Not Even a Pandemic Could Settle One of Medicine’s Greatest Controversies
Doug Robertson is the kind of doctor who eats his own dog food. As a gastroenterologist in the Department of Veterans Affairs health-care system, he is overseeing a 50,000-person study comparing two different ways to screen for colon cancer: Patients aged 50 to 75 are randomly assigned to receive either a colonoscopy or a fecal immunochemical test, which can be conducted at home and detects tiny amounts of blood in a patient’s poop. As a way to honor the veterans who volunteered to have their medical care determined by chance, Robertson, when he turned 50, decided to randomize himself too. A flip of an oversize novelty coin determined the (informal) outcome: tails—the doctor would get at-home fecal tests for his colon-cancer screenings in the years to come.
Most of us aren’t a Doug Robertson; we’re not willing to let important decisions regarding our medical care be decided by dumb luck. As a result, much of our medical knowledge is left with surprising and uncomfortable gaps. The National Cancer Institute has spent $100 million on a breast-cancer screening trial comparing “3-D mammograms” with traditional mammograms, for instance, yet it’s still enough participants. Radiologists are already convinced that 3-D mammography is better, and that belief has trickled down to patients. Answers to even more fundamental questions—such as whether any kind of screening is better than no screening at all—are simply unattainable, because, ethically and logistically, it’s all but impossible to run a study in which one than it was before? We just don’t know. Does getting for cancer really ? We aren’t sure. Even screening tests with proven benefits, such as pap smears for cervical cancer, also have potential to consider.
