Thank you for the article NCOT, I love to read.
However I like to say my opinion and hope you don't take it wrong.
Sometimes studies are like pre-election polls. For ex. in this study there is no mention of severity of those participants.
Did GI's pick and choose records of patients or they were random?
I hope I am wrong-GI's don't like negative reviews about biologics
simply because they don't have any other ammunition. I also believe they get good incentive but that beside the point.
I read many articles and believe following article represents true nature of UC treatment and it is latest one too.
Well, it was just an abstract I posted - the full version isn't available. All I can tell you is that patients with UC who are on Infliximab almost by definition have severe disease.
Here's another, more detailed, article which points to the decreasing colectomy rate, at least in Europe. It analyses a wide range of studies and admits that "The lower colectomy rates in population-based studies might reflect the inclusion of more subjects with milder disease than in studies of selected patient populations." But it also says that "The risk of colectomy seems to be lower than reported in studies completed prior to 1990 ... The surgery rates at 10 years after diagnosis are between 4 and 10% in recent studies, and the colectomy rate for patients with severe UC who require hospitalisation has remained stable at 27%."
In other words, the 30% colectomy rate applies mainly to those with severe UC who are hospitalised, not to all UC patients. austinpublishinggroup.com/gastroenterology/fulltext/ajg-v1-id1017.php
It might be different in America, I dunno.
I had to lol a bit when you said that "GIs don't like negative reviews about
biologics". Surgeons probably don't like negative reviews about
their livelihood either. It's no secret that GIs tend to be more conservative about
surgery than surgeons. In the UK at least, there's no financial incentive for keeping a patient on expensive drugs indefinitely. Even in America, I doubt that most doctors get huge kickbacks. Most doctors are inherently conservative about
treatment: the "do no harm" principle and all that. Or more long-windedly, "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good."In this context, there has been ample speculation about whether the use of biologicals would truly reduce the need for surgery or only delay the inevitable whereby increasing the risk of postoperative complications
It's only one opinion, and a subjective one at that, but my surgeon told me that she did less Crohn's surgeries than she used to. She put it down to the introduction of Infliximab. And indeed during my first infusion I met an 82-year-old woman with Crohn's colitis who'd been on it for 7 years. She reckoned it was the only thing which has worked. Now maybe she will still need surgery eventually, but in my opinion an extra 7 years of remission is well worth it. Happiness scores were also high at 10/10 ten years after IPAA surgery
Can I sell anyone a bridge? This statistic is about
as believable as those 99% votes tinpot dictators in third world countries get in 'democratic' elections. I literally don't know a single person in my life who is likely to rate their happiness at 10/10. Clearly I must live among really miserable people. Maybe they'd all be happier if they had j-pouches.