Colonoscopy in Comedy and the Arts

Abstract

In this communication, the authors attempted to weave together medical history, public policy, popular culture, comedy, film, and the arts to examine how ‘colonoscopy’ has entered the public lexicon. The narrative flows from evidence-based screening policy to cultural commentary, while maintaining a thoughtful and balanced tone. The manuscript attempts to highlight legitimate patient anxieties while also acknowledging the medical community's efforts to improve patient experience through advances in preparation, sedation, and technique while never losing sight of reinforcing the value of colorectal cancer screening and shared decision and recognizing that cultural visibility – whether humorous, artistic, or provocative – can serve as a powerful catalyst for patient-provider conversations.

In daily parlance and lay literature, medical procedures often serve as metaphors for discomfort or distress. A classic example is “undergoing a root canal” as a trope for engaging in something excruciatingly painful. Over the past 25 years, several factors moved colonoscopy to the fore as a figure of speech for uncomfortable experiences. These factors include the adoption and promulgation of colonoscopy for colon cancer screening and prevention by key policy and health organizations, including the U.S. Preventive Services Task Force, the Centers for Disease Control and Prevention, and the American Cancer Society,¹ an aging U.S. population²; the untimely death from metastatic colon cancer of well-known personalities, such as the actor Chadwick Boseman; and the resulting celebrity advocacy and public health campaigns. Indeed, colonoscopy is the recommended next step after a positive result on any other screening test for colon cancer.¹

Few examples illustrate this better than Katie Couric’s televised colonoscopy in 2000 following her husband’s death at age 42 from metastatic colon cancer. Viewed by some 12.5 million people and subsequent repeat views on YouTube, the segment was credited with a 19% surge in screening colonoscopy³ and inspired other celebrities, such as Ryan Reynolds, to televise or otherwise publicize their own procedures.⁴ Ms. Couric’s engagement in promoting age- and family history–appropriate colon cancer screening continued with other noble efforts including escorting television host Jimmy Kimmel through his procedure⁵ and a recent public service announcement on behalf of the Colorectal Cancer Alliance “Lead from Behind” program.⁶

With such widespread messaging regarding the benefits of colon cancer screening, it is perhaps not surprising that comedians and artists viewed colonoscopy as suitable grist for their work. Colonoscopy-related humor now appears in cartoons,^7,8 puns, one-liners, and extended comedic routines.⁹ The latter commonly includes detailed accounts based on personal experiences. Some comedians, such as Jeff Foxworthy,¹⁰ used their platform to advocate colon cancer screening, whereas others, such as Robin Williams,¹¹ simply launched into a hysterically comedic performance. Humor not only entertains but can serve to demystify, humanize, and render colonoscopy less intimidating—after all, laughter is said to be the best medicine. This is true even in the endoscopy suite, where patients often attempt levity to allay their anxiety about this invasive procedure. Aided by administration of benzodiazepines, sedatives, and narcotics, this may result in comments that are all too frequently scatological, sexualized, and sometimes objectionable.

Beneath the humor lie real concerns: the 24- to 48-hour preparation with dietary restrictions, ingestion of a large-volume prep, and loss of sleep from repeated trips to the toilet. Patients worry about embarrassment from the invasion of intimate personal spaces, procedural and postprocedural discomfort (including retained gas), and many others. Over the years, instrument manufacturers and the GI community have responded to many of these concerns with more flexible, thinner instruments endowed with improved optics that generate high-resolution images; artificial intelligence add-ons that can assist polyp detection; more tolerable, smaller-volume preparation regimens; a transition to monitored anesthesia care with propofol in lieu of moderate sedation; and bowel insufflation with carbon dioxide (CO₂) rather than air during colonoscopy, given that CO₂ is more rapidly absorbed from the intestines, thereby reducing postprocedural bloating, abdominal distension, and flatulence.

Colonoscopy has also inspired poetry,¹² prose, and verse,13, 14, 15 including a tune by the late Peter Yarrow of the popular folk trio Peter, Paul, and Mary.¹⁶ A recent review of a compilation of the writer John Updike’s correspondence included the following tortured phrase alluding to presumed character flaws: “Updike was a man of an earlier era, and a colonoscopy of such creatures generally turns up polyps.”¹⁷ This odd metaphor likens polyps to a blemished life! In a review of the film Uncut Gems, the writer refers to “many sequences in which characters talk over one another which makes the viewing experience of Uncut Gems feel like a tight colonoscopy.”¹⁸ Try as one might, it is difficult to imagine the connection between these two images or to understand what the writer means by the phrase “tight colonoscopy.”

Colonoscopy has also appeared prominently in films. The aforementioned 2019 movie Uncut Gems opens with a sequence linking the shafts of an Ethiopian diamond mine, a rare uncut black opal, and its future owner’s colon. This sequence uses colonoscopy to symbolize the hubris, lust, and greed at the protagonist’s inner core.¹⁹ One of the few negative critiques of the film posited, “For some audiences, getting an actual colonoscopy would be more pleasant than the experience of sitting through ‘Uncut Gems’.”²⁰ The 2024 semi-documentary, André Is an Idiot, centers on the consequences of neglecting colon cancer screening. Its title derives from his mother’s response when the late advertising executive André Ricciardi informs her that he has stage IV colon cancer and that despite his having surpassed 45 years of age, he had never undergone screening colonoscopy. Her response? “You are a f**king idiot!” When it was previewed at the Sundance Film Festival, the movie received a standing ovation²¹; whether this translated into increased colorectal cancer screening remains unknown.

Beyond Couric’s televised procedure, the impact of cultural references to colonoscopy in comedy and the arts on perceptions of preventive medicine and colon cancer screening behavior is uncertain. Nonetheless, one can argue there is no such thing as bad publicity, and anything that brings colonoscopy into public consciousness is likely to engage patients and providers in conversation. Humor—across cartoons, stand-up comedy, poetry, film, and celebrity advocacy—can simultaneously humanize and demystify colonoscopy while emphasizing its importance as a cancer screening and prevention tool. Shared decision-making to implement any form of colon cancer screening is likely to have a favorable impact on both morbidity and mortality. For this purpose, providers could consider looping a few of these humorous or cinematic takes or provide QR codes or smartphone-friendly links in their waiting rooms to help turn anxiety into meaningful conversation about the importance of colon cancer screening, regardless of which method is ultimately chosen.

CRediT authorship contribution statement

Jean-Pierre Raufman: Conceptualization, Methodology, Writing – original draft. Ekta Gupta: Methodology, Writing – review & editing. Danielle Baek: Conceptualization, Methodology, Writing – review & editing.

Declaration of competing interest

None.