Map of life expectancy at birth from Global Education Project.

Wednesday, September 06, 2006

This is probably more information than you needed . . .

Anthropologists, traditionally, are social scientists who go to societies that are strange and exotic to them, and describe what they find for the folks back home. Sociologists are people who talk about where they live. (Yeah yeah, that distinction has blurred over time and I'll probably have the entire American Anthropological Association storming my house with torches and pitchforks, but it's basically how it was.)

So anyway, as a medical sociologist, I am also, as Sy Sperling used to say, "I'm also a cloyent." I'm with my late friend and mentor Irving Kenneth Zola, who was a founder of the sociological study of disability, an advocate for the full participation of people with disabilities in the life of the community, a person with disabilities, and a very famous and important medical sociologist. Irv's position was that we should not pretend to be detached, olympian observers of the reality we study, but rather fully proclaim our involvement, and our point of view. Eschew the passive voice, or, as another teacher of mine, Shulamit Reinhartz put it, more or less (I forget the exact quote), the construct of the disembodied observer undermines the very foundations of sociology.

So, here's what you don't want to know. I'm scheduled for a colonoscopy on Friday. You can read what the CDC has to say about this here. I have expressed reservations about some screening procedures -- notably prostate cancer screening, particularly using the Prostate Specific Antigen test, and routine mammography, particularly for women in their 40s and early 50s. The intuitive idea that it can't hurt to do something that might detect cancer early is wrong -- a false positive test result can hurt a lot, and the cost of screening everybody to find a few cancers earlier than they might have been detected otherwise might just not be worth it. So these really are personal decisions, that ought to be influenced by your individual risk factors as well as your individual fears and aversions. Check out what I have to say about Bayes Theorem and screening tests in general, and a recent post on what people don't understand about screening, if you're really interested.

Colon cancer screening is another matter, however. There is a slight risk of injury from an inexperienced operator, but there really isn't a false positive problem. If lesions are detected during colonoscopy, they are removed as part of the procedure -- which is already good even if they aren't cancerous, because they could become cancerous later -- and they can be examined under a microscope to find out what's really going on. In other words, colonoscopy can actually prevent cancer as well as detect it, and that's a major plus. The test is definitely more expensive than other screening tests, but it's cost-effectiveness has been pretty well established. One reason, and again it's counterintuitive, is that there really aren't strong risk factors known for colon cancer. You're at somewhat higher risk if you have a family history, but you aren't off the hook if you don't. If you have inflammatory bowel disease, you're also at higher risk, but in that case the doctors will probably want a look anyway.

Actually, in my case, I'm not even doing just as a screening test -- it's diagnostic as well, they want to get a look at what appears to be diverticulosis.

So, here is one case where that issue of people without health insurance really screams injustice. This is a procedure that just about nobody who doesn't have good health insurance can afford, or will get. For a percentage of people, that means that their lack of health insurance is a death sentence. How's that for compassionate conservatism and keeping us safe?

Finally, it's unpleasant and it is, well, a pain in the ass. You have to fast and purge, you have to go through something to which men in particular are averse due to what I guess are psycho-sexual hangups, and it really takes the better part of a day out of your much too busy life. But, bottom line [sic], if you're over 50 you probably ought to do it.

The sociological part comes later -- I'll tell you my sociological observations after it's over.

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