For those who are on the fence about colonoscopies, please just get one. Due to a combination of family history and symptoms I got screened at 25 and it saved my life. Many of my cousins lost parents to colon cancer while they were still teenagers. Your kids will appreciate you taking care of yourself.

I am surprised and disappointed that this article made no mention of the exceptionally disturbing disparities we see across race when it comes to colon cancer. Black Americans, who have the highest CRC incidence and mortality rates of all racial groups in the US, have a 20 percent higher likelihood of getting colorectal cancer and a 40 percent higher death rate. You’re writing about variation of incidence across age groups, and the disproportionate burden on the Black community did not also seem worthy of mention?

The most important thing is that it’s a very treatable disease if found early. My father died of colon cancer and I just had my first screening at age 40. No polyps. I tried all sorts of mental gymnastics to get out of it but it comes down to it’s treatable if you find it early. Also the prep wasn’t nearly as bad as some make it out to be. You can do this!

Thanks, Emily, for sharing this important information about colon cancer screening. I lost my mom 13 years ago when she was just 50 years old to colon cancer. We had no history of colon cancer in our family and we didn’t know the signs and symptoms to look for. Now, my sister and I are big advocates for colon cancer screening and I’m so glad to see that the recommended screening age has been lowered to age 45. I do think it’s important to note that Black Americans have a much higher incidence of colon cancer, and we need to spread the word in this community. This disease is treatable if caught early, so thank you for sharing this piece during the month of March!

From experience as someone who is high risk. The colonoscopy isn’t the hardest part (and I’m personally afraid of anesthesia) but it’s the prep that sucks. You must be home all day and close to the toilet. Pro tip clear juice popsicles are your friends! It feels like eating but it’s not (only certain colours are allowed be careful). Otherwise it’s very much short term pain (it doesn’t actually hurt!) for long term gain. If you have reasonable access to test, please do. And if you have concerns about higher up in your GI you can also have a gastroscopy done at the same time. 🩷

I am 32 and recently had a colonoscopy due to experiencing some rectal bleeding. I also have a family history of it. Both my grandfather and uncle have had it and unfortunately my uncle passed away from colon cancer. My exam revealed a 30 mm non cancerous polyp that was immediately removed when found. Moral of the story: get a colonoscopy! Especially if you have a family history of it or you’re experiencing any symptoms.And if your doctor is ignoring your worrisome experiences, find a new doctor who will listen. Getting a colonoscopy and finding a polyp early before it ever turns into cancer is way cheaper than cancer treatment.

-Susan G

I know you are making recommendations based on the data, and for that reason your recommendations are sound. I know that there are false positives in tests, and those can cause intense pain. But, for someone who lost a close friend, mother of two little boys, who was in perfect health otherwise to colorectal cancer this past year, I cannot encourage parents enough to just get screened. My dear friend didn’t have a family history. She didn’t have any symptoms until it was stage 4 and spread widely. Colonoscopies are EASY! Poop tests are EASY! Colorectal Cancer is a death sentence. It is worth the cost, and time, and energy for the peace of mind and to be there for your children.

I was diagnosed with stage 4 colon cancer at 39. The only reason we found it was that I went in for an extra because i had a lingering cough i thought might be pneumonia. You know what sucks a whole lot more than being afraid of what a test might say? The fact that I may not get to see my two boys grow up. We need to collectively get over it and start testing much earlier. A simple blood test for your CEA level every year could be a great early warning. Sure, you might get an FP, but whatever. I would give anything for my tests to have been FPs and my initial scans to have been on overreaction.

When you mentioned that Cologuard and colonoscopies have similar rates of mortality reduction…I took some pause. I do see your reasoning for why that might be the case. But I’m also curious about how we separate out the idea that maybe an individual who takes the time to do ANY consistent cancer screenings might also lead lifestyles that lower colon cancer risk or improve survival outcomes. In addition I’m curious about the true effectiveness of early intervention with colon cancer screenings with regards to preventing distant metastatic cancer. My understanding is that while more effective than say, mammography, colon cancer screening has been more effective at reducing localized colon cancer than metastatic…which is the one that will kill you. I feel like the the elephant in the room is that screening programs, even yearly ones, are not great at catching those really aggressive cancers that unfortunately seem to disproportionately affect young people. This isn’t to say they aren’t important…but I think we are overstating the impact of early detection when we mention younger patients, many of whom are too early to screen, as they are the ones most likely to have really aggressive disease that are unlikely to be caught “early” or don’t respond to treatment. We desperately need other tools to detect and most importantly prevent these cancers. I wonder if cologuard and colonoscopy have similar effectiveness because they typically detect less aggressive disease.

2 comments on colon cancer screening:
First, it’s one of the cancers most avoidable based on individual decision-making. Diet matters immensely here. Many cancers seem pretty random; colon cancer is within your power to avoid in many cases, by comparison.

Second, colonoscopies didn’t used to be done with anesthesia. They still don’t have to be. Some places will do them just with sedation (eg valium), and this is preferable for most to total anesthesia. The unpleasant prep and the risk of a serious complication are the same, but sedation is a great way to go and should be considered if intubation and the risks of GA are putting you off.

We jokingly refer to the FIT test as a “shitment” when we put it through the mail.

I feel very torn about the newborn exposure/kissing recommendation, and I was hoping to see more data on this with regards to physical and mental health outcomes for moms and babies. While a “lying in” period has been common across many cultures forever, that doesn’t necessarily mean isolation for the purpose of avoiding germs. Historically, many cultures will have a woman and newborn rest separately, but with women coming in constantly to care for her; it’s more about bonding and recuperating. In practice, a lot of families are just so involved with those early day demands that they don’t go a whole lot of places…I sure didn’t. But the few places we did go, and the people we did see through visits were a lifeline to me during this time where you feel isolated enough. Post-partum mental health is a real issue here. What I am observing is that a lot of families are just slogging through on their own perhaps with occasional the help of one relative and sometimes not even that. I do think there is a cost to this and I wonder if this message of social avoidance during such an already isolating time is really helping women and babies. I had my baby over 10 years ago and my message from my pediatrician was very different. We were encouraged to “take him everywhere” and enjoy family as our physical needs allowed, using common sense like avoiding people with colds, etc. and I was also told that nursing him would be protective for him, and I was hoping to see some data on how true that is today. He got passed around, snuggled, and yes, kissed. So, while I completely understand that avoiding a spinal tap (yikes) is goal for some people, I do wonder about the cost to our long-term health by avoiding people in a way that I just don’t believe we’ve evolved to do. I feel like if you can demand that I sit in doctor’s waiting room with him at 2 days, 2 weeks, 1 month, etc. etc., then maybe we can socialize with some of our support systems, or take him shopping.

Just want to reiterate my appreciation (for a change from the more vocal people that love hearing the sound of their own voice) that having a separate community discussion section is both more appropriate and healthier for everyone. I don’t pay for this website to read unsolicited advice from unqualified overly-online randoms that comment on online articles as a habit arising out of boredom and high levels of main character syndrome. It is always worth the money to read quality, well-thought out and researched pieces from someone with the time to dedicate as their career. Having the community section on the site lets me go here on the occassion when I actually want to see people’s perspectives when I want to. But it also helps me avoid the urge to be reactionary in a way that I need to actually post those thoughts for others to read when unnecessary (most of the time).

Keep up the good work!

I would love to hear more about this discrepancy between starting solids at 4 months vs 6 months. I also had a confusing situation where my GP suggested solids at 4 months, but all the articles that quoted WHO says 6 months. I went into the data myself and found a Lancet article that WHO referenced. However when I pulled up the Lancet article, it quoted WHO. So I don’t know where the evidence for 6 months (or 4 months) came from. My best guess is that, as WHO is a worldwide organization, and certain developing countries don’t have access to safe drinking water, the later start may decrease illnesses in those countries. That’s the summary of my findings, but I’d love to hear if anyone else has found differently. The evidence of starting earlier than 6 months seems beneficial from the allergen prevention side, so I started earlier for my baby.

I strongly disagree with there being no option C!

Most of the people I admire most are exceptionally creative with finding options Cs. I value that about myself too. It’s a lot more freeing and practical than black-and-white thinking.

1) For the example about scheduling a repeat C-section or going for a VBAC, I would ask myself some questions that might lead to a secret option C that’s better than the default options A or B:
– What did I hate most about having a C-section? If it was feeling disconnected from the birth, can I make a scheduled repeat section a little better by choosing a hospital that will allow a clear drape, immediate skin-to-skin, and other humane touches? If it was knowing the impact on the baby’s microbiome, can I do a vaginal swab to seed good bacteria on the baby?
– What worries me most about a VBAC? If it’s the chance of an emergency C-section, can I avail myself of known factors that reduce the risk of C-section, such as hiring a doula, planning a home birth with a midwife, laboring at home for as long as possible before heading to the hospital, and declining most drugs and interventions unless there is a medical need? Or if it’s the risk of uterine rupture, can I assuage that fear by planning a hospital birth and declining Pitocin augmentation, and if I want additional kids, reading statistics that show VBACs reduce the likelihood of future uterine rupture whereas additional C-sections increase it?

2) For the example about university job offers, the sky is the limit on secret option Cs. One partner could decide to switch from academia to industry, or work in a different field entirely. They could decide to have kids and have one partner be a stay at home parent. They could break up if they both value having the best job but hate the idea of maintaining a long-distance relationship. These secret option Cs might quickly be ruled out as less good than options A or B, but they are in fact options!

3) For the example about seeing family or not during the pandemic, I would hope that everyone here would be familiar with option Cs that reduce risk by now. Wear N95 s! Meet outside! Run Hepa filters inside! There are a variety of interventions that can reduce the risk (and anxiety) of Covid by an order or two of magnitude. You don’t have to choose all or nothing. There are plenty of secret option Cs. Think for yourself and get creative and practical.

I don’t think I got a copy of starting solids to my email – is there something I should change to be sure I get newsletters like that? I’m confused by the new format and not sure why I’ve missed it.

This is something I have always struggled with. I honestly don’t know if I’m capable of this, in these hard scenarios.

I *know* decisions have to be made. I have personally experienced having them “made for me” by not choosing. It probably doesn’t help that when I *do* male choices, they’re usually the wrong ones. 🤦🏻‍♀️

Yet again & again, I just can’t seem to make myself choose between 2 bad options, 2 options with large downsides, or even 2 equally great options.

Is there some secret process or way that people do this? *HOW* do you just jump off a cliff and completely turn your back on some other version of your life that could’ve been? I really need to know, tangibly, HOW to do this. “Just accept that you’re going to be unhappy & make a choice – & do it” isn’t enough to tell me HOW to do those things…

I’d love any tips. Or if you share this affliction, I’d love the camaraderie (misery loves company, after all)!

This is in response to the magic mushroom use while breastfeeding:

One thing that was missing (maybe only alluded to) in the write up from the Q&A was a discussion of the chemical properties of psilocybin and its metabolites. Psilocybin is moderately lipophilic (log kow = 1) (fat loving, meaning it will preferentially accumulate in body compartments with more fat, including breast milk) but I wasn’t able to find a measurement of psilocin. Without knowing how much psilocybin metabolizes into psilocin and without knowing how lipophilic psilocin is, the safe assumption is to assume it has the same lipophilicity or that very little is metabolized. This means we would expect the breast milk concentration of psilocybin/psilocin to be HIGHER than whatever is in the blood. There could be additional biomechanics that would make this untrue but without measurements in humans or animals we don’t really know.

I agree with the conclusion that there is really not enough information to make a decision about how much is entering the milk. However, I think it safe to err on the side of assuming the child would be exposed (and during a huge sensitive period of their neurodevelopment) and talking with a doctor about alternative treatments or feeding formula while using.

As a point of comparison, cannabidiol, which is highly lipophilic (log kow seems to be >6!) does seem to make it into human milk, but at concentrations below what we would expect given how much it dissolves in fat. However, there is also little biomonitoring data on that compound.
https://www.ncbi.nlm.nih.gov/books/NBK535598/#:~:text=Cannabidiol%20is%20a%20component%20of,mothers%20who%20used%20cannabis%20products.

My credentials: I am not a toxicologist but I model chemical exposures/biokinetics professionally and last year wrapped up building a model of chemical accumulation in human milk for EPA to use in regulating compounds for which there isn’t much biometric data available.

Technically, there have been 4 cases of measles in California in 2024. The most recent ones were at a hospital very close to my house and there was concern of exposure to 300 people. Thankfully that was contained, so numbers are still very low considering the population of California!
https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/measles.aspx

Identical twin here! I am SO grateful my mom separated my sister and I in kindergarten. It allowed us to form our own opinions about school, find confidence in our own strengths and navigate independence. I don’t recall an ounce of distress over going to separate classrooms, and I am thankful I got to forge my own identity at school instead of being knowns as “the twins” in class. My sister and I still ended up going to the same college and even living together in adulthood – I wanted to offer a positive anecdote for the mom who is struggling with this decision!

Re: measles- you can give MMR vaccine early at 6 months to cover your baby! https://www.healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/When-should-the-measles-vaccine-be-given-early.aspx

On Fluoride, what about the reverse case? Our 5-year old refuses to drink regular tap water, just reverse-osmosis filtered water, which I believe filters out fluoride. Should we be re-introducing it?

I don’t see a way to comment on the doula article directly. Maybe this is the correct place??

I think it’s great for everyone to be allowed to bring an emotional support person to labor. I think it’s great if a quick online training helps those people be good support people. But I don’t think everyone wants or needs a doula. I certainly did not want a friend or doula at my labors. My husband was the only person in the room I’d accept (aside from medical folks). I’d find pressure to get a doula 100% as annoying as the browbeating about breastfeeding. It’s not for everyone.

Thank you for the post on the HPV vaccine. I have been thinking about it recently as I hadn’t heard much (I work in early childhood and my daughter just turned 7). I got the vaccines in 2006 at 18 years old and didn’t have a great experience. I think it was mainly in the person giving the vaccine doing a less than great job placing it and then that I got it later than recommended. I tested positive for HPV in my early 20s and it cleared on it’s own so I’m glad to hear that it’s effective when given before any chance of exposure.

Thanks for the HPV post. The HPV vaccine became available right before I was sexually active and at the time I got it but didn’t realize how lucky I was. My younger cousin didn’t know about this vaccine and died recently from cervical cancer at the age of 30 which was heartbreaking. It’s worth getting the vaccine and it makes so much sense to do it at an early age.

Thanks for the HPV article. I can’t help but think there must have been some really poor marketing about the vaccine when it first came out. The implications of preteen sexual activity were a huge reason my parents balked at having me get it-it had nothing to do with concerns about efficacy or safety. Has this changed in recent years to focus more in the cervical cancer prevention? Doctors can do a lot of damage if they don’t respect your culture. Showing people data on HPV & cervical cancer rates among totally monogamous people who only had sex in the context of a committed relationship (and the impact of the vaccine) probably would be more helpful than basically insulting parents beliefs about their teens’ potential behavior, even if sexual activity is statistically common.

Part of why I hate this new newsletter/website format so much – I was curious to see what the comments were in response to the HPV article. When I scrolled to the bottom of the email containing the article, and clicked, “Leave a Comment”, it took me to this page where the first comments I see are about colonoscopies. I have to scroll to the bottom of the page to find the most recent comments, which will line up with the article most recently received.

Re: HPV vaccine
How do you have a convo with a 9-yr old about this, or do you just say, “you gotta get a vaccine today!”?

Dear breast worrier: I just wanted to say that my son did not want to give up breastfeeding on his own at all. In fact, the longer it went, the more he regressed to wanting to feed more frequently, often in public, and feeling anxious if I delayed. That said, when I was ready to stop, the process was much more simple than I thought it would be. Given his anxious feeding tendencies, I thought it would be almost impossible, but my friend suggested I use big band-aids and tell him my “nums” had boo boos, and he couldn’t have any more milk. He became concerned for me, more than for himself, and transitioned fairly well. It was such a lesson for me in the idea that you can make transitions when you need to. Of course, self-weaning would be wonderful, but if it doesn’t happen, I just thought I would recommend the boo boo method!

(PS. The chat being disassociated from individual articles, etc., makes it so much less useful to us all! I hope that’s changed!)

My daughter mostly self-weaned at 15mo, but she also didn’t drink much cow’s milk for quite a long time. She ultimately started liking it more later on, closer to 18mo-24mo. But you can focus on other sources of calcium for now!

(Also, can we have separate discussion topics or something for these comment sections? I used to love reading the comments, and now they are so annoying.)

I just read the article about birth control and you mentioned Addyi (flibanserin). I never heard about this drug so looked it up. Will you dive more into it in a future article? I always felt it was so unfair that there wasn’t something for women with low sex drive. But can we trust this drug? I personally suffer from PMMD and am taking Loryna and Zoloft as treatment (game changer by the way) but Addyi (flibanserin) seems to possible interact with these meds. Is that right?

Is the sensitivity for FIT+DNA based on an annual test? My HMO will only foot the bill every 3 years for FIT+DNA vs annually for FIT.

Just read the article on the decline in teen mental health. I think the article missed a lot of other more recent discussions and views on the topic that have come out lately, particularly from Jonathan Haidt in Anxious Generation and from Abigail Shrier in Bad Therapy. These should be highly recommended reads for any parent interested in the topic.