Respectful Insolence

I’ve heard of physicians using themselves as guinea pigs for their own research before, but this is ridiculous.

Yesterday, my copy of General Surgery News arrived at my office. As I was whiffling through it to see if there were any articles worth reading, I came across a tale of a Japanese doctor who was truly dedicated to his research, so much so that that I had to hand it to him. Well, sort of.

Yes, on p. 22 of the June issue of General Surgery News (sadly, not yet online as of this writing, so you’ll have to take my word for this–or check up on me in a couple of weeks when they’ll probably post this online), I found an article entitled Where Intrepid Endoscopists Boldly Go: Self-Endoscopy.

You heard me right: Self-endoscopy, in this case, self-colonoscopy (I’m not so sure that self-esophagogastroduodenoscopy is even possible.)

I’ve heard of dedicated GI docs or surgeons before, but this puts them all to shame. Steve Frandzel, the writer of the article, at least had a sense of humor about it:

One might initially surmise, a bit flippantly perhaps, that an endoscopist who performs a colonoscopy on himself has a little too much time on his hands. But a Japanese physician had a commendible goal when he inserted a colonoscope into his own colon–multiple times.

Akira Horiuchi, MD, from the Department of Gastroenterology at Showa Inan General Hospital, Komagane, Japan, discovered that a pediatric endoscope was particularly useful in patients for whom colonoscopy was difficult. He hypothesized that such an endoscope “might enable an endoscopist to perform self-colonoscopy screening, which could be a valuable research tool” to repeatedly study the effects of drugs or other therapies.

Dr. Horiuchi was even kind enough to write up his work and publish it in Gastrointestinal Endoscopy in January, where he described his technique:

After bowel preparation, the endoscopist (A.H.) sat on the back of a chair in front of the monitor. The endoscopist, who was directly facing the monitor, then self inserted the colonoscope into the colon (Figure 1). The knob of the colonoscope was manipulated with the endoscopist’s left hand, and the insertion tube was held with the right hand.

He even provided a helpful illustration of his technique:

i-36a7c5bd9b0f406d379bf863f4e0438e-Selfendoscopy.jpg

My first thought upon seeing that picture was: How on earth did he manage to do a colonoscopy on himself with his pants on? Did he have a handy hole in his pants? Best not to think too much about it.

Dr. Horiuchi’s experiment, thankfully for intrepid colorectal investigators everywhere, was a success:

In our first attempt, complete colonoscopic examination to the cecum was completed within 4 minutes, with only mild discomfort related to looping of the sigmoid colon. Because this initial attempt was so easy, it was repeated 3 additional times over the following 2 months, with cecal intubation times of 5, 3.5, and 4 minutes.

Such dedication! And, intrepid investigator that he is, he reports more:

Surprisingly, the endoscopist learned that the feasibility and the discomfort were different in each session, despite the same examiner and the same patient. This finding supports our view that patient discomfort during endoscopy may vary within the same patient.

And, finally, like all good researchers, he suggests areas for “further research”:

The fact that colonoscopy was surprisingly easy with the patient in the sitting position suggests that studies to compare sitting vs. supine positions with different endoscopes are warranted. To be feasible, colonoscopy in the sitting position would likely require the use of a specially designed colonoscopy chair.

You know, I need more publications just as bad as the next academic surgeon, but there are some things even I wouldn’t do to get another notch on my CV. His fellow gastroenterologists are even giving him the thumbs up (so to speak). Dr. Tarun Mullick, MD, at the Rush-Copley Medical Center in Chicago said this of Dr. Horiuchi, “He deserves some extra credit.”

Now that‘s an understatement! Dr. Horiuchi is subjecting himself to a very uncomfortable procedure which, while in general is pretty safe, still carries a small risk of perforating the colon each time that he does it when he doesn’t need the procedure, all in the name of science? And he’s not just doing it once, but several times, with all the bowel preps that go with the procedure. I asked EneMan what he, caped defender of colon health that he is, thought of the whole thing:

i-fdc4fdb4ab173da6d30e99885d483658-16371061_efa3ca4e2b_o.jpg

Yes, that was my initial reaction too, although I’m betting that the performer of this song would beg to differ with EneMan and would give Dr. Horiuchi a big thumbs up, as well.

Either that, or a finger wave.

Comments

  1. #1 Sophie
    June 14, 2006

    To me the ultimate self-experimentator is Kevin Warwick (he’s not a physician): http://www.kevinwarwick.com/Cyborg1.htm

    He self-implanted a chip to decode his arm muscle inputs… and plays a lot on the cyborg image.
    He’s also enroled his wife in the experiments.

  2. #2 ArtK
    June 14, 2006

    I remember some years ago, hearing a piece on NPR. It was a vet who infected himself with feline ear mites. Not once, but several times. He chronicled the progress of the infestation as his ear became filled with mites. It was funny, but shiver-inducing at the same time.

    There’s something deeply troubling (and troubled) about someone who does a self-colonoscopy.

  3. #3 Mark Chu-Carroll
    June 14, 2006

    Dear god… The guy’s out of his freaking mind.

    Speaking as someone who has had the misfortune of having experienced pretty much *every* GI exam at least twice, and frequently more often than that, I just cannot imagine what kind of insane masochist would be willing to do that to himself *multiple times*.

  4. #4 William the Coroner
    June 14, 2006

    I’m as fond of D.I.Y. as the next guy, but this is rediculous.

  5. #5 TheBrummell
    June 14, 2006

    Now this is on the interweb, we can expect a site tailored for the self-colonoscopy community to appear momentarily.

    Now, the uncounted legions of self-colonoscopy fetishists (they probably prefer a term like “self-colon-topography-curious”) can assemble (no pun intended) at regular intervals to compare techniques, positions, and hardware.

    For some people, the world just got slightly better. For the rest of us, total weirdness remains constant, but exposure to it has increased.

  6. #6 ebohlman
    June 14, 2006

    There seems to be a long tradition of self-experimentation in GI matters. Remember how Marshall deliberately infected his stomach with h. pylori? Going back to the 19th century, one researcher (forgot the name) analyzed gastric juices by swallowing sponges on a string and pulling them back up; another one simply took advantage of his ability to puke at will.

  7. #7 alphabitch
    June 14, 2006

    dear sweet mary on a matchbook cover.

    I’ve worked in medical research for a long time, and I’ve volunteered as a control, when I qualify, or as a subject in my friends’ research. But that’s just too weird. And yeah, I think he should take off his pants, but that’s just me. And for the love of pete, get a more comfortable chair.

    ArtK — I remember that piece very vividly — it was in Harper’s too, if I’m not mistaken. And as someone who occasionally experiences formication (just the tactile hallucination part, not the delusional disorder; I don’t really believe there are ants crawling on my skin), I really wish I’d never heard about that guy & his ear mites.

  8. #8 Katie
    June 15, 2006

    I would have to say that perhaps there is such a thing as too much dedication and this proves my point. I have always been a firm believer in “boundaries”.

    I have to say that the song was a nice touch for the entry. Very funny!

  9. #9 Jimmy James
    June 16, 2006

    Scientists have used themselves to test many discoveries.Marshall who won Noble Prize in 2005 did that.Remember story of Lightning and Metal key.
    Scientist use animals/humans to test new discoveries–then what is the problem if they use these on themselves.

  10. #10 Jimmy James
    June 16, 2006

    The famous EndoCapsule or Pill Camera when developed was tried by inventors on themselves.
    Recently,a famous Gastroentrologist reported testing this New ENDOCAPSULE on himself a few times as he has GERD problem–he is doing research on GERD–so this was an easy way to see what happens with GERD pains–Taking a Camera Pill is like taking a Vitamin Pill–you can view the affected area.This was reported at Digestive Disease Week 2006 in Los Angeles.
    Many discoveries/new ideas/new inventions have come from research on oneself.

  11. #11 Jimmy James
    June 16, 2006

    18th Century Italian Scientist Lazzaro Spallanzani–in order to explore Our Digestive System and digestion issues–Swallowed food encapsulated in wooden tubes or clth satchels and then analyzing the remains of the samples upon their exit from the intestinel tract.
    Many of his discoveries and observations are still valid.
    Laughing Gas used an anesthetics was discovered the same way.
    SOURCE: GUINEA PIG SCIENTISTS–BOLD SELF EXPERIMENTERS in Science & Medicine by Mel Boring,Leslie Dendy and c B Mordan.

  12. #12 Jimmy James
    June 17, 2006

    I am not a doctor,but I have read that Marshall was having trouble convincing other Gastroenterologists of his theory of Bacterium causing the GI problem which was being wrongly treated for years by Board Certified famous doctors.He fought for 10 years to validate his finding–That means Patients suffered for 10 years based on wrong treatment.In order to convince others–he had to take the bacteria himself to prove his discovery.He even left USA and went to Australia and found a Gastroentrologist willing to work with him.Still took 10 years.
    Now in Japan FDA takes years to approve new products.PILL CAMERA was approved in USA in 2001 and has been taken by over 350,000 persons in US and Europe.BUT Japan’s FDA has not approved it.The Japanese have the highest rate of Gastro problems in the Industrialized developed world.The Japanese FDA is so bad in its approval protocal that major discoveries in medical field by Japanese cannot be marketed in Japan.
    Also remember–the Ethics in USA are different–So long you do on other human beings or animals–you are OK.If they die–that is OK during trials.JUST DON’T DO IT ON YOURSELVES.
    In other societies–SELF TESTING is considered an Ethical way–Do on yourself what you want to subject others to.
    SO IT IS AN ETHICAL ISSUE in addition to the fact that many bigwigs in any field pooh pooh many good ideas from others(Marshall’s Noble Prize in 2005 proves it.).Often young researchers can not find money to test their ideas but we know that major inventions have happened by these–OUT OF BOX thinkers.
    Fortunately,US still is ahead in inventions/Noble Prizes–look at Bill Gates–Could he succeed at IBM.Even IBM faced dire predictions when it went into computers–forecasters said only a few computers will be needed.
    Many major inventions in medicine before 1920 happened where researchers took risks.In Gastro field,this has happened in 80′s,90′s and now also.Miniature Ingestible Capsule or Pill Camera or Endo Capsule were tested by its inventors on themselves.
    In Cancer,Non FDA approved medicines have been taken by desperate patients.People and Discoverers/inventors get frustrated with long delays in Procedures/Protocols thereby forcing them to use themselves as Guinea Pigs.
    We should ask why Japanese FDA has taken 4 years and NOT APPROVED PILL CAMERA for GASTRO/digestive system viewing.

  13. #13 Jimmy James
    June 17, 2006

    I thought of finding out “Who is DR.AKIRA HORIUCHI”.Is he a wierd or great researcher/doctor?
    Thanks to GOOGLE–DR.Akira HORIUCHI’s credentials are Impeccable.He is a humanitarian and famous Gastro doctor in Japan.
    He has done research on Pancreatic cancer,wound infection after Percutaneous Wndoscopy Gastrostomy,Comparison of Propofol and Mida Zolan on driving ability after Diagnostic EGD.He did this research with well known GI doctors in the world–including Dr.Douglas K Rex–chairman of Indiana Univ.GI dept. and former president of Amer.Gastro.Assoc.(AGA).VERY FAMOUS MAN.
    His research is published in well known Journals in GI field–like Amer.College of Gastro. publications and AGA publications.He is listed as first author–so he seems to be a great researcher.He has a patent also.
    NOW on HUMANITARIAN AREA:
    HE is the CHAIRMAN of JAPAN International FOOD FOR HUNGRY-serving Ethopia,Uganda,Bangladesh,Afghanistan,Phillipines,Cambodia,Peru and Bolivia in medical fields.
    He is listed among the donors to CHILDREN’s Digestive Health & Nutrition Foundation.
    SO DR.AKIRA HORIUCHI credentials are GREAT.

    ORAC–who wrote this BLOG–PLEASE CHECK GOOGLE for AKIRA HORIUCHI and perhaps contact him to find out his reasoning for this testing on himself.YOU OWE TO HIM–before writing a funny but derogatory BLOG.PLEASE BE FAIR.

  14. #14 Orac
    June 17, 2006

    ORAC–who wrote this BLOG–PLEASE CHECK GOOGLE for AKIRA HORIUCHI and perhaps contact him to find out his reasoning for this testing on himself.YOU OWE TO HIM–before writing a funny but derogatory BLOG.PLEASE BE FAIR.

    Oh, please. Give me a break. It was a facetious post, and I’m guessing it’s nothing that Dr. Horiuchi hasn’t heard before in the five months since he published his paper. I’m also speculating that Dr. Horiuchi, were he aware of my post (unlikely, but possible), would probably find my little, light-hearted take on his adventures amusing. If not, there was no insult intended, more a fascination over what–if you’ll excuse the term–ends people will go to in their own research.

    Lighten up, dude. You’re taking something that was meant in friendly jest way too seriously. Come on, didn’t you click on the link to the snippet of a song at the–sorry, couldn’t resist–end?

  15. #15 Jimmy James
    June 19, 2006

    ORAC–Here is a joke/comment made by my GI a few years ago.
    When I was lying down on a table/bed for Colonscopy–He joked”I have seen your front all the time and now I will get to see your behind/back”
    My GI lives in front of my house.Generally when I see him ,we face each other.So his joke put me at ease–after his joke,I was totally out and so don’t remember what happened–only 30/45 min. later–he came around and gave thumbs up to say everything is OK.
    Your column is fun but some comments called Dr.Horiuchi as a WIERDO—I am sure Dr.Horiuchi is a capable/well known in his field and there must be some reason for this adventure.
    As I wrote that GI’s before 1930 did a lot of wierd things to understand Digestive problems,but Dr.Marshall was ridiculed so much that he took the bacterium to prove his point.He was laughed at in USA.Other GI’s thought he was crazy.But SOME INVENTORS are CRAZY when it comes to their IDEAS.
    I have written about some inventors and read books on this subject.Some have gone to extremes to prove their point to nonbelievers like EvilKnivel.

The site is undergoing maintenance presently. Commenting has been disabled. Please check back later!