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I would be interested in peoples reactions to a 'Commentary' piece in this week's JAMA. Colonoscopy vs Sigmoidoscopy Screening <http://jama.ama-assn.org/cgi/content/full/304/4/461?etoc> by Alfred Neugut and Benjamin Lebwohl To me they do a great job of succinctly comparing the two modalities in light of the evidence, concluding that sigmoidoscopy now is seen to have comparable effectiveness to colonoscopy for screening. But then comes the penultimate paragraph: "Colonoscopy, similar to other screening tests, came into widespread use based on a common sense appeal to clinicians regarding its potential efficacy. Much of medicine operates in a similar absence of definitive evidence, and this is not unreasonable. However, as evidence subsequently accumulates, physicians must be prepared to reevaluate even a long-standing clinical practice. If de novo decisions were being made today about whether to initiate colonoscopy as a screening tool in place of sigmoidoscopy for average-risk individuals, in light of the available evidence (Table) doing so would probably be inappropriate. " With them so far.. "However, because colonoscopy is well established with a high acceptance rate among both clinicians and patients, the level of evidence necessary to modify an existing standard-of-care practice is higher." Having discussed the increased complication rates, and mentioned the increased cost, after demonstrating that on available evidence there is similar efficacy for the 2 modalities as a population screening tool I can't see how you can come to that conclusion. Why would you accept increased harm for your patients for the same outcome? Regards Gary ________________________________________________________________________ ___ Gary Jackson, Clinical Director Health Intelligence Counties Manukau District Health Board 19 Lambie Drive, Manukau City Private Bag 94052, South Auckland Mail Centre ph 64-9-262 9535 fax 64-9-262 9501 mob: 021 286 1815 [log in to unmask] This e-mail message and any accompanying attachments may contain information that is confidential and subject to legal privilege. If you are not the intended recipient, do not read, use, disseminate, distribute or copy this message or attachments. If you have received this message in error, please notify the sender immediately and delete this message. <html><body><B> For exciting career opportunities at WDHB, CMDHB and healthAlliance visit <a href="http://www.aucklandhealthjobs.co.nz/"> www.aucklandhealthjobs.co.nz </body></B></html>