I agree that there are no guarantees, but I also take that to mean that there is no guarantee that heredity is not a major factor, and that this must be taken into account, especially if one has relatives who have had colon cancer.

My mother and her mother both died of colon cancer, although my mother survived longer because she started getting colonoscopies once my grandmother was diagnosed, and she should have gotten them sooner because she did have cancer, but they were able to treat it.

My brother refused to get a colonoscopy until he was 53 because he thought his risk was lowered because of his diet, and he did not eat red meat. Also, he had a doctor who told him he could wait until he was 60, but I finally got him to change doctors when he was 53, and the new doctor made him get a colonoscopy immediately. However, it was too late, and he already had colon cancer. It was curable through surgery, but now he has to live with an ostomy bag. If he had had the colonoscopy at age 50 when I told him to, this would not be the case.

I am on a three year return, and I am now one year late for my next colonoscopy, but I plan to get it in March. I really did not want to try to go go the hospital during the peak of the pandemic, and I think that waiting four years will be okay. They always find polyps and remove them, and the same is true for my sister and my other brother.

I have every reason to believe that heredity can be a major factor - despite lifestyle and diet. My brother lived in a fool's paradise thinking he was not at risk because of his diet.

My brother lived in a fool's paradise thinking he was not at risk because of his diet.

We all want to believe we have more control over our bodies than we actually have. Fortunately, early detection is so effective with respect to crc.

Consider lung cancer, smoking is not the sole factor. Many non smokers get lung cancer.

All we can do is control what we can through lifestyle and medical advice/screenings.

Oh no doubt, Lars. I wouldn't call it a guarantee, I would call that a tendency. It is prudent when there is a tendency in a family to have that sort of outcome to do something about it

What I meant was, just because one has the BRCA gene doesn't mean they're going to have cancer, for instance.

I am so sorry for those of you who have lost people due to colon cancer.....and your brother Lars.....an ostomy bag.....I'm so sorry.

My MIL died of colon cancer. By the time she'd gone in for a colonoscopy, the cancer had spread to her other organs...it was too late. But....she smoked ALL her life. Ate junk. Didn't exercise until the very end when she purchased a treadmill. I think she was 64 when she passed. My husband is rather frustrated, after eating well...and exercising they found two small polyps, one hemorrhaged, had to be stapled. In three months, he goes back in. Nothing major....just scary. I'd like to think diet & exercise was a heal-all-cure...it just isn't. ♥ If wishes were fishes...

Hugs to your husband, nicole. It's stressful having this loom over you.

I have to confess I have never had a colonoscopy. I know shame on me. I do have every other test such as pap, mammograms, all vaccines, shingles pneumonia shots..but I am squeamish. I know I am playing with fire. The only cancer in my family that I know of is my father dying of lung cancer but he was a smoker for 50 years. I do do an at-home test every year and just had a negative report on that. I would say I have a very good diet. I never drink soft drinks, haven't had meat in 40 years, eat many fruits and veggies a day and whole-grain products, don't drink and never smoked and weigh the same as I did in junior high . And I hike 3.5 miles every day of the week.

While your colon may not suffer, your blood vessels, heart, brain, kidneys, liver, and other organs will see the consequences.

Preventing disease by eating nutriciously, exercising, and avoiding toxins like tobacco is far more effective than treatment.

While I was taught this in school, it was during a geriatrics rotation a few years ago (while getting an additional certification) that I saw it, when I talked to many people in 90's living very healthy active lives. None were obese or smokers, almost all said they ate well, exercised, and never smoked or drank alcohol excessively. Also most were relatively affluent, educated, and had access to a lifetime of good medical care.

Since we're talking about screening, this is a great app, funded by tax $$$. While primarily used by physicians, it can easily be used by others. Enter the info and it will tell you current, evidence-based screening recommendations. It also gives info on the strength of, and rationale for the recommendation.

Here in Austalia, there's a free bowel cancer screening program for everyone 50 to 74.  That's the home test every 2 years -a bit icky but a safeguard.  I tested positive about 4 years ago, so it was off to my first colonoscopy, aged 67.  I had a follow up last year. In both cases I had polyps, which were removed, but no cancer.  I have photos of my colon.  I will not be posting them on Annie's photo thread.

@jmm1837, oh, poo(h)!

As I understand it, poop screening is a diagnostic approach that is less accurate and less sensitive in detecting actionable issues than a colonoscopy. It's also significantly cheaper so it's often used as a "better this than nothing" approach where cost containment is a priority. Outside of her specialty but maybe mdln can weigh in.

In the US, medical insurance typically covers colonoscopies (and often with no charge or co-pays) at intervals recommended by the physician for the patient concerned. Mine started at age 40. Frequently recommended intervals can be 2 years, 5 years, or 10 years (this for those whose colonoscopies are clear and who have no family history to be concerned about).

@jmm1837....:0) I also have photos.

@lily316...It's not that bad.

@Elmer J Fudd....our medical insurance didn't cover it. Paid $825ea and expect to get a lab bill later. Maybe they were out of network...? But....we really like this doctor.

If Ilved on junk food and didn't exercise, I'd feel lousy, no matter what the condition of my colon.

nicole, this was what I'd found. To quote one part:

"The Affordable Care Act (ACA) requires both private insurers and Medicare to cover the costs of colorectal cancer screening tests, because these tests are recommended by the United States Preventive Services Task Force (USPSTF). The law stipulates that there should be no out-of-pocket costs for patients, such as co-pays or deductibles, for these screening tests. But the definition of a "screening" test can sometimes be confusing, as discussed below."

and

"Although many private insurance plans cover the costs for colonoscopy as a screening test, you still might be charged for some services."

I have pretty good insurance coverage from my employer, same one since my mid-20s, and have never paid anything for mine (every 10 years since age 40) or my wife's (every 5 years). It maybe depends in the insurance. Charges at retail must be $10K or more when you consider the time of the gastroenterologist, an anesthetist, the facility itself and its staff, testing, etc. Though negotiated insurance rates are less than "retail". Your $825 charge would seem to be a small part of the total anyhow.

Best wishes for you and your husband.

Amercan Cancer Society's discussion of colorectal screening

The Affordable Care Act (ACA)/"Obamacare" requires insurance policies cover certain screenings, e.g., colonoscopy, at no cost.

However, not all policies are ACA compliant (thanks to insurance companies and politicians).

Also, if colonoscopy is not coded as a "screening," it may not be fully covered; if you get a bill - check to see it was coded correctly.

Also, if insurance already covered a different screening test (e.g., fecal DNA ~$600.) in the recommended time period the colonoscopy will not be considered screening and will not be covered like a screening.

Fecal tests are good for patients who medically cannot tolerate the colonoscopy procedure or sedation, and are an alternative for those who absolutely refuse to get one.

I'm pretty sure it's just out-of-network. A few months back my husbands boss went in, had a polyp removed...they cut his intestine....sent him home. After bleeding buckets, he went to the emergency room for an emergency operation. In light of THAT....we chose a doctor we just love, used before and has 359 5 star reviews. ♥ ♥ ♥ THIS doctor has almost a FAN following. People love him!!!

@lily316,

If you absolutely will not get a colonoscopy, consider getting a cologuard test. The stool sample is collected by you, no doctor or hospital visit required.

cologuard.com

"It's also significantly cheaper so it's often used as a "better this than nothing" approach where cost containment is a priority."

Of course it's better than "nothing." "Nothing" is what happens when a colonoscopy is too expensive or too intimidating for the patient. People will defer or outright refuse to have a colonoscopy because of the cost or unpleasantness of the procedure. A colonoscopy that only happens every 10 years, or doesn't happen at all, is not a particularly effective screening tool. A non-invasive bowel screening test every couple of years is a very viable alternative. The priority with these programs is not cost containment; the priority is increasing the number of people who actually get screened (and the regularity of the testing means that most problems can be identified earlier than with a 5 or 10 year colonoscopy schedule).

I had my first colonoscopy last month. I had put it off for a couple of years because of Covid. My prep was different than what my husband has had in the past. I was put on a restricted diet starting seven days before the procedure and then given further restrictions the day of prep and the next day for procedure. I wasn't expecting to be told to eat less healthy food, but I cut out out the fiber, nuts, etc., as instructed and ate what I was told was acceptable. I got through the first bottle of liquid fine. I have a weak stomach and hat second bottle was harder, but I made it. I followed instructions and the thing went smoother than I expected. Everything turned out fine. I go back in seven years..

My husband's family has a history of polyps and he had one last time. I was just talking to him about it earlier today. It's time for him to go back. He and I have our check engine lights coming on. We're going to have to be more diligent about doctor's visits from here on out.

The priority with these programs is not cost containment;

That statement is demonstrably untrue. NHS doe not pay for screening colonoscopies even for patients with first degree relatives who had crc under a certain very advanced age.

The priority is absolutely cost containment. And not just for the test, but for the downstream treatment.

I had a colonoscopy two years ago. No problems. I don't know of anyone in my family who had colon cancer....or any cancer for that matter, except my father, who got brain tumors from the chemical he worked around.

Well, I truly think that genetics always has the last laugh, but you can fight it off longer with good lifestyle habits. This makes me think of Bob Harper, one of the first trainers on "The Biggest Loser." Here is a man who would seemingly be the very picture of health, good diet, religious exercise, all that yada yada. Yet he very nearly died of a massive heart attack while working out at the gym, saved only by a doctor who was also at the gym. He revealed that severe heart disease runs in his family, and began restricting his diet even more.

That being said, I am TIRED of people using genetics as an excuse for certain conditions. Like say, being heavy. Genetics may in some form contribute, but your genetics does not dictate your food choices. Its likely that if your family is all heavy, that you all share the same eating habits. That is NOT genetics. Also, I roll my eyes at people who proclaim that its okay that they smoke or drink bacon grease every morning because their Great Aunt Myrtle did it and she lived to be 155 years old.

My family had NO history of cancer in recent generations at least. That did not stop my maternal aunt from succumbing to cancer a few years ago in her late fifties. You never know.

All in all, I would say pay attention to what you cannot change, that is know your family history. But pay MORE attention to what you can. Healthy lifestyle which includes exercise. healthy eating, mental self care and preventative screenings. It is all you can do.....

"Of course it's better than "nothing." "Nothing" is what happens when a colonoscopy is too expensive or too intimidating for the patient. People will defer or outright refuse to have a colonoscopy because of the cost or unpleasantness of the procedure."

The priority here is patient care, not governmental cost containment. As far as cost is concerned, for most covered people in the US, there is no charge for the procedure, by law. As was recommended by a national board of prominent experts. Government civil servants and politicians are not involved in making medical care decisions.

Someone who refuses to have any recommended or necessary procedure done has made a choice. I'm not sure anything is more unpleasant than an avoidable premature death. But it's for each individual to decide. People don't always make good choices.

The re-examination cycle is determined by the well trained gastroenterologist treating the patient. It sounds like the Aussie cycle is once every never never. I'll bet Aussies with private insurance can get colonoscopies on a medically determined cycle.

"That statement is demonstrably untrue. NHS doe not pay for screening colonoscopies even for patients with first degree relatives who had crc under a certain very advanced age."

Zalco - you're out of line. What the NHS does is irrelevant to my point, which was clearly about the Australian health care system.

The National Bowel Cancer screening program is very much designed to get more people screened on a regular basis. It is, of course, free.

Australian Medicare (the public system) covers the cost of any colonoscopy ordered by a specialist gastroenterologist.. Obviously, that could be because of a positive result on a bowel screen, but also if there are familial or other risk factors involved, with or without a bowel screening done first.

Jmm, I am not out of line. My apologies for citing the UK's policies, but it is abundantly clear that using a second tier test for detecting cancer is about saving money. Any other explanation is silly, or deluional. Colonoscopies are the gold standard for screening for bowel cancers. Mailing in stool samples are better than nothing, but they should not be the first line of action in a patient over 45. Obviously, I am not a doctor, but I have worked in health policy at the national level, though and am well aware of how resources are allocated in the public and private spheres.

From the Australian Medicare cite:

Medicare covers screening colonoscopies once every 24 months if you're at high risk for colorectal cancer. If you aren't at high risk for colorectal cancer, Medicare covers the test once every 120 months, or 48 months after a previous flexible sigmoidoscopy.

https://www.medicare.gov/coverage/colonoscopies

NB Colonoscopies allow doctors to remove polyps which could turn into cancers, polyps whose dna may not show up on a stool sample.

Also, it is important to consider how one can access a GI. Must you be refered by a GP? That means the GP gatekeeps whether or not you have access, whether or not she deems your risk sufficient to move on to the GI. The system here is much more conservative, which I prefer. For me, reaching 50 triggered the screening. No need for anyone's approval. The guidelines were clear, and prevention, not detection was the goal.

Unfortunately while colonoscopy is preferred, it is not 100%, due partially by inadequate prep and operator skill.

Cologuard study, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771036/ 

Zalco - that citation is from the US Medicare system, not the Australian one.

As for accessing a GI, here in Aus you need a GP referral for any specialist (unless you're in the ER of course). It's no big deal. I have never had a GP hesitate for a minute to write a referral I asked for, or one she thought I needed. I've never had one try to act as a gatekeeper. Ánd of course the GP always gets reports back from the specialists. I like a system in which I have a team of medical professionals working cooperatively in my best interest. The US system seems a little more piecemeal, at least from a distance.

But we get back to the question of what really is the gold standard. Is it a very good test but one that many people (including some commenting on this thread) either defer or refuse outright, for the reasons I've listed? Or is it a good test that is non-invasive, readily accessible and accompanied by clear explanations of its importance? Almost half the over 50s here in Aus do take the bowel screening test, and, having done it once, a very high proportion repeat the process every couple of years. The bowel test is reaching far more people than the colonoscopy can do, particularly in remote areas. To me, that has more value than you are acknowledging.

"It sounds like the Aussie cycle is once every never never."

???

No, it doesn't. And if patient care is the priority in the US, why are the outcomes below those of other developed countries?

Yikes, jmm, I specifically searched for Australian medicare. I should have checked what came up, my apologies.

The American system is fantastic when it is working properly. It is very much a team approach with your Pimary Care Physician playing the central role.

In my case I see an Internist and he takes care of what he can and either facilitates my getting specialist care by making reccomendations, or just acts as a coordinator. This has been the system all of my life and it has worked flawlessly for me.

I have seen a deterioration in the system insofar as my out of pocket expenses have grown and that makes me sad and outraged for people who cannot afford the extra expense. We need healthcare reform here. I am afraid we will be getting some major changes post Covid, just not the kind of changes some of us had hoped for.

As for patient outcomes, people from the world over choose to receive their medical care in the US. There is an entire office at Stanford dedicated to helping patients from every corner of the globe who seek out care there. We have outstanding outcomes for those who can afford the access. One day, we may have the political will to use the healthcare dollars we spend more equitably.

If the public health system in Australia provides timely and comprehensive services and is one the population is satisfied with, why do 50% of Aussies pay extra to have private insurance to get more timely access to medical services and types of care not satisfactorily obtained in the public system called Medicare?

Do you have private coverage?

US health outcomes are what they are because we have a large population of people who are not well educated, and some of whom in addition live at or below the poverty level and many of whom live in sub-cultures in which healthy livestyles in all diverse forms are not known nor practiced.

You can see the same ignorance in the general public relative to pushback about mask wearing among people who should know better than to believe intentional disinformation. And in the C virus vaccination stats. The vaccines were rolled out in the US very early on, free of charge and much sooner and mostly better ones than Australia initially used. Vaccination rates in Australia and other countries now exceed the US's and always will. Not because it's Australia, as an example, but because there are some things possible in other countries (including more heavy handed government rules) that are not possible here. The barring of international travel, closure of state borders, quarantining of neighborhoods, are examples of things that would never fly here. There are more.

I believe there is significant support in the US for broader healthcare coverage, beyond what exists now in the 80-90 percent range. Few (maybe no one) would be willing to sacrifice their own existing comprehensive coverage to allow coverage for others currently without it. Less coverage but coverage for all, as is typical in countries with one payer/one supplier systems like the UK, Canada, Australia, and others, will never fly here.

"If the public health system in Australia provides timely and comprehensive services and is one the population is satisfied with, why do 50% of Aussies pay extra to have private insurance to get more timely access to medical services and types of care not satisfactorily obtained in the public system called Medicare?"

I guess your Australian friend didn't explain this to you. There's a tax incentive to take out medical insurance.

The Australian health care system has two components: the public and the private. The government has structured health care insurance in such a way as to shift some of the health care burden from the public to the private sector. How?  By instituting a Medicare surcharge on the income tax paid by people who make above the median wage (about AUD 90,000 for a single income, AUD180,000 for a family) - unless/unless they take out private health insurance.  Those who can afford it pay more and get timelier service for elective treatment by private sector providers, true, but that in turns frees up access to public sector hospitals for those that can't afford private.  

It's not a perfect system, but  it's far less complicated than the US system, much cheaper, and provides outcomes that are at least as good and in many areas superior to US outcomes.

@Zalco - "We have outstanding outcomes for those who can afford the access. One day, we may have the political will to use the healthcare dollars we spend more equitably"

I absolutely agree with your first sentence and hope for the second.

Here is the info for Australia's colonoscopy coverage (I double checked this time ;-)

Endoscopic examination of the colon to the caecum by colonoscopy, for a patient:

(a) following a positive faecal occult blood test; or

(b) who has symptoms consistent with pathology of the colonic mucosa; or

(c) with anaemia or iron deficiency; or

(d) for whom diagnostic imaging has shown an abnormality of the colon; or

(e) who is undergoing the first examination following surgery for colorectal cancer; or

(f) who is undergoing pre‑operative evaluation; or

(g) for whom a repeat colonoscopy is required due to inadequate bowel preparation for the patient’s previous colonoscopy; or

(h) for the management of inflammatory bowel disease

Applicable only once on a day under a single episode of anaesthesia or other sedation

Multiple Operation Rule

(Anaes.)

Fee: $347.90 Benefit: 75% = $260.95 85% = $295.75

(See para TN.8.2, TN.8.17, TN.8.152 of explanatory notes to this Category)

http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=32222

So this appears to go after bowel disease once here is reason to suspect the disease is present. In the US colonoscopies are recomended before the presence of disease is suspected, as a preventive measure.

jmm, as far as outcomes are concerned, there is no contest, we all know that. Poor Americans have horrible outcomes, rich Americans have the best possible outcomes. People in between have all sorts of outcomes. We have some crazy socialized medicine for insurance companies. A free market would never work this way.

Zalco - I am trying to argue that widespread bowel screening for people where cancer is not/ not necessarily suspected is an effective public health tool. Whether the US "recommends" colonoscopies as a preventative measure is not really the point: recommendations don't mean much.   What matters is how many people are able or willing to do any type of screening. That's the point. Anything that increases those numbers is a benefit.  

The whole point of all the universal health schemes, whether British, Australian, Canadian, German, French or Norwegian,  is not to eliminate risk in the few but reduce it in the many.

I frankly don't have an interest in continuing to try to hold up factual comments to counter the baloney being served, by a person who time and again demonstrates a very limited understanding of the US and persists with ethnocentric opinions.

The feedback that I've heard through my friendships with about a half a dozen Aussies paints a very different picture than this person's characterizations. Long waits, limited services, cattle car environments are stories I've heard. As I mentioned above, the attitude of "doing something is better than doing nothing, and be happy you got that", even if the "something" is less than what's medically indicated and not timely.

An example of the half-story baloney perhaps because of a limited understanding of the reality of things is the description of the "Medicare levy" for higher income people without private insurance. The reality is that it's a political device, a way of cost sharing medical costs- higher income individuals pay more either by having private insurance to offload services from the public system or pay a very modest additional tax to pay for the government system. It's largely theoretical, most people to whom this applies are the societal segment that want better and more timely services and are those inclined to have private insurance, with or without the supplemental tax penalty as an incentive to do so. We have something similar here, means adjusted costs. "Free" Medicare coverage for seniors is free only for lower income people - there's a sliding scale of cost that caps out at about $578 per month.

Have a nice day.

I loved my visits to Australia. We did mingle with the people on the streets. At night, walking around we walked past two medical offices....standing room only. The later it got, past 9pm , the fuller they got....lines out the doors. Parents with small children on their hips.....walking around. I asked and heard what Elmer said, "Long waits, limited services, cattle car environments" all normal, part of the process. A couple can make $225,000AUD & medicare will still take you here, as lower income. If your an illegal alien, medical services are FREE here. No one can be refused care. Tax dollars are spent for this. We know Canadians that cross the boarder to get better health care.... here. They do pay out of pocket, from stories told to me.

I think it's nice we can afford to pay for any doctor we want to use for routine services. I'm just thankful for THAT. And....very thankful we didn't use the one/DR that cut open DH's boss's colon. He had to pay his deductible for the operation to correct that faux pas. My complaint would be doctors are NOT held accountable for their mistakes. Botch it up...and the patient pays to fix it. That's messed up!

A few years ago there was a new tech being implemented where a patient swallows a capsule containing a tiny camera that takes pictures as it passes through the intestines. Have not heard if this became a viable option, anyone here try it? It may still involve the pre-treatment of clearing the digestive system so I'm not sure of any advantage other than avoiding being put under and scoped the usual way. If the tiny camera discovered any polyps or other problems then I would assume the patient would have to go through the cleansing procedure again with a follow-up colonoscopy to confirm and remove any polyps?

^^^ sounds like the old movie Fantastic Voyage. The miniaturized doctors in the tiny spaceship could just blast the polyps with their lasers. After taking a biopsy of course! :-)

@vgkg Z-7 Va.... Cleansing once for the pill with the camera and once to remove the polyp.....would be a LOT of cleansing! :0) As much as I dislike having a colonoscopy.....it is doable.

^^^ Nyuk, Yeah they were lucky and escaped thru a tear duct rather than being pooped out on their voyage to Uranus.

^^^ hard pass on double prepping for me. Once every 3 years is enough for me.

About a decade ago I had some bleeding after a colonoscopy and had to go back for another one a couple days later after prepping again. By then the bleeding had stopped but why waste a perfectly clean as a whistle bowel.

Are those camera capsules reused?

^^^ I would hope that the camera is reused, but repackaged first ;-)

“Parents with small children on their hips.....walking around. I asked and heard what Elmer said, "Long waits, limited services, cattle car environments" all normal, part of the process.”

Of course, Nicole, it is what it is.

I don’t find the country as interesting to visit as others but the Aussie people are very nice as a rule.

"Cattle car waits "  

How odd.  A Canadian friend and I were visiting Sydney a while back. My friend became ill on a Friday night. I was able to get on line and book an appointment with her at a local clinic near our hotel for the following morning. No line up at all.  And I don't know Sydney particularly well.And it was a busy family clinic in the center of the city.

There are clinics which only "bulk bill" (ie charge Medicare rates) and there are clinics which charge higher fees(except to people who are on government pensions or disability).  Medicare pays the base fee and the individual pays the "gap."   Many people, with or without insurance, are quite happy to pay the gap fee and get quick service. The gap fee runs around $30 - $60 for a GP visit depending on the length of the visit. Bulk billing, walk in clinics in major cities may well have line ups (I daresay there are similar lineups in inner city New York or Philadelphia), but the clinics I've used, in 3 states and 4 cities, operate  by appointment, even the ones that do bulk bill.   

This notion of cattle car service is about as accurate as the notion that every American has full insurance coverage and immediate access to top flight health care.  And in fact, in the studies I've cited in the past, while countries like Australia and Canada do have waiting lists for public health care, access in general is still better than in the US.

I am about done with Elmer and his"Australian friends". I didn't intend this to become another personal debate coloured by inaccuracy and animus.

I raised the subject of the bowel screening program as an example of what I think is an effective public health measure that extends screening for colorectal cancer to a broader range of people.  Nothing more. I don't dispute that colonoscopies are the gold standard, but they are simply not accessible to everyone for a whole lot of reasons. Not here, not in the US. Bowel screening is much more accessible and picks up a significant number of cases, often early enough for treatment.

 Never forget that the pursuit of excellence is often the enemy of the good.  That adage applies here.

We all agree with you - only your experiences and opinions matter, no one else's (including no Aussie locals) is accurate

Have a nice day.

Note: We go to Australia to dive the Great Barrier Reef.....then play tourist.

The clinics we walked past were similar to our Urgent Care's here in the US. They could give referrals for anything more than a meds script. Non emergency cases only. Maybe it was flu season, they seemed really full. There is no perfect system.

DH just googled, "Average cost of a colonoscopy"....answer: $2700.

"We all agree with you - only your experiences and opinions matter, no one else's (including no Aussie locals) is accurate."

I am not asking you, or anyone, to agree with me. I have provided my own experience, for what its worth. More to the point, in the past, I have linked to several resources - actual objective studies from reputable institutions, not third-hand accounts supplied by "Aussie friends" - which support what I'm saying. I leave it to readers to decide where the truth lies.