[HN Gopher] Robot dentist performs first human procedure
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Robot dentist performs first human procedure
Author : voxadam
Score : 185 points
Date : 2024-07-31 14:44 UTC (1 days ago)
(HTM) web link (newatlas.com)
(TXT) w3m dump (newatlas.com)
| Mistletoe wrote:
| I'm simply too old and seen too many BSOD to ever allow this to
| be done on me. Also I just watched the Fallout episode with the
| Mr. Handy in it. The picture in the article of the robot hand
| moving a drill into his mouth fills me with intense dread. Maybe
| the younger generation would feel differently. I didn't let my
| Tesla drive either.
| bluGill wrote:
| > I didn't let my Tesla drive either.
|
| I know how bad humans are at driving. I don't have a Tesla, so
| I don't know if I'd let one drive, but they only need to be
| better than humans not perfect. I just wish there was some
| unbiased source of data as to how good they are - the only
| numbers I can find come from those who have reason to lie
| (mostly Tesla, but other self driving car companies as well).
|
| There are rules around how medical software is developed and so
| if this is property approved by the FDA or equivalent I'm not
| worried - it may not be perfect, but human dentists are not
| either.
| infamouscow wrote:
| You must not have any experience working with medical
| software.
|
| This is lawyers checking boxes, nothing more. The people that
| actually wrote the software likely are outside the
| jurisdiction of the FDA and have zero incentive to treat the
| software any different than any other hastily organized
| project. After all, why would any of these people care beyond
| their paycheck -- it's extremely foolish to assume others
| hold the same priorities and values as you do.
| galangalalgol wrote:
| My experience with the recent tesla supervised-but-still-full
| self drive beta was largely positive. I have a cameras only Y
| with hw4. I think John Carmack will win his bet. I do think
| they need regional model modifications though. The way you
| drive in different places is different. In some places you
| can't signal that you want to change lanes or people close
| ranks. In others people make room. It did two stops at each
| stop sign in places that had no crosswalks, picking some
| arbitrary distance before the intersection to watch for
| pedestrians, then it pulled up to look for road traffic.
| Perhaps not a horrible idea, but humans around here don't do
| that so it confuses other drivers and pedestrians both.
| HeatrayEnjoyer wrote:
| It only has to screw up and inflict harm at a lower rate than a
| human. Human dentists injure patients every day.
| __MatrixMan__ wrote:
| I don't think "lower" is enough. Human psychology requires
| "much much lower".
|
| It's not rational, but that's us.
| whynotmaybe wrote:
| But you're letting your device auto update even though you
| might come from a period where you had to voluntarily and
| manually install a service pack or start manually your internet
| session by dialing up your provider... Like I did.
|
| I even remember manually mowing my parent's lawn when I was a
| teenager while there are now many mowing robots that wander
| around with several spinning blades.
|
| And what about having 2 tons Waymo's car wandering around
| without a driver?
|
| Are we getting too old for this shit?
| wrs wrote:
| At least this is actual CNC software using math and geometry
| that somebody can find the bugs in. What terrifies me is
| "software" that is really just black boxes filled with floating
| point numbers and no one knows how it works, or when it won't.
| inglor_cz wrote:
| IDK. Logically you are right, but humans are emotional.
|
| Just a day or so ago, here on HN, full of IT guys, there was
| a discussion about some Tesla autopilot crash. People were
| absolutely livid and demanded the impossible. Now - generic
| Musk hate might have something to do with it, but I suspect
| that it is not just Musk. We really react very unfavorably to
| _machines_ wreaking havoc, while our tolerance for humans
| fessing up is somewhat higher.
| Sohcahtoa82 wrote:
| > We really react very unfavorably to machines wreaking
| havoc, while our tolerance for humans fessing up is
| somewhat higher.
|
| Yup.
|
| Over 100 people die in car crashes in the USA every day.
| When a fatal car crash happens, it MIGHT make it to the
| local news. But a single car crashes while driving
| autonomously and it's national news for MONTHS.
|
| Now, I'll acknowledge that there will be statistical bias
| here. There percentage of cars driving autonomously at any
| given moment is likely less than 1%. But autonomous cars
| make different kinds of mistakes. They'll fail to identify
| the lines in the road correctly, or fail to recognize an
| obstacle. Meanwhile, humans will drive drunk, drive
| distracted, or have massive egos and drive dangerously
| because they think they own the road and everyone else is
| just in their way, or just simply be bad drivers that don't
| even look around themselves before changing lanes.
| Rinzler89 wrote:
| Because we feel better when those humans can go to jail as
| a form of Justice since now that person gets to suffer in
| exchange for the suffering caused.
|
| Meanwhile we don't feel anything if the robot that killed
| someone gets decommissioned because machines Don't suffer.
| whimsicalism wrote:
| It's going to become increasingly apparent in the US over time
| the degree to which doctors & the regulatory state are blocking
| us from getting cheap new care.
|
| Already ML algos are more accurate at diagnosing melanomas from
| an image than dermatologists - but we will never get that tech
| because doctors are fiercely protective of their salaries and
| have captured the arm of the state to help them do so.
| marinmania wrote:
| And the lowest hanging fruit doesn't even necessarily have to
| do with AI or robotic tech.
|
| In the US you need a prescription within the last year to buy
| contact lenses. European countries do not require this. Not
| only does this mean contacts are more expensive and come from
| fewer suppliers, but demand for appointments with eye doctors
| would never go down, even though a test of vision could easily
| be done now by an automated machine where you choose a series
| of A/B options.
| bluGill wrote:
| The vison test is to ensure your eyes are checked for things
| other than what correcion you need. Though machines do most
| of that.
| tredre3 wrote:
| For healthy adults a yearly eye exam isn't necessary.
|
| Forcing people to do it just to get a contact prescription
| is indeed a cash grab.
|
| But yes, they will sell it to you as being for your own
| good.
| deegles wrote:
| The issue is liability, just like self driving cars. Even if ML
| is more accurate, when it does get it wrong the buck has to
| stop somewhere. Those questions need to be answered first.
| whimsicalism wrote:
| If ML is more accurate than doctors at the task, seems like
| the liability insurance should be lower.
|
| But yes, I agree that the US needs major tort reform
| regardless. I just don't think tort is the major barrier
| compared to occupational licensing & the FDA though.
| bluGill wrote:
| Sure, but who pays for that insurance? It probably isn't
| someone currently buying it and that makes ubfront costs
| higher.
| fred_is_fred wrote:
| For radiologists places in the US are already sending the
| images to India and other countries for analysis
| electronically. Is similar done with dermatology or do you need
| to be physically located there rather than sending an image?
| BenFranklin100 wrote:
| The medical establishment also artificially limits the number
| of doctors in order to keep salaries high. I live in Boston,
| arguably the top city for medical care in the US, and it is not
| uncommon to have a six month waiting list to see a specialist.
| People talk about prescription drugs being the cause of high
| medical costs in the US, but it's really the hospitals and
| doctors that are driving the majority of the costs.
| rscho wrote:
| Maybe I'm mistaken, but I don't think places like Boston are
| where docs earn the most ?
| analyte123 wrote:
| Doctors don't seem to be driving the majority of the costs.
| After adjusting for inflation, doctors don't make much more
| than they did in 1984, yet the percentage of GDP spent on
| healthcare has almost doubled since then (and the real GDP
| has also doubled in that time).
|
| For example, see [1] where a general surgeon made an average
| of $118,689 in 1984 and a family practitioner $84,256. This
| would be $358k and $254k in 2024 dollars. Today in 2024 they
| make on average $423k and $272k respectively [2].
|
| [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4192917/ [2]
| https://www.whitecoatinvestor.com/how-much-do-doctors-make/
| BenFranklin100 wrote:
| Thanks for the datapoint about physician inflation adjusted
| salaries, but I said 'hospitals and doctors are driving the
| majority of the costs'. In 2023, hospitals and physician
| and clinical services made up just over half of costs:
|
| https://www.ama-assn.org/about/research/trends-health-
| care-s...
|
| Nursing care added another 4.3%, and other personal health
| care expenditures (dental, medical equipment, and other
| professional services) added another 16.5%, or about 2/3 of
| total costs when all taken together.
|
| By the way, an average salary of $423K is pretty good, and
| a six month wait to see a specialist amounts to denial of
| medical care. Serious reform is needed.
| SkyPuncher wrote:
| I can't remember the exact cost, but physician's
| salary/costs are less than 10% of healthcare spending.
|
| Cutting their salaries in half would have almost no
| perceivable impact on the cost of care.
| lovethevoid wrote:
| If only you guys had universal healthcare and therefore the
| state would prioritize cheap new care to minimize those costs.
| apwell23 wrote:
| Don't doctors have unions in those systems also.
| lovethevoid wrote:
| Yes they do! Unions though aren't the reason for the lack
| of cheap care, after all each party involved in a private
| system is incentivized to gouge as much as possible due to
| a lack of collective safety nets.
| apwell23 wrote:
| > collective safety nets.
|
| as in losing jobs to ML algorithms ? What would the point
| of a union then :)
| lovethevoid wrote:
| Is this the hypothetical future where every job is
| replaced by a ML algorithm? In such case, you better hope
| there is some form of collective safety net for you ;)
| apwell23 wrote:
| > Is this the hypothetical future where every job is
| replaced by a ML algorithm?
|
| No. we are talking about doctors in specific.
|
| Your original point won't stand if everyone in the world
| is replaced by AI.
|
| > If only you guys had universal healthcare
|
| There would be no private insurance through their
| employers if no one has a job in first place.
| 15155 wrote:
| > doctors are fiercely protective of their salaries
|
| A freshly-minted dermatologist isn't making that much, though
| they will be in the long term. As a whole, physicians aren't
| very organized to deal with these types of technological
| "invaders." The AMA and similar organizations' core
| competencies have traditionally been limiting supply and
| creating personnel exclusivity (limiting residency slots,
| limiting the usefulness of foreign-obtained credentials, etc.)
|
| I promise you can find an endless supply of freshly-minted
| dermatologists who will sign off on these ML-identified
| melanomas, bypassing the old guard with their rubber stamp.
| Once the tech is proven, that rubber stamp is worth nothing and
| may be removed. It's just too easy to chip away at these types
| of schemes where "assistance" can be rendered to a licensed
| professional and eventually completely relied upon.
| rscho wrote:
| So, why hasn't it been done yet ?? (I'm a doc, BTW)
| 15155 wrote:
| Every piece of breakthrough technology you use has followed
| this process to some degree, it takes time. As with any
| field, folks are resistant to new ideas and methods.
|
| Despite being poorly-organized, the medical field is
| collectively quite conservative and moves slowly - "first
| do no harm" is kind of the name of the game.
| whimsicalism wrote:
| > Despite being poorly-organized, the medical field is
| collectively quite conservative and moves slowly - "first
| do no harm" is kind of the name of the game.
|
| The medical profession seems to hold on too dearly to the
| action/omission distinction. Preventing life saving tech
| from becoming prevalent, arguing against challenge
| trials, advocating against NP responsibility expansion,
| etc. etc. -- all of these things do tons of measurable
| harm.
| rscho wrote:
| Being a doc, I can confidently tell you you are totally
| incorrect as to why things happen the way they do in
| healthcare. That won't surprise you, I guess. I long tried to
| make outsiders, and especially tech people, understand what our
| job is, but discussions always lead to the same stereotypes.
| pegasus wrote:
| I suspect you're right, and would be interested to hear more.
| rscho wrote:
| In a nutshell, no amount of lobbying will stop equivalent
| service for 100x cheaper. Tech does not permeate healthcare
| for 2 reasons: 1. mostly inapplicable. Everyone is focusing
| on ML model performance, but really information retrieval
| in healthcare is dismal and prevents the use of such new
| tech altogether except in very niche cases. 2. no
| integration in the workplace. Tech people and docs don't
| understand each other _at all_ , so docs ask for impossible
| things, and tech people deliver perfectly functional,
| totally inapplicable tech.
| robertlagrant wrote:
| Me and my team made a piece of successful software for
| patients and clinicians. It is really difficult, mostly
| for the reasons you state, but it is possible. It's used
| in about half the NHS, and I personally know three people
| who've used our app to successfully manage their
| pregnancy complication, which is great.
| whimsicalism wrote:
| There is less political capture of this process in the
| UK.
| robertlagrant wrote:
| My company/team is an unusual exception. The UK has a
| much bigger problem with creating tech than the US does.
| That's why almost all NHS trusts in the UK use US-created
| EHR systems: Cerner and Epic, mostly.
|
| The UK is bad at creating a pro-business/pro-investment
| environment, so we have to buy in stuff from elsewhere,
| even though it's not well-suited to our needs. Or best
| case we find US-based investment for our companies.
| whimsicalism wrote:
| If there are algos out there (and there are) that can
| accurately provide a strong heuristic on melanoma from a
| photo and this is being blocked by the state - that seems
| like an obvious instance of regulatory apparatus stopping
| an equivalent 100x+ cheaper service.
|
| I've discussed with a number of people who work directly
| on DL for imaging at a major hospital system in Boston.
| They say that (outside of the doctors they work directly
| with) fear over competition and losing out on the pricier
| billings are one of the largest barriers to getting their
| (very accurate) tech deployed more widely.
| rscho wrote:
| Yes, so as usual it's so superior but it's never used.
| And the people building it say it's stellar, promise!
| Here's a clue: instead of building a tool, and try
| teaching people already practicing how and why they
| should use it, maybe we could actually go see what
| practitioners are doing and try to integrate into that
| without requiring 30 additional mouse clicks and the use
| of a new soft that nobody understands ?
| whimsicalism wrote:
| You can find the studies on the recent melanoma
| classifiers. There are tons showing in various settings
| that they pretty clearly outperform physicians.
|
| If 'additional mouse clicks' is a major barrier to
| physicians using a tool that leads to _far better_
| diagnosis outcomes of a fast-progressing and deadly
| disease, I 'm not sure why that is an argument for why
| things should continue to be as physician-gated as they
| are.
|
| I will happily perform the 30 extra clicks myself if it
| is my potential melanoma. But if I were to offer it as a
| self-serve app ($2 for melanoma diagnoses too cheap to
| meter), I would be thrown in jail.
| rscho wrote:
| Yes, we have so many models that completely outclass
| docs. It's really strange, they're not more widely
| available don't you think ? Providing so much value, one
| would think there would be a black market for those, at
| this point. Or maybe, just maybe, the setting necessary
| to make things work in large-scale realistic practice is
| more difficult than what the paper authors would have you
| believe? No, they would never do that...
| whimsicalism wrote:
| I'm being very specific about melanoma because this is
| one of the cases with very compelling evidence. You can
| broaden the discussion if you want - but that is not what
| I'm discussing. Here's a study of this technology with
| 67k real-life practitioners showing obvious increases in
| accuracy. [0]
|
| Apologies if the link to that article is one mouse click
| too many for you.
|
| [0]: https://med.stanford.edu/news/all-news/2024/04/ai-
| skin-diagn...
| rscho wrote:
| I never denied the performance. Now make it usable to the
| average doc. That's where we disagree. You believe it's
| usable, but you've never seen clinicians handle computer
| stuff.
| ProllyInfamous wrote:
| Myself a med-school-dropout, I've found myself several times
| telling doctors how I really feel: "You aren't paid enough
| for the sacrifices you made _just to be able to help people
| that probably aren 't going to listen to your advice,
| anyways_."
|
| Thank you for your sacrifices, including to the oncoming ML
| "clinicians."
| pnut wrote:
| Come on, doctors are some of the most highly compensated
| wage earners.
|
| Every working stiff at all income levels sacrifices
| disproportionately to their income, and if I were a high
| school teacher, I'd belly laugh at this doctor pity party.
| eppp wrote:
| Some doctors*
|
| The front line primary care doctors and nurse
| practitioners dont make as much as IT people quite often.
| Sohcahtoa82 wrote:
| From what I understand, the primary care physicians that
| work for a large medical company don't make much, but
| ones that run their own practice can make double or even
| triple, but then they take on _enormous_ risk.
| whimsicalism wrote:
| Lets not lump in nurse practitioners. I'm absolutely in
| favor of giving more responsibilities to NPs and paying
| them more than they currently are.
|
| Data on doctor salaries is very difficult to come by
| publicly, however H1B salaries indicate the average pay
| for H1B PCPs is $200k [0]. These are the lowest paid
| physicians. If you look at the data, many many physicians
| are making much more than that - with many specialities
| averaging $300k+. Generally H1B workers make less than
| comparable native-born (even though that's illegal) so we
| should view this as a lower-bound.
|
| That puts hourly pay for average PCPs lower than the top
| SWEs, but comparing average with average or specialty
| with average and you're already quickly outpacing large
| majority of SWEs.
|
| [0]: https://h1bdata.info/highestpaidjob.php
| bornfreddy wrote:
| Some IT people*
| whimsicalism wrote:
| Doctors have such high social standing that you're
| downvoted for saying the obvious
| SkyPuncher wrote:
| Sure, but it's extremely hard to overcome the hole that
| medical school and residency puts you into. 4 years of
| tuition, then 4 years of pitiful wages is a long time.
| The top, most competitive fields have astronomical wages,
| but most doctors salary is closer to that of an engineer.
|
| Anecdotally, I'm a software engineer. My wife is a
| physician. We'll be in our 50's before my wife's career
| out earns mine. That financial hole of med school and
| residency is so deep and the salaries on the other side
| just aren't _that_ much better than other paths. I didn't
| even pursue FAANG level salaries, either.
|
| That being said, job security and availability is far,
| far better for my wife. We can basically live anywhere we
| want and she can find a job.
| ben_w wrote:
| > Come on, doctors are some of the most highly
| compensated wage earners.
|
| You mean it's _not us tech workers_? :P
|
| Seriously though, I've seen the pay scales in some
| countries, they're nice and all, but they come with many
| extra years of training (expensive plus limited income
| while you do that), plus shift work and overtime that is
| bad for everyone (staff and patients) and which shouldn't
| be necessary -- and wouldn't be necessary, if most
| nations all hired about twice as many of them... but that
| would require us to also _train_ twice as many and
| politicians who do that get the budget shortfall today
| while their successors (possibly in other countries) get
| the reward for the benefit of their being more trained
| doctors and nurses.
|
| I'd pay them the same for less hours. Mandatory less
| hours -- go home and sleep, let someone else tend to this
| patient while you rest.
| swayvil wrote:
| Would you say that doctors are overworked?
| rscho wrote:
| Most docs are overworked for many, mostly bad reasons.
| Clinical overload is one thing, but healthcare is more like
| drowning in admin work, these days. So mostly yes, but the
| true answer is more complex than I can write about in a
| comment.
| torginus wrote:
| The US has 26.1 doctors per capita, while Germany has
| 42.5, which is a middle-of-the-road number for the
| developed West.
|
| Do you accept the criticism that the US simply
| artificially limits the supply of doctors, which leads to
| overwork for physicians, and worse health outcomes for
| patients?
|
| Do you think most doctors would take less hours for a
| somewhat lower salary if you it was possible?
| slt2021 wrote:
| the admin bloat comes from medical insurance industrial
| complex. same as in education
| rscho wrote:
| All countries control rather strictly who can practice
| medicine. Yes, there is some amount of protectionism, but
| that happens almost everywhere. The reason is not only
| money, but also cultural issues. So yes, I expect that to
| be a valid criticism, but I don't think opening the
| floodgates would have the result you expect either.
| Access to care is a complex problem, and IMO not
| primarily limited by doc counts in the US.
|
| Young docs would absolutely work less for less if
| possible, I think. Old docs wouldn't. IMO, that's
| reflected in the rise of big network providers such as
| Kaiser and friends.
|
| In Europe, access to care is better IMO mainly because
| both patients and docs are far less aggressive, and often
| quite happy just doing nothing. Which is in fact the true
| problem about US healthcare: the culture of absolutism.
| whimsicalism wrote:
| > All countries control rather strictly who can practice
| medicine
|
| To pretend that the restrictions in other countries like
| Germany are at all comparable to the restrictions in the
| US is laughable. Just look at the work involved for a
| German doctor to legally practice in the US vs the
| reverse if the controls are so similarly strict (they're
| obviously not).
|
| You are very clearly engaging in motivated reasoning in
| this thread.
| rscho wrote:
| I agree the US is especially restrictive. But that's just
| the US doing its usual thing: treating everywhere else as
| a 3rd world country. Docs from developing countries also
| have a hard time in Europe. You clearly have an axe to
| grind with MDs.
| Scoundreller wrote:
| The comparisons between countries is hard because roles,
| processes and existence of other practitioners will vary
| a ton.
|
| High doctor-per-capita could be a sign of inefficient use
| of resources rather than being a good thing.
|
| Examples: Do you need a prescription for stuff that's
| otherwise over-the-counter elsewhere?
|
| Is over-the-counter stuff paid by (state) insurance if
| you get a prescription for people that don't value their
| time?
|
| Do people go to the doctor anyway for every possible
| matter (e.g. cough/cold/flu in otherwise healthy people)?
|
| Do you have to make a pointless appointment with your GP
| every year to confirm you still have that incurable
| disease in order to keep seeing your specialist? Or renew
| that allergy med prescription every allergy season? Or go
| once for a lab test, and then again in-person just to
| find out the results, even if they're negative?
|
| Who puts in most IV lines? In some places it's a doctor,
| other places, nursing staff.
| vkou wrote:
| If we're going to talk about inefficient use of
| resources, maybe we could start with the education
| requirements. In the US and Canada, doctors spend years
| getting useless degrees before they are allowed into
| medical school.
|
| In Europe, they somehow get through medical school
| without them.
|
| (Not that any of this would matter because the incentives
| of the residency system are perfectly set up to make it
| impossible to train any more doctors.)
| Scoundreller wrote:
| 100%. The US/Can approach also limits/compresses the
| potential career length. Make it ~6 years and out,
| straight from high school (if you so please). It kinda
| works like this already in Quebec: you can enter medical
| school straight out of CEGEP.
|
| It's also a meritocratic matter: you have to take a lot
| of risk to make a go for medical school, and the best
| candidates may not be able to afford the risk of failing
| to achieve their med school goal and ending up with a
| degree with ??? value, so the best may not take that
| path.
|
| Or worse, taking an easier degree program (to beef up
| their grades and have time for other application-
| enhancing activities) and not getting themselves educated
| to their full potential.
| whimsicalism wrote:
| Hm, guess who lobbies for those education requirements?
| syedkarim wrote:
| How is a 26.1 per capita calculated? Various unrelated
| sources state that there are 1.1M physicians (MD and DO)
| in the US. The US has a population of 360M?
| ToValueFunfetti wrote:
| It's per capita * 10,000. 26.1 doctors per citizen would
| definitely be a surprising standard of care.
|
| 26.1 / 10000 * 336M Americans = 876960 active physicians,
| and the error is probably a measurement artifact (how do
| you define 'active physician') and the fact that both the
| population and number of doctors vary over time.
|
| https://www.who.int/data/gho/data/indicators/indicator-
| detai...
| SkyPuncher wrote:
| US supply is artificially limited. There's literally no
| arguing this. There are essentially a fixed number of
| residency spots and that's basically the only way to
| become a physician.
|
| > Do you think most doctors would take less hours for a
| somewhat lower salary if you it was possible?
|
| It is possible. Lots of doctors work fractionally. It's
| one of the easiest fields to do it in. Given the
| artificial shortage, hospitals essentially have to accept
| it.
|
| The reality is many doctors are simply driven people.
| They don't really mind the hours, but they do mind the
| type of work. A lot of it is just terribly unfun.
| avgDev wrote:
| So, what is your job?
|
| I will be honest, I've had better luck with google than most
| doctors. I've had doctors say things which were completely
| incorrect. I've had doctors prescribe unnecessary and not
| advised meds for what they diagnosed me with(incorrectly).
|
| I have friends who are pharmacists and they agree with my
| opinion, and they interact with doctors daily.
| dj_gitmo wrote:
| I have had the opposite experience. I have had
| professionals find and treat problems in weeks after
| wasting years using books and the internet. I am not saying
| it is impossible, but find good info on the internet, but
| it has its limits.
| dietr1ch wrote:
| There's gotta be errors on both sides, now the question
| is if we are assessing their risks properly or not. Maybe
| giving a shot to a low risk thing you read on the
| internet is worth a try, and maybe booking a doctor visit
| and getting examined will be worth the time and money.
|
| It'd be nice to have this decision tree being built out
| in the open, ultimately everyone needs it.
| matwood wrote:
| Doctors are people doing a job just like anyone else. The
| old joke, 'what do you call someone who graduated last in
| their med school class? Doctor.' Just like software, there
| are good ones, bad ones, and average ones. By definition,
| most are average.
|
| I know a few surgeons who are nerds about surgery like many
| on HN are about technology. But they are also the first
| ones to tell you not all doctors are the same.
| inglor_cz wrote:
| "I can confidently tell you you are totally incorrect as to
| why things happen the way they do in healthcare"
|
| If you have enough time, read this 5-page article. Can this
| be explained by anything else but naked greed?
|
| https://digitalsmiledesign.com/files/Old-Website-
| Assets/PDF/...
| antisthenes wrote:
| > That won't surprise you, I guess. I long tried to make
| outsiders, and especially tech people, understand what our
| job is, but discussions always lead to the same stereotypes.
|
| You can explain all you want, but the US is the only country
| that has exorbitant bills for healthcare culturally
| normalized for some reason, despite outcomes being roughly
| the same as other developed countries.
|
| Unless your explanation sufficiently addresses that (which I
| doubt, since you are not an economist), no one will care to
| listen.
|
| So maybe a little less confidence and a bit more humility and
| empathy (for those that need healthcare and can't afford it).
| rscho wrote:
| So, if I tell you: 'I'd like help, but when I ask for it I
| get something worse than what I had at the start', that's
| me being a typical insufferable doctor, I guess ? We both
| fit our stereotypes really well, then !
| loandbehold wrote:
| Can you explain why optometrist is necessary to buy glasses?
| Eye exam is already automated to a large extend, and it
| shouldn't be hard to make it 100% automated by having machine
| ask questions instead of optometrist. Optometrist already
| follows a well defined algorithm to come up with prescription
| by putting a series of lens pairs in phoroptor and asking
| patient which one is better.
| SkyPuncher wrote:
| It's not entirely required. You can go on Zenni (and other
| online stores) and buy a pair of glasses with whatever
| correction you want.
|
| Though, I do largely agree that the actual assessment by an
| optometrist is literally unnecessary. I've personally had
| to adjust my prescriptions because the optometrist pushes
| me to something that strains my eyes.
| kube-system wrote:
| An eye exam doesn't simply prescribe lenses. They also, for
| example, evaluate for disease.
| whimsicalism wrote:
| I would like to see RCTs on whether the current approach of
| care gatekept by doctors (ie. prescription for glasses, can't
| use this melanoma diagnosis tool unless you visit and pay for
| a derma) actually has any measurable impact on downstream
| health.
|
| It's interesting that we have all these RCTs for drug
| interventions, but never conduct the RCTs on policy like
| letting NPs do more procedures, etc.
| rscho wrote:
| Ah, RCTs! The final truth, the end all of all arguments.
| I've been working for enough profs to know that the best
| thing to do with 90%+ medical papers is to transfer them
| directly to the wastebin, and that includes RCTs.
| whimsicalism wrote:
| Yeah, what is a randomized controlled trial when we have
| your 'gut feel' to rely on. Great showing from the
| physicians in the comments here, now I can clearly see
| why we should have trust in your evidence-based practice.
| rscho wrote:
| I do clinical statistics. I _make_ such studies. Sorry
| the sausage is not the way you dreamt it!
| theGnuMe wrote:
| State licensing weeds out the cranks. But these AIs could go
| for FDA approval and direct to consumer. So I don't think
| doctors are the limiting reagent here in your example. If these
| AIs are good, they will reduce demand for dermatologists as
| some enterprising doctor will offer it as a service that
| scales.
|
| While I think doctors are paid handsomely and there are
| critical shortages, I don't think regulatory licensing
| requirements per se limit access to new and cheaper care.
| Zenzero wrote:
| Doctor here. I know HN loves to hate on doctors, but your
| framing is just ridiculous.
|
| The medical world moves at a glacial pace compared to tech.
| Complaining that ML algos haven't swept the industry ignores
| all of the factors pushing it in that direction.
|
| "Best medicine" operates on a consensus model of the most
| prudent decision-making given present knowledge and evidence.
| That takes time. Pushing boundaries as a doctor outside of a
| research environment doesn't earn you brownie points. It
| increases your chances of getting sued.
|
| You also dramatically overestimate the amount of autonomy any
| given doctor has over the tools they are able to use. The vast
| majority are employees. It is like if you worked at Google as a
| SWE, and I came on HN ranting that you don't want to use the
| most recent release of Sonnet 3.5 to help you write features
| faster for Gmail, because you're "fiercely protective of your
| salary." You would laugh at how ignorant the complaint sounds.
| whimsicalism wrote:
| I'm blaming the regulatory apparatus more for that one. These
| image based algos are ones that could be DTC but of course
| the FDA (with a side of lobbying) would _never ever_ allow
| that.
|
| > You also dramatically overestimate the amount of autonomy
| any given doctor has over the tools they are able to use.
|
| I'm not saying that doctors are mostly choosing not to use
| these tools - but that lobbying organizations involving
| collectives of doctors would lobby against it if it ever
| tried to do a DTC approach or something like that. Please,
| steelman what I'm saying - I am very aware that doctors who
| don't own their practice (vast majority of them) cannot
| simply choose their tools and even those with their own
| practice are often limited by what they can bill. I know lots
| of doctors personally.
| blackeyeblitzar wrote:
| Their professional organizations have prevented us from having
| lower cost healthcare independent of technology. For example
| limited supply (from schools) of various specialties,
| resistance and FUD about less qualified care (like dental
| therapists), etc. Their lobbying and influence is all over the
| system.
| jorblumesea wrote:
| There's very few, if any doctors, that are saying we shouldn't
| use ML or algos to diagnose cancer. This is a wild accusation
| and hilariously conspiratorial. What most are saying is we
| should evaluate all of this new tech, but be careful of the
| rollout because medical practices shouldn't operate like a hot
| startup where we pivot every 6 months.
|
| Healthcare, similar to government, shouldn't be a move fast
| break things situation. If your service breaks, you just roll
| back. False or incorrect cancer diagnoses...that's a huge deal.
|
| Imagine your tumor getting missed because of a bug in software,
| one which a human might have caught. Peoples' lives are on the
| line here. It's not a game.
| HanClinto wrote:
| For another example of this, see the tooth decay vaccine (that
| is currently only available in Honduras):
|
| https://news.ycombinator.com/item?id=39819248
| ChumpGPT wrote:
| I know very little about the regulatory system but, what is
| stopping an app to scan your skin via mobile camera to try and
| determine melanoma. As long as there is a disclaimer to see
| your physician and this is not medical advice. It would be the
| same as taking your blood pressure or blood sugar test at home.
| whimsicalism wrote:
| The FDA would absolutely not permit that, you cannot just
| 'disclaimer this is not medical advice' for an actual
| diagnosis service.
| SkyPuncher wrote:
| Physician salaries are less than 10% the cost of healthcare.
| You could eliminate their salary entirely and it'd have no
| meaningful difference on the cost of healthcare. There is
| _absolutely_ an artificial supply limitation, but that's
| increasingly being worked around by the use of PA and NP
| providers. Doctors essentially become managers for PA and NPs.
|
| My wife is a physician. Actual, scientific diagnosis is a
| ridiculously small part of her job.
|
| Most of her time is taken up on "soft problems". Writing notes
| for continuity/quality of care. Justifying medical decisions
| for billing purposes. Advocating with insurance and healthcare
| administrators. Discussing treatment plans and options with
| patients. More notes. Well, really, most of her time is taken
| up with notes. It's really the only way for her to capture all
| of the soft variables.
|
| Writing notes is a bit like coding. LLM/AI can help solve the
| problem, but ultimately you still need to go through them
| piece-by-piece to ensure they're correct.
| whimsicalism wrote:
| Unlike the other comment defending current medical practice,
| this one I absolutely agree with. I do not think that
| physician salaries are the major drivers of healthcare cost.
| I do think that occupational licensing reform would help
| bring down cost, but agree it is only a relatively small
| factor.
|
| _However_ I do think that in the process of engaging in wage
| protectionism (and there is absolutely no question that
| doctors do this) there is a ton of consumer surplus that is
| being lost and not captured by either patient or provider.
| For instance, in the case of the melanoma AI, that is a
| casualty of the wage protectionism (+ medical conservatism +
| FDA failure) - the value there isn 't being captured by
| doctors, it is just disappearing into thin air and tons more
| people will just have undiagnosed melanomas.
| cogman10 wrote:
| Part of the problem is quackery. Remove the regulatory state
| and all the sudden you have people claiming bleach enemas as a
| cure all (We have that with the regulatory state, but those
| people get prosecuted).
|
| I don't think that some regulations ensuring the tooth drilling
| robot isn't going to explode teeth is unwarranted even though
| that drives up cost of development.
| whatever1 wrote:
| Does not even need AI. Simple algo: default: filling If too much
| filling: crown If crown failed: pull
|
| For each step don't forget to collect the cash.
|
| There I saved you 200k worth of training.
| SteveSmith16384 wrote:
| If (world_pace == false) solve_world_peace();
|
| easy!
| inglor_cz wrote:
| Undefined variable world_pace.
| xaellison wrote:
| 1. I want a human drilling because I want empathy in my care 2.
| 90% detection rate on cavities isn't great
| whimsicalism wrote:
| 2 - based on?
| xaellison wrote:
| the article says that
| whimsicalism wrote:
| does the article say that 90% is 'not great'? i am curious
| what the human baseline is.
| jonhohle wrote:
| Have you switched dentists recently? I have little trust in the
| profession (though I like my current dentist).
|
| Around 2008 every time I went in to the dentist she found
| cavities. I moved states between a bad diagnosis and getting
| any fillings and when I went to a new dentist I came out with a
| clean bill of health.
|
| I moved back and had a dentist that I trusted, she sold the
| practice and the new dentist started finding cavities every
| single visit. I switched dentists and magically those cavities
| were gone.
|
| Not only did I likely get drilled and filled superfluously, the
| first dentists fillings fell out or broke and needed to be
| replaced after a few years.
|
| If a machine was doing the work, economies of scale also create
| a large enough class that if the treatment is not effective the
| class can sue. Against a one-off terrible dentist with a small
| sample size, the chance of compensation for terrible work is
| almost non-existent.
| avgDev wrote:
| In the end dentist offices are businesses, and often dentists
| have small practices.
|
| I've recently listened to a podcast of a dentist turning
| consultant to increase numbers. Dude literally applied a lot
| of marketing tricks, tested them and analyzed the results. He
| did things like naming teeth cleaning, a "clinical teeth
| cleaning" or something along those lines. This resulted in an
| increase in cleanings. I guess he could be lying as he is now
| selling his services but the whole podcast felt disgusting.
| emchammer wrote:
| Last time I went to see my US dentist, he said I needed
| another filling. I wasn't feeling it for some reason, I told
| him not now, and he looked at it again, and said "I agree".
| Now I sort of regret getting my other "small" fillings.
|
| I've had a dentist in Europe who laughed and said there's no
| need to come here every year, that's an American thing.
| rurban wrote:
| Dental repair is really nothing. Automatic welders are very
| common e.g.
|
| I've worked on automatic brain surgery robots, which really needs
| to be automatic. because 3d, tricky, and the doctor outside sees
| much less than the tiny sensors inside. but you can interfere and
| even invite remote specialists on remote duty to observe or
| handle the pedals.
| rscho wrote:
| That's interesting! Up to now, I've never seen automated
| surgical robots. They're just big swiss knives with stereo
| vision, usually. Are there automated robots on the market ?
| onemoresoop wrote:
| > I've worked on automatic brain surgery robots, which really
| needs to be automatic. because 3d, tricky, and the doctor
| outside sees much less than the tiny sensors inside. but you
| can interfere and even invite remote specialists on remote duty
| to observe or handle the pedals.
|
| Just curious.. Are these fully automatic/autonomous? I assume
| human supervision is required but are there steps that humans
| have to choose/decide such that the robot could not possibly
| work without any human supervision?
| spacecity1971 wrote:
| Fantastic development (I'm in the dental field) As a side note; a
| Chinese team already performed an implant surgery with a "fully
| automatic" robotic system in 2017.
|
| https://time.com/4952886/china-world-first-dental-surgery-ro...
| nerdjon wrote:
| Its cool tech, don't get me wrong.
|
| But maybe, before we remove any amount of comfort with another
| human being we look at wether all of the dental practices are
| actually backed by science (which there is some scruitiny over).
|
| But also going to the dentist already isn't exactly pleasant, the
| pokes, scrapes, drill noises, etc. Maybe we improve that first
| before sticking it in a robot?
|
| People already have a ton of anxiety about going to the dentist.
| Removing humans will make that worse.
|
| I realize this is early, but still. I feel like we skipped some
| things.
| sameoldtune wrote:
| I read the headline to my partner and they said "AI is here to
| make the dentist scary again"
| dashtiarian wrote:
| Haha, as a 3rd worlder; I'd much rather take my chances with
| a robot dentist than a dentist who's father has ties with the
| ruling class, who's father has bought their university sit,
| or who's father (allegedly) being a veteran of a war that was
| finished 34 years ago has gotten them a university sit.
| nerdjon wrote:
| Honestly... yeah.
|
| As someone who 5 or 6 years ago was not going to the dentist
| since the very idea of it gave me anxiety after having a
| particularly bad and damaging dentist experience as a kid.
| When I would to to the dentist I would have a fight or flight
| moment just sitting in the chair. (TLDR, I was told they were
| going to do one thing as a kid, but they purposefully lied to
| me and did something else thinking I would be less anxious
| about it happening... yeah that went swimmingly)
|
| The only way I got over that was being able to talk to the
| Dentist that I was working with, having them explain step by
| step what they are doing, they check in regularly, etc etc. I
| finally feel mostly comfortable going, to this specific
| dentist. The idea of switching has me anxious.
|
| The idea of a robot, while great maybe it could have less
| human error and all that. No... just, no.
| BobaFloutist wrote:
| >But also going to the dentist already isn't exactly pleasant,
| the pokes, scrapes, drill noises, etc. Maybe we improve that
| first before sticking it in a robot?
|
| Dentists are definitely trying. The drills have gotten smaller
| and gentler, my dentist (and many others) offers a headset so
| you can listen to music/podcasts while getting your cleaning,
| and overall they make an effort to be less scoldy and more
| encouragey.
|
| The process itself is still kind of naturally unpleasant, and
| the billing sucks, but the people seem to have taken
| traditional criticisms to heart and made some moves to make it
| suck less.
| nerdjon wrote:
| > and overall they make an effort to be less scoldy and more
| encouragey.
|
| Oh, 100%. Yeah there has for sure been progress. I do also
| recognize that my anxiety is not just "oh I don't like the
| dentist", I was lied too. That breaks that trust.
|
| I remember before I found my current dentist, I was having a
| ton of pain and I tried to find someone. I called them,
| explained the situation, explained the anxiety and where it
| was coming from. They reassured me, we have someone who knows
| how to help with that.
|
| I went there, the dentist came in, I again explained the
| anxiety and where it came from. This was meant to be a, get
| comfortable thing. It wasn't a cleaning, just talking. He
| decides the entire time that he was feeling around my mouth
| with his fingers, he would hold the scraping tool inches from
| my face. And then, right at the end to purposefully do a
| quick little scrape as if, its not big deal see its not that
| bad.
|
| I just got through telling you I was lied too, that is not
| the time to do something without telling me that you said you
| were not going to do to try to convince me that "its not that
| bad". And then he was like, yeah so we have time if you want
| to get a cleaning. I have not wanted to get up and leave as
| quick as I had in that situation in my life, never went
| back...
|
| That is a rant, sorry about that. But that moment is burned
| into my brain.
|
| I was so thankful to find my current dentist. When I told
| them, the dentist called me while I was at home to talk to me
| in my space that I am comfortable in. Then when I got there I
| just sat in the chair for a while talking, not laying back,
| my feet were at the side.
| lovethevoid wrote:
| There are a lot of fields like this, where they have mostly
| been reduced to refinements but ultimately are still very
| barbaric procedures. All we've done is upgrade the stick (in
| this case, a nice shiny pick), but the procedure hasn't
| changed much at all.
|
| Too much of dentistry is still stuck on instant fix
| solutions. Take hard metal, scrape teeth. Something wrong on
| inside, just drill into it scrape it out and fill it. Dental
| implants were the last major invention and that was what, in
| the 60s? There really needs to be far more money and research
| in the field, because there is ample opportunity for major
| improvements here as it's lagging so far behind other health
| fields.
| munificent wrote:
| _> ultimately are still very barbaric procedures._
|
| At some point, you bottom out on the reality that we are
| all just big bags of meat and bones. No amount of
| technology or AI will change the fact that we are material
| objects who sometimes have problems with that composition
| and structure of that material.
| lovethevoid wrote:
| That hasn't stopped other fields. You can get skin
| patches that utilize micro-needles to inject serum into
| your pimple, reducing the need to wait for pimples to
| "naturally" disappear. This was previously thought to be
| wildly unaffordable. Didn't we just get a new
| breakthrough for hair regeneration earlier this year
| using similar techniques?
|
| Fact of the matter is, dentristry has lagged so far
| behind other fields because there's a lack of care for
| it. Dental is often not even considered "healthcare",
| despite how important oral health is to general health.
| It's also the easiest to hide, who cares about actual
| rotting teeth just sharpen them down and replace them
| with plastic. Whereas things like skincare and hair get
| far more priority due to being visible. Of course there's
| also the severity, people don't care if their teeth
| disintigrate, but a broken leg is a broken leg and gets
| handled appropriately.
| munificent wrote:
| Maybe it's because dermatology is much less risky since
| you're talking about a surface level treatment for a very
| small part of a very large organ. With dentistry, you're
| going into an orifice that humans must use to survive and
| directly interacting with the only place in the human
| body where bone is exposed to the outside environment.
| The risks are huge. You can die of heart failure if
| bacteria gets into your gums.
|
| _> a broken leg is a broken leg and gets handled
| appropriately._
|
| Funny that you say that because I'm currently stuck on my
| couch with a broken ankle, unable to walk for the past
| two months. I'm very grateful for the quality of care
| I've gotten, but seeing the X-rays with three metal
| plates and 18 screws going into my bones sure as heck
| does look barbaric. But when chunks of bone snapped off
| and need to be put back in the right place and forcibly
| held there, maybe that's the best you can do.
| supportengineer wrote:
| If you avoid sugar and floss religiously, and have a decent
| calcium intake, that takes care of most of the potential
| problems.
| MiddleEndian wrote:
| >the billing sucks
|
| This has not been the case in my experience. Dentists have
| always told me exactly how much I owe them, and the one time
| I forgot a payment, they called me and texted me to let me
| know and I resolved it in a matter of minutes.
|
| Meanwhile a hospital visit sent me a bunch of bills in the
| mail ranging from $50 to $100, they refused to tell me the
| total sum even when I visited in person, and when I missed
| one $50 payment I was sent to collections a year later.
| golergka wrote:
| I don't know about US and it's healthcare system, but in many
| countries changing dentists is really easy because it's not
| tied to your healthcare, just pay out of pocket kind of
| situation. People discuss dentists, they give recommendations
| to friends, so it's a pretty efficient market. And people pay
| a lot of attention to how scary or not scary their procedure
| was.
| svachalek wrote:
| In the US, dentists and optometrists are separate from our
| health insurance system, and have their own insurance.
| Dental insurance usually covers cleaning every six months,
| and some percentage of the minimum possible correction for
| things that need work. For example, they may cover 50% of
| having the tooth pulled but 0% of putting in an implant,
| because the implant is considered cosmetic and not
| necessary work.
|
| Anyway, it ends up being like you say, it's a largely out
| of pocket service that people shop around for.
| pessimizer wrote:
| I'm not bothered by any of these concerns, none of them are
| more important than cheap dental care because bad teeth and
| gums are agony that may lead to heart disease or cancers. The
| only thing I'm concerned about other than costs are failsafes.
| If the thing (or rather the 20th generation of the thing) can
| be absolutely guaranteed not to cause a disaster in someone's
| mouth (it should panic on the most minor confusion), and is
| cheaper than dentists (not hard) it should be made standard.
|
| If somebody needs a dentist to hold their hand, they can go to
| a fancy clinic that has some sort of doula. But normal people
| used to get their dentistry done by the same guy who would cut
| their hair.
| nerdjon wrote:
| > I'm not bothered by any of these concerns, none of them are
| more important than cheap dental care.
|
| Is there really any indication that this will make any change
| to the cost of dental care? Is the dentists the problem or is
| it the other parts? There still has to be someone there to
| manage it.
|
| Also this machine will not be cheap either, will require
| maintenance, etc. From what I have seen most robot operated
| medical things, are not to replace jobs but for precision
| that humans just can't do. Or to reduce human error.
|
| > But normal people used to get their dentistry done by the
| same guy who would cut their hair.
|
| I would strongly advise against saying "normal" when dental
| anxiety is very much a thing for many people. I would likely
| even say most people have some sort of dental anxiety.
|
| There is a reason that a lot of people don't get their
| regular cleanings, and I am sure cost is part of that but not
| all of it.
| mlyle wrote:
| I mostly agree with you, but note that "absolutely
| guaranteed" to not have a terrible outcome is not something
| human practitioners provide. The standard should be
| comparable.
| crystalmeph wrote:
| > But also going to the dentist already isn't exactly pleasant,
| the pokes, scrapes, drill noises, etc. Maybe we improve that
| first before sticking it in a robot?
|
| From the article:
|
| > The machine's first specialty: preparing a tooth for a dental
| crown. Perceptive claims this is generally a two-hour procedure
| that dentists will normally split into two visits. The robo-
| dentist knocks it off in closer to 15 minutes.
|
| So this robot is actually improving the dental experience for
| the patient, which will hopefully reduce anxiety as well as
| reducing costs.
| ChrisMarshallNY wrote:
| _> There sure are some brave guinea pig types out there._
|
| You can say that again.
| smokel wrote:
| Back in 2004, people had microchips inserted under their skin
| to enter their discos more quickly.
|
| https://www.newscientist.com/article/dn5022-clubbers-choose-...
| jl6 wrote:
| I hope this kind of "do a simple procedure in a complex
| environment" robotics leads to automation of high-toil jobs like
| fruit picking.
| nottorp wrote:
| Fruit won't cooperate though, so it may be harder than
| dentistry.
| apwell23 wrote:
| I am more impressed by the guy who signed up to the be the test
| subject. get him on redbull youtube channel.
| avgDev wrote:
| I'm 100% positive that if you came up with something "first in
| the world", but the risk of death was 50% during the procedure,
| you would find people willing to do it.
| inglor_cz wrote:
| The first expeditions to the South Pole come to mind.
|
| Not just dangerous, but arduous, long and in extreme cold.
| josefritzishere wrote:
| This is not what I wanted robots for. The future is not Startrek.
| It's Blade Runner.
| thih9 wrote:
| > [OCT] cuts harmful X-Ray radiation out of the process,
|
| This seems unrelated to the fact that a robot is performing the
| procedure. Is there anything that prevents human dentists from
| using OCT instead too?
|
| Also, I guess X-Ray usually isn't part of the process in a
| procedure like this - but IANAD.
| d_burfoot wrote:
| This is great news. Many people, even in developed countries,
| suffer a lack of quality dental care because of the cost. Once
| these devices become widespread, costs should start to drop
| significantly.
| smokel wrote:
| Why do you think that? MRI scanners are still terribly
| expensive machines, for example. And in most countries, the
| hourly wage for a dentist need not be high.
|
| It is more likely that some robot company is going to make a
| fortune. Whether other people profit from that is an open
| question.
| ZeroGravitas wrote:
| There is apparently about to be a revolution in MRI, making
| them portable and cheap to run.
|
| I've only read pop science articles on it but I think the
| gist is to use software (AI!) to make up for a much weaker
| magnet.
| progbits wrote:
| There are fundamental signal processing limitations. AI
| will just hallucinate plausibly looking garbage and kill
| people.
| pkaye wrote:
| Its not going to be cheaper than training more dentists in
| those countries.
| drewchew wrote:
| Will robot dentists facilitate the option to lay face down for
| procedures so that the debris and saliva falls out instead of
| needing the suction tool?
| settsu wrote:
| On first blush, this is an interesting premise. And it would
| seem to make sense once there is no need for human attendants,
| nor any potential accommodation for them.
| cogman10 wrote:
| I imagine, particularly with V1, there's probably going to be
| human attendants for a good portion of the procedure. You'd
| want them for administering the numbing agent and positioning
| the machine for the procedure.
| robertlagrant wrote:
| > And it would seem to make sense once there is no need for
| human attendants, nor any potential accommodation for them.
|
| Perhaps it could be combined with a back massage. Those
| chairs that you stick your face in would be tailor-made for
| this!
| __MatrixMan__ wrote:
| Wow that would be a game changer.
| candiddevmike wrote:
| What if I like the taste of burning tooth enamel? Can I flip
| over still?
| doubled112 wrote:
| I can taste this comment, and I really don't like it.
|
| You'll have to ask when the time comes and report back.
| worstspotgain wrote:
| This, and the fact that a sterilized robot is way less likely
| to transmit airborne pathogens than a dentist and an assistant
| wearing a surgical mask at best. Maybe not v.1.0b4, but I'd
| sign up for v.1.2.
| hanniabu wrote:
| Probably not since you'd be drooling all over the robot "hand"
| and arm making it more difficult to keep clean.
|
| But it could probably moisten your drying out lips so they
| don't crack
| matt_heimer wrote:
| All reusable dental tools have to go through a sterilization
| procedure after every use so would it matter? And they could
| have one-time use sleeves to put on the arms.
|
| I think the main concern would be debris and drool getting on
| the camera but that is probably a concern for any position.
| nharada wrote:
| Is there a tech version of "not in my backyard"? Like, "I support
| the idea but I'm sure as hell not going first"?
| racl101 wrote:
| Imagine being the guy testing this.
| __MatrixMan__ wrote:
| Sometimes the drill is necessary, but imagine how infrequently
| we'd need it if there were robots in our homes that could do an
| immaculate job with the daily cleaning.
| ben_w wrote:
| I have good news: https://www.amazon.de/s?k=electric+toothbrush
|
| ;)
| agumonkey wrote:
| They're indeed pretty incredible. That said I'm waiting for
| microcurrent brushes now.
| sva_ wrote:
| Waiting for the toothbrush that brushes all teeth at once in
| about 15 seconds
| a_t48 wrote:
| They also exist eg https://sonic-brush.net - but they
| aren't very good yet.
| tssge wrote:
| That's a dropshipping site for AliExpress products
| shipping from China. You'll save money if you buy the
| product straight from AliExpress without a middleman in
| between.
|
| However as you said, the toothbrush doesn't actually
| work.
| a_t48 wrote:
| Sorry, I just picked a representative example from
| Google. It was definitely not an endorsement.
| czottmann wrote:
| https://www.kaercher.com/uk/home-garden/pressure-
| washers.htm... maybe?
| adrianmonk wrote:
| I also want a laserwash shower that takes 60 seconds. It
| would save time, and I'm pretty sure it would save water
| too.
| tzs wrote:
| I've wondered if you could make something to floss multiple
| teeth at once. Maybe something that fits over a span of
| teeth such as all the top teeth and is custom fitted so
| that it fits on the same way each time. It would have holes
| that you can thread floss through so that when you put it
| on the floss ends up between the teeth. Then you can pull
| on the ends of the floss and it flosses between all the
| teeth that the device is covering.
| paxys wrote:
| Even better news: https://www.amazon.de/s?k=dental+floss
| __MatrixMan__ wrote:
| I use one twice daily, but why do I still have to go to the
| dentist for cleaning?
|
| Wouldn't it be better to get a dentist-grade cleaning every
| day in the the same amount of time?
| krunck wrote:
| There is no mention of a feedback mechanism for the patient to
| express that the pain level is too high and something should be
| changed in method and/or anesthetic. And what about soft tissues?
| Does the robot image those so it knows there is a tongue in the
| way?
| cogman10 wrote:
| From the pictures, it looks like the dentist is positioning the
| machine so I'm guessing the administration of the anesthetic
| and ensuring the area is clear will be on them.
| photon_lines wrote:
| Hopefully they also provide a pair of adult diapers for each test
| subject :)
| cogman10 wrote:
| I think what's being overlooked here by some commenters is the
| speed of this machine.
|
| A normal cavity filling can take 20/30 minutes. Imagine if that
| could be cut down to 1 minute with a perfect filling at the end?
| Even if we are talking about the dentist messing up the pain
| killing application it'll all be over pretty damn fast.
| MOARDONGZPLZ wrote:
| Pfft. That's nothing. Imagine if it was 30 seconds rather than
| twice that time? Can't get better than that.
| cogman10 wrote:
| The actual drilling can be quiet fast. The limiting factor is
| making sure it isn't so fast that it shatters the tooth. What
| will take time is bonding the filling.
|
| My assumption is that for a regular cavity fill, the drilling
| will be a much smaller portion of the time than the filling
| bonding. You can see that in the crown placement video in the
| article, almost no time is spent removing the outside tooth.
| The actual spent time is building up the crown.
| doubled112 wrote:
| Agreed.
|
| The freezing doesn't always work for me. If I say "hey, I can
| feel that" the second dose might work, and it might not.
|
| What happens next is that they slow down, and while this sounds
| like compassion, it also lengthens the time they're drilling
| into my head while I can feel it.
|
| Just building up a resistance to physical torture. Bring it on,
| movie CIA guy.
|
| I think a quick, very intense filling might be better than a
| long, slow one.
| cogman10 wrote:
| I may be weird about this, but for me when I've been drilled
| (or even cleaned) and experienced tooth pain the level is
| 100%. I can't feel more pain.
|
| I'm certainly not advocating that dentists don't do their
| best to numb patients before drilling. What I'm saying is
| it's fairly likely that by the time they can stop the machine
| in the case of pain the procedure will be nearly complete and
| the pain over.
| iandanforth wrote:
| I would be more comfortable with this technology if it had saw-
| stop like behavior. If I sneeze it has to be fast enough to safe
| the dental tool before I impale myself on it.
| gwbas1c wrote:
| > Remarkably, the company claims the machine can take care of
| business safely "even in the most movement-heavy conditions,"
| and that dry run testing on moving humans has all been
| successful. There sure are some brave guinea pig types out
| there.
| rtkwe wrote:
| But will it carry on a conversation with me that consists
| entirely of open mouthed vowel sounds? I'm not sure speech
| recognition has gotten quite that far.
|
| https://www.youtube.com/watch?v=4F7sWy4JQ18
| ugh123 wrote:
| There will most certainly be a dental assistant operating the
| machine in various ways, and "managing the conversation" with
| the patient.
| hiddencost wrote:
| https://sites.research.google/euphonia/about/
| idunnoman1222 wrote:
| Basically, they put the drill on a CNC machine. I'm not sure that
| AI is more than a buzzword in this procedure
| sierra1011 wrote:
| SO is a dentist. They laughed and said 90% detection leaves a lot
| to be desired, and there's rarely a good reason to not have an
| X-ray.*
|
| In addition, there's some things a human dentist does that I
| doubt this does - early detection of oral or skin cancer on the
| face being one of them. If you have the same dentist you'd be
| amazed at what they remember about your face and what's different
| from last time.
|
| General vibe is that even if it can technically do a drill 'n'
| fill, it has a long way to go before it can substitute for a
| trained medical professional.
|
| * Edit: I'm actually going to go further and say that calling an
| X-ray "harmful" should constitute disinformation and therefore
| wariness towards the attitude or motive of the author, since it's
| patently not true. The fraction they use at the dentist's isn't
| going to hurt anyone. The comparison point I've heard (and can't
| personally verify) is 6 dental X-rays is equivalent to 1 trans-
| Atlantic flight; alternatively 1 x-ray to a weekend in Cornwall.
| robertlagrant wrote:
| > there's some things a human dentist does that I doubt this
| does - early detection of oral or skin cancer on the face being
| one of them
|
| I'm sure this can happen, but that's different to every dentist
| doing it. And a dentist doing harder to automate stuff while
| the 15 minutes go on instead of 2 hours means way more patients
| treated in the same time period, which means costs can
| hopefully come way down for some dentistry.
| sierra1011 wrote:
| It's definitely what I'd like to see for the future, in the
| same way that calculators improved the capability and
| throughput of professional mathematicians; as a tool that
| assists to enhance and augment delivery of a service.
|
| CNC milling already exists for crown prep. The drilling of
| the tooth itself is not a long operation. The reason that a
| crown is split into 2 sessions is (depending on your local
| health board's practice guide) to ensure that the tooth is
| still viable for a crown; bleeding to stop, inflammation to
| go down.
|
| This revolutionises nothing... But it is a step towards a
| revolution. It can only be a good thing. However, in the same
| way that there's technically a lab-grown hamburger out there,
| it's not going to be commonplace for a while.
| sierra1011 wrote:
| I should add that my perspective is based in secondhand UK
| dental experience; in a hospital setting this would be used
| to improve care. In a private practice I have no doubt that
| it wouldn't affect the price handed to the customer.
| random3 wrote:
| I keep seeing this template response/attitude but I think it's
| generally flawed. Here's why.
|
| You judge a prototype / instance of a technological field
| that's otherwise in full swing, cranking on releasing next
| version long before you see the current one
|
| You assume this will be isolated from the rest of advancements,
| but in reality once you have the mechanics to automate imagery
| and drilling 100x more technologies can be composed. Memory in
| particular is something tech has always surpassed humans.
|
| The combination of these two, particularly in the context of AI
| is much faster than most people can perceive.
|
| So saying yes but x, is irrelevant for the most part.
| m3kw9 wrote:
| I'm optimistic about AI but if you know anything about dental
| procedures and then look at what this does, it's the simplest
| and done in extremely filtered patients. While in 100 years
| there will be a robot that can do most cases but it is very
| justified to write this off in the near future and in the
| current form.
| sierra1011 wrote:
| A reasonable take, but one that I don't think lessens my
| point.
|
| I can't speak to the other responses from which you've
| identified this yes-but-x template, and can speak really only
| from the 2 bits of knowledge I have: IT/infrastructure stuff
| is my primary knowledge, and my SO's dental training and
| practice, which is not "my" knowledge, but from this I have
| access to more knowledge than would the average person.
|
| Now, the IT stuff. Automation has come a long way and
| quickly, but if I break something, it's just a service. Worst
| case scenario a customer can't buy something, or maybe a
| couple thousand customers can't. Big deal, one a minute, etc.
| I don't need to preach on this, I'm sure.
|
| The medical field is significantly slower to adopt new
| practices, with the reasoning that their customers' custom is
| not an item in a cart, it's their health or life. New
| technology comes in slowly, with trials for wide population
| application taking decades in some cases. The stakes are so
| much higher that safety demands caution.
|
| This does not of course mean never. I've said this in another
| reply also, but I think tooling like this augments service
| delivery at the very least (provided it meets safety
| standards) and could be the start of a boom of up-tooling
| practitioners. And I will be surprised if I see one in the
| flesh before 2050.
| worstspotgain wrote:
| > there's rarely a good reason to not have an X-ray
|
| I'd much rather have a 90% detection rate without an X-ray than
| 100% with. Destists are very trigger-happy with X-rays, in part
| because of the extra billing, but mostly because it makes their
| job easier and prevents mistakes.
|
| The estimates of the hidden costs of radiation risk are
| tentative at best. Some people have inherently higher risk and
| many are not aware of it. Either way, it can take years or
| decades before the effect plays out. By then, no one is going
| to implicate the original providers who pushed for an elective
| X-ray.
|
| Also, note that not all ionizing radiation is alike. The exact
| spectra are different and the exposure intervals are very
| different, so the comparisons to environmental sources don't
| necessarily hold.
| sierra1011 wrote:
| Absolutely correct, and my examples given are unsubstantiated
| and anecdotal at best; I'm not in the medical physics field.
|
| Honestly, I'd take both. If standard light imaging is 99%
| efficient then it adds additional triage and diagnostic
| capability.
|
| As regards the billing situation, that may partially be a
| locale issue rather than an all-dentists thing, but even
| within the UK it's disappointingly nonstandard and subject to
| manipulation by the dentist.
|
| Despite all that, you say that X-rays are pushed because it
| "prevents mistakes". And my response would be along the lines
| of "well... yeah..." because a mistake turns a simple filling
| into a more complex (and expensive) operation that could cost
| a tooth and PSx,000.
|
| Speaking from personal experience, if the dentist wasn't
| concerned about anything on my teeth and I didn't ask for an
| x-ray, I didn't get one.
| insane_dreamer wrote:
| The problem with your observation is this is what can be done
| TODAY with a robot. Current dentists are indeed safe as you
| point out.
|
| But after 20 years of iteration it might be able to do most or
| all of what you describe. This means that my 8 year old should
| maybe not, when he grads from college in the future, decide to
| go to dental school and rack up $200K of debt (actually that's
| conservative) for a profession that won't disappear but will
| likely face tremendous downward pressure (ability to perform
| more operations==fewer dentists needed==greater competition
| among dentists). And that is the problem.
| why_at wrote:
| For those who are worried about radiation from X-rays I always
| recommend:
|
| https://xkcd.com/radiation/
| meroes wrote:
| Ya my dentist checks for cancers not just by sight but by
| touching neck/throat.
|
| He also noticed I had a breathing issue.
|
| Pass.
| m3kw9 wrote:
| Dental cases are deep and wide, I can see these robots doing the
| simplest and less complicated case of a single procedure and
| there are 100s of procedures
| m3kw9 wrote:
| At least 20 years before you get to see one in an office doing
| very limited procedures. The dental association isn't gonna give
| this an easy path to replace human dentists
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