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This is one of those medical revolutions that I am waiting dearly for. Facilities that are not hospitals(to avoid the risk of occupying medical devices that s

This is one of those medical revolutions that I am waiting dearly for. Facilities that are not hospitals(to avoid the risk of occupying medical devices that sick people need) built to _regulary_ check up otherwise healthy people for preventive care. Heck, I have so many alerts defined on my monitoring setup for servers to watch for signals of failure before they get too big. But, my own body is not observed until something bad needs treatment. Why can’t we observe ourselves medically and analyze that record for early signs of trouble before it becomes serious?! All the advancement in technology in recent years, this ought to happen sooner than later.

zrail 5y ago
That's already a thing, at least everywhere I've ever lived. You have a primary care doctor, you see them at least once a year, they do a physical exam, maybe some blood work. This test maybe becomes standard of care for everyone annually.
- reacharavindh 5y ago
  May be I have been living in a bubble. I remember doing a “annual check up” in the US about 5 years ago, and that was super basic - blood pressure, sugar, cholesterol levels etc. they didn’t even do a detailed enough bloodwork to test for allergies. Definitely not looking for any disease vectors. Now, I live in DK, and my visit to the GP would always go with my hard attempts to convince my GP that something is really wrong and I am not a crazy lunatic who is simply looking for attention. Although, I have never directly asked for a checkup(while being healthy) to look for disease vectors. I’ll ask and see what they say. I’d prefer if this is outside of the general healthcare system though. I don’t want to occupy Doctors, and medical labs from people who are actually sick _now_ and need those tests, and attention.
  - flemhans 5y ago
    Another Danish person here, your GP would never check you in any sort of fashion here, unless you already have (serious) symptoms.
  - horstmeyer 5y ago
    Same for me in Germany. You are eligible to one checkup when you turn 35, that's it, lol. Otherwise you have to convince the doctor a certain check is necessary. Usually doctors don't like that very much. I would even happily pay for it myself, but I still need to convince the doctor I'm not a hypochondriac.
    - moooo99 5y ago
      Thats not true. The cost of the checkup are covered once before you turn 35 and every three years for anybody above the age of 35 [1]. Still, people have to be willing to do that checkup, make an appointment by themselves and so on. Still, seeing what is and what isn't covered by public health insurance just seems so stupid. The focus on cure instead of prevention, and that not even particularly good. It's sad to see how much money goes to waste for useless treatments with something like homeopathy while people who really need proper treatment are stuck with the cheapest option that is paid for. [1] https://www.bundesgesundheitsministerium.de/checkup.html https://www.bundesgesundheitsministerium.de/checkup.html (German)
      - horstmeyer 5y ago
        Thanks for the correction, that was what my doctor told me. But maybe I also misunderstood him.
  - refurb 5y ago
    This approach actually works really well for conserving healthcare dollars. If a doctor feels like nothing is wrong, 99% of the time they’ll be right. Sucks to be that 1% where you die of a cancer that would have been caught, but that’s the trade off. The marginal return of each dollars spent on screening goes down quickly. At a population level you can’t justify it, but at a personal level you can.
  - msrenee 5y ago
    I don't think blood tests for allergies are a regular thing anywhere. It's generally done if you can't have the skin testing and the skin testing is something you go to a specialist for. It's not something that's screened for regularly.
- vmception 5y ago
  That’s not good enough for cancer because we dont even know how fast or slow it grows. Even if it cancer cells multiplied at the rate of a fetus that would be too fast for an annual physical. Congratulations, death. Ideally something like a wearable computer or nanomachines in your blood stream automatically report anomalies for individualized treatment.
  - danuker 5y ago
    > Even if cancer cells multiplied at the rate of a fetus I suspect at least some cancers multiply slower than that, because they work against the rest of the cells.
  - dryrun 5y ago
    Given the amount of "I don't want bill gates injecting me a tracker!", I have some idea of how a conversation with the same people about nano machines in their body would go. I would also bet on the time-frame between this and the availability of your data on the servers of your health insurance.
    - vmception 5y ago
      Not my problem, human cancers stay in there own bodies and are not communicable To our knowledge
      - jacquesm 5y ago
        Not normally, no. But there are some puzzling exceptions: https://www.discovermagazine.com/health/the-cancers-that-are-contagious https://www.discovermagazine.com/health/the-cancers-that-are...
        vmception 5y ago
        These are all in animals and I specified human cancers for that specific reason, thanks for the article though, I only knew about the Tasmanian Devil one
- Clampower 5y ago
  This is not true in the Netherlands. You don’t get any tests if there is nothing wrong. Healthcare in this country scares me.
  - pelorat 5y ago
    You can ask for a blood test though and ask that they check specific markers. But I agree that huisartsen are too dismissive in general.
    - egeozcan 5y ago
      Same in Germany (Hausärzte). Even if you have a specific complaint, you'll just be told to go home and drink a lot of water. They just don't have the capacity to test for causes. I'm not sure if I can even pay someone to make extensive tests here. Never tried. Perhaps one needs to go to the US for that.
  - the-dude 5y ago
    Take control. Regular doctors in NL are basically there to prevent you from getting care. Say you want a blood test, and what for. I they don't cooperate, move to the next doctor.
  - danuker 5y ago
    In the US, the medical system was (and might still be) the top third cause of death, of which 5/6ths were due to medicine side-effects. https://nutritionfacts.org/video/how-doctors-responded-to-being-named-a-leading-killer/ https://nutritionfacts.org/video/how-doctors-responded-to-be... I suspect doctors in the Netherlands are taught not to over-diagnose. Are they paid through national insurance?
    - goodpoint 5y ago
      Yes, the US medical system is a disaster.
  - refurb 5y ago
    Really? Not even a blood pressure check or a physician listening to your lungs or just examine your skin for weird moles? That’s terrible.
- postingawayonhn 5y ago
  I've never lived anywhere where this was common. The public health system can't afford to fund it and most of the population doesn't want to (or can't afford to) pay for it themselves.
xwdv 5y ago
My experience is people don’t really care much about their bodies beyond the aesthetics. Most treat it like a dumpster and ingest whatever crap feels good and hope for the best. Caring too much makes you some sort of health freak in their eyes, with way too much time on your hands.
- carlmr 5y ago
  I'm not sure this is true. At least in my friend circle most people put a lot of care into their nutrition and fitness. Maybe talk to your friends about it and get them to be healthier?
  - handrous 5y ago
    How do you think we get the rates of diabetes and obesity we have in the US, without that being true for most people in most places and in most social circles? Rich social networks tend to live much healthier lifestyles than average. Normal is fried starch and tens to hundreds of ounces of soda more days than not, and exercise is that maybe you golf sometimes or play in a seasonal company softball league (drinking way more calories than you're burning, almost certainly).
- danuker 5y ago
  The top risk factors for death confirm what you say, sadly. https://ourworldindata.org/causes-of-death#the-number-of-deaths-by-risk-factor https://ourworldindata.org/causes-of-death#the-number-of-dea...
sbelskie 5y ago
A big part of this is the fact that learning information (about a disease or condition) early is often NOT the same thing as learning information that will change a patient’s clinical outcome.
- radu_floricica 5y ago
  I never understood this. I mean I totally get the concept, but I don't get how it came to influence policy. Put it like this: how many people are you willing to kill to make sure people don't find out they're sick? Because that's what it boils down to. And it sounds... sociopathic.
  - sbelskie 5y ago
    I’m not sure I understand what you mean. It seems like you’re framing my motivation as not wanting people to know that they are sick and being willing to trade peoples lives to achieve that outcome, which I don’t think is at all what my above comment says.
    - radu_floricica 5y ago
      It is how I understood it, sorry about that. What did you mean?
  - dabbledash 5y ago
    The idea is that treatment also has risks and false positives are an issue. If you gave a mammogram to every 20 year old woman, you would end up doing a large number of unnecessary biopsies and you’d find almost no real cancer. In the end, you’d lose more people than you would save. Or that’s the idea. I’m no expert in this but it makes sense to me conceptually.
    - JumpCrisscross 5y ago
      > If you gave a mammogram to every 20 year old woman, you would end up doing a large number of unnecessary biopsies and you’d find almost no real cancer If you gave a mammogram to every 20-year old, you wouldn't do a biopsy when you got a positive. You'd increase monitoring and maybe suggest lifestyle changes. The same way we don't immediately catherize everyone who comes back with high cholesterol.
Gatsky 5y ago
Note this test is about early detection, not prevention. If your pancreatic cancer is detected early, you will still need to have your insides rearranged to get it out.
- junon 5y ago
  "Preventative care" refers to the field of medicine called preventative medicine/care/health, which specifically aims at making regular checkups and other monitoring facilities free and accessible in order to improve health via early-detection. Oftentimes, doing these sorts of things lowers your insurance premiums or makes costs lower if something does happen (not always, but sometimes). These sorts of things are also generally free as it costs the insurance company less in the long run if you're doing them frequently enough. Perhaps a bit of a misnomer, but "preventative care" doesn't necessarily mean medicinal prevention of any sort.
- dannyw 5y ago
  That's a critically better health outcome though. It's like fixing a corruption bug when you detect it on one server, versus finding out there's corruption in every shard and all of your backups.
  - carlmr 5y ago
    Ransomware infecting one machine or all machines including backups would also be a good analogy.
  - jacquesm 5y ago
    > That's a critically better health outcome though. Not necessarily. It depends on how old you are, what your genetic make-up is, whether the cancer is growing rapidly, whether it has easy access to other organs to spread to (or has already begun to do so) and so on. It's not a binary thing.
  - Gatsky 5y ago
    I’m not saying it isn’t a great development. It certainly adds an option for early detection of some cancers where there previously were none. But it isn’t cancer prevention. It is a highly sophisticated technical undertaking which for educated and motivated patients in well resourced health systems will reduce cancer mortality and morbidity by some increment. Depending on many factors this could be a big or small increment. In the real world the efficacy will be less than what the trial shows. It is also likely that Grail (with north of $1 billion in VC funding) will charge as much as they can for this test. The size of the trials necessary to prove efficacy means that there will be highly constrained competition in this space. The distinction with prevention is important, because we ultimately must aim for preventing almost all cancers, and not be content with anything less than that. Disclaimer: I’m an Oncologist.
Tolyzz 5y ago
Cause things break down all the time. And everything can look like early signs of trouble. There are lot useless docs and surgeons waiting to perform unnecessary expensive procedures much like building contractors. Oh that pipe is leaking let's just replace this entire load bearing wall etc cause we have this new cool machine that can. Second opinions are over rated cause the majority don't care. There is an endless demand for their trade. My dad lost his hearing at 35 after they performed surgery to remove a tumor they detected. They detected the same Tumor in my brother when he was in his 20s and wanted to operate with no guarantee of hearing preservation. He declined. He is going to turn 40 soon and would have most likely been deaf for 20 years if he had gone through with it. Minor issues with his balance but other than that he is fine even though tumor gets tracked every couple years and is still growing.
- BallyBrain 5y ago
  This sounds like a regulation and education problem to me. early detection doesn't have to mean treatment, it could just be monitoring and change of lifestyle.
jacquesm 5y ago
Regularly checking people that are otherwise healthy for cancer will turn up a lot of cancer through false positives or slowly growing ones, will lead to a lot of unnecessary intervention and will in fact lead to a reduction in quality of life and lifespan. This is one of the reasons why exhaustive cancer screening (which was more costly in the past but could have been done) was not promoted, it had nothing to do with ability, but everything to do with outcomes. Those cancers where checkups are useful we already do regular screenings for. For aggressive cancers - the ones that are really problematic - you would have to do such a test too frequently to make any real difference, for instance, if you were to test annually you'd be on average 6 months away from your next test, plenty of time for such a cancer to develop and kill you. So this is not the kind of breakthrough that you may think it is.
- bruce343434 5y ago
  Who are "we"? I'm certainly not "regularly" screened.
  - jacquesm 5y ago
    That's your choice, assuming you live in a developed country. Assuming the United States see here: https://www.cdc.gov/cancer/dcpc/prevention/screening.htm https://www.cdc.gov/cancer/dcpc/prevention/screening.htm and if elsewhere consult your local CDC equivalent.
    - postingawayonhn 5y ago
      Current screening methods tend to be costly and/or uncomfortable for the person being screened. A simple blood test could lead to higher uptake and more regular screening.
- tarsinge 5y ago
  > Those cancers where checkups are useful we already do regular screenings for. More like “are <practical given available tests> and useful”. Regarding your last paragraph cancer screening seems very rare except for one or two types (at least where I live), so statistically yes an annual test will miss the worst case you presented, but for the vast majority it will be a huge improvement.
deleted 5y ago
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TaupeRanger 5y ago
Actually you don't want this, and you are describing a nightmare scenario that everyone who studies health policy understands all too well. Mass screening of healthy people will result in extreme iatrogenics and unnecessary psychological damage and stress (which leads to physical effects as well), not to mention overwhelming the medical system. The fact is that many things that could be detected will never result in symptoms or other noticeable problems. Further, for many things that can be detected we can't really do much about, so by detecting it early you are just reducing the amount of life they have left without worrying about their disease, or causing unnecessary treatment (which includes unnecessary damage, cost, stress, etc.)
- throwawaynotmd 5y ago
  The argument you’re making has always bothered me because it’s hiding the ball. If finding something that otherwise carries no symptoms is best left untreated, then the fact that you found it should make no difference to the decision. The doctor should say that the best course of action is to do nothing. More information can never be harmful. If you know information is best not acted on in the abstract, then you also know you should not act on it in particular. So what you really mean but have left unspoken is one of two things. First, that doctors are untrustworthy people who make recommendations and decisions based on concerns other than their patient’s wellbeing, such as covering their asses from lawsuits or making more money. But rather than fix that, you would rather keep patients more ignorant and away from the doctor in the first place. Which actively harms people who do have honest doctors. That is, your approach of not testing hurts people with honest doctors to protect people with dishonest doctors. Or second, if you take dumb patients as the problem, you are willing to hurt people with good decision making ability (who would heed their good doctor’s advice to leave the possible ailment untreated) so you can protect people with bad decision making. Because many times, these tests will uncover things that obviously need treatment. They will save many lives. But because more stupid people will hurt themselves, then no one should have access to them. The political and moral assumptions built into these positions are immense and yet the medical field tucks those away and pretends that this is just a purely scientific truth, that someone running more harmless tests is actually inherently harmful. That is a lie! And a very nasty one at that.
hannob 5y ago
The reason this is not happening isn't a technical one. It's that people with a medical background will tell you this isn't a healthy utopia, it's a nightmare. Medical tests are complicated. They often have significant false positive and false negative rates. Testing people at scale increases the number of people with wrong test results and can cause harm if you start treating people based on wrong test results. The more healthy people you test the more false positives you get. The goal of evidence based medicine is to use tests when they can help. It's not to test as many people as possible. This is reasonable. You want to improve patient's lives. Whether or not a test is improving patient's lives is often not easy to answer and has to consider many things.
- axxto 5y ago
  The point of this is not that you get a definitive diagnosis; it's just a somewhat reliable marker on whether you may need to be concerned and get more accurate (but more harmful) imaging or invasive tests to rule out something.
  - dangerlibrary 5y ago
    You only need one false positive test result that ends up with a colonoscopy to understand how costly and uncomfortable these errors can be. (I'm using an uncomfortable and illustrative example, but a colonoscopy is honestly pretty safe and boring as invasive clinical diagnostic procedures go)
    - theptip 5y ago
      Perhaps a better example than you intended -- recently colonoscopies are being considered more risky as a regular screening tool, because the procedure itself can result in harms, including (rarely) death. Not an expert here, but it seems they are still used in a fairly wide age group, but the recent trend is to be more cautious about their usage, as particularly for older patients they are more risky vs. the potential benefits. [1] However I think this concern would be reduced if we had better first-line screening like the tests in TFA; the harms come from using a relatively-risky assay like colonoscopy for regular screening in healthy individuals, whereas if we had better noninvasive screening, the colonoscopy could be reserved for patients where there's a higher probability of a positive diagnosis. [1]: https://jamanetwork.com/journals/jama/fullarticle/2529486 https://jamanetwork.com/journals/jama/fullarticle/2529486
dukeofdoom 5y ago
One issue is that your body may have all types of tissues that might be precancerous or slow growing cancerous growths that the test will identify. To get to them and remove them would do far more damage than leaving them alone. Even with things like prostate cancer, which is fairly easy to get to. Leaving it alone, is often the right choice depending on the age of the patient and speed of growth of the cancer.
andai 5y ago
I expect this won't catch on until it becomes a wearable technology, and then it will catch on overnight.
DoreenMichele 5y ago
Why can’t we observe ourselves medically and analyze that record for early signs of trouble before it becomes serious?! We can and plenty of people do, usually with tools like health journals and smart watches recording biometrics.
matheusmoreira 5y ago
> Why can’t we observe ourselves medically and analyze that record for early signs of trouble before it becomes serious?! Maybe one day we'll have cybernetic implants that can constantly monitor our health. Hopefully it won't turn into a privacy nightmare.

zrail 5y ago

That's already a thing, at least everywhere I've ever lived. You have a primary care doctor, you see them at least once a year, they do a physical exam, maybe some blood work. This test maybe becomes standard of care for everyone annually.

reacharavindh 5y ago
May be I have been living in a bubble. I remember doing a “annual check up” in the US about 5 years ago, and that was super basic - blood pressure, sugar, cholesterol levels etc. they didn’t even do a detailed enough bloodwork to test for allergies. Definitely not looking for any disease vectors. Now, I live in DK, and my visit to the GP would always go with my hard attempts to convince my GP that something is really wrong and I am not a crazy lunatic who is simply looking for attention. Although, I have never directly asked for a checkup(while being healthy) to look for disease vectors. I’ll ask and see what they say. I’d prefer if this is outside of the general healthcare system though. I don’t want to occupy Doctors, and medical labs from people who are actually sick _now_ and need those tests, and attention.
- flemhans 5y ago
  Another Danish person here, your GP would never check you in any sort of fashion here, unless you already have (serious) symptoms.
- horstmeyer 5y ago
  Same for me in Germany. You are eligible to one checkup when you turn 35, that's it, lol. Otherwise you have to convince the doctor a certain check is necessary. Usually doctors don't like that very much. I would even happily pay for it myself, but I still need to convince the doctor I'm not a hypochondriac.
  - moooo99 5y ago
    Thats not true. The cost of the checkup are covered once before you turn 35 and every three years for anybody above the age of 35 [1]. Still, people have to be willing to do that checkup, make an appointment by themselves and so on. Still, seeing what is and what isn't covered by public health insurance just seems so stupid. The focus on cure instead of prevention, and that not even particularly good. It's sad to see how much money goes to waste for useless treatments with something like homeopathy while people who really need proper treatment are stuck with the cheapest option that is paid for. [1] https://www.bundesgesundheitsministerium.de/checkup.html https://www.bundesgesundheitsministerium.de/checkup.html (German)
    - horstmeyer 5y ago
      Thanks for the correction, that was what my doctor told me. But maybe I also misunderstood him.
- refurb 5y ago
  This approach actually works really well for conserving healthcare dollars. If a doctor feels like nothing is wrong, 99% of the time they’ll be right. Sucks to be that 1% where you die of a cancer that would have been caught, but that’s the trade off. The marginal return of each dollars spent on screening goes down quickly. At a population level you can’t justify it, but at a personal level you can.
- msrenee 5y ago
  I don't think blood tests for allergies are a regular thing anywhere. It's generally done if you can't have the skin testing and the skin testing is something you go to a specialist for. It's not something that's screened for regularly.
vmception 5y ago
That’s not good enough for cancer because we dont even know how fast or slow it grows. Even if it cancer cells multiplied at the rate of a fetus that would be too fast for an annual physical. Congratulations, death. Ideally something like a wearable computer or nanomachines in your blood stream automatically report anomalies for individualized treatment.
- danuker 5y ago
  > Even if cancer cells multiplied at the rate of a fetus I suspect at least some cancers multiply slower than that, because they work against the rest of the cells.
- dryrun 5y ago
  Given the amount of "I don't want bill gates injecting me a tracker!", I have some idea of how a conversation with the same people about nano machines in their body would go. I would also bet on the time-frame between this and the availability of your data on the servers of your health insurance.
  - vmception 5y ago
    Not my problem, human cancers stay in there own bodies and are not communicable To our knowledge
    - jacquesm 5y ago
      Not normally, no. But there are some puzzling exceptions: https://www.discovermagazine.com/health/the-cancers-that-are-contagious https://www.discovermagazine.com/health/the-cancers-that-are...
      - vmception 5y ago
        These are all in animals and I specified human cancers for that specific reason, thanks for the article though, I only knew about the Tasmanian Devil one
Clampower 5y ago
This is not true in the Netherlands. You don’t get any tests if there is nothing wrong. Healthcare in this country scares me.
- pelorat 5y ago
  You can ask for a blood test though and ask that they check specific markers. But I agree that huisartsen are too dismissive in general.
  - egeozcan 5y ago
    Same in Germany (Hausärzte). Even if you have a specific complaint, you'll just be told to go home and drink a lot of water. They just don't have the capacity to test for causes. I'm not sure if I can even pay someone to make extensive tests here. Never tried. Perhaps one needs to go to the US for that.
- the-dude 5y ago
  Take control. Regular doctors in NL are basically there to prevent you from getting care. Say you want a blood test, and what for. I they don't cooperate, move to the next doctor.
- danuker 5y ago
  In the US, the medical system was (and might still be) the top third cause of death, of which 5/6ths were due to medicine side-effects. https://nutritionfacts.org/video/how-doctors-responded-to-being-named-a-leading-killer/ https://nutritionfacts.org/video/how-doctors-responded-to-be... I suspect doctors in the Netherlands are taught not to over-diagnose. Are they paid through national insurance?
  - goodpoint 5y ago
    Yes, the US medical system is a disaster.
- refurb 5y ago
  Really? Not even a blood pressure check or a physician listening to your lungs or just examine your skin for weird moles? That’s terrible.
postingawayonhn 5y ago
I've never lived anywhere where this was common. The public health system can't afford to fund it and most of the population doesn't want to (or can't afford to) pay for it themselves.

xwdv 5y ago

My experience is people don’t really care much about their bodies beyond the aesthetics. Most treat it like a dumpster and ingest whatever crap feels good and hope for the best. Caring too much makes you some sort of health freak in their eyes, with way too much time on your hands.

carlmr 5y ago
I'm not sure this is true. At least in my friend circle most people put a lot of care into their nutrition and fitness. Maybe talk to your friends about it and get them to be healthier?
- handrous 5y ago
  How do you think we get the rates of diabetes and obesity we have in the US, without that being true for most people in most places and in most social circles? Rich social networks tend to live much healthier lifestyles than average. Normal is fried starch and tens to hundreds of ounces of soda more days than not, and exercise is that maybe you golf sometimes or play in a seasonal company softball league (drinking way more calories than you're burning, almost certainly).
danuker 5y ago
The top risk factors for death confirm what you say, sadly. https://ourworldindata.org/causes-of-death#the-number-of-deaths-by-risk-factor https://ourworldindata.org/causes-of-death#the-number-of-dea...

sbelskie 5y ago

A big part of this is the fact that learning information (about a disease or condition) early is often NOT the same thing as learning information that will change a patient’s clinical outcome.

radu_floricica 5y ago
I never understood this. I mean I totally get the concept, but I don't get how it came to influence policy. Put it like this: how many people are you willing to kill to make sure people don't find out they're sick? Because that's what it boils down to. And it sounds... sociopathic.
- sbelskie 5y ago
  I’m not sure I understand what you mean. It seems like you’re framing my motivation as not wanting people to know that they are sick and being willing to trade peoples lives to achieve that outcome, which I don’t think is at all what my above comment says.
  - radu_floricica 5y ago
    It is how I understood it, sorry about that. What did you mean?
- dabbledash 5y ago
  The idea is that treatment also has risks and false positives are an issue. If you gave a mammogram to every 20 year old woman, you would end up doing a large number of unnecessary biopsies and you’d find almost no real cancer. In the end, you’d lose more people than you would save. Or that’s the idea. I’m no expert in this but it makes sense to me conceptually.
  - JumpCrisscross 5y ago
    > If you gave a mammogram to every 20 year old woman, you would end up doing a large number of unnecessary biopsies and you’d find almost no real cancer If you gave a mammogram to every 20-year old, you wouldn't do a biopsy when you got a positive. You'd increase monitoring and maybe suggest lifestyle changes. The same way we don't immediately catherize everyone who comes back with high cholesterol.

Gatsky 5y ago

Note this test is about early detection, not prevention. If your pancreatic cancer is detected early, you will still need to have your insides rearranged to get it out.

junon 5y ago
"Preventative care" refers to the field of medicine called preventative medicine/care/health, which specifically aims at making regular checkups and other monitoring facilities free and accessible in order to improve health via early-detection. Oftentimes, doing these sorts of things lowers your insurance premiums or makes costs lower if something does happen (not always, but sometimes). These sorts of things are also generally free as it costs the insurance company less in the long run if you're doing them frequently enough. Perhaps a bit of a misnomer, but "preventative care" doesn't necessarily mean medicinal prevention of any sort.
dannyw 5y ago
That's a critically better health outcome though. It's like fixing a corruption bug when you detect it on one server, versus finding out there's corruption in every shard and all of your backups.
- carlmr 5y ago
  Ransomware infecting one machine or all machines including backups would also be a good analogy.
- jacquesm 5y ago
  > That's a critically better health outcome though. Not necessarily. It depends on how old you are, what your genetic make-up is, whether the cancer is growing rapidly, whether it has easy access to other organs to spread to (or has already begun to do so) and so on. It's not a binary thing.
- Gatsky 5y ago
  I’m not saying it isn’t a great development. It certainly adds an option for early detection of some cancers where there previously were none. But it isn’t cancer prevention. It is a highly sophisticated technical undertaking which for educated and motivated patients in well resourced health systems will reduce cancer mortality and morbidity by some increment. Depending on many factors this could be a big or small increment. In the real world the efficacy will be less than what the trial shows. It is also likely that Grail (with north of $1 billion in VC funding) will charge as much as they can for this test. The size of the trials necessary to prove efficacy means that there will be highly constrained competition in this space. The distinction with prevention is important, because we ultimately must aim for preventing almost all cancers, and not be content with anything less than that. Disclaimer: I’m an Oncologist.

Tolyzz 5y ago

Cause things break down all the time. And everything can look like early signs of trouble. There are lot useless docs and surgeons waiting to perform unnecessary expensive procedures much like building contractors. Oh that pipe is leaking let's just replace this entire load bearing wall etc cause we have this new cool machine that can. Second opinions are over rated cause the majority don't care. There is an endless demand for their trade. My dad lost his hearing at 35 after they performed surgery to remove a tumor they detected. They detected the same Tumor in my brother when he was in his 20s and wanted to operate with no guarantee of hearing preservation. He declined. He is going to turn 40 soon and would have most likely been deaf for 20 years if he had gone through with it. Minor issues with his balance but other than that he is fine even though tumor gets tracked every couple years and is still growing.

BallyBrain 5y ago
This sounds like a regulation and education problem to me. early detection doesn't have to mean treatment, it could just be monitoring and change of lifestyle.

jacquesm 5y ago

Regularly checking people that are otherwise healthy for cancer will turn up a lot of cancer through false positives or slowly growing ones, will lead to a lot of unnecessary intervention and will in fact lead to a reduction in quality of life and lifespan. This is one of the reasons why exhaustive cancer screening (which was more costly in the past but could have been done) was not promoted, it had nothing to do with ability, but everything to do with outcomes. Those cancers where checkups are useful we already do regular screenings for. For aggressive cancers - the ones that are really problematic - you would have to do such a test too frequently to make any real difference, for instance, if you were to test annually you'd be on average 6 months away from your next test, plenty of time for such a cancer to develop and kill you. So this is not the kind of breakthrough that you may think it is.

bruce343434 5y ago
Who are "we"? I'm certainly not "regularly" screened.
- jacquesm 5y ago
  That's your choice, assuming you live in a developed country. Assuming the United States see here: https://www.cdc.gov/cancer/dcpc/prevention/screening.htm https://www.cdc.gov/cancer/dcpc/prevention/screening.htm and if elsewhere consult your local CDC equivalent.
  - postingawayonhn 5y ago
    Current screening methods tend to be costly and/or uncomfortable for the person being screened. A simple blood test could lead to higher uptake and more regular screening.
tarsinge 5y ago
> Those cancers where checkups are useful we already do regular screenings for. More like “are <practical given available tests> and useful”. Regarding your last paragraph cancer screening seems very rare except for one or two types (at least where I live), so statistically yes an annual test will miss the worst case you presented, but for the vast majority it will be a huge improvement.

deleted 5y ago

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TaupeRanger 5y ago

Actually you don't want this, and you are describing a nightmare scenario that everyone who studies health policy understands all too well. Mass screening of healthy people will result in extreme iatrogenics and unnecessary psychological damage and stress (which leads to physical effects as well), not to mention overwhelming the medical system. The fact is that many things that could be detected will never result in symptoms or other noticeable problems. Further, for many things that can be detected we can't really do much about, so by detecting it early you are just reducing the amount of life they have left without worrying about their disease, or causing unnecessary treatment (which includes unnecessary damage, cost, stress, etc.)

throwawaynotmd 5y ago
The argument you’re making has always bothered me because it’s hiding the ball. If finding something that otherwise carries no symptoms is best left untreated, then the fact that you found it should make no difference to the decision. The doctor should say that the best course of action is to do nothing. More information can never be harmful. If you know information is best not acted on in the abstract, then you also know you should not act on it in particular. So what you really mean but have left unspoken is one of two things. First, that doctors are untrustworthy people who make recommendations and decisions based on concerns other than their patient’s wellbeing, such as covering their asses from lawsuits or making more money. But rather than fix that, you would rather keep patients more ignorant and away from the doctor in the first place. Which actively harms people who do have honest doctors. That is, your approach of not testing hurts people with honest doctors to protect people with dishonest doctors. Or second, if you take dumb patients as the problem, you are willing to hurt people with good decision making ability (who would heed their good doctor’s advice to leave the possible ailment untreated) so you can protect people with bad decision making. Because many times, these tests will uncover things that obviously need treatment. They will save many lives. But because more stupid people will hurt themselves, then no one should have access to them. The political and moral assumptions built into these positions are immense and yet the medical field tucks those away and pretends that this is just a purely scientific truth, that someone running more harmless tests is actually inherently harmful. That is a lie! And a very nasty one at that.

hannob 5y ago

The reason this is not happening isn't a technical one. It's that people with a medical background will tell you this isn't a healthy utopia, it's a nightmare. Medical tests are complicated. They often have significant false positive and false negative rates. Testing people at scale increases the number of people with wrong test results and can cause harm if you start treating people based on wrong test results. The more healthy people you test the more false positives you get. The goal of evidence based medicine is to use tests when they can help. It's not to test as many people as possible. This is reasonable. You want to improve patient's lives. Whether or not a test is improving patient's lives is often not easy to answer and has to consider many things.

axxto 5y ago
The point of this is not that you get a definitive diagnosis; it's just a somewhat reliable marker on whether you may need to be concerned and get more accurate (but more harmful) imaging or invasive tests to rule out something.
- dangerlibrary 5y ago
  You only need one false positive test result that ends up with a colonoscopy to understand how costly and uncomfortable these errors can be. (I'm using an uncomfortable and illustrative example, but a colonoscopy is honestly pretty safe and boring as invasive clinical diagnostic procedures go)
  - theptip 5y ago
    Perhaps a better example than you intended -- recently colonoscopies are being considered more risky as a regular screening tool, because the procedure itself can result in harms, including (rarely) death. Not an expert here, but it seems they are still used in a fairly wide age group, but the recent trend is to be more cautious about their usage, as particularly for older patients they are more risky vs. the potential benefits. [1] However I think this concern would be reduced if we had better first-line screening like the tests in TFA; the harms come from using a relatively-risky assay like colonoscopy for regular screening in healthy individuals, whereas if we had better noninvasive screening, the colonoscopy could be reserved for patients where there's a higher probability of a positive diagnosis. [1]: https://jamanetwork.com/journals/jama/fullarticle/2529486 https://jamanetwork.com/journals/jama/fullarticle/2529486

dukeofdoom 5y ago

One issue is that your body may have all types of tissues that might be precancerous or slow growing cancerous growths that the test will identify. To get to them and remove them would do far more damage than leaving them alone. Even with things like prostate cancer, which is fairly easy to get to. Leaving it alone, is often the right choice depending on the age of the patient and speed of growth of the cancer.

andai 5y ago

I expect this won't catch on until it becomes a wearable technology, and then it will catch on overnight.

DoreenMichele 5y ago

Why can’t we observe ourselves medically and analyze that record for early signs of trouble before it becomes serious?! We can and plenty of people do, usually with tools like health journals and smart watches recording biometrics.

matheusmoreira 5y ago

> Why can’t we observe ourselves medically and analyze that record for early signs of trouble before it becomes serious?! Maybe one day we'll have cybernetic implants that can constantly monitor our health. Hopefully it won't turn into a privacy nightmare.