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Are you advocating that we shouldn't bother testing instead? I'd imagine that many people would be quite interested in knowing the ways they're not 100% that m

Are you advocating that we shouldn't bother testing instead? I'd imagine that many people would be quite interested in knowing the ways they're not 100% that might actually kill them... like cancer.

ColanR 8y ago
It's a question of false positives and false negatives. Most medical tests have a decent percentage of both. > Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks. [1] [1] https://www.cancer.gov/types/colorectal/patient/colorectal-screening-pdq https://www.cancer.gov/types/colorectal/patient/colorectal-s...
EliRivers 8y ago
If you simply go looking, you'll find a lot of abnormalities associated with various conditions that turn out to be false positives and, for that person, fairly normal. Here's a piece on the subject; http://www.journalgazette.net/features/20180604/anomalies-in-human-body-so-normal-everyone-has-them http://www.journalgazette.net/features/20180604/anomalies-in...
pfranz 8y ago
Nothing specific to this article, but this comes up often in medicine. Sure, you can pay to run more tests, find some things earlier (along with some false positives), but the outcomes and treatment aren't any different than if you waited for more obvious symptoms and could take a more accurate test.
- hawaiianbrah 8y ago
  What? An ounce of prevention and a pound of cure and all that. Early detection is key in a lot of situations, so how could earlier not be better? Why wait unnecessarily?
  - mbreese 8y ago
    So don't ignore symptoms, but don't go looking for them if you're otherwise healthy. Early detection of many things is important... but you don't want everyone getting screened for every disease. You'll just end up with a bunch of false positives, which will cause emotional stress and backup an already overworked medical system. By all means, don't ignore symptoms! Just don't go looking for them.
  - Someone 8y ago
    The cure may statistically be worse than doing nothing. For example, prostate cancer can kill, but more people die with prostate cancer than of prostate cancer, in the latter case often with minor symptoms. Detecting it before it bothers people helps those it would kill, but subjects lots of others to testing, and those tests will initially have false positives that unnecessarily stress those it wouldn’t kill. Worse, the side effects of treatment can include incontinence and erectile dysfunction that can significantly affect quality of life for those were follow-up tests also produce false positives. Thats’s why there is discussion on whether screening for prostate cancer makes sense, and if so, for whom. See for example https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004720.pub3/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD....
arrrg 8y ago
Just imagine all the stress and suffering caused by the misdiagnosis and unnecessary visits to the doctor and unnecessary tests and imagine that on a grand scale (to say nothing of wasted resources). I’m not saying that to automatically disqualify and increase in the availability of testing – but it does have to be implemented with the proper care and caution.
- BoingX4 8y ago
  That is precisely the beauty of something like an Apple Watch. Everybody can be screened without wasting resources and the device can alert if it is really something that needs a specialist. Of course, we are on the early stages of something like that and the devices are not really capable of diagnosing on their own, thus you end up with a spike in consultations. But given some time it should be way more accurate and helpful.
  - iguy 8y ago
    It's entirely possible that a test which was net positive when applied "with probable cause", can even become a net negative if applied without. Because testing the whole population will produce many more false positives. I doubt the tests they are running here will actually go that far. But pervasive testing does need different trade-offs to targeted testing. At least we may have more complete data from which to understand this.
    - BoingX4 8y ago
      > Because testing the whole population will produce many more false positives. That is the issue that should get resolved with time. The watch will receive a lot of feedback from medical professionals to adjust its reporting because now we'll know so much more about what symptoms are really worth paying attention. But of course, there will be an adjustment period like what we are seeing now. This has always been true of new technologies introduced in medicine.
      - mbreese 8y ago
deleted 8y ago
[deleted]
astura 8y ago
It's complicated... Not all instances of cancer are harmful, more men die with prostate cancer then die because of of it and thyroid cancer is found as an incidental in ~30% of autopsies. More detection can cause more harm than good, as what happened in South Korea with thyroid cancer screening, a huge increase in detection and treatment without any decrease in survival rates. Here's a good overview: https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni... Info about thyroid cancer over diagnosis: https://www.npr.org/sections/health-shots/2017/05/09/527569291/dont-screen-for-thyroid-cancer-task-force-says https://www.npr.org/sections/health-shots/2017/05/09/5275692...
- chii 8y ago
  Under-rated opinion - if you're not feeling ill, there's probably no reason to perform any medical diagnostics. If you're wearing a medical diagnostic bracelet, and it tells you that you have some issue, you might end up getting more anxcious and stressed (which can cause real harm), despite the fact that there's nothing "wrong" really.
  - astura 8y ago
    There's evidence that the following are beneficial on an asymptomatic population level: Obesity screening Blood pressure screening Cervical cancer screening (pap test) though most medical providers test at the wrong intervals.

Are you advocating that we shouldn't bother testing instead? I'd imagine that many people would be quite interested in knowing the ways they're not 100% that might actually kill them... like cancer.

ColanR 8y ago

It's a question of false positives and false negatives. Most medical tests have a decent percentage of both. > Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks. [1] [1] https://www.cancer.gov/types/colorectal/patient/colorectal-screening-pdq https://www.cancer.gov/types/colorectal/patient/colorectal-s...

EliRivers 8y ago

If you simply go looking, you'll find a lot of abnormalities associated with various conditions that turn out to be false positives and, for that person, fairly normal. Here's a piece on the subject; http://www.journalgazette.net/features/20180604/anomalies-in-human-body-so-normal-everyone-has-them http://www.journalgazette.net/features/20180604/anomalies-in...

pfranz 8y ago

Nothing specific to this article, but this comes up often in medicine. Sure, you can pay to run more tests, find some things earlier (along with some false positives), but the outcomes and treatment aren't any different than if you waited for more obvious symptoms and could take a more accurate test.

hawaiianbrah 8y ago
What? An ounce of prevention and a pound of cure and all that. Early detection is key in a lot of situations, so how could earlier not be better? Why wait unnecessarily?
- mbreese 8y ago
  So don't ignore symptoms, but don't go looking for them if you're otherwise healthy. Early detection of many things is important... but you don't want everyone getting screened for every disease. You'll just end up with a bunch of false positives, which will cause emotional stress and backup an already overworked medical system. By all means, don't ignore symptoms! Just don't go looking for them.
- Someone 8y ago
  The cure may statistically be worse than doing nothing. For example, prostate cancer can kill, but more people die with prostate cancer than of prostate cancer, in the latter case often with minor symptoms. Detecting it before it bothers people helps those it would kill, but subjects lots of others to testing, and those tests will initially have false positives that unnecessarily stress those it wouldn’t kill. Worse, the side effects of treatment can include incontinence and erectile dysfunction that can significantly affect quality of life for those were follow-up tests also produce false positives. Thats’s why there is discussion on whether screening for prostate cancer makes sense, and if so, for whom. See for example https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004720.pub3/full https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD....

arrrg 8y ago

Just imagine all the stress and suffering caused by the misdiagnosis and unnecessary visits to the doctor and unnecessary tests and imagine that on a grand scale (to say nothing of wasted resources). I’m not saying that to automatically disqualify and increase in the availability of testing – but it does have to be implemented with the proper care and caution.

BoingX4 8y ago
That is precisely the beauty of something like an Apple Watch. Everybody can be screened without wasting resources and the device can alert if it is really something that needs a specialist. Of course, we are on the early stages of something like that and the devices are not really capable of diagnosing on their own, thus you end up with a spike in consultations. But given some time it should be way more accurate and helpful.
- iguy 8y ago
  It's entirely possible that a test which was net positive when applied "with probable cause", can even become a net negative if applied without. Because testing the whole population will produce many more false positives. I doubt the tests they are running here will actually go that far. But pervasive testing does need different trade-offs to targeted testing. At least we may have more complete data from which to understand this.
  - BoingX4 8y ago
    > Because testing the whole population will produce many more false positives. That is the issue that should get resolved with time. The watch will receive a lot of feedback from medical professionals to adjust its reporting because now we'll know so much more about what symptoms are really worth paying attention. But of course, there will be an adjustment period like what we are seeing now. This has always been true of new technologies introduced in medicine.
    - mbreese 8y ago

deleted 8y ago

[deleted]

astura 8y ago

It's complicated... Not all instances of cancer are harmful, more men die with prostate cancer then die because of of it and thyroid cancer is found as an incidental in ~30% of autopsies. More detection can cause more harm than good, as what happened in South Korea with thyroid cancer screening, a huge increase in detection and treatment without any decrease in survival rates. Here's a good overview: https://sciencebasedmedicine.org/a-skeptical-look-at-screening-tests/ https://sciencebasedmedicine.org/a-skeptical-look-at-screeni... Info about thyroid cancer over diagnosis: https://www.npr.org/sections/health-shots/2017/05/09/527569291/dont-screen-for-thyroid-cancer-task-force-says https://www.npr.org/sections/health-shots/2017/05/09/5275692...

chii 8y ago
Under-rated opinion - if you're not feeling ill, there's probably no reason to perform any medical diagnostics. If you're wearing a medical diagnostic bracelet, and it tells you that you have some issue, you might end up getting more anxcious and stressed (which can cause real harm), despite the fact that there's nothing "wrong" really.
- astura 8y ago
  There's evidence that the following are beneficial on an asymptomatic population level: Obesity screening Blood pressure screening Cervical cancer screening (pap test) though most medical providers test at the wrong intervals.