6 ms·

I imagine this is just scratching the surface and before long we'll be doing full-body, 3D scans every few years and everything from cancers (all of them) to he

by mikece 7y ago

I imagine this is just scratching the surface and before long we'll be doing full-body, 3D scans every few years and everything from cancers (all of them) to heart disease, to gastero-intestinal issues, to things even as mundane as acne and dandruff will be diagnosed by algorithms pulling on a cumulative database of images of healthy and diseased body parts. The real hope is to be able to see into the brain and pick up things like CTE and Alzheimers years before symptoms manifest.

3fe9a03ccd14ca5 7y ago
I think I’ll pass on being a beta tester. Sounds like there’s a lot of risk from unnecessary intervention.
- jabits 7y ago
  Only if you act on it. Just because you know or suspect something doesn’t mean you have to do something about it.
- jcims 7y ago
  My wife had multiple softball sized tumors growing in her abdomen for months/years that would have easily been detected by something like this. Instead they burst and metastasized and now we're a million dollars deep into medical treatments and still nothing remotely resembling a guarantee of resolution. You can always choose not to act on what you learn. You can't act on what you don't know.
  - catalogia 7y ago
    > You can always choose not to act on what you learn. You can't act on what you don't know. You can also act on what you think you know but in fact don't. False negatives kill people but so can false positives.
    - jcims 7y ago
      What are the numbers though? Having unnecessary procedures done because of false positives from a screening test can absolutely kill people, but so can wearing a seatbelt. People drown and burn up all the time because they couldn't get out of a wrecked vehicle. There is presently some set of screening tests with varying levels of sensitivity and specificity, and they aren't all appropriate for mass screening. However, if millions of people started regularly getting non-ionizing imaging done through MRI or ultrasound or infrared or whatever, we would learn a shitload about predicting maladies and likely save quite a few more people than we kill in the process.
      - catalogia 7y ago
        > What are the numbers though? I couldn't say, but I wage the medical science community / industry is cognizant of the phenomena and, not being an expert in the field myself, I trust them to handle the matter reasonably. In the specific case of breast cancer, I've heard that the cost of false positives is high enough to be a major consideration in recommended breast cancer screening schedules.
  - jturpin 7y ago
    Yeah I'm on your side here. This fear of AI medicine creating false positives that overwhelm hospitals and doctors and cause unnecessary and risky surgery is one of those ideas I see floating around comments here and there, and it doesn't seem to be backed in anything tangible. I mean maybe it's a concern, but it also seems like that if it ever happened, we'd adjust for it quickly.
Gatsky 7y ago
This is the wrong idea. Detecting pathology early and then treating it is going to be complicated and expensive, and available to only a few people for a long time. We don't actually want some kind of constant AI body surveillance (for CTE?? So an NFL player can take just enough knocks before they retire?). What we want is prevention, not early detection. Bear in mind that prevention is a proven outcome, because some people never get Alzheimers, and some people never get cancer. Detecting cancer or Alzheimers early and then intervening to cure the condition is actually not something that is definitely possible.
- dwelch 7y ago
  While I think I know what you’re getting at, there are of course examples of “detecting pathology early and then treating it” preventing morbidity, mortality, and saving money. This is the basis of all (good) public health cancer screening practices. Think of a screening colonoscopy identifying a local pre-invasive adenocarcinoma and cutting it out (cure).
  - Gatsky 7y ago
    There are specific examples for high prevalence conditions as you cite, but the original comment was not talking about that, it was talking about a broader approach. Even taking your example, getting to the point of removing a pre-invasive adenocarcinoma is actually very complicated. You need a motivated patient, you need a healthcare team of specialist doctors or nurse practitioners, pathologists, radiologists, anaesthesiologists, nurses, an endoscopy suite, a recovery area, you need a system to follow up and track these cases etc. The full embedded cost of this undertaking is huge, I don't think it is scalable, and at the same time, will never capture everyone. Randomised studies usually just barely show that these screening approaches are better than not screening, once false positives are accounted for. Furthermore, you have chosen an example where there is a useful pre-screening test (fecal blood tests), a relatively non-invasive diagnostic test (colonoscopy) and a relatively painless intervention (removing a polyp with the scope). This is not broadly applicable. A pancreatic lesion for example is very hard to diagnose for sure, and the intervention is a massive and life changing operation.
- 7y ago
ufo 7y ago
There are reasons why this is probably not a good idea. 1. Even the best tests have a chance that the scan will produce a false positive. If we indiscriminately test everyone for every disease under the sun, most of the findings will be false positives. 2. The benefit must outweigh the cost of the test. Both in terms of expense, and intrinsic factors such as radiation exposure. 3. Certain things that show up in a scan would never cause a problem if they were just left alone. In these cases detecting it early has little benefit, and may lead to unnecessary interventions. 4. If a cure is not available, testing for the disease may not always be appropriate, from an ethics point of view.
- cc81 7y ago
  False positives could just be us not being able to detect that they are just false positives while more advanced methods and technologies might be able to differ.
  - ufo 7y ago
    That's true. The problem is that most diseases occur in a very small percentage of the population (less than 1/100 or 1/1000), which means that unless the false positive rate is exceedingly small, testing the population as a whole will still produce a bunch of false positives. This is one of the reasons why doctors only order a test if there is a reasonable suspicion that the underlying disease is present.

by mikece 7y ago

3fe9a03ccd14ca5 7y ago

I think I’ll pass on being a beta tester. Sounds like there’s a lot of risk from unnecessary intervention.

jabits 7y ago
Only if you act on it. Just because you know or suspect something doesn’t mean you have to do something about it.
jcims 7y ago
My wife had multiple softball sized tumors growing in her abdomen for months/years that would have easily been detected by something like this. Instead they burst and metastasized and now we're a million dollars deep into medical treatments and still nothing remotely resembling a guarantee of resolution. You can always choose not to act on what you learn. You can't act on what you don't know.
- catalogia 7y ago
  > You can always choose not to act on what you learn. You can't act on what you don't know. You can also act on what you think you know but in fact don't. False negatives kill people but so can false positives.
  - jcims 7y ago
    What are the numbers though? Having unnecessary procedures done because of false positives from a screening test can absolutely kill people, but so can wearing a seatbelt. People drown and burn up all the time because they couldn't get out of a wrecked vehicle. There is presently some set of screening tests with varying levels of sensitivity and specificity, and they aren't all appropriate for mass screening. However, if millions of people started regularly getting non-ionizing imaging done through MRI or ultrasound or infrared or whatever, we would learn a shitload about predicting maladies and likely save quite a few more people than we kill in the process.
    - catalogia 7y ago
      > What are the numbers though? I couldn't say, but I wage the medical science community / industry is cognizant of the phenomena and, not being an expert in the field myself, I trust them to handle the matter reasonably. In the specific case of breast cancer, I've heard that the cost of false positives is high enough to be a major consideration in recommended breast cancer screening schedules.
- jturpin 7y ago
  Yeah I'm on your side here. This fear of AI medicine creating false positives that overwhelm hospitals and doctors and cause unnecessary and risky surgery is one of those ideas I see floating around comments here and there, and it doesn't seem to be backed in anything tangible. I mean maybe it's a concern, but it also seems like that if it ever happened, we'd adjust for it quickly.

Gatsky 7y ago

This is the wrong idea. Detecting pathology early and then treating it is going to be complicated and expensive, and available to only a few people for a long time. We don't actually want some kind of constant AI body surveillance (for CTE?? So an NFL player can take just enough knocks before they retire?). What we want is prevention, not early detection. Bear in mind that prevention is a proven outcome, because some people never get Alzheimers, and some people never get cancer. Detecting cancer or Alzheimers early and then intervening to cure the condition is actually not something that is definitely possible.

dwelch 7y ago
While I think I know what you’re getting at, there are of course examples of “detecting pathology early and then treating it” preventing morbidity, mortality, and saving money. This is the basis of all (good) public health cancer screening practices. Think of a screening colonoscopy identifying a local pre-invasive adenocarcinoma and cutting it out (cure).
- Gatsky 7y ago
  There are specific examples for high prevalence conditions as you cite, but the original comment was not talking about that, it was talking about a broader approach. Even taking your example, getting to the point of removing a pre-invasive adenocarcinoma is actually very complicated. You need a motivated patient, you need a healthcare team of specialist doctors or nurse practitioners, pathologists, radiologists, anaesthesiologists, nurses, an endoscopy suite, a recovery area, you need a system to follow up and track these cases etc. The full embedded cost of this undertaking is huge, I don't think it is scalable, and at the same time, will never capture everyone. Randomised studies usually just barely show that these screening approaches are better than not screening, once false positives are accounted for. Furthermore, you have chosen an example where there is a useful pre-screening test (fecal blood tests), a relatively non-invasive diagnostic test (colonoscopy) and a relatively painless intervention (removing a polyp with the scope). This is not broadly applicable. A pancreatic lesion for example is very hard to diagnose for sure, and the intervention is a massive and life changing operation.
7y ago

ufo 7y ago

There are reasons why this is probably not a good idea. 1. Even the best tests have a chance that the scan will produce a false positive. If we indiscriminately test everyone for every disease under the sun, most of the findings will be false positives. 2. The benefit must outweigh the cost of the test. Both in terms of expense, and intrinsic factors such as radiation exposure. 3. Certain things that show up in a scan would never cause a problem if they were just left alone. In these cases detecting it early has little benefit, and may lead to unnecessary interventions. 4. If a cure is not available, testing for the disease may not always be appropriate, from an ethics point of view.

cc81 7y ago
False positives could just be us not being able to detect that they are just false positives while more advanced methods and technologies might be able to differ.
- ufo 7y ago
  That's true. The problem is that most diseases occur in a very small percentage of the population (less than 1/100 or 1/1000), which means that unless the false positive rate is exceedingly small, testing the population as a whole will still produce a bunch of false positives. This is one of the reasons why doctors only order a test if there is a reasonable suspicion that the underlying disease is present.