOBT deserves at least a mention.

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story devotes a few sentences to costs, without actually providing dollar figures. Still, the effort is far stronger than in most stories about colonoscopies or other procedures. This sentence was especially nice to see: "An alternative to colonoscopy is flexible sigmoidoscopy, a shorter, less expensive exam which looks only at the bottom portion of the colon, combined with a fecal occult blood test, which looks for blood in the stool."

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

This story mentions two different studies as part of a broader evaluation of the new technology. In both cases, it shows that the new technology is a minor improvement. This point could have been made more forcefully by providing some absolute numbers. It says "A 2,430-patient study by researchers at the Mayo Clinic in Jacksonville, published earlier this year in Clinical Gastroenterology and Hepatology, found adenomas in 28.8% of patients examined with high-definition colonoscopy, compared with 24.3% in those examined with standard colonoscopy. Polyps were found in 42.2% versus 37.8%. The scope tested, from Olympus, had both high-definition and a wide-angle view." Assuming that the groups were split exactly in half, this means that adenomas were found in about 350 patients versus about 300 with the standard method.

 

Does the story adequately explain/quantify the harms of the intervention?

Not Satisfactory

Something missing from the studies mentioned were any sort of placebo controls or comparisons to alternative screening techniques. Too much screening can lead to unnecessary surgeries that have their own risks. The story does say, "the additional polyps found may result in more biopsies, raising costs." But it should have also talked about the potential downsides of screening and any potentail side effects from undergoing this procedure.

Does the story seem to grasp the quality of the evidence?

Satisfactory

Right in the lead of the story, the evaluation begins. "Several recent studies have found a small benefit to high-definition colonoscopy over the standard variety, but gastroenterologists say physician technique is more important in detecting polyps than equipment." The story continues in this vein and even has the high-def camera’s proponents explaning the importance of technique over technology.

Does the story commit disease-mongering?

Satisfactory

The second graph defines the potentail impact of an advance in colon screening using plain language. "Colonoscopy, a screening test doctors recommend for most people starting at age 50, allows doctors to remove pre-cancerous growths before they become full-blown cancer." It would have been helfpul to see how many people are diagnosed with colon cancer every year and how many die as a result. At about 100,000 new cases a year, colon cancer certainly has an impact, but what slice of those cases were detected through colonoscopy?

Does the story use independent sources and identify conflicts of interest?

Satisfactory

Great job in identifying and calling out conflicts. There is one independent source in the story and more would have been nice. At the same time, though, the reporter pulled together so much good, well balanced information that the independent voices were not as missed as they often are in stories like this.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

As mentioned above, the story discusses several options and ends with two good graphs that actually rely on the lead doctor in the most recent study to show the benefits of high-def colonscopy, a doctor who "receives research funding from Olympus Corp., a manufacturer of HD scopes." He helps emphasize the importance of colonscopy technique and provides specifics that could help patients ask tough questions of their own physicians.

The last graph in the story is about a cheaper alternative that is described as a "reasonable alternative" that has to be performed with more frequency. But why no mention of fecal occult blood stool tests? FOBT is the only screening test for colon cancer showed by randomized clinical trial to decrease colon cancer mortality and incidence.  As good as the story may have been on other points, this story joins many journalistic efforts that don’t seem to give FOBT its due. And for that we must rule this criterion unsatisfactory.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

Three graphs in, the story says, "Many hospitals now use high-definition colonoscopes, which are sold by a number of companies." That’s a vague sentence in a story that provides a lot more specifics in other areas. How many hospitals?  Where?  How likely is a reader to be in a situation where she/he is encouraged to have this type?

Does the story establish the true novelty of the approach?

Satisfactory

It is rare when a story manages to fit in two treatment protocols. This one discusses the new advance in colonoscopies, the standard method, an emerging technology and an alternative procedure.

Does the story appear to rely solely or largely on a news release?

Satisfactory

This story does not rely on a news release.

Total Score: 7 of 10 Satisfactory

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