5 ms·

Care to elaborate?

chongli 7y ago
False positives are a major source of morbidity in cancer treatment. Biopsies and unnecessary major surgeries are a big problem.
- nopinsight 7y ago
  What if human doctors double check results for false positives? They will help prevent unnecessary procedures. The algorithms would still allow scans to be read more efficiently since negative results for low-risk patients can be mostly automated away.
  - chongli 7y ago
    If a human radiologist is double-checking all of the results (for both false positives and false negatives) then it's not so much a disruptive technology, it's another tool in the radiologist's tool belt at that point.
    - jlisam13 7y ago
      how about less radiologists required to double check? I would consider that as disruptive.
    - jrumbut 7y ago
      You say that like it's a bad thing! I don't think taking the human all the way out of the loop is a great idea given the state of models we've seen to date (in medicine, anyway). I think a better direction would be looking at how to make these systems more complementary with human operators, surfacing interesting features or distant connections humans tend to miss and guarding against the big errors anyone might make staring at grayscale images on the night shift.
    - nopinsight 7y ago
      As in my last sentence, even just mostly automating the cases with negative results for low-risk patients would improve throughout and efficiency quite a bit. Yes, I agree it should be another, yet increasingly important tool for a while. Perhaps not until a near-AGI is invented that machines can completely automate away doctor jobs.
    - m_ke 7y ago
      Radiologists get second opinions all the time. I've seen radiology projects where the radiologists gave a different reading almost 40% of the time. (example of this: https://pubs.rsna.org/doi/full/10.1148/radiol.2018171557 https://pubs.rsna.org/doi/full/10.1148/radiol.2018171557). In some cases they also spend a lot of time annotating and measuring small areas of the images and having a model generate suggestions for them would save a ton of time.
- jcims 7y ago
  Are you aware of any studies in this regard? I can't find anything conclusive, just handwavy assertions like this[0]: If the NNS for a screening test is 5,000, those who advocate screening must make the ethical argument that the large benefits to 1 individual justify the sum of the harms to which 4,999 people are exposed. Whether this holds up to moral scrutiny depends on the nature of the harms. The problem that I think the medical community misses is that the unwashed masses are generally completely unable to access procedures that aren't recommended by a doctor. So in the above assertion, that someone 'advocating for screening' must take on the ethical burden of harms coming from that screening, in my estimation, is complete and utter bullshit. What I would prefer to see is that screening comes with patient education so they understand the potential risks and inaccuracies and then let 'er rip. If something goes south, it's on them. [0] https://www.ncbi.nlm.nih.gov/books/NBK223933/ https://www.ncbi.nlm.nih.gov/books/NBK223933/
  - DanBC 7y ago
    Here's an easy to read introduction to over-testing and over-diagnosis. This isn't talking about false postives. It's talking about harm caused by actual positives. https://ebm.bmj.com/content/23/1/1 https://ebm.bmj.com/content/23/1/1 Gerd Gigerenzer has done a lot of work on this, so his books are useful. Reckoning With Risk or Risk Savvy are good. > What I would prefer to see is that screening comes with patient education so they understand the potential risks and inaccuracies and then let 'er rip. If something goes south, it's on them. Informed choice should already be built into all healthcare systems because it's a feature of international human rights laws and patients are usually allowed to decline to have a test done. And there's usually a doctor somewhere who'll perform an unnecessary test if you're prepared to pay. Communicating risk is difficult. We know that merely giving people information and letting them take full responsibility won't work. We know it won't work because we already study whether people understand the risks of testing and treatment, and we find a disturbingly large number of people don't, and that includes the HCPs recommending the testing and treatments. Most people struggle with this question: "A machine has been invented to scan a population for a disease. The machine is good but not perfect. If you have the disease there is a 90% chance it will return positive. If you do not have the disease there is a 1% chance it will return positive. About 1% of the population have the disease. Mr Smith is tested, and the test comes back positive. What's the chance Mr Smith actually has the disease?" But the problem of lack of numeracy is more severe: only 20% - 25% of people understand that 0.1% is 1 in 1,000. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310025/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310025/ People do not understand the difference between "absolute" vs "relative" risk increases, so we see newspapers reporting "100% increase in risk from eating X" when the numbers are an increase from 1:100,000 to 2:100,000 deaths. https://bestpractice.bmj.com/info/toolkit/practise-ebm/understanding-risk/ https://bestpractice.bmj.com/info/toolkit/practise-ebm/under... https://www.eufic.org/en/understanding-science/article/absolute-vs.-relative-risk-infographic https://www.eufic.org/en/understanding-science/article/absol...

Care to elaborate?

False positives are a major source of morbidity in cancer treatment. Biopsies and unnecessary major surgeries are a big problem.

nopinsight 7y ago
What if human doctors double check results for false positives? They will help prevent unnecessary procedures. The algorithms would still allow scans to be read more efficiently since negative results for low-risk patients can be mostly automated away.
- chongli 7y ago
  If a human radiologist is double-checking all of the results (for both false positives and false negatives) then it's not so much a disruptive technology, it's another tool in the radiologist's tool belt at that point.
  - jlisam13 7y ago
    how about less radiologists required to double check? I would consider that as disruptive.
  - jrumbut 7y ago
    You say that like it's a bad thing! I don't think taking the human all the way out of the loop is a great idea given the state of models we've seen to date (in medicine, anyway). I think a better direction would be looking at how to make these systems more complementary with human operators, surfacing interesting features or distant connections humans tend to miss and guarding against the big errors anyone might make staring at grayscale images on the night shift.
  - nopinsight 7y ago
    As in my last sentence, even just mostly automating the cases with negative results for low-risk patients would improve throughout and efficiency quite a bit. Yes, I agree it should be another, yet increasingly important tool for a while. Perhaps not until a near-AGI is invented that machines can completely automate away doctor jobs.
  - m_ke 7y ago
    Radiologists get second opinions all the time. I've seen radiology projects where the radiologists gave a different reading almost 40% of the time. (example of this: https://pubs.rsna.org/doi/full/10.1148/radiol.2018171557 https://pubs.rsna.org/doi/full/10.1148/radiol.2018171557). In some cases they also spend a lot of time annotating and measuring small areas of the images and having a model generate suggestions for them would save a ton of time.
jcims 7y ago
Are you aware of any studies in this regard? I can't find anything conclusive, just handwavy assertions like this[0]: If the NNS for a screening test is 5,000, those who advocate screening must make the ethical argument that the large benefits to 1 individual justify the sum of the harms to which 4,999 people are exposed. Whether this holds up to moral scrutiny depends on the nature of the harms. The problem that I think the medical community misses is that the unwashed masses are generally completely unable to access procedures that aren't recommended by a doctor. So in the above assertion, that someone 'advocating for screening' must take on the ethical burden of harms coming from that screening, in my estimation, is complete and utter bullshit. What I would prefer to see is that screening comes with patient education so they understand the potential risks and inaccuracies and then let 'er rip. If something goes south, it's on them. [0] https://www.ncbi.nlm.nih.gov/books/NBK223933/ https://www.ncbi.nlm.nih.gov/books/NBK223933/
- DanBC 7y ago
  Here's an easy to read introduction to over-testing and over-diagnosis. This isn't talking about false postives. It's talking about harm caused by actual positives. https://ebm.bmj.com/content/23/1/1 https://ebm.bmj.com/content/23/1/1 Gerd Gigerenzer has done a lot of work on this, so his books are useful. Reckoning With Risk or Risk Savvy are good. > What I would prefer to see is that screening comes with patient education so they understand the potential risks and inaccuracies and then let 'er rip. If something goes south, it's on them. Informed choice should already be built into all healthcare systems because it's a feature of international human rights laws and patients are usually allowed to decline to have a test done. And there's usually a doctor somewhere who'll perform an unnecessary test if you're prepared to pay. Communicating risk is difficult. We know that merely giving people information and letting them take full responsibility won't work. We know it won't work because we already study whether people understand the risks of testing and treatment, and we find a disturbingly large number of people don't, and that includes the HCPs recommending the testing and treatments. Most people struggle with this question: "A machine has been invented to scan a population for a disease. The machine is good but not perfect. If you have the disease there is a 90% chance it will return positive. If you do not have the disease there is a 1% chance it will return positive. About 1% of the population have the disease. Mr Smith is tested, and the test comes back positive. What's the chance Mr Smith actually has the disease?" But the problem of lack of numeracy is more severe: only 20% - 25% of people understand that 0.1% is 1 in 1,000. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310025/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310025/ People do not understand the difference between "absolute" vs "relative" risk increases, so we see newspapers reporting "100% increase in risk from eating X" when the numbers are an increase from 1:100,000 to 2:100,000 deaths. https://bestpractice.bmj.com/info/toolkit/practise-ebm/understanding-risk/ https://bestpractice.bmj.com/info/toolkit/practise-ebm/under... https://www.eufic.org/en/understanding-science/article/absolute-vs.-relative-risk-infographic https://www.eufic.org/en/understanding-science/article/absol...