St Louis Re Union

David and Moe

David is Moe's sister Joy's oldest child, ie, my cousin.  Both are from St Louis. I saw David last summer in London.

David's special interests include esophageal diseases, colon cancer screening and outcomes in endoscopy (his website bio says). He has has been a member of the OHSU faculty since 1982, and Chief of the GI Division since 1998.

David's research into colon cancer (VA Cooperative Study on Colon Cancer Screening, 1993 to 2002) changed the way colon cancer screened in the US. His work has saved tens of thousands of lives. Famously he gave Katie Couric a colonoscopy live, on air, during the Today Show (Couric's husband died from colon cancer).

David is also a walker and whenever together we try to organise a hike of some sort. Some years ago we marched across London covering the West End to East London. My earliest memories of David from visits to St Louis when I was maybe 4 or five.

Abstract from David's research:

Background Aims: The relative efficacy and effectiveness of different colon screening programs has not been assessed. The purpose of this analysis was to provide a model for comparing several colon screening programs and to determine the key variables that impact program effectiveness. 

Methods:  Five screening programs were compared: annual fecal occult blood test (FOBT) alone, flexible sigmoidoscopy, flexible sigmoidoscopy and FOBT combined, one-time colonoscopy, and air-contrast barium enema. Key variables were adjusted for sensitivity analyses. Cost-effectiveness was defined as the cost per cancer death prevented. 

Results : FOBT alone prevents fewer cancer deaths than the other programs. The addition of flexible sigmoidoscopy to the FOBT increases the rate of cancer prevention. One-time colonoscopy has the greatest impact on colorectal cancer mortality, largely because of assumptions that cancer would be prevented in most patients who undergo polypectomy. FOBT alone is the most cost-effective of the programs, but the cost is sensitive to several key variables.

Conclusions: The model shows key variables that impact the cost-effectiveness of colon screening programs. Compliance is an important determinant of effectiveness of all of the screening programs. Future study should be focused on methods of patient education that improve patient compliance with screening.