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You don't know what you're talking about. Before my software career I spent a few years working in a diagnostic medical field. Specifically osteoporosis testin
by iandanforth 5y ago
You don't know what you're talking about.
Before my software career I spent a few years working in a diagnostic medical field. Specifically osteoporosis testing. I worked both in a research capacity at Stanford looking at osteoporosis in older men (not pretending to be the PI here) and in a day to day testing clinic. So I've seen exactly what happens when you test a cross-sectional asymptomatic sample of the populous and what happens during the normal course of referred testing.
Low bone mass at the spine, hip, heel, and forearm as measured by DXA are correlated with increased risk of fracture, but it's only a correlation. Some people have resilient architecture which looks porous on an x-ray but only leads to serious fracture much later in life.
Because the current diagnostic tests are set up with levels like 'osteopenia' and 'osteoporosis' the reaction to clinical referrals was most often treatment. Some of those treatments have serious side effects like necrotizing impacts on the jaw. However the reaction to testing in a large asymptomatic population was much more likely to be an increase in preventative behavior (exercise) or no treatment except in extreme cases. While our study was exploratory and didn't have a treatment cohort (we cared about the impact of sleep quality on bone mass) we got to see a lot of older men who if they were referred to a clinic might have received treatment because that's what clinics do. Instead we had sufficient data to discuss what's normal and what isn't. For a time we were the leading experts in the world on what "normal" meant.
Because I've conducted these tests myself and seen data from hundreds of experimental and clinical patients I feel comfortable contrasting the two. The problem is the clinical medical field reacting to a lack of data with over-prescription of treatments.
- jacquesm 5y agoSure, but that's a completely different setting than the one the OP described: mass testing for presence of cancers by non-specialist labs. And that's the thing that triggered my response. The outcome of such an approach could easily be a negative one. FWIW I too have some experience with medical diagnostic systems (specifically: cancer testing), and one of the main reasons why I'm still skeptical about this test is that for many cancer types tested for the base rate is much lower than the false positive rate.