3 ms·

This one is even more relevant as he talks about dangers of over screening for beast cancer, and side effects of mastectomy+chemo: https://youtu.be/yNzQ_sLGIuA

by ejolto 5y ago

This one is even more relevant as he talks about dangers of over screening for beast cancer, and side effects of mastectomy+chemo: https://youtu.be/yNzQ_sLGIuA https://youtu.be/yNzQ_sLGIuA

aeternum 5y ago
Even in his examples, the screening itself does not seem to be the problem. It's relatively cheap and quick. The problem was the decision to undergo treatment when the complications outweighed the benefit. What if we did more screening but also less treatment?
- allturtles 5y ago
  Unfortunately you can't know the benefit in advance. It's not generally possible to tell from a MRI/CT that detects a tumor if it will kill you soon if not treated, if it will kill you no matter what you do, or if it will just sit there for a decade and do nothing.
  - aeternum 5y ago
    The only way we will figure that out is to collect lots of data on it. Perhaps there are correlations in the MRI/CT that determine lethality/malignancy. Even if we perform zero treatment, this data argument should be sufficient reason to increase rather than decrease the number of MRIs we do. CT is different since there is some radiation exposure risk that must be considered.
    - jedberg 5y ago
      If you do a screening and find something that might be cancer and do nothing about it, you've committed a major ethical violation. If you tell the patient "we found something that might be cancer but we suggest you don't do anything about it so we can get more data on whether it ends up killing you", well, the patient will probably see another doctor.
    - allturtles 5y ago
      I'm not sure how this would work. Doctors start ordering lots of MRIs that wouldn't have been ordered before, and some percentage of those that wouldn't have been ordered before show tumors. Now what to do you do? If you are just doing it to gather data, you don't tell the patients the results, I guess? This seems unethical. If you do disclose the results and proceed with a normal patient relationship, you are in the same dilemma as above. You don't know if the tumor is dangerous or not, so the safe course is to do a biopsy, which is itself often invasive. Depending on the results that may lead larger surgeries to exicse large parts of organs and/or the starting of chemotherapy. Also MRIs are expensive, and in the U.S. a significant amount of that cost (usually hundreds of dollars) is borne by the patient, even if they are insured. But I don't think we lack for MRI or CT data, there are lots ordered every year. The biggest problem with gathering your data set would be medical privacy regulations. I would guess that medical researchers have already tried longitudinal studies on this to see if different imaging characteristics lead to different outcomes. It's a hard problem, the only data you really get from scans is tissue density, which can probably never tell you what you need to know.

by ejolto 5y ago

This one is even more relevant as he talks about dangers of over screening for beast cancer, and side effects of mastectomy+chemo: https://youtu.be/yNzQ_sLGIuA https://youtu.be/yNzQ_sLGIuA

aeternum 5y ago

Even in his examples, the screening itself does not seem to be the problem. It's relatively cheap and quick. The problem was the decision to undergo treatment when the complications outweighed the benefit. What if we did more screening but also less treatment?

allturtles 5y ago
Unfortunately you can't know the benefit in advance. It's not generally possible to tell from a MRI/CT that detects a tumor if it will kill you soon if not treated, if it will kill you no matter what you do, or if it will just sit there for a decade and do nothing.
- aeternum 5y ago
  The only way we will figure that out is to collect lots of data on it. Perhaps there are correlations in the MRI/CT that determine lethality/malignancy. Even if we perform zero treatment, this data argument should be sufficient reason to increase rather than decrease the number of MRIs we do. CT is different since there is some radiation exposure risk that must be considered.
  - jedberg 5y ago
    If you do a screening and find something that might be cancer and do nothing about it, you've committed a major ethical violation. If you tell the patient "we found something that might be cancer but we suggest you don't do anything about it so we can get more data on whether it ends up killing you", well, the patient will probably see another doctor.
  - allturtles 5y ago
    I'm not sure how this would work. Doctors start ordering lots of MRIs that wouldn't have been ordered before, and some percentage of those that wouldn't have been ordered before show tumors. Now what to do you do? If you are just doing it to gather data, you don't tell the patients the results, I guess? This seems unethical. If you do disclose the results and proceed with a normal patient relationship, you are in the same dilemma as above. You don't know if the tumor is dangerous or not, so the safe course is to do a biopsy, which is itself often invasive. Depending on the results that may lead larger surgeries to exicse large parts of organs and/or the starting of chemotherapy. Also MRIs are expensive, and in the U.S. a significant amount of that cost (usually hundreds of dollars) is borne by the patient, even if they are insured. But I don't think we lack for MRI or CT data, there are lots ordered every year. The biggest problem with gathering your data set would be medical privacy regulations. I would guess that medical researchers have already tried longitudinal studies on this to see if different imaging characteristics lead to different outcomes. It's a hard problem, the only data you really get from scans is tissue density, which can probably never tell you what you need to know.