7 ms·

A decent portion of my family are MDs. This is accurate. However, this is also one of the places where it's quite disappointing to see human squishiness in act

A decent portion of my family are MDs. This is accurate. However, this is also one of the places where it's quite disappointing to see human squishiness in action. When we opt to not receive data because we know there'll likely be non-malignant anomalies, we are also depriving ourselves of the raw data that allows us to discern non-malignant from malignant, data which would help very much in deciding on the cases we do receive. A stream of known false positives is worth its weight in gold in any detection system, it's just that this specific system happens to contain squishy feely human doctors that are susceptible to short-term human 'Please don't spend more money than necessary, we're already in the red for this quarter' kind of pressures from their superiors. Had we enforced a full-body MRI for every patient, we would quickly amass enough imaging data to know which anomalies are malignant and which are not to a very high degree, which would counteract the temporary cost increase in chasing false positives. The fact that we don't want to eat the short term initial cost means some of those things that could be uncovered by the scan, things that could save a person from a malignant deviation, is left unseen, untreated, to its natural end.

internet_user 7y ago
It's just more profitable to fob off patients as fast as you can, good for business. In-depth investigations have massive opportunity costs for someone reimbursed on piece-work basis, takes up way too much time.
- aantix 7y ago
  Then more money needs to be charged or a refusal to perform them.
jmhmd 7y ago
The idea that lots of full body MRIs will necessarily lead to better discrimination of malignant vs benign anomalies assumes that the imaging is able to detect differences at all, which often is not true. Some benign and malignant abnormalities can look _exactly_ the same on imaging, particularly at an early stage, when you could make a difference, for example lung nodules. Nevermind the fact that many benign entities can undergo malignant transformation at some point in the future. Or that MRI is only a good test for a subset of cancers, CT is better for others. All these issues help explain why doctors are averse to full-body scanning everybody. It is neither cost-effective nor medically sensible.
- concernedstats 7y ago
  I think their statement is more general than what you're making it out to be. The goal of receiving better and more data puts pressure to have better imaging technology.
  - abakker 7y ago
    I think there are perverse incentives at work, too. If running the MRI machine cost $100, people would do it. If it can bill insurance $100k, and then any follow up might cost $500k, there is a rational aversion to doing it as it might make the _system_ less good for everyone if insurance cracked down on exploratory imaging as a billable thing (obviously, they already do this to some extent). Better technology is unlikely to be cheaper, unless it is so new and novel that it can get its own unique billing codes, and if it becomes ubiquitous so it cheaper and more available than existing machines which are not yet depreciated. Just typing that out depresses me.
    - D_Alex 7y ago
      >If running the MRI machine cost $100, people would do it. There are different kinds of MRIs, but the actual direct costs for running an MRI without preparatory procedures is around $100 (preparatory dye injection may be another $50 cost). Marginal costs are lower still. See also here: https://www.npr.org/templates/story/story.php?storyId=120545569 https://www.npr.org/templates/story/story.php?storyId=120545... https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...
      - flemhans 7y ago
        If you would like a $100 scan, you can do it in Romania. <http://www.hiperdia.ro/servicii-medicale/> http://www.hiperdia.ro/servicii-medicale/> It's a modern 1.5T MRI.
mattkrause 7y ago
You're understating the costs. Determining whether something is (non) malignant isn't trivial. It often requires a more invasive test (e.g., biopsy, exploratory surgery). We try to avoid those procedures not just because we're cheap or afraid, but because they have a real risk of harming us 'squishy humans'. For example, detecting prostate cancer a few months earlier is often not a huge win on its own. It is even less of a success if doing so requires that four people have allergic reactions to the anesthetic and two others acquire some kind of infection at the biopsy site. It's certainly possible that more data would eventually let us avoid most invasive followups, that's nowhere near certain. Even if it were, the ethical calculus is still pretty tricky.
- stcredzero 7y ago
  You're understating the costs. I think you're correct in the current context. However, this strikes me as a sign of some kind of paradigm shift waiting to happen, enabled by the reduced cost of data gathering, data processing, and improvements in AI. There was a time when many things which are mass produced now were once handcrafted luxury items. Perhaps, as technology improves, it will one day be cost effective to take a whole body scan into account. I can imagine a day when an AI would digest the information from a full body scan, then autonomously plan robot keyhole surgery to take many of the biopsies. It's certainly possible that more data would eventually let us avoid most invasive followups, that's nowhere near certain. I think it's likely to happen in decades, if our civilization doesn't fall soon.
  - saulrh 7y ago
    Perhaps, as technology improves, it will one day be cost effective to take a whole body scan into account. That's the really funny thing about this: A colossal library of full-body imaging studies over time is exactly the kind of technology that would make that library useable. Think about Google 411 and similar projects: Voice recognition was unusable until people dumped a ton of money into bootstrapping the necessary datasets and now I talk to my phone every day. Similarly, I bet that a bunch of that "anomalies are indistinguishable on images" is solely because we don't have enough images about non-malignant anomalies over time. The data itself would be the technology that makes it usable.
needlesurgeon 7y ago
For those interested, I have posted a relevant screening-exam paper on the main thread that asks the question, "what do we find if we scan the brains of 2000 people?": https://news.ycombinator.com/item?id=19965095 https://news.ycombinator.com/item?id=19965095
tellak 7y ago
I am actually an MD. > Had we enforced a full-body MRI for every patient, we would quickly amass enough imaging data to know which anomalies are malignant and which are not to a very high degree How, pray tell, are we actually determining which are malignant and which are not?? I’ll give you a hint: the charitable explanation is you are completely ignorant, the less charitable one is that you consider Mengele and Ishii modern medicine heroes. And that is even if the determination by imaging alone is even possible. Once again I have to point out on HN... not everyone in the medical world is an idiot incapable of analytical thinking, it is just that a lot of us care about ethics. Our patients, even in research, are more than just numbers.
- WoodenChair 7y ago
  > How, pray tell, are we actually determining which are malignant and which are not? When people on this forum speculate about things like this, I assume they are thinking of some future ML application. Of course you're right though, that is not doable today. The point of the OP is that if we collected more data perhaps it would be possible. > the less charitable one is that you consider Mengele and Ishii modern medicine heroes. The ad hominem attacks against the OP are completely unnecessary. > I am actually an MD. The start of your post feels like "appeal to authority."
  - tomcam 7y ago
    > The start of your post feels like "appeal to authority." Sounds like a declaration of fact to me
    - WoodenChair 7y ago
      What I mean is, just because the person is "actually an MD" doesn't mean the person has expertise in this specific area yet the person is using it to claim such. I.E. some might call me a computer scientist, but that doesn't mean I have enough expertise in machine learning, a sub-discipline, to say definitively that the OP's idea about using full body scan data is feasible. Should I have started my post "I am actually a computer scientist." No, right? That would be an appeal to authority that doesn't prove I know anything about what I'm talking about. Now, if the person had started with "I am a radiologist who has looked at empirical data about full body scans versus more selective scans." that would be a more useful and valid statement.
ska 7y ago
Had we enforced a full-body MRI for every patient, we would quickly amass enough imaging data to know which anomalies are malignant and which are not to a very high degree These sorts of statements come across as naive optimism at best. And I like our long term odds of increasing clinical efficacy, and have designed and worked on several systems in this space that are in clinical use.

internet_user 7y ago

It's just more profitable to fob off patients as fast as you can, good for business. In-depth investigations have massive opportunity costs for someone reimbursed on piece-work basis, takes up way too much time.

aantix 7y ago
Then more money needs to be charged or a refusal to perform them.

jmhmd 7y ago

The idea that lots of full body MRIs will necessarily lead to better discrimination of malignant vs benign anomalies assumes that the imaging is able to detect differences at all, which often is not true. Some benign and malignant abnormalities can look _exactly_ the same on imaging, particularly at an early stage, when you could make a difference, for example lung nodules. Nevermind the fact that many benign entities can undergo malignant transformation at some point in the future. Or that MRI is only a good test for a subset of cancers, CT is better for others. All these issues help explain why doctors are averse to full-body scanning everybody. It is neither cost-effective nor medically sensible.

concernedstats 7y ago
I think their statement is more general than what you're making it out to be. The goal of receiving better and more data puts pressure to have better imaging technology.
- abakker 7y ago
  I think there are perverse incentives at work, too. If running the MRI machine cost $100, people would do it. If it can bill insurance $100k, and then any follow up might cost $500k, there is a rational aversion to doing it as it might make the _system_ less good for everyone if insurance cracked down on exploratory imaging as a billable thing (obviously, they already do this to some extent). Better technology is unlikely to be cheaper, unless it is so new and novel that it can get its own unique billing codes, and if it becomes ubiquitous so it cheaper and more available than existing machines which are not yet depreciated. Just typing that out depresses me.
  - D_Alex 7y ago
    >If running the MRI machine cost $100, people would do it. There are different kinds of MRIs, but the actual direct costs for running an MRI without preparatory procedures is around $100 (preparatory dye injection may be another $50 cost). Marginal costs are lower still. See also here: https://www.npr.org/templates/story/story.php?storyId=120545569 https://www.npr.org/templates/story/story.php?storyId=120545... https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/interviews/ikegami.html https://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/...
    - flemhans 7y ago
      If you would like a $100 scan, you can do it in Romania. <http://www.hiperdia.ro/servicii-medicale/> http://www.hiperdia.ro/servicii-medicale/> It's a modern 1.5T MRI.

mattkrause 7y ago

You're understating the costs. Determining whether something is (non) malignant isn't trivial. It often requires a more invasive test (e.g., biopsy, exploratory surgery). We try to avoid those procedures not just because we're cheap or afraid, but because they have a real risk of harming us 'squishy humans'. For example, detecting prostate cancer a few months earlier is often not a huge win on its own. It is even less of a success if doing so requires that four people have allergic reactions to the anesthetic and two others acquire some kind of infection at the biopsy site. It's certainly possible that more data would eventually let us avoid most invasive followups, that's nowhere near certain. Even if it were, the ethical calculus is still pretty tricky.

stcredzero 7y ago
You're understating the costs. I think you're correct in the current context. However, this strikes me as a sign of some kind of paradigm shift waiting to happen, enabled by the reduced cost of data gathering, data processing, and improvements in AI. There was a time when many things which are mass produced now were once handcrafted luxury items. Perhaps, as technology improves, it will one day be cost effective to take a whole body scan into account. I can imagine a day when an AI would digest the information from a full body scan, then autonomously plan robot keyhole surgery to take many of the biopsies. It's certainly possible that more data would eventually let us avoid most invasive followups, that's nowhere near certain. I think it's likely to happen in decades, if our civilization doesn't fall soon.
- saulrh 7y ago
  Perhaps, as technology improves, it will one day be cost effective to take a whole body scan into account. That's the really funny thing about this: A colossal library of full-body imaging studies over time is exactly the kind of technology that would make that library useable. Think about Google 411 and similar projects: Voice recognition was unusable until people dumped a ton of money into bootstrapping the necessary datasets and now I talk to my phone every day. Similarly, I bet that a bunch of that "anomalies are indistinguishable on images" is solely because we don't have enough images about non-malignant anomalies over time. The data itself would be the technology that makes it usable.

needlesurgeon 7y ago

For those interested, I have posted a relevant screening-exam paper on the main thread that asks the question, "what do we find if we scan the brains of 2000 people?": https://news.ycombinator.com/item?id=19965095 https://news.ycombinator.com/item?id=19965095

tellak 7y ago

I am actually an MD. > Had we enforced a full-body MRI for every patient, we would quickly amass enough imaging data to know which anomalies are malignant and which are not to a very high degree How, pray tell, are we actually determining which are malignant and which are not?? I’ll give you a hint: the charitable explanation is you are completely ignorant, the less charitable one is that you consider Mengele and Ishii modern medicine heroes. And that is even if the determination by imaging alone is even possible. Once again I have to point out on HN... not everyone in the medical world is an idiot incapable of analytical thinking, it is just that a lot of us care about ethics. Our patients, even in research, are more than just numbers.

WoodenChair 7y ago
> How, pray tell, are we actually determining which are malignant and which are not? When people on this forum speculate about things like this, I assume they are thinking of some future ML application. Of course you're right though, that is not doable today. The point of the OP is that if we collected more data perhaps it would be possible. > the less charitable one is that you consider Mengele and Ishii modern medicine heroes. The ad hominem attacks against the OP are completely unnecessary. > I am actually an MD. The start of your post feels like "appeal to authority."
- tomcam 7y ago
  > The start of your post feels like "appeal to authority." Sounds like a declaration of fact to me
  - WoodenChair 7y ago
    What I mean is, just because the person is "actually an MD" doesn't mean the person has expertise in this specific area yet the person is using it to claim such. I.E. some might call me a computer scientist, but that doesn't mean I have enough expertise in machine learning, a sub-discipline, to say definitively that the OP's idea about using full body scan data is feasible. Should I have started my post "I am actually a computer scientist." No, right? That would be an appeal to authority that doesn't prove I know anything about what I'm talking about. Now, if the person had started with "I am a radiologist who has looked at empirical data about full body scans versus more selective scans." that would be a more useful and valid statement.

ska 7y ago

Had we enforced a full-body MRI for every patient, we would quickly amass enough imaging data to know which anomalies are malignant and which are not to a very high degree These sorts of statements come across as naive optimism at best. And I like our long term odds of increasing clinical efficacy, and have designed and worked on several systems in this space that are in clinical use.