8 ms·

I'm so glad to hear that. I've been thinking for years that MRIs seem like an industry that could and should be disrupted. The benefits could be massive. I'm n

I'm so glad to hear that. I've been thinking for years that MRIs seem like an industry that could and should be disrupted. The benefits could be massive. I'm not in the medical field, but I really believe the future of cancer medicine will strongly lean towards prevention and early detection, as opposed to just cure.

highd 10y ago
Regarding cancer, we think you're right. That and possibly maintenance - for example, most prostate cancers are asymptotic for life if untreated. For slower cancers that are acquired in old age it can make sense to use less aggressive chemotherapies that maintain quality of life. We think that being able to monitor the development of the cancer closely and frequently is a key component of enabling future therapeutic approaches like that.
gozur88 10y ago
Where I live there used to be radio advertisements for a service that would give you a full body MRI in an effort to find cancers that could be treated before they spead. After a bit of reseach I discovered it's a false promise. A lot of people have benign lumps and growths they can carry around for a lifetime without any trouble, and while MRIs are quite safe biopsies are not. If you don't have a reason to think you might have cancer, i.e. the MRI is a screening tool and not being used for a diagnosis, the very small chance you'll die of complications from unnecessary biopsies outweighs the very small chance you'll save your life by discovering a treatable malignant growth. At least, that was the state of the art 7-8 years ago.
- Dove 10y ago
  I've heard the same said of getting mammograms started earlier in life: they don't recommend it because the time spent chasing benign lumps is neither safe nor efficient. This always seemed to me a terrible indictment of how medicine is practiced. Knowing that, do you have to chase down every lump your screening finds? Can you not consider the benefits of investigating further based on the dangers of doing so, the risk factors the patient has, maybe even what you see in successive scans over time? I am not a doctor, but there seems something unhealthy about a system in which you are advised to avoid learning information about yourself in order to avoid treatment.
  - highd 10y ago
    I think you're exactly right - more frequent, less expensive testing means we have to change the criteria that mandates further investigation. One dilemma I've been thinking about recently is that there's an unfortunate burden put on care providers due to litigation that results in increased cost - the provider or radiologist that sees a "maybe" or a "shadow" on an image has to order a biopsy just to protect themselves from being sued on the off 1% chance that the thing becomes a serious health concern. In an environment where consumers evaluated their medicine based on value/$ they would be further dissuaded from a biopsy, but in America the nature of medical insurance disincentives this sort of cost analysis skepticism.
  - jeffdavis 10y ago
    The incentives aren't aligned. A doctor who sees a lump and does nothing has a huge downside risk: it could be malignant and everyone will believe that the doctor is at fault. A doctor who orders the test will never be blamed for a fluke complication during a biopsy. It's hard to resolve becuse it's not even about money. It may be the doctor who is blaming himself.
    - saalweachter 10y ago
      The doctor or the patient; if you're told that there is a lump (or seventeen) and it's probably nothing but you can get it checked out if you really want, most people will blame themselves if they don't get something checked out that later turns out to be something, and they know it.
      - Dove 10y ago
        That doesn't make sense to me. I have, many times in the last year, had a doctor say to me some variation on, "this isn't dangerous, but it could become so -- we'll keep an eye on it." So it's not that they can't act with sense and restraint with respect to risk. They clearly can. With respect to breast cancer specifically, they told me in school that finding it early improved your odds, and the earlier the better, and if you really wanted to do the right thing, you'd physically examine yourself looking for lumps on a monthly basis. That didn't seem unreasonable - and yet when something more accurate and objective is available, it's to be avoided out of a fear of unnecessary biopsies? Something strange is going on.
- unabridged 10y ago
  Getting an MRI and having each (so far symptomless) lump examined is not the goal. But getting an MRI every 6 months to a year and being able to see the changes in these lumps is much more important.
- nommm-nommm 10y ago
  A Skeptical Look at Screening Tests - https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
- BurningFrog 10y ago
  So if you got a full body MRI each year/month, you could track the lumps and probably tell the bad from the good.
  - lostlogin 10y ago
    No, you just generate loads of biopsies. These have risk too, so it's a giant waste of time. MRs produce a lot of data and without knowing what you are looking for you are going to miss things. As with most things, ask a good question, get a good answer.
    - Brakenshire 10y ago
      Really would've thought that with high resolution, time series, and sophisticated algorithms to look at the structure and location relative to what's expected/likely, you could make the data useful. I know what you're saying is true now, but is it inherently true or just a factor of immaturity in the technology?
      - lostlogin 10y ago
        Immature tech and the way people are. For every lump and bump you see on a person with your eyes, there are a load inside. We do a lot of research scans on healthy volunteers. You scan certain areas with some trepidation. Scanning the liver of a 50 year old is a great way to find yourself in a world of 'incidental finding' paperwork.
    - BurningFrog 10y ago
      You're missing my point, probably because I didn't make it very clearly. I'm imagining new technology here. You'd take the first scan as a baseline. Whatever lumps you have are assumed harmless. Then you track the diffs from there on. I assume that, at least after collecting experience, we can learn to tell the bad growths from the ignorable.
- flukus 10y ago
  I remember a similar one with prostate cancer years ago. A significant amount of men will get it but only a fraction of the cancers will develop to be dangerous in a normal lifetime. Removing all cases early on would likely cause more deaths than it prevents.
  - ClassyJacket 10y ago
    This is still only an argument to not take surgical action immediately every time something is detected. There should never be incentive to deliberately know less information about your own health.
- ClassyJacket 10y ago
  I've heard this defence before but it is absolutely wrong form a logical perspective. We aren't forced to perform a biopsy on everything that shows up just because we see it. It seems only logical that occasionally there would be something detected which is unambiguously cancer. The ones that are ambiguous, we could simply monitor without taking action on. If having more information about the state of your health is putting you in danger, then the medical system is broken. It's as simple as that.

highd 10y ago

Regarding cancer, we think you're right. That and possibly maintenance - for example, most prostate cancers are asymptotic for life if untreated. For slower cancers that are acquired in old age it can make sense to use less aggressive chemotherapies that maintain quality of life. We think that being able to monitor the development of the cancer closely and frequently is a key component of enabling future therapeutic approaches like that.

gozur88 10y ago

Where I live there used to be radio advertisements for a service that would give you a full body MRI in an effort to find cancers that could be treated before they spead. After a bit of reseach I discovered it's a false promise. A lot of people have benign lumps and growths they can carry around for a lifetime without any trouble, and while MRIs are quite safe biopsies are not. If you don't have a reason to think you might have cancer, i.e. the MRI is a screening tool and not being used for a diagnosis, the very small chance you'll die of complications from unnecessary biopsies outweighs the very small chance you'll save your life by discovering a treatable malignant growth. At least, that was the state of the art 7-8 years ago.

Dove 10y ago
I've heard the same said of getting mammograms started earlier in life: they don't recommend it because the time spent chasing benign lumps is neither safe nor efficient. This always seemed to me a terrible indictment of how medicine is practiced. Knowing that, do you have to chase down every lump your screening finds? Can you not consider the benefits of investigating further based on the dangers of doing so, the risk factors the patient has, maybe even what you see in successive scans over time? I am not a doctor, but there seems something unhealthy about a system in which you are advised to avoid learning information about yourself in order to avoid treatment.
- highd 10y ago
  I think you're exactly right - more frequent, less expensive testing means we have to change the criteria that mandates further investigation. One dilemma I've been thinking about recently is that there's an unfortunate burden put on care providers due to litigation that results in increased cost - the provider or radiologist that sees a "maybe" or a "shadow" on an image has to order a biopsy just to protect themselves from being sued on the off 1% chance that the thing becomes a serious health concern. In an environment where consumers evaluated their medicine based on value/$ they would be further dissuaded from a biopsy, but in America the nature of medical insurance disincentives this sort of cost analysis skepticism.
- jeffdavis 10y ago
  The incentives aren't aligned. A doctor who sees a lump and does nothing has a huge downside risk: it could be malignant and everyone will believe that the doctor is at fault. A doctor who orders the test will never be blamed for a fluke complication during a biopsy. It's hard to resolve becuse it's not even about money. It may be the doctor who is blaming himself.
  - saalweachter 10y ago
    The doctor or the patient; if you're told that there is a lump (or seventeen) and it's probably nothing but you can get it checked out if you really want, most people will blame themselves if they don't get something checked out that later turns out to be something, and they know it.
    - Dove 10y ago
      That doesn't make sense to me. I have, many times in the last year, had a doctor say to me some variation on, "this isn't dangerous, but it could become so -- we'll keep an eye on it." So it's not that they can't act with sense and restraint with respect to risk. They clearly can. With respect to breast cancer specifically, they told me in school that finding it early improved your odds, and the earlier the better, and if you really wanted to do the right thing, you'd physically examine yourself looking for lumps on a monthly basis. That didn't seem unreasonable - and yet when something more accurate and objective is available, it's to be avoided out of a fear of unnecessary biopsies? Something strange is going on.
unabridged 10y ago
Getting an MRI and having each (so far symptomless) lump examined is not the goal. But getting an MRI every 6 months to a year and being able to see the changes in these lumps is much more important.
nommm-nommm 10y ago
A Skeptical Look at Screening Tests - https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
BurningFrog 10y ago
So if you got a full body MRI each year/month, you could track the lumps and probably tell the bad from the good.
- lostlogin 10y ago
  No, you just generate loads of biopsies. These have risk too, so it's a giant waste of time. MRs produce a lot of data and without knowing what you are looking for you are going to miss things. As with most things, ask a good question, get a good answer.
  - Brakenshire 10y ago
    Really would've thought that with high resolution, time series, and sophisticated algorithms to look at the structure and location relative to what's expected/likely, you could make the data useful. I know what you're saying is true now, but is it inherently true or just a factor of immaturity in the technology?
    - lostlogin 10y ago
      Immature tech and the way people are. For every lump and bump you see on a person with your eyes, there are a load inside. We do a lot of research scans on healthy volunteers. You scan certain areas with some trepidation. Scanning the liver of a 50 year old is a great way to find yourself in a world of 'incidental finding' paperwork.
  - BurningFrog 10y ago
    You're missing my point, probably because I didn't make it very clearly. I'm imagining new technology here. You'd take the first scan as a baseline. Whatever lumps you have are assumed harmless. Then you track the diffs from there on. I assume that, at least after collecting experience, we can learn to tell the bad growths from the ignorable.
flukus 10y ago
I remember a similar one with prostate cancer years ago. A significant amount of men will get it but only a fraction of the cancers will develop to be dangerous in a normal lifetime. Removing all cases early on would likely cause more deaths than it prevents.
- ClassyJacket 10y ago
  This is still only an argument to not take surgical action immediately every time something is detected. There should never be incentive to deliberately know less information about your own health.
ClassyJacket 10y ago
I've heard this defence before but it is absolutely wrong form a logical perspective. We aren't forced to perform a biopsy on everything that shows up just because we see it. It seems only logical that occasionally there would be something detected which is unambiguously cancer. The ones that are ambiguous, we could simply monitor without taking action on. If having more information about the state of your health is putting you in danger, then the medical system is broken. It's as simple as that.