[HN Gopher] The real cost of a preventive health scan goes well ...
___________________________________________________________________
The real cost of a preventive health scan goes well beyond the
price tag
Author : lxm
Score : 37 points
Date : 2023-08-25 19:43 UTC (3 hours ago)
(HTM) web link (www.wsj.com)
(TXT) w3m dump (www.wsj.com)
| version_five wrote:
| I'd like to see a "back of the envelope" analysis of how many MRI
| scanners would be needed to make this universal, and in
| particular how much helium we'd need. I'd guess it would be
| challenging, but the scale might be good for spurring advances in
| AI (edit, I had meant to say advances in MRI).
| ttyprintk wrote:
| It absolutely would help train AI. We have a huge amount of CT
| and little MRI.
| version_five wrote:
| I must have AI on the brain, I actually meant to say MRI, as
| in advances in scanner technologym. But of course you're
| right it would be a very rich source of data
| jauntywundrkind wrote:
| I want one. It feels like having a snapshot to compare against
| latter just makes hella sense.
|
| And I'm a geek who could actually go load up & visualize the data
| myself. Which would be cool.
| ljf wrote:
| Where you are, will you actually get access to the Data? Or
| will they just review and store it for you? Just interested in
| the output and what you actually get to keep.
| sidewndr46 wrote:
| I can't find it presently but I read some blog post about a
| guy getting his MRI data. It's apparently possible but like
| most things in life, a pain.
| JimtheCoder wrote:
| If they are paying for it out of pocket, I assume they would
| have the option for the raw data. Maybe a small-ish
| processing fee, because...American healthcare.
| sturob wrote:
| Prenuvo give you a link to all the .dcm files downloadable in
| a zip.
| tux3 wrote:
| Where I am, they just handed me a CD with the DICOM files
| inside
|
| Loads up fine on Linux. You can move around in 2D slices, or
| in a reconstructed 3D (albeit the resolutions of the MRI I
| had wasn't all that great)
| ggm wrote:
| I had significant resistance to getting a leg bone length scan
| from my GP despite explaining this was purely to inform a
| decision to fit one sided lifts to my rowing shoes.
|
| Luckily the practice has a run-on field doctor for one of the
| local sporting codes who agreed it was low risk of harm and
| potentially useful. My physio at the gym noticed postural issues
| some time ago under load.
|
| I'm told by an E.P. that almost everyone has some leg length
| variance, and it's "normal" -and rarely matters. My partner has
| hypermobile joints, and in her case gait issues meant getting an
| asymmetric lift helped her enormously.
|
| Now, I can sit straighter in the 4 on the water, I can do more
| legwork on a pilates reformer, I have the choice to get
| differential height orthodics. I'm not going to do anything
| quickly because I have no visible gait problems or pain, it's
| purely biomechanics under load rowing for me.
|
| Tl;DR some diagnostic scans are worth it outside of illness.
| xwdv wrote:
| Doctors will tell you don't do this: waste of time, more harm
| than good, etc.
|
| This is all fine as _general_ advice when you see patients as
| mere statistics and you want to apply broad generally applicable
| advice for everyone.
|
| However, it is more meaningful for the wealthier individual or a
| VIP to have their body fully documented. Even if no action is
| taken for some possible tumors, having some knowledge is better
| than being totally blind. And maybe it's a waste of money, but if
| you have the money to waste it's not a big deal.
| TaupeRanger wrote:
| Some knowledge actually ISN'T always better than none. Imagine
| you get a scan and find an aneurysm. The aneurysm has a 1/100
| chance of rupturing during your life. Surgery is too risky for
| the relatively small chance of rupture, so the advice is to
| "watch and wait". Now you have to go to bed every night
| wondering if tonight is the night that it ruptures and you
| don't wake up tomorrow. We know that psychological distress
| exacts a physical toll on the body. So, on net, assuming no
| rupture, you gained nothing except the harms associated with
| knowing about the aneurysm, or the harms associated with
| unnecessary treatment for a low risk condition. This is the
| case with all kinds of diseases across the board.
| xwdv wrote:
| The stress is temporary. Eventually, you come to terms: You
| will die and there will be nothing you can do about it. So be
| grateful for everyday, and take nothing for granted. Then,
| you will know peace.
| blogornot wrote:
| While on vacation in Korea I received a full work up (MRI, blood
| labs, echo, CT scan, dental work, etc) for a couple thousand
| dollars. I wanted to do it because I wanted a clear picture of my
| health. I get headaches a lot and have expressed concerned to
| doctors in the USA but they never seemed to care. I honestly
| wanted the MRI to rule out anything bad.
|
| Was it worth? I think so. The doctors ended up seeing something
| on my thyroid which was then biopsied. It came back benign but
| something to keep an eye on and check every six months or so.
| This carried back over to the USA.
| spullara wrote:
| Longitudinal data is extremely useful absent discovering
| something in the scan.
| sMarsIntruder wrote:
| https://archive.ph/BDZX8
| foogazi wrote:
| Anyone getting these scans. I'd be interested in knowing more
| JoshTriplett wrote:
| Seems like _having more data_ can only be a good thing (modulo
| any degree to which the scan itself has the potential to cause
| damage), but it 's going to make it _much more important_ to be
| cautious of false positives, as well as to not automatically
| assume that every potential issue is worth addressing and has no
| tradeoffs that would motivate choosing to handle it differently.
| oldgradstudent wrote:
| Some people believe in data like other people believe in God.
|
| Data is meaningless without context and without knowing how
| reliable it is.
|
| PSA tests, for example, provide data that sent a lot of people
| to an early grave, or to years of unnecessary treatment and
| anxiety.
| sseagull wrote:
| Kinda related story about data and context: I saw a
| discussion on a website (ask a doctor type of stuff). A guy
| found that a lymph node in his neck seemed a little big. He
| found an academic article that stated about 50% of lymph
| nodes over a particular size at that location were cancerous,
| and he was panicking. He was gently informed by a doctor that
| he was missing an important context about the paper.
|
| I think about that a lot when people in various forums
| (including this one) cite academic papers or other
| information from areas they aren't experts in. They may be
| correct (technically correct), and have the correct data, but
| context might they be missing?
|
| (The 50% number was of samples sent to a lab. Doctors aren't
| in the habit of taking random healthy people's lymph nodes
| and sending them for biopsy, so those patients had other
| symptoms of lymphoma that triggered the need for a biopsy of
| suspicious lymph nodes.)
| seizethecheese wrote:
| There's only no harm in more data if you handle false positives
| perfectly. Surely, this is never the case, so there's always
| some harm in more data.
| Bukhmanizer wrote:
| I've heard it's quite hard to handle due to lawsuits and
| such. E.g if you get a scan and they find something that's
| benign 99.99% of the time, if it does happen to be malignant,
| you're going to find yourself in court.
| whateverman23 wrote:
| > There's only no harm in more data if you handle false
| positives perfectly. Surely, this is never the case, so
| there's always some harm in more data.
|
| That's not the correct way to think about it. The correct way
| to think about it is whether or not there's _more_ harm with
| more data than the status quo.
|
| Most medical professionals seem to think there's more harm
| than the status quo, but that doesn't change the fact that
| you're thinking about it wrong.
| JoshTriplett wrote:
| What I'm suggesting is that the harm is not, then, in having
| the data; the harm is acting on it in ways that make you
| worse off than if you hadn't acted, without considering false
| positives and without considering possible harms caused by
| the selected treatment.
| tptacek wrote:
| Your doctor may not have much of a choice but to follow up
| on anomalies discovered during diagnostic scans, so you
| need to factor in your willingness to overrule your doctor.
| [deleted]
| NickC25 wrote:
| I don't see anything unnecessary about getting full body scans,
| especially if one has a family history of a given disease or
| aliment.
|
| If I'm predisposed for ________, and I find out really early, to
| the point where I might be able to fight (some of) it with
| lifestyle changes, why not?
| TaupeRanger wrote:
| Why not? Because of the well known, widely understood problem
| of iatrogenic harms. Your conclusion does not follow from your
| premise. If you have a predisposition to a particular disease,
| get screened FOR THAT specific thing. Getting a full body scan
| just opens you up to unnecessary psychological distress,
| unnecessary treatments, and unnecessary healthcare costs for
| many things which would have never affected you in the
| slightest had you avoided getting a full body scan. Do you
| REALLY want to know that you have an aneurysm that only has a
| 1/100 chance of rupturing, when you would've otherwise gone
| your entire life without ever worrying about whether tonight
| will be the night that it ruptures and you won't wake up
| tomorrow? Do you really want to know that you have a slow
| growing cancer that would only affect you when you're already
| less 12 months from your ultimate death at age 92, but instead
| you got invasive life-altering surgery at age 65 because it
| just happened to show up on a scan? If we had instant, easy
| cures for every disease, then yes, get a full body scan -
| unfortunately this just isn't the case, and the harms greatly
| outweigh the benefits.
| madacol wrote:
| What I take from your arguments is that medicine is a full
| shit-show.
|
| Don't blame the full-body scan if you think the medical
| system is the real problem
| TaupeRanger wrote:
| The full body scan would be part of the problem, because
| it's not always clear what medicine should do given a
| specific finding on a scan, and decisions made on the basis
| of the scan would then lead to potential harms, as I
| outlined above. Why advocate for scans that would cause net
| harm?
| madacol wrote:
| If an MRI scan is truly practically harmless, and its
| only consequence is the information you get from it, then
| it's not the MRI who is causing the harm, but our own
| response to it
|
| "Avoiding MRI scans" as a solution is a hack, you are
| trapped in a local minima solving the problem very
| indirectly. I may be willing to accept it as a
| temporarily pragmatic solution because solving our
| medical system may be very hard and bureaucratic
|
| But, according to your arguments, the real problem then
| would be how we react to the results of a scan. Whether
| it is how patients react to them, or how the medical
| system reacts.
|
| If full-body scan only informs, then do not kill the
| messenger!
| intrasight wrote:
| What's funny is that I recall reading an article 30 years ago
| about rich Japanese forming clubs to purchase MRI access for
| regular scans. It stuck with me because I thought "someday, we'll
| all get annual MRIs for baseline data. But now 30 years in the
| future it still not happening. Because we suck at preventative
| medicine.
| bottlepalm wrote:
| It's a tough decision to make even if you have the money - PET
| scans use a radioactive tracer injected in your blood that's like
| 5 years worth of radiation in one day. It can detect cancers, but
| yea that's an unsettling amount of radiation.
|
| Then there's the risk of them actually finding something, which
| is very stressful, requires biopsies, potentially surgery, etc..
| for something that could actually be benign.
|
| My gf did it already with no issues luckily, but I haven't been
| able to rationalize doing it myself.
| JimtheCoder wrote:
| Are they not using MRI primarily?
| bottlepalm wrote:
| They offer MRI combined with PET. They give you a high dose
| of iron for to see things better in the pancreas. PET scan
| uses like radioactive sugar to find hungry cancer, even tiny
| ones. MRI is used to find large scale structural problems.
| version_five wrote:
| It's an MRI, there's no radiation. And I understood these scans
| look for changes more than specific structures, so have fewer
| false positives than just a one-of
|
| https://archive.md/BDZX8
| bottlepalm wrote:
| In terms of people getting preemptive scans, hospitals around
| the world offer PET/MRI/CT, etc.. basically an a la carte
| menu of diagnostics. To find cancer early you want PET.
| [deleted]
| ttyprintk wrote:
| This article centers on an MRI company, who I'm sure tout the
| lack of exposure from MRI.
|
| If you're going to get a PET scan, might as well do full-body,
| and make it PET/MRI. A PET/CT will reach 5-8 years equivalent
| of ambient background radiation.
| bottlepalm wrote:
| I wonder if there's a difference between internal and
| external radiation. 8 years of radiation internally in the
| space of a day has got to be worse than 8 years of external
| radiation slowly.
| Xcelerate wrote:
| The counterarguments presented in the article are silly. Of
| course we should have full body scans for preventative purposes.
| Could you imagine a utopian society where we _don't_ regularly
| have full body scans to detect problems early? Any new problems
| that arise as a result of this trend should be handled as exactly
| that -- new problems.
|
| Too many false positives leading to wasted time and costs? Raise
| the price for the supplemental scans and improve detection
| precision and recall. Unnecessary procedures that make a benign
| situation worse? That's a sign to improve medical research in
| that area. Too much demand for MRI machines pulling away time
| from patients that need to use them? Build more MRI machines.
| This is one of those situations where the ideal end goal seems
| obvious, and I think we should just plow ahead and address new
| problems as they arise. In the long run, better preventative
| medicine will save time, costs, and minimize suffering for
| everyone. A few road bumps along the way shouldn't dissuade us
| from even getting started, otherwise we never will.
| solids wrote:
| For me the biggest problem is the anxiety it produces. Both
| false positives as well as the fact itself of waiting for a
| result.
| duxup wrote:
| At least in the US consumers really don't have much experience
| / have a lot of trouble managing medical costs.... even getting
| the cost.
|
| I think raising the price would just mean raised prices and
| effectively where we are now.
| icoder wrote:
| In the spirit of parent post (and for a whole lot of reasons
| by itself) then change the system.
| duxup wrote:
| I think the spirit of the parent post put more thought into
| it than "change the system".
| groby_b wrote:
| I think that long term, preventative scans do make sense. With
| that preface, I don't think we should just argue there are no
| problems, and it's all easily solvable.
|
| "Too many false positives leading to wasted time and costs?
| Raise the costs for the supplemental scans and improve
| detection precision and recall."
|
| You can't improve precision/signal on an inherently weak and
| noisy signal. There are many things showing up on MRIs that
| currently _require_ a biopsy. You need alternative DX routes to
| disambiguate, MRI alone can 't do that. As for raising the
| costs - who pays? Medical costs are already completely bonkers.
|
| "That's a sign to improve medical research in that area. "
|
| We know we need to improve search. We don't need to cause
| negative outcomes to reinforce that signal.
|
| "Too much demand for MRI machines pulling away time from
| patients that need to use them? Build more MRI machines. "
|
| Again, who pays?
|
| "we should just plow ahead and address new problems as they
| arise."
|
| There is the problem of opportunity cost. Is that the best
| possible way to spend sparse resources? The medical community
| currently mostly thinks that it isn't.
|
| Targeting wealthy people first does solve the "who pays"
| problem. It might make the "too few researchers" issue worse.
| It will cause a lot of unnecessary biopsies (because often
| that's the only alternative dx route) - but you could certainly
| lean into informed consent there. You do run the risk of
| poisoning MRIs as a diagnostic tool, because media _will_
| report any inconvenience to sufficiently wealthy people as a
| major problem.
|
| All of this might be solvable, but "let's just press ahead and
| see" is a very bad approach here.
| gojomo wrote:
| If the "things showing up on MRIs that currently _require_ a
| biopsy " don't actually pass cost-benefit analysis on their
| own, that 'requirement' can & should be adjusted down. Or,
| new diagnostics with less cost/risk developed. That today's
| "MRI alone can't do it" isn't a hint what novel techniques
| might be able to do - once demand created.
|
| A sufficiently-flexible & high-res set of downstream
| decisions can always choose to ignore data that isn't really
| helpful. Enough scans & experience might discover the new
| patterns.
|
| Our ossified medical system, with those "already completely
| bonkers" costs, has a hard time adjusting, & sticks with
| habits & tech that's stale. Thus things the legacy system
| isn't ready to handle efficiently - novel diagnostics with
| floods of new data - get blamed.
|
| But the only way out is through. Letting those with
| discretionary funds try speculative things is a way to
| improve faster than waiting for a burnt-out &
| bureaucratically-deformed "medical community" to rustle up
| the will/resources.
| [deleted]
| [deleted]
| kragen wrote:
| > _There are many things showing up on MRIs that currently_
| require _a biopsy_
|
| they don't require a biopsy; you're still free to not get the
| biopsy after the mri
|
| sometimes getting the biopsy is actually worse for you, on
| average, than the small chance that you'll have a very rare
| disease. probably in those cases you shouldn't get the
| biopsy, which means the mri didn't actually help you, but it
| didn't hurt you much either; you're US$650 poorer and
| worried, that's all
|
| in other cases getting the biopsy is better for you, in which
| case the mri did help you
|
| > _Is that the best possible way to spend [scarce]
| resources?_
|
| fortunately, we have private property, so we already have a
| system for allocating scarce resources: their owner decides
| how to spend them. this turns out to work much better than
| the alternatives that have been tried, which routinely result
| in famines and genocides. so we don't need to come to a
| global community-wide consensus on that question; instead we
| can consider each case as it comes up
| ch4s3 wrote:
| No medical intervention is without risk. Any drug or surgical
| intervention has the risk of negative side effects which must
| be weighed against the benefits of the intervention. Medical
| research won't make surgeries much less risky than they are,
| even highly targeted laparoscopic procedures have risks.
| Cutting deep into you tissues is just inherently risky. Drugs
| too, even the safest drugs will have very negative outcomes for
| some number of people.
|
| That you think this is a trivial problem shows that you're
| largely ignorant of some 30 years of research and clinical
| debate.
| Xcelerate wrote:
| > That you think this is a trivial problem shows that you're
| largely ignorant of some 30 years of research and clinical
| debate.
|
| Am I not allowed to criticize decades of research on
| astrology because I haven't paid any attention to it?
|
| If 30 years of research and clinical debate have led to this
| situation where you get 5 different opinions from 5 different
| doctors, then maybe it's time to kick out the incumbents and
| replace them with people who adhere a little better to the
| scientific method. I would rather trust my medical care to a
| group of particle physicists who had one year to study
| medicine than the 30 year experts who can't reproduce any of
| each others' work and seem ignorant of any advances in
| statistics or inference over the same period of time.
| jstummbillig wrote:
| What are the risks involved with getting an MRI?
| ch4s3 wrote:
| It is well established that more MRI lead to more
| procedures that are ultimately themselves risky and
| useless. This is extremely difficult to parse out on an
| individual level but obvious in the data at a population
| level.
|
| Colonoscopies are a great example. As their use increases
| past a threshold more people are injured by additional
| surgery than you actually help. This is again at a
| population level.
| jstummbillig wrote:
| Are you claiming that, at population level, the amount of
| false positives MRIs produce outweigh the benefits in
| terms of human health benefits?
| ch4s3 wrote:
| Beyond a certain point all scans will produce more
| unnecessary procedures than beneficial ones. It's the
| nature of treating illnesses with uncertain
| presentations. Everyone has lots of odd bits and small
| benign tumors that are harmless. But these often look
| indistinguishable from the early stages of something
| serious. Even biopsy isn't without risk.
|
| There's no free lunch here.
| sawert wrote:
| I believe they're saying that this type of comprehensive
| early detection leads to subsequent interventions on issues
| that would never develop into anything serious where they
| left alone. by increasing the number of interventions
| happening you could actually be making the patient worse
| off
| foogazi wrote:
| > early detection leads to subsequent interventions on
| issues that would never develop into anything serious
| where they left alone.
|
| Then wouldn't these be left alone ?
|
| The more research and procedures done the more info
| gathered on the evidence
| pdonis wrote:
| _> Then wouldn't these be left alone ?_
|
| The problem is that you don't _know_ which ones would
| never develop into anything if left alone.
|
| The reason they're left alone now is that you don't know
| they're there, because you never do any test that shows
| them being there.
|
| But once you do a test that shows that something is
| there, it's a lot harder to just leave it alone.
| Something is there, and you don't _know_ that it 's never
| going to be a problem, so you end up not leaving it
| alone.
|
| If you were going to leave the thing alone anyway
| regardless of what the first test showed, there's no
| point in doing the first test at all.
| rawgabbit wrote:
| At least in the US, that's not how the healthcare system
| works. Some blame CYA. Some blame the fact that the
| system only makes money per procedure. The GP is saying
| in the US, patients often get procedures that are not
| worth the risk.
| ch4s3 wrote:
| No, I'm saying that anywhere in the world you might get
| an unnecessary procedure. It is impossible to know in
| many cases if small tumors will become malignant, so
| judgement calls must be made. Finding more of them
| inevitably leads to more unnecessary procedures across a
| population. This is well established in European and
| American public health literature. This is why screening
| guidelines exist.
| ch4s3 wrote:
| On an individual level, lets assume a polyp in the colon,
| there's no way to know which may become individually
| cancerous and which will remain small and benign. The
| genes are the same, the size and appearance may be the
| same. You can't know.
|
| At a population level its well established that beyond a
| certain point you're injuring more people than you are
| helping by doing the colonoscopies at all. Where to draw
| that line is where the debate is playing out. The problem
| is well known, and I'm not aware of ANYONE seriously
| suggesting that it's possible to eliminate this problem.
| SketchySeaBeast wrote:
| If the MRI finds a dozen indicators in your body in a
| bunch of different locations that might be cancer, all
| with different likelihoods where would you draw the line
| on getting them biopsied? Would you be comfortable having
| heterogeneous masses in your body that have a minor
| chance of being cancer? Because the MRI is going to say
| "might be", not "is".
| jstummbillig wrote:
| After getting another answer from them further below in
| this thread, I am under the impression that they are not
| entirely forthright about what it is they are claiming,
| or not claiming.
| kragen wrote:
| > _No medical intervention is without risk_
|
| no but an mri scan and blood tests are pretty damned close
|
| 30 years of research and clinical debate have largely come to
| the wrong conclusion because medical doctors are, by and
| large, mathematically illiterate; in some countries, like the
| usa, they are also strongly motivated by cya, which comes
| into direct conflict with the patient's well-being in cases
| like this
| ch4s3 wrote:
| What are you talking about? There's a huge body of public
| health literature about the dangers of for example doing
| too many colonoscopies on people below a certain age.
|
| This isn't a controversial claim at all among people
| familiar with stats on outcomes across large populations.
| It's tricky to get right and your glib dismissal comes
| across as arrogant and ignorant.
| kragen wrote:
| i'm familiar with the literature and the incorrect
| consensus in the field
| ch4s3 wrote:
| The idea that you believe that the entire public health
| establishment on 3 continents is wrong about the risk of
| preventative scans is ridiculous. Surely you. have some
| evidence to support your heterodox position. It can't be
| that "doctors are innumerate," because I assure you that
| many aren't, and there are statisticians that work in
| public health.
|
| How do you propose the medical field determines which
| small tumors will become life threatening in general? Can
| you beat the best research hospitals in this task? Even
| an average oncologist?
| kragen wrote:
| i already explained my reasoning above; it's obviously
| correct, and it doesn't depend on my knowledge about
| which small tumors will become life-threatening, so it
| sounds like you didn't understand it
|
| you can calculate the cost and expected morbidity due to
| any particular candidate test (mri, blood panel, biopsy,
| ct, pet, whatever) and compare it against the reduced
| expected morbidity due to the probably-not-present
| disease, using whatever metric of morbidity you like best
| (ypll, daly, expected change in your malpractice
| insurance premiums, whatever), using whatever risk
| tolerance you like best
|
| for mris and blood panels obviously this will favor doing
| the test in almost all cases, unless traveling to the
| hospital is a significant hardship or the money is enough
| to be important to you
|
| for other tests it may not, and watchful waiting is often
| a better choice than doing further tests
|
| with a little work, you can always beat the best research
| hospitals at this task because you care about different
| things than they do. this is not the same thing as
| beating them at guessing whether your prostate is going
| to kill you before something else does
| SketchySeaBeast wrote:
| MRI scans and blood tests are, but what comes next? If they
| find something there's always a least a follow-up biopsy,
| and often times what's seen on the screen would have never
| impacted the person's life. Yes, there are outliers, but if
| you do enough scans you are guaranteed to find something
| wrong with you that you would never have known about
| otherwise.
| kragen wrote:
| if the mri scans and blood tests show strong enough
| evidence of a problem that will impact your life that the
| risk outweighs the risk of the follow-up biopsy, you
| should get the biopsy
|
| if they don't you shouldn't
|
| so either you're better off or you're no worse off
|
| unless you have to be dealing with a doctor in cya mode
| ska wrote:
| > strong enough evidence
|
| This is actually a bit subtle. For example I've heard
| more than one radiologist claim that if you look
| carefully, literally anyone's body scan will contain
| details that could justify work up.
|
| The fact is, if you do this broadly in a population and
| you work up everything you see that would justify it,
| some small number of people will die or suffer serious
| problems from complications of follow up.
|
| This is a fundamental problem in screening technologies
| (of any kind) with imperfect sensitivity. You can't get
| away from this, so you try and be clear that the net
| benefit is (much) higher.
|
| I'm not even against the idea of baseline scans, but the
| idea that this part is simple is naive.
| kragen wrote:
| that's just because the radiologists' standard for 'could
| justify work up' are too low
| ska wrote:
| Or it's because the problem is genuinely hard. See above
| ('imperfect sensitivity')... the same problem exists in
| e.g. blood tests.
|
| I'm no radiologist but I've seen enough of this done that
| I'd lean that way. Especially if you consider realistic
| bounds on time and additional information.
| kragen wrote:
| yes, of course the problem is genuinely hard, but having
| less information about your body makes it harder, not
| easier
| SketchySeaBeast wrote:
| I have some familiarity with diagnostic imaging - a lot
| of the time with these scans there's enough to say "yes,
| there is something there you should definitely get
| checked out" but you can't make a full assessment without
| a biopsy. The MRI is going to find things you need to
| investigate further.
|
| It'll also reveal a bunch of stuff you didn't need to
| know. Do you want to know about that minor slipped disc
| in your back that wasn't bothering you before? The nocebo
| effect is very real.
| kragen wrote:
| if investigating it further isn't worth the risk, you
| _don 't_ need to investigate further
|
| if investigating it further _is_ worth the risk, then it
| 's a good thing you did the scan
|
| this superstitious ideology that ignorance is good for
| you has always been popular; what's surprising is that
| some people still hold to it despite the industrial and
| scientific revolutions
|
| knowing about the minor slipped disc in your back might
| be important information if it starts hurting; you'll
| know it isn't a metastatic bone cancer. you might also be
| well advised to avoid taking up olympic weightlifting
| SketchySeaBeast wrote:
| > if investigating it further isn't worth the risk, you
| don't need to investigate further
|
| How do you make that call? What do you, as an eager but
| uneducated layman, use to decide that? You now know
| there's a heterogeneous cyst in your abdomen that the
| doctor says is super unlikely to be cancerous but it's
| not impossible that it could be. How do you evaluate your
| odds? Are you opting for the biopsy? If there's a dozen
| of such cysts in all corners of your body? Again, the MRI
| is a tool to help spot a problem, it's not going to give
| you the diagnosis.
| abletonlive wrote:
| > You now know there's a heterogeneous cyst in your
| abdomen that the doctor says is super unlikely to be
| cancerous but it's not impossible that it could be.
|
| That's up to the individual to decide - blanketing people
| in ignorance and leaving it up to chance should not be
| the only option.
| SketchySeaBeast wrote:
| But you're still making decisions out of ignorance and
| you're biased towards worst case outcomes because it's
| you. People are going to make the choice out of fear and
| that will lead to a ton of extra procedures and those
| people possibly having a worse quality of life as a
| consequence of all the elective procedures.
| abletonlive wrote:
| I would say you're biased because it's _not_ you. You 've
| turned everybody into a statistic to make your decisions
| based on the idea that it's more important to keep your
| percentages in line with expectations created in a broken
| health care environment where reactionary medicine is
| preferred over preventative medicine.
|
| How are we supposed to ever make progress here if that's
| your mindset? This is the medical system that fears its
| own incompetence so much that it would prefer to NOT have
| data. How silly is that? What other industry operates
| this way?
|
| Can you imagine an engineer doing maintenance a plane and
| saying "hey actually, we have no idea what we are doing
| so it's better if we don't do an inspection so we don't
| mess it up even more by trying to fix something that
| might not be a problem."
| kragen wrote:
| usually i read the wikipedia articles about the disease
| and the common treatments, a couple dozen papers starting
| from google scholar via pubmed and sci-hub, maybe a
| relevant medical textbook via libgen. also talk to family
| members and friends about the issue. you can also find
| papers in medical journals and the mmwr on the prevalence
| of possible complications from different kinds of
| biopsies
|
| this takes a little longer than undergoing the biopsy,
| but it's enormously more pleasant, and it lets you know
| when doctors are ignorant or lying, which is perhaps even
| more important information. it's orders of magnitude
| easier than undergoing chemo and radiation so i don't
| know why 'eager but uneducated' laypeople don't _always_
| do it. maybe they 're too used to living in a world
| without sci-hub and libgen
|
| it's also easier when it's not the first time
|
| it's _never_ impossible that any part of your body could
| be cancerous, so 'super unlikely to be cancerous but
| it's not impossible that it could be' is a terrible
| justification for taking action
| SketchySeaBeast wrote:
| > it's never impossible that any part of your body could
| be cancerous, so 'super unlikely to be cancerous but it's
| not impossible that it could be' is a terrible
| justification for taking action
|
| If you knew that you or your spouse had something that
| could be an issue but was unlikely to be - and it's
| nearly guaranteed that somewhere in your body right now
| you have stuff that would come back as "possibly a
| problem" in imaging - you'd be comfortable not taking
| action? I doubt that's how most people would response.
| kragen wrote:
| yes, i have in fact done this
|
| i'm not here to protect most people from the consequences
| of their own bad decisions
|
| and i don't want to be subjected to a medical system
| that's oriented toward doing that to me
| echelon wrote:
| > No medical intervention is without risk
|
| Risk will dramatically decrease with advances.
|
| > That you think this is a trivial problem shows that you're
| largely ignorant of some 30 years of research and clinical
| debate.
|
| Biologists are still doing punch card-level stuff. If we
| started cloning monoclonal, antigen-free bodies in massive
| body farms and performing head transplants, that'd solve
| almost every non-cranial disease. I could see that becoming a
| preventative solution to aging, too. Renewed cardiovascular
| health, clean lungs, thymus, etc.
| SketchySeaBeast wrote:
| "This isn't a problem because of science fiction" isn't a
| terribly realistic answer to the concerns being raised.
| echelon wrote:
| > "This isn't a problem because of science fiction" isn't
| a terribly realistic answer to the concerns being raised.
|
| This isn't a step function difficult thing to do [1-3].
| Nobody is doing it because it's "icky".
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116034/
|
| [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511668/
|
| [3] https://www.nature.com/articles/ncomms15112
| SketchySeaBeast wrote:
| But it is. Giant body farms of clones raised without the
| benefit of a womb that we then decapitate and reattach
| our heads to is a non-trivial enterprise.
| MengerSponge wrote:
| Again, for the people in the back: There's no such thing as
| minor surgery.
|
| Every surgical procedure carries a real risk, which amortizes
| over the population of billions of people into thousands to
| millions of complications and deaths. That's the _cost_ , and
| an intervention has to be good enough to justify that cost.
| Vaccines are good enough for that. Some types of cancer
| screening is good enough for that. Popping yourself in a
| full-body scan for a fishing expedition? Almost certainly
| not.
|
| The result of this product is that a few more very rich
| people will die a bit sooner than they would have otherwise.
| Whether or not you think that's an upside is up to you and
| your personal politics.
| specialp wrote:
| I was thinking of this when a friend passed away from
| pancreatic cancer a couple of weeks ago. One of the reasons
| pancreatic cancer is so deadly is that it is deeply internal
| and symptoms of it are not present. This is true with all of
| the deadliest cancers. We already recommend colonoscopy to
| older adults which is a fairly invasive procedure to screen for
| colon cancer with no other history. If we could scan people
| with low or no ionizing radiation that would be a great tool.
| AlbertCory wrote:
| > We already recommend colonoscopy
|
| You're behind the times. Now it's Cologuard. Not invasive
| although it _is_ gross.
|
| It's the 16% false positive rate, which they helpfully do not
| provide a dramatic anecdote for, that should give you pause.
| EA-3167 wrote:
| It isn't just wasted time and costs, it's a risk beyond that.
|
| If you scan any middle aged adult you will find abnormalities
| in their scan. In almost EVERY case those abnormalities will be
| benign, but once you've found them depending on risk factors a
| biopsy may be required. Almost all of those biopsies will also
| be negative, the tiny calcification in your lung or breast
| isn't a tumor. The swollen lymph node isn't a sign of lymphoma.
| A spot on a scan is FAR more likely to be down to habitus and
| scanning issues than some underlying medical issue.
|
| But if you scan everyone, biopsy everyone, you're going to end
| up killing some of them too in addition to the waste of limited
| resources.
| AuryGlenz wrote:
| Wouldn't that be largely solved by doing two scans a few
| months (or so?) apart?
|
| You'd see if any of those potential issues grew, or
| disappeared.
| xwdv wrote:
| Why not simply do nothing?
|
| If you get the scan and do nothing, or you choose not to scan
| and do nothing, and it turns out to be something fatal, the
| outcome is the same: you die.
|
| The difference, is if you do the scan, you might have an
| epiphany about your own mortality, and live your life truly
| savoring every moment, instead of being blindsided and
| quickly dying someday.
| wahnfrieden wrote:
| are you suggesting controlling the price as a centrally-planned
| public healthy policy, or that costs drive medical prices? in
| the US free market the price goes to administrative overhead
| and profit margins
| vanviegen wrote:
| Well, yes, but all of that would need to be optimized for
| expected patient quality-of-life. If instead it'd be optimized
| to reduce risks as much as possible, we'd ultimately be
| spending all of our lives in medical facilities.
|
| In non-utopian reality it'd be even worse, as the system would
| be optimized for shareholder value instead. Shareholders profit
| by scaring patients into believing they need to buy more
| medical interventions.
| ath92 wrote:
| A full body scan is a bit like p-hacking. If you have a
| hypothesis of what might be wrong and perform a specific test
| to see if some value is within normal range, there's relatively
| little chance of a false positive.
|
| If you test everything at the same time, some values are bound
| to be outside of the normal range, just because you're
| measuring so many things at once. Doing any kind of procedure
| to further investigate or treat the symptoms has a risk
| associated with it.
|
| In the end, doing a full body scan, with current medical
| technology (both in terms of the test equipment as well as our
| means to treat anything that comes up as a result of the test)
| is a risky thing to do. It sounds nice in theory, but
| unfortunately we do not live in the utopia you speak of.
| skybrian wrote:
| Maybe show a little sympathy? It only looks easy because it's
| not our problem to solve.
|
| > Raise the price
|
| Although raising a price does lower demand, a different price
| for a test doesn't make decision-making any easier. Predicting
| _future_ costs and benefits (based on test _results_ , not the
| test cost) is the hard part.
|
| > a sign to improve medical research in that area
|
| Decisions about whether to do a procedure assume current
| technology, not imagined future technology.
| rrsp wrote:
| As a doctor organising a scan is the path of least resistance,
| patients almost universally think that a scan = good care, and
| why would they not? More data is better surely as another
| commentator has noted.
|
| So we do the scan and find an ovarian cyst, not to be unexpected,
| the prevalence of an ovarian cyst is widely quoted as anywhere
| between 8-15% [1]. You tell the patient that you found an ovarian
| cyst. Naturally she asks if it's concerning. It's a simple cyst,
| so if we use [1] to inform our figures we can tell her that in 1
| years time there's a 50% chance that the cyst will be gone, a 34%
| chance it will still be there, a 7.5% chance that there will be
| more than one cyst and a 5.5% chance that there will be a complex
| cyst. Simple cysts are not thought to be linked with an increased
| risk of ovarian cancer, but complex ones are.
|
| Now on hearing that there's a 5.5% chance of finding a complex
| cyst next year the patient opts for follow up scanning. They of
| course Google symptoms of ovarian cancer and see that bloating is
| a symptom. The patient worries, she has very bothersome bloating,
| she reads about doctors missing ovarian cancer and worries if her
| cyst has been misdiagnosed. Of course 31% of the population have
| bloating of significance [2], but how do we know in this case it
| isn't ovarian cancer? So she gets an early ultrasound 3 months
| later. The cyst has now gone from the ovary, but the other ovary
| now has a cyst. She gets another scan in 3 months time and the
| cyst is still there, she's finds herself more and more worried,
| why didn't it go like the last cyst? She reads online about a
| blood test for ovarian cancer, the CA125. She reads survivors
| stories telling her the importance of having this blood test done
| early, so she goes to the doctor and asks to have it done. It
| comes back slightly elevated. Her fear is confirmed, she has
| cancer. Now a raised CA-125 has a positive prediction rate of
| about 10%, and with her imaging findings the likelihood is likely
| lower, but it is not zero. So we proceed to biopsy. A couple of
| weeks later the result is in, no cancer, in keeping with the most
| likely outcome in the scenario. The patient elated at the news
| thanks the doctor and all is well. Her journey has been 6 months
| all in all, she's had multiple sleepless nights, her blood
| pressure has gone up and her stress levels have been higher,
| slightly invisibly nudging her up risk of a stroke or other
| cardiovascular disease in the future.
|
| Now is this good medicine? I guess that's up for debate, and like
| I said at the beginning patients _like_ when we scan them, and
| appreciate when we tell them that their biopsy is negative. They
| like seeing things done. The doctor who told her not to the scan
| was clearly a hack as it showed the cyst. Despite the fact that
| if she'd listened to them she'd have saved herself months of
| worry and ultimately her health would have probably been slightly
| better through having avoided the stress and an invasive biopsy.
| We also know that screening for ovarian cancer does not change
| mortality for ovarian cancer, it leads to 1% of all women
| screened having some form or surgery who do not end up having
| cancer and 3-15% of these women end up with a major complication
| from this surgery. [6]
|
| Another statistic that I keep in mind is that 11.5% of people
| under 40 have a thyroid cancer at autopsy and 13.4% of people
| over 80 [5]. These people lived a good chunk of their lives with
| this cancer which never caused them any issues or harm, it lay
| there growing slowly completely undetected and then they died of
| something else. Now would these people have been better off if
| they'd got a whole body scan, picked up the cancer and spent the
| last year of their life having their thyroid gland removed,
| taking new medication to replace their thyroid hormone, having
| regular bloods and follow up, all for something that ultimately
| never would have caused them issues, again I'm not convinced. The
| patient themselves however if we did go down that route will come
| in and thank me for saving their life, they're often so grateful
| and happy that the cancer was picked up, sometimes they come in
| with a complication from the surgery, their voice horse from the
| vocal cord palsy, but they don't mind as their cancer has been
| cured. The cancer that would never have caused them any harm.
|
| [1]https://ascopubs.org/doi/abs/10.1200/jco.2008.26.15_suppl.55..
| . [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264926/
| [3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583394/ [4]
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592785/ [5]
| https://academic.oup.com/jcem/article-abstract/107/10/2945/6...
| [6] https://pubmed.ncbi.nlm.nih.gov/29450530/
| lalos wrote:
| Do doctors want to gatekeep technology to make sure they get a
| cut every time someone uses this machine? This seems to be
| sending a signal to the market for more competition of scanning
| technology so I can see this driving the price down for everybody
| in the long term.
| version_five wrote:
| People will disagree but I think a lot of it is people angry
| that some can afford it and some cannot. In Canada we have
| _only_ public healthcare, so everyone gets the same poor
| government service (unless you are rich enough to go to the US
| or know the loopholes). And people fight tooth and nail to keep
| it that way, in the interest in fairness. We recently has a
| court rule that even though people will die because of the
| absence of private options, that 's an acceptable trade off to
| enforce "one-tier" universal healthcare. I'm sure doctors
| wanting a cut is another root cause, but a lot of it is just
| jealousy.
|
| See https://www.canadianlawyermag.com/practice-
| areas/litigation/...
| duxup wrote:
| Are they gatekeeping? We saw how recommending mammograms
| earlier and earlier was not a great benefit. Medical arts
| aren't always just magic and more isn't always better.
| ROTMetro wrote:
| My mom had cancer that was treated. The official correct
| follow-up was to get checked to make sure it didn't come back
| every 2 years. At the 2 year check it was too late and
| untreatable. I no longer trust doctors/advisory panels and
| their 'statistically what's best' and never will again. It
| cost me my mom. I just want my mom back.
| davikr wrote:
| Scanning Everyone Considered Harmful (and iatrogenic) - look up
| "overdiagnosis", "incidentalomas" and "cascade effect".
| wrp wrote:
| I've seen discussion about this. It seems the general opinion
| among doctors is that full-body scans for everyone would be a bad
| idea, because most people have some structural anomalies inside
| that shouldn't be a concern but would make people anxious anyway.
| duxup wrote:
| Agreed, I think people imagine these scans are a magic Star
| Trek tricorder. These aren't magic machines that diagnose exact
| things precisely. Most of the time you're looking to diagnose
| something you already know about, different situation and
| different uses altogether.
| ryandrake wrote:
| I know if I could get a report on my body that said something
| like: Death by heart disease - 50%
| chance by age 65 - 99% chance by age 87
| Death by cancer - 50% chance by age 67 - 99%
| chance by age 78 Death by stroke - 50%
| chance by age 73 - 99% chance by age 92
|
| ... and so on, and it was fairly accurate: It would make me a
| nervous wreck for the rest of my life. Nothing good would come
| of this knowledge. Maybe I'd exercise more.
| OnuRC wrote:
| Also majority can't handle truth, even it's about their body.
| Humans dont follow logic, they're emotional.
| gojomo wrote:
| This is absolutely true of many personality types! But not
| others. (And there are perhaps some marginal temperaments
| that could, with more practice & supporting culture, become
| more sanguine about any worrying-but-non-terminal
| interim/probabilistic estimates.)
|
| So, rather than denying the info from those who could use it
| without becoming a 'nervous wreck', maybe the optimal policy
| would be to offer it based on a psychological pre-screen?
| matwood wrote:
| Presumably if we are doing full body scans regularly on
| everyone, we would learn about anomalies that shouldn't be a
| concern.
| jjtheblunt wrote:
| maybe radiology has so many scans of various types over the
| last 50+ years that there is already a sense for how weird
| "normal" can be.
| gojomo wrote:
| The artificially rationed - & frankly abusive - traditions for
| training & licensing doctors in the US makes me heavily
| discount "the general opinion among doctors" as a guide to
| what's systemically-optimal.
|
| They've been strongly filtered for obedience & conformity to a
| deeply-broken system.
| [deleted]
| blueprint wrote:
| here, take this pill, you'll soon forget your worries (and
| get new ones)
| tptacek wrote:
| It's not just that it makes people anxious; it's that the
| anomalies trigger follow-up procedures which are often less
| benign than the MRI.
| jstummbillig wrote:
| Would the confidence level necessary to trigger a procedure
| not quickly be adjusted to keep the false positive rate in
| check?
| tptacek wrote:
| How would it be? Again, the base rates of a lot of these
| conditions are very low, but not low enough to say "this is
| a zebra, not a horse", so I think a suspicious lump is
| likely to trigger a CT, PET, or (in the worst case) a
| biopsy.
| SketchySeaBeast wrote:
| What confidence level? Isn't this advocating for the
| patient to make their own choices around elective scans and
| procedures?
| TaupeRanger wrote:
| It's not just the anxiety and psychological distress either. If
| we scanned everyone all the time, you would find literally
| millions of conditions that would never cause symptoms or major
| health issues, but would nevertheless be treated unnecessarily,
| incurring massive additional costs and needless interventions
| with their own risks. It would be a nightmare.
| shiftpgdn wrote:
| This doesn't make any sense to me. It's either a problem or
| it isn't unless doctors are willing to admit they perform
| lots of unnecessary procedures already.
| ch4s3 wrote:
| Most doctors will freely admit that they sometimes do
| unnecessary procedures out of an abundance of caution.
| duxup wrote:
| >It's either a problem or it isn't
|
| Try looking at a full body scan and make that call.
| madacol wrote:
| Your argument implies that having less information is better.
| Why?
| TaupeRanger wrote:
| Because sometimes it is. This is widely understood in
| health epidemiology. There are no screenings or
| interventions with zero risk:
| https://www.bmj.com/content/352/bmj.h6080
| jsiepkes wrote:
| Personal anecdote: The wife of someone I know got a full body
| scan in Germany (because they were outlawed in the Netherlands,
| don't know if they still are). Clean bill of health. About 4
| months later she was in the hospital with cancer.
| yieldcrv wrote:
| Damn, one of the worst parts about cancers is that there isn't
| information on how fast they grow unimpeded, so that messes up
| knowing what interval would be best
|
| Its like a fetus growing in the wrong part of your body,
| several weeks go by and you'll have an organ problem
| liminal wrote:
| Definitely buy your life/disability insurance before you get the
| scans!
| oldgradstudent wrote:
| Has it ever been shown that full body scan reduces mortality or
| morbidity?
|
| The simple answer is No. It may, or it may not. Probably not.
|
| It's not even clear that mammography or colonoscopy reduce
| mortality or morbidity.
| cyberax wrote:
| Doing a CT or PET scan just for fun is not a great idea, because
| of the radiation dose received.
|
| However, MRI is completely benign. It doesn't expose patients to
| any dangerous radiation and is minimally intrusive (you just need
| an IV for contrast).
|
| The justification "but then we'll have to check the findings!" is
| super-weak.
| tptacek wrote:
| No, it's not at all a weak justification, and it is the
| _primary reason_ you shouldn 't get these scans done.
|
| The problem here is our old friend the Bayesian Base Rate
| fallacy. The diseases you're looking to intercept and intervene
| against are, in the general population, pretty rare. That means
| that even if the indications you'd get from diagnostic imaging
| are _extraordinarily_ accurate (they aren 't), the overwhelming
| majority of the flags they raise are going to be false
| positives.
|
| The cost of a false positive imaging flag is far worse than
| having to have an unpleasant chat with your doctor, or worrying
| for several weeks (do not discount the cost of worrying for
| several weeks, though; these scares can absolutely fuck up a
| month of your life). Rather: you'll pay the price in follow-up
| imaging, which won't be as benign as the MRI, or worse, in
| unnecessary intrusive diagnostics.
| robwwilliams wrote:
| Absolutely right! The WSJ article could have done a much
| better job on this topic but instead ends with a rare true
| positive cancer detection success by a for-profit scanning
| company. That one rare success needs to be weighed against NN
| false positives. And a fraction of the true positives might
| well resolve on their own.
|
| What next--trolling assisted living communities?
| jstummbillig wrote:
| Seems plausible. So what's up with the wealthy? They do not
| care? They do not know? They get talked into it by greedy
| physicians? Or is the story more likely just not true?
| DragonStrength wrote:
| Well, it's not as if wealthy people are any different from
| the average Joe. They may go on HN instead of FB for their
| medical advice (and I've seen these sorts of scans
| advocated in comments here, to be clear), but that doesn't
| mean they have any more knowledge of outcomes for these
| screenings. What they do have is a knowledge of their own
| (and parents') mortality and means to do anything they can
| to prevent it. Buy a bunker in NZ, try to build a base on
| the moon, or spend a couple grand on a frivolous scan? Rich
| people gonna rich people.
|
| Yes, the medical system in the US is for-profit and fee-
| based. Medical providers make money by building small
| businesses which do a lot of procedures. Here is another
| very expensive, uncovered procedure for them to bill.
| robwwilliams wrote:
| In general, physician do not understand false discovery
| rates, and when profit motives are involved they do not
| even want to hear about FDRs.
| DragonStrength wrote:
| Yes, orthopedics has gone down this road. Intervention based
| only on imaging does not have the best outcomes. Not every
| abnormality is cause for alarm. Using genetic profiling and
| family history to decide who to check for conditions is not
| merely for the benefit of the at-risk; it is also to protect
| those who might show false positives from unnecessary
| interventions.
| zajio1am wrote:
| Point is that if you know that overwhelming majority of the
| result are false positives so that it is not worth to follow-
| up them with additional diagnostics, then reasonable step is
| to not follow-up in that case.
|
| It is a fallacy to account the cost of follow-up procedure to
| the initial scan, when the follow-up procedures are not
| necessary regardless of the result from the scan.
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