5 ms·

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 t

by 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.
jcims 7y ago
We can want what we want but we have to work with what we've got. Cancer prevention is best, I agree, but it's not always clear that it can be perfectly prevented. So then you have to move to detection and therapeutic intervention to either eliminate the cancer or prevent it from materially impacting the health of the individual. And with cancer specifically, early detection is one of the best predictors of a good outcome. This is not always possible of course, some cancers are very difficult to detect, but some aren't. It just seems like we are making perfect the enemy of good.
- Gatsky 7y ago
  What you are saying sounds reasonable, but I still feel very strongly that prevention is the key. Consider that prostate and breast cancer are extremely common, occurring in 1 in 6 men and 1 in 7 women respectively in Western countries. As someone that treats cancer, I can tell you that management of an established cancer, even if detected early, is very complex and highly unpleasant for the patient, if not only psychologically. This is unlikely to change, except it will get more expensive. The strongest argument is an economic one. If we can develop preventative treatments that we can just give to everyone, it is a much more justifiable expenditure. The risks and benefits are much clearer. This is in contrast to what we do now, which is apply extremely expensive and complex care to a group of people that are diagnosed with cancer. There are only a small number of people in the world that can even get this care. Consider that a preventative therapy is the only type of therapy some people in the world will ever get for their cancer. Papua New Guinea for example has zero oncology specialists in a country of 8 million people.
  - jcims 7y ago
    >I still feel very strongly that prevention is the key In case it didn't come through I'm 100% agreement with you on this. Learning about TIL and CAR-T therapies now, but in general feel that cancer vaccines would rival any pharmaceutical on the market in terms of profitability and net decrease in global misery. Just trying to optimize the time between now and that (IMHO) inevitable day.
  - dennis_jeeves 7y ago

by Gatsky 7y ago

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.

jcims 7y ago

We can want what we want but we have to work with what we've got. Cancer prevention is best, I agree, but it's not always clear that it can be perfectly prevented. So then you have to move to detection and therapeutic intervention to either eliminate the cancer or prevent it from materially impacting the health of the individual. And with cancer specifically, early detection is one of the best predictors of a good outcome. This is not always possible of course, some cancers are very difficult to detect, but some aren't. It just seems like we are making perfect the enemy of good.

Gatsky 7y ago
What you are saying sounds reasonable, but I still feel very strongly that prevention is the key. Consider that prostate and breast cancer are extremely common, occurring in 1 in 6 men and 1 in 7 women respectively in Western countries. As someone that treats cancer, I can tell you that management of an established cancer, even if detected early, is very complex and highly unpleasant for the patient, if not only psychologically. This is unlikely to change, except it will get more expensive. The strongest argument is an economic one. If we can develop preventative treatments that we can just give to everyone, it is a much more justifiable expenditure. The risks and benefits are much clearer. This is in contrast to what we do now, which is apply extremely expensive and complex care to a group of people that are diagnosed with cancer. There are only a small number of people in the world that can even get this care. Consider that a preventative therapy is the only type of therapy some people in the world will ever get for their cancer. Papua New Guinea for example has zero oncology specialists in a country of 8 million people.
- jcims 7y ago
  >I still feel very strongly that prevention is the key In case it didn't come through I'm 100% agreement with you on this. Learning about TIL and CAR-T therapies now, but in general feel that cancer vaccines would rival any pharmaceutical on the market in terms of profitability and net decrease in global misery. Just trying to optimize the time between now and that (IMHO) inevitable day.
- dennis_jeeves 7y ago