Skip to Main Content

At a time when medical researchers are under pressure to increase diversity in clinical trials, a Johns Hopkins study is sparking outrage among some physicians because of its large number of Black patients.

The controversy has stoked concerns that the institution infamous for its role in the Henrietta Lacks story may have once again exploited marginalized people for medical research. The university denies any wrongdoing and instead said it was simply providing a service to its local community, which has a mostly Black population.

The paper was published last fall without much notice but caused a stir on social media in recent weeks. It was a retrospective study analyzing the abilities of three specially trained nurse practitioners to perform colonoscopies, an invasive and potentially lifesaving cancer screening procedure normally done by gastroenterologists. Of the more than 1,000 patients who received screening colonoscopies from the nurse practitioners between 2010 and 2016, nearly 75% were Black.

advertisement

“That is a huge red flag because that could not have happened randomly,” said Fola May, a gastroenterologist at the University of California, Los Angeles. “Did they preferentially pick Black patients to be in the study and to get the NP colonoscopies?”

African Americans make up about 63% of Baltimore’s population and 88% of the Middle East Baltimore neighborhood where Johns Hopkins Hospital is located. But Black people account for only about 25% to 31% of the patients treated in the Hopkins hospital system, according to annual reports from 2015-2016 and 2017. Johns Hopkins did not provide racial demographics of the patients who undergo colonoscopies, but said it provides the procedure to people living in the local community and outside the community.

advertisement

Amid projections that demand for colonoscopies will soar as the population ages and as colorectal cancers rise among younger people, the researchers wanted to find out whether nurse practitioners who completed a yearlong gastrointestinal training fellowship could perform colonoscopies up to the same standards as doctors. For comparison, a gastroenterologist typically completes three years of internal medicine residency and three years of a gastroenterology fellowship.

Critics of the study questioned whether the patients were adequately informed that nurses don’t commonly do the procedure in the U.S., and whether they were given a choice to have their exam done by a doctor.

“When I saw the paper, my immediate concerns were around informed patient consent,” said Rachel Issaka, a gastroenterologist at the Fred Hutchinson Cancer Research Center in Seattle. “I really wanted to know, were those patients told up front that their colonoscopy was being done by a nurse practitioner, because that’s not the standard of care in the United States.”

Anne Marie Lennon, who is director of the Johns Hopkins division of gastroenterology and hepatology and was not involved in the research, said the data from the study show that the nurse practitioners met the same national metrics for safety and effectiveness set for gastroenterologists performing screening colonoscopies.

“This is a service where it was offered to the community, and the community happened to be people of color,” Lennon told STAT. “The concept that … people think this is Hopkins sort of looking at and doing something that is incorrect or immoral — that is simply just not true.” She said patients could choose a nurse practitioner or a gastroenterologist when they called to make an appointment, and some may have opted for NPs because they typically had shorter waits.

The study was spearheaded by Anthony Kalloo, a gastroenterologist who preceded Lennon as director of gastroenterology and hepatology before his recent appointment as chair of the department of medicine at Maimonides Medical Center in Brooklyn, N.Y.

Kalloo told STAT the patients were informed that their procedure was being done by a nurse practitioner and that they did have the option to have it done by a doctor. None of the patients refused treatment by a nurse practitioner in favor of a gastroenterologist, he added. He said patients signed a standard consent form to undergo the colonoscopy and were not asked to explicitly acknowledge they understood their procedure was being done by a nurse practitioner as opposed to a doctor who would have had more training.

Kalloo started training nurse practitioners at Johns Hopkins Hospital to perform colonoscopies, he said, as a way to save money and give back to the community, as well as meet the rising demand for the procedure, especially in underserved areas and rural places where access to a gastroenterologist might be limited.

“My God, it’s such a no-brainer to me almost. Why wouldn’t you want to save costs, especially when you have demands for a procedure that’s increasing and increasing,” he said. “So the logical thing, in terms of supply and demand, would be to train nurse practitioners to do this.”

He chalked up the criticism from gastroenterologists to longstanding tensions between physicians and nurse practitioners over the growing scope of medical procedures that non-physicians are allowed to do. “It has a lot to do with the perceived conception that it’s a threat to their livelihood,” said Kalloo. “I expected a little bit of pushback, but I did not expect this degree of pushback.”

He compares it to complaints that emerged when certified registered nurse anesthetists began administering anesthesia to patients, and noted that nurse practitioners regularly perform colonoscopies in the United Kingdom. He said he was simply duplicating a procedure that happens elsewhere in the world, though in the U.S., the American Society of Gastrointestinal Endoscopy had published guidelines in 2009 that stated “there are insufficient data to support nonphysician endoscopists to perform colonoscopy. …”

“It’s flabbergasting that this is such an issue … this is nothing new,” he said. “Except we for the first time in this paper showed that we could do this in the U.S. and the implication of that is cost savings.”

On Twitter, May, at UCLA, suggested the Hopkins study was exploitative. She responded to a fellow gastroenterologist’s tweet by saying the paper was “fueling the woes and fears of experimentation and exploitation in the Black community yet again!”

She was not alone in her worries, as doctors from various specialties, health professionals, and others also voiced their concerns on social media.

“Feels a lot like medical experimentation (*cough* racism) to me,” wrote Jazmyn Shaw, an emergency room nurse and medical student.

“Trying to wrap my head around how they managed to get ~750 Black people to sign up for this. I can’t even convince family to get vaccinated,” tweeted Kerry Mitchell, a plastic surgeon at Ohio State University Wexner Medical Center.

“Two-tiered medical system here we come. ‘MD for me but not for thee,’” wrote Daniel Choi, an orthopedic surgeon at Spine Medicine and Surgery of Long Island.

Adding to the critics’ concerns was a 2015 study published by Kalloo and two colleagues that evaluated colonoscopies performed independently by a single nurse practitioner between 2010 and 2012. Of the 300 people in that study, nearly 85% were African American.

“What happened to all of the white patients that normally walk into Hopkins to get a colonoscopy?” May said in an interview. If the researchers wanted to ethically demonstrate that nurse practitioners can do high-quality colonoscopies, she said, they should have instead conducted a trial on a randomly selected group of patients. “You should start with all types of patients. You shouldn’t be targeting Black patients,” she said.

The patient makeup of the studies is particularly concerning to some because African Americans are disproportionately affected by colorectal cancer. They are 20% more likely to get colorectal cancer than white people and 40% more likely to die from it, according to the American Cancer Society. The American Society for Gastrointestinal Endoscopy says African Americans are also more likely to have advanced colon cancer when it is diagnosed, and to have polyps — abnormal tissue growths that could potentially become cancerous — deeper in the colon, where they can be harder to spot with a colonoscopy.

“Because their care is so complex, they need the gold standard,” said Ruqaiijah Yearby, a bioethicist at Saint Louis University. “They don’t just need somebody who was able to do it, they actually need somebody who can catch all of the problems that they may suffer because they’re at increased risk of a higher rate of disease, cancer, and death,” she said.

Kalloo defended his work against claims of racial exploitation, asserting the study would lead to better care and more access for patients of color seeking colonoscopies.

“I found those comments to be amusing,” said Kalloo. “Obviously, they saw that I was the lead author from Hopkins, but they obviously didn’t know what I look like,” he said. Kalloo is a Black man who was born in Trinidad.

“There was not a selective intent to seek out patients of minority [groups],” he added. “And as I said, I am a minority.”

The three nurse practitioners in the study performed at least 140 colonoscopies while supervised by a gastroenterologist during a fellowship program at Hopkins before they could perform the procedure independently. That amount was the minimum number of colonoscopies necessary to demonstrate competency, according to recommendations at that time from the American Society for Gastrointestinal Endoscopy. They also underwent a performance evaluation before being credentialed to perform the procedure on their own.

The paper noted that the nurse practitioners were women between the ages of 18 and 36. Two were white and one was Asian, and two held a master’s as their highest degree and one a doctorate. (STAT reached out to one of the nurse practitioners who was also the study’s lead author, but was referred by Johns Hopkins to speak with Lennon instead.)

Sophie Balzora, a gastroenterologist at NYU Langone Health, said 140 colonoscopies seemed very low to develop competency, and estimated that by the end of her three-year clinical fellowship at NYU, she had completed more than 800 colonoscopies.

“By the end of first year, you would have several hundred under your belt, and you still wouldn’t be comfortable performing procedure after procedure on your own without any supervision,” she said.

Some studies have suggested that colonoscopy competency comes after around 250-300 procedures and others around 500 procedures. In 2017, after the time frame of the Hopkins study, the American Society for Gastrointestinal Endoscopy raised its recommended minimum to 270 procedures for competency assessment.

A look at the Johns Hopkins gastroenterology and hepatology webpages from 2013 to 2016 suggests there were typically about 40 to 50 gastroenterologists and about 15 gastroenterology medical fellows on staff each year.

“You’re in a highly populated urban area where there are physicians who perform thousands of colonoscopies throughout their career, but then you’re having a colonoscopy done by an NP who has done only at least 140 procedures. Why is that?” Balzora said. “It’s a perfect example of systemic racism in my mind.”

Yearby, the Saint Louis University bioethicist, agreed that the study raises ethical issues. She said she doesn’t think the researchers targeted Black patients in the same way they were targeted in the Tuskegee syphilis study, or in a Hopkins HIV study in Ethiopia in which researchers cancelled plans to give pregnant women a placebo instead of the drug AZT to prevent HIV transmission to their babies, or the Hopkins Krieger study that evaluated interventions to reduce lead poisoning in children. But she called the procedures problematic for other reasons.

“They used a population because they were in an urban area at an academic medical center, and they had lots of people coming in who needed colonoscopies, and so they used that as an opportunity to try this out,” she said. “That is undue influence and targeting of particular populations.”

The nurse practitioners were permitted to work only at the hospital, according to Lennon. While they were performing on their own, there was always a gastroenterologist “on the floor,” Kalloo noted.

During the study period, the three nurse practitioners conducted a total of 1,425 colonoscopies. About 400 were excluded from the study because the patients either did not have clean enough bowels or they came in for screening and it was found they had a disease like inflammatory bowel disease, which led to a doctor taking over. The nurses detected adenomatous polyps in about 36% of cases, which exceeded the standard for detection of more than 25% of cases as set by the ASGE and the American College of Gastroenterology. The NPs also achieved cecal intubation, which is at the end of the colon, 98.5% of the time, which also met the national standards of higher than 95%. They did not cause any perforations of the colon.

“They can tout their results, but when they started the study they didn’t know what the results were going to be,” said May. She also took issue with the paper’s lack of follow-up. “They finished these colonoscopies over five years ago. Why not tell us how many of those patients have developed cancer in the interim?”

The study had several limitations. The use of only three nurse practitioners limits how much the results can be generalized to other nurse practitioners. It also did not say how many of the colonoscopies required the assistance of a physician to reach cecal intubation.

Kalloo said he struggled to get the work published in one of the more established GI journals, and ultimately published it in the journal Endoscopy International Open.

Johns Hopkins is no longer training nurse practitioners through its gastrointestinal fellowship to perform colonoscopies, Lennon said. Two of the three NPs involved in the study are now at different institutions, and the one still at Hopkins no longer does colonoscopies, she said. But Lennon asserted the program wasn’t stopped because of any concerns with it.

“There’s no insidious [reason], there’s nothing unusual about this. This is simply people have moved on,” she said. “It’s an interesting thing the prior division director did, but we’re not running this at the moment.”

Another factor in the Hopkins decision, Kalloo said, was the fact that Medicare and Medicaid don’t reimburse for nurse practitioners who perform colonoscopies. Still, he said he would be interested in starting up a similar gastrointestinal fellowship at his new medical center in Brooklyn to continue training nurse practitioners to conduct colonoscopies.

“I just got here at Maimonides four weeks ago, so I’m trying to get my feet wet,” Kalloo said. “It is something I would love to reinstate here. It’s just not going to happen tomorrow.”

  • I am not a medical professional (although I use the services of several regularly). Let me get some facts straight:
    1. Are Nurse Practioners permitted to perform colonoscopies in Maryland?
    2. Were their outcomes and adverse events worse than those experienced or expected of “real doctors”?

    As for #1: I see no references to legal violations. As for #2, while the article and several commenters have cited various numbers as the “required” number of procedures to be qualified to perform colonoscopies, it appears that the results for these NPs met or surpassed standards and/or averages, with NO perforations.

    In fact, there is a very good probability that the many hundreds of colonoscopies “expected” before one is “qualified” may very well be nothing more than yet another “guild” rule, designed to keep people OUT of a profession. (On commenter reminds us that “They fought hard and, in some cases, dishonestly against ColoSure and then Cologuard, which they feared might reduce business.”)

    As for “there was a gastroenterologist on the floor…,” what’s the alternative — a gastroenterologist in every procedure room? If that were the case, there would be no point to the whole study, would there?

    As I read it, the patients were “informed” and “consented.” As to whether they fully understood what they were consenting to … how many Caucasian patients with PhDs really understand what they are “consenting” to when they consent to medical procedures?

    HEY! Here’s a thought: Let’s let this ill-served population do without their colonoscopies, or else have them experience lengthy–possibly life-threatening–delays waiting for a “real” GI doc?

    A more pressing medical question might be “Where are we going to find doctors to treat all the people who have gotten hernias straining to make this a racial issue?”

    • HEY – how bout we allow actual medical professionals to account for legitimate questions surrounding the administration of care, given the many KNOWN negative even fatal consequences of bias in health care.
      In your eagerness to tell others what kind of questions are legitimate to ask or opinions appropriate to hold about this very personal issue of health care, you’ve totally disqualified yourself as giving a DAM in this situation. So HAVE A SEAT. 👍

    • Re: M. Cumming’s reply: If you find fault with any of my arguments or facts, I am eager to hear them. As for “leaving it to the professionals,” (1) “professionals” seem to disagree on this issue; and (2) the “professionals” on Maryland’s board of medical practice seem to feel that colonoscopies by NPs are acceptable. In addition, SOME professionals might allow their own professional and economic interests to bias their opinions.
      Ad hominem arguments like yours are weak, and they add nothing to the discussion.

  • This is extremely concerning. How do you end up with a study that dominated by one race when you are starting out an experiment. Just because the lead author was a minority doesn’t mean that they didn’t exploit a vulnerable population. I would be willing to bet that the patients weren’t fully informed about the training difference between the physician and NPs. There is already a huge distrust of our system by minorities due to countless heinous acts done in the past and we don’t need to continue those atrocities. Minorities deserve to be seen by a training physician just as much as anyone else.

    • Would you like to be the person who had to inform waiting patients that they would not be able to receive their doctor-recommended colonoscopies because “we already have too many black persons in the study”? I certainly would not want to be the one who had to deliver such a racialist message.

  • This article really highlights my growing frustration with the public perception of nurse practitioners and how the exceptional care many of them provide to our communities and often populations of color where “doctors” don’t find it lucrative to practice in, is often belittled or ignored. So now it’s racist to have a nurse practitioner provide care or perform procedures for patients? Could it just be that because the population was largely black and people of color tend to be more open to accepting care from physician’s assistants and nurse practitioners that that could be the reason there was such a high percentage of black participants? Judging from all the negative and downright offensive commentary about dumb nurses, automatic assumption that the care is subpar and people who don’t understand the role and the training NPs also go through along with practice experience, I think there needs to be more publicity regarding the safe and effective care nurse practitioners have demonstrated as well as better outcomes in many cases. I mean, language like “disgusting…” is it really disgusting for an NP to perform a procedure after meeting training requirements and demonstrating safety with good outcomes? I’ve seen plenty of medical residents who didn’t get the proper exposure during their training but they have the piece of paper that says doctor on it, so they are automatically assumed to be qualified. To me this is just another form of bias and judgement and this is the larger problem than the invented racism in a study that was led by a black man who is supposedly conducting wild unethical experiments on people of his own race. Personally, I just want to be able to do my job (as an NP) without being second guessed or questioned by the very patients I see because of the negativity and role confusion that exists in the public. I don’t want to have to “win someone over” every time I meet a new patient to get them to trust me. I have very high patient satisfaction scores and am well respected by my physician colleagues but I still have to prove myself to patients and it’s tiring. I’ve worked with physicians who were supposedly fellowship trained and when it came down to performing the surgical procedure they supposedly had expertise in, it became clear that they did not. But no one questions it. There are lot more checks and balances in place if an NP wants to do something, and there is often backlash whenever NPs try to do anything to advance their profession or expand their role. If we are gonna continue to promote that mid level providers provide subpar care then get rid of the role and don’t have them doing all the things that physicians don’t want to do (they’re are complaining in these situations). Make medical school more accessible to more people or create a bridge program where NPs can enter medical school (who already hold doctorates or masters degrees), and don’t have to go back and take 2 years of entry level undergraduate classes with a bunch of children just to even apply to medical school when they are already excel in their field and have been practicing for many years. I don’t think the issue this article brings up really has anything to do with racism, I think it has everything to do with the often incorrect public assumption that if an NP is doing it, you’re not getting a high level of care.

    • I appreciate your thoughts Nicole, and can feel your frustrations through the screen. But your proposed solutions do not address the issue highlighted in the article, which is creation of a two-tiered healthcare system from a patient safety standpoint. If we accept the assumption that NPs will practice in rural areas (the evidence demonstrates that they overwhelmingly do not, and instead practice in the same urbanized areas where new physicians migrate), then those patients (of all races) in rural or under-served areas are receiving a lower standard of care from a safety standpoint. This does NOT mean that nurse practitioners cannot produce similar “outcomes” as physicians under certain settings (the “ceiling”). But the “floor” of the NP standards (minimal safety standards), from a patient safety standpoint, is not adequate (see below) – and this is a clear ethical issue.

      If allowing an alternate route into medical school (as you proposed) was the goal of the AANP, they would use their incredibly powerful lobby to make that happen with little resistance. Unfortunately, their goal is not to create more qualified physicians in urban and rural areas to address these issues; it is to pump out as many nurse practitioners in the shortest time possible to overwhelm the system (read their stated mission/goals on their website). A byproduct of this frenzy is the proliferation of under-qualified nurse practitioners from online schools and similar non-standardized training sites. I imagine the “push-back” you feel from patients or colleagues is extremely frustrating; but imagine if your patients learned that instead of seeing a qualified and experienced NP as yourself, they and their loved ones would instead be cared for by a NP who graduated from an online school in 12 months with 600 hours of clinical shadowing split among two physicians. This sounds extreme, but google “online DNP” (I can’t link here). This should be extremely aggravating to well-qualified NPs, as these short-cuts makes the safety concerns of patients entirely valid.

      This is the fundamental issue in terms of safety and quality control (“the floor”). There are measures to ensure that every physician licensed to practice medicine in the United States has not simply passed licensure and certification exams, but completed their clinical rotations in standardized and accredited institutions. This does not mean that there are not physicians who are rude, dismissive, or even incompetent. But the percentages of those exist in small enough numbers to not endanger public safety (without the threat of malpractice). That simply is not the case for nurse practitioners at this point in time – and this is directly due to the aggressive policies and goals of the AANP.

      Instead of venting your frustrations towards patients and colleagues, I would recommend reaching out within your own house and ask your AANP policy-makers to address the main issue: limited access to medical school for all qualified students and lack of adequate training for rural practice in the current health-care system.

    • I agree; I am a black woman; and I have never had any problems or ever felt uncomfortable with NPs or PAs providing care. As a matter of fact, they tend to be more attentive and patient than doctors who literally have one foot out the door, cutting you off before you finish even explaining your issue, their dry personalities and bedside manner, and no enthusiasm.

      I had surgery done a few years ago by the head of gynecological/oncology. He seemed nice during the consultation (I was referred to him) and subsequent visits leading up to the surgery; day of – he was several hours late and had a disgusting attitude.

      Afterwards, PAs and NPs took wonderful care of me. I didn’t see him the again till the morning of my discharge a couple days later; and he still had a craw up his ass. He tried to discharge me after I told him I started feeling ill a couple hours prior. He says you me, “What do you think we can do for you here”? I like, ” we’re in a hospital, correct? I assume you can at least prevent me from stroking out”? I then proceeded to but the covers over my head and refused to leave. He then agreed to run some tests due to utter exasperation from my lack of compliance. THE DOCTOR, THE WHITE DOCTOR.

      Two weeks later, (back at his practice) his PA/NP removes a few staples – which I barely felt; two weeks after that, he removes the rest, and he’s YANKING THEM OUT BEGRUGEDLY, like I owe him money or something. As he is causing me immense pain, not even taking into consideration that my the incision slightly reopened a week-and-half previously; as I am reacting to his subpar treatment of me, he has the nerve to say, “you don’t have to make all that noise.” I tell him, “but you’re hurting me!” He says, “YEAH, BUT YOU DON’T T HAVE TO BE SO DRAMATIC.” ?????????? THE DOCTOR!!!!!

      He was the worse, but the others are aren’t much better, THAT’S RACISM!! Not the attempt to better equip an underserved community with trained individuals already in the field.

      P.S. When I mentioned my lackluster treatment to patient services; because I also had a white nurse who tried to the diminish and belittle the fact that my husband was helping/seeing certain things.

      She felt those things weren’t “becoming” of a lady/wife; I essentially wasn’t censoring my humanity enough in the hospital/recovery room for her liking.
      So instead if the hospital addressing all if that, they instead “write-up” the black CNA assigned to me.

      THAT’S RACISM!
      Not trained medical personnel performing medical procedures.

    • Nicole, you are right 100%. The nonsensical accusations are just the poisonous fruit of critical race theory that has now infected the medical establishment and dominates the public health field. It is truly a shame that race pimps have this much authority and media coverage.

    • Honey, I’d pick the NP to do me 10 times on Monday & 20 on Sunday. Everyone knows doctors are lazy & rushed with tremendous ego’s & poor attitudes. No thanx. If given a choice, I’d of chose the NP. Mahalo!

    • 1) the AANP actively opposes their NPs getting more training
      2) The “Doctorate” degree you speak of (DNP) is a non-clinical degree. It has nothing to do with clinical capability. More like a Master of Public Health degree

  • Crying racism just seems insane. People on Twitter with nothing better to do than scour everything for race and then find injustice somewhere.

    Let’s apply common sense:

    1. Do the complainers think black people are too stupid to understand the consent forms? Or too ignorant to understand that a nurse practitioner is the procedure, even when it was explicitly explained to them? If no, then stop trying to deny these patients their freedom to make choices for themselves. If they signed the forms and agreed without coercion, stop whining.

    2. John’s Hopkins is in a predominantly black neighborhood. And the NP appointments have shorter wait times.

    3. When studies are mostly comprising white people, people say it’s racism. And when a student happens to have more black people, they also say it’s racism. Seems you can never please the Twitterati.

    4. There is no evidence that care was compromised or lower quality. The NPs were trained to the national standard, and they were supervised. What we see here is also doctors getting nervous about nurses encroaching onto their ‘territory’.

    5. People complain about healthcare costs, and they even say that is racist too. Yet here, when a practical solution is tested and published, they still complain. Again, no pleasing the Twitterati.

    6. Apply some common sense. Did John’s Hopkins, and the black senior author think ‘ha, we’re going to exploit some black people so I can publish a juicy paper?’ Or maybe they were just trying to do good work, solve a problem in medicine, and provide a service to the local area. Which is more likely?

    Much respect for the senior author here. He is doing the right thing by not issuing some grovelling PR statement. Ignore, dismiss and ridicule these people who find ‘injustice’ everywhere.

  • Two important points:

    1. This is why we can’t have nice things.

    2. It’s not a randomized, controlled trial, and therefore it’s crap.

    Congratulations, Johns Hopkins, you played yourself, and played everyone else as well.

    • A RCT isn’t guaranteed to produce high-quality evidence. Conversely, there are many well-designed observational studies that produced results later confirmed by RCTs. Randomization and the use of a control are no panacea.

      There’s much more that could be said, but I would suggest you go back to school, John, because you just played yourself.

  • I am astonished at the paternalism displayed by these physician commentators. They completely deny the agency and autonomy of the Black individuals participating in the study. If you have evidence of undue influence, excess adverse outcomes or other harm, by all means, criticize but do not deny their right to make a decision to participate. In a country where prevention is grossly undervalued, this study demonstrated a potential way to expand access to lifesaving preventative care. The participants were essential contributors. Do not infantilize them without evidence.

  • Wow, what a lot of defensive whining by the physicians, especially notable because those Nurse Practitioners’ results were higher than typical by physicians. Not sure this is not due to physicians’ vested interests in limiting others’ practice opportunities. I note that the same practice is now stopped.
    We women Sure Do Need the addition of U.S.Constitutional coverage more than Ever. “Equality of rights under the law shall not be denied or abridged by the United States or by any state ON ACCOUNT OF [ONE’S] SEX.”
    Seems that way to me.
    40 year Nurse Practitioner
    Professor Emerita, Adelphi U, NY
    Fmr. elected official
    Co-author, Pharmacology reference texts
    Many awards, etc. 5/4/2021

    • WOW, what a lot of defensive whining by those defending lower levels of care.
      SO much slander and characterization of a group of people in pejorative terms. If this were another group exposed to such characterizations, it might be called an “-ism”. As in Racism, Ageism, Sexism, etc
      A couple of truths – people are slandering a group of people who cared enough to give many years of their lives to be sure they had the best training they could have before practicing independently. NO SHORTCUTS. To be sure they could take care of you at the best level our society can offer. Contrast that with NPs who often say that they do not want to spend the time necessary to become as expert as physicians, only want the same rights and reimbursement after minimal training, and no significant verification of skills.

  • Sophia L. Thomas DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, the president of the American Association of Nurse Practitioners (AANP), says NPs do not practice medicine, but that they actually “practice healthcare.” When I look around at what NPs are doing, and slowly gaining independent practice, all I see are those individuals practicing medicine. They should be regulated by the states medical boards if they’re no longer “practicing healthcare.” When I see NPs doing colonoscopies, or NPs opening independent PSYCHIATRY clinics, where it takes MD/DO years to become experts in those fields, I get extremely angry. Angry for patients who do not know the difference, and angry that they don’t know to question what kind of education and training their “provider” has. Large health systems want to save money by replacing doctors with midlevels (CRNAs/NPs/PAs), and doctors fell their jobs are at risk. But if we all stop for a moment and think, we see that the true victims are the poor patients.

    • You are right to have concerns but your outrage here is misplaced. The NPs in this story were supervised by a physician and performed colonoscopies to a level of quality above the National standard. They demonstrated a potential way to expand access to preventative care.

  • Perhaps the question should be how many tumors were found and lives saved as a result of this study. Everything is not about race. You can’t claim ignorance and exploitation in informed consent. A patient is responsible to do their due diligence prior to consenting to a procedure. It also doesn’t sound like anyone was forced to participate. I hope many tumors were resected and lives saved.

    • Ah yes, the Ends justify the Means. *That* rationale has certainly never gone sideways, has it?

      “Yes, we took advantage of their poverty, but look how many problems we found and corrected!”

      “Yes, we’re making them use separate facilities, but those facilities are equal!”

      “Yes, we’ve condemned them to a life of violent bondage, but at least we converted them to Christianity!”

Comments are closed.