27 ms·

If we can have cheap scanners or other instruments to go with the AI, I think it could easily appear as a screening tool that less qualified medical professiona

If we can have cheap scanners or other instruments to go with the AI, I think it could easily appear as a screening tool that less qualified medical professionals (midwives, nurses, GPs) or even the patients themselves can use. Those people already do various rough screening tests and refer the patient up the chain of expertise according to the outcome.

gjulianm 5y ago
> If we can have cheap scanners or other instruments to go with the AI That's a big if already. Not to mention that a lot of times you don't want to give unnecessary radiation to patients, so they wouldn't be interested in making, say, X-rays more accesible. > screening tool that less qualified medical professionals (midwives, nurses, GPs) or even the patients themselves can use But how beneficial would that be? When you need an scan, it's probable that something weird is happening, and you'll probably need more tests than just a scan, and also some specialist that knows which tests to order and what conditions to consider. Once you think of it in that way, it makes less sense. You'd be investing money, resources, training, time into a solution that might benefit only a small subset of patients (those with something weird but that can easily be discarded by a cheap scanner with high certainty without needing an specialist), without even being sure of what actual clinical benefits you would produce. It's far better to invest and research in other areas.
- exporectomy 5y ago
  I was thinking more like ultrasound. If some crude scanner was cheap enough for every GP's office to have, and an AI could decipher the noisy signal which is perhaps too messy for a human to read, it could be used routinely like blood pressure measurement and stethoscopes are. If it's a regular screening test rather than a response to the patient's complaint, then false negatives wouldn't be as much of a problem because at least it's better than nothing.
  - gjulianm 5y ago
    Ultrasound scanners are fairly cheap. But operating them is not easy, you still need training to use them and know what you're looking at. > it's better than nothing. Not necessarily, that's the issue with screening asymptomatic people. You have to balance the consequences and rates of false positives with the benefits of true positives. If ultrasound screening mostly catches indolent diseases, or those where catching them so early doesn't affect outcomes too much; and you have a lot of people going through unnecessary/risky tests, you might end up doing more damage with those screenings. It's not so easy.
    - Enginerrrd 5y ago
      The potential harm runs deeper than this even. Once a structural abnormality is found, the nocebo effect can come into play and essentially cause symptoms in asymptomatic people, which is a terrible result.
      - inglor_cz 5y ago
        Also, one thing that is found does not preclude existence of other things to be found. The first discovered problem may attract so much attention that potential others are neglected. Tl;dr: the first diagnosis tends to stick with the patient.
    - exporectomy 5y ago
      I know that can be an issue but like you say, there's a balance and I don't think we know where that balance is for the non-existent AI technology with unknown error rates. Newborn babies undergo a whole lot of simple and inaccurate screenings. I guess those are cases where the harm due to inappropriate treatments is lower than that due to leaving diseases undetected. Either way, I'd rather the technology exist and then people work out how best to use it, rather than the decision being forced on us by it not existing.
  - hdhjebebeb 5y ago
    I had an abdominal ultrasound recently - the actual process of placing the probe and annotating the images seems like a pretty specific technical skill. I don't think any old person (or even a doctor) off the street can just rub the wand on you and find your kidneys for instance.

gjulianm 5y ago

> If we can have cheap scanners or other instruments to go with the AI That's a big if already. Not to mention that a lot of times you don't want to give unnecessary radiation to patients, so they wouldn't be interested in making, say, X-rays more accesible. > screening tool that less qualified medical professionals (midwives, nurses, GPs) or even the patients themselves can use But how beneficial would that be? When you need an scan, it's probable that something weird is happening, and you'll probably need more tests than just a scan, and also some specialist that knows which tests to order and what conditions to consider. Once you think of it in that way, it makes less sense. You'd be investing money, resources, training, time into a solution that might benefit only a small subset of patients (those with something weird but that can easily be discarded by a cheap scanner with high certainty without needing an specialist), without even being sure of what actual clinical benefits you would produce. It's far better to invest and research in other areas.

exporectomy 5y ago
I was thinking more like ultrasound. If some crude scanner was cheap enough for every GP's office to have, and an AI could decipher the noisy signal which is perhaps too messy for a human to read, it could be used routinely like blood pressure measurement and stethoscopes are. If it's a regular screening test rather than a response to the patient's complaint, then false negatives wouldn't be as much of a problem because at least it's better than nothing.
- gjulianm 5y ago
  Ultrasound scanners are fairly cheap. But operating them is not easy, you still need training to use them and know what you're looking at. > it's better than nothing. Not necessarily, that's the issue with screening asymptomatic people. You have to balance the consequences and rates of false positives with the benefits of true positives. If ultrasound screening mostly catches indolent diseases, or those where catching them so early doesn't affect outcomes too much; and you have a lot of people going through unnecessary/risky tests, you might end up doing more damage with those screenings. It's not so easy.
  - Enginerrrd 5y ago
    The potential harm runs deeper than this even. Once a structural abnormality is found, the nocebo effect can come into play and essentially cause symptoms in asymptomatic people, which is a terrible result.
    - inglor_cz 5y ago
      Also, one thing that is found does not preclude existence of other things to be found. The first discovered problem may attract so much attention that potential others are neglected. Tl;dr: the first diagnosis tends to stick with the patient.
  - exporectomy 5y ago
    I know that can be an issue but like you say, there's a balance and I don't think we know where that balance is for the non-existent AI technology with unknown error rates. Newborn babies undergo a whole lot of simple and inaccurate screenings. I guess those are cases where the harm due to inappropriate treatments is lower than that due to leaving diseases undetected. Either way, I'd rather the technology exist and then people work out how best to use it, rather than the decision being forced on us by it not existing.
- hdhjebebeb 5y ago
  I had an abdominal ultrasound recently - the actual process of placing the probe and annotating the images seems like a pretty specific technical skill. I don't think any old person (or even a doctor) off the street can just rub the wand on you and find your kidneys for instance.