7 ms·

This is just silly. You are never disadvantaged by knowing more about what's inside your body. What you don't know can easily kill you, though. Hopefully in th

This is just silly. You are never disadvantaged by knowing more about what's inside your body. What you don't know can easily kill you, though. Hopefully in the long term future we will have extremely cheap & frequent MRI and blood testing so you can assemble a high resolution digital history of your body. Doctors are generally not very innovative people though and they will probably resist it to the end.

bagels 4y ago
It's not silly. Look at how the mammogram guidelines are set. If the scans are too frequent, the harm done from false positives (unnecessary surgeries and risks from those surgeries) can become too great. The standards were relaxed to include fewer scans in the last few years because of this. Apply this to more invasive exploratory surgeries, and you see people dying from internal surgery complications for benign cysts and lumps.
- derefr 4y ago
  That's because single datapoints are used to trigger intervention. We should be intervening based on growth trends from time-series data. Time-series data which can only be collected by... frequent scans.
  - Sebb767 4y ago
    Don't discount psychological stress. "You have something growing in your breast which might be cancer, just wait a few months and we'll scan again" is not something that gives people a good nights sleep.
    - derefr 4y ago
      So don't tell them. Like I said, a single datapoint by itself is meaningless — so you wouldn't bring it to the patient's attention. Heck, the software shouldn't flag it for the doctor's attention. (Think: metrics-based alerting thresholds in software systems.)
  - lazyasciiart 4y ago
    We do have time series data for mammograms. You may think it doesn't meet whatever standard you are setting, but it is objectively false to say it isn't there.
    - derefr 4y ago
      My standard is "doing it for everything, rather than for one thing"; and more importantly, not acting upon data about chronic disease progression, if it isn't a time-series. In science, you don't call one datapoint "data." You call it an anecdote. Outside of emergency medicine/urgent care, medical practice should be the same.
      - lazyasciiart 4y ago
        I honestly can't imagine how you believe breast cancer is diagnosed and treated, but it's clearly inaccurate. So is the cute phrase about "in science".
        derefr 4y ago
        You didn't understand what I said. Breast cancer screening is the "one thing" I referred to that we're doing right. But who cares if we're doing one thing right? We're doing screening for literally every other cancer wrong. And not getting any less wrong over time. We — the medical profession in general — are aware of the proven effectiveness of time-series analysis of regular mammograms as a screening technique. However, we have failed utterly to spread this "obvious" knowledge out from the specialty that understands it and has proven its effectiveness, to literally anywhere else. We've been doing regular mammograms for decades now, but that hasn't sparked (wide) adoption of regular scans + time-series-based screening for any other cancer. There is a certain moral culpability in that. A certain negligence of duty / not seeing the forest for the trees in what it means to be saving lives. (I hypothesize that doctors in at least some specialties, could save more lives over the course of their career by dropping their practice and instead turning into advocates for wide adoption of periodic-scans + time-series-analysis-based screens. Somewhat like would have been true of a doctor in the 1800s quitting doctoring to instead become an advocate for hand-washing before surgery.)
jghn 4y ago
It can be hard to predict how aggressive a tumor will be. It isn't uncommon for people to obtain cancers that they "die with" instead of "die of". In those cases, treatment can be worse for the patient than the cancer. But since you don't know which it'll be, people get the treatment and sometimes wind up worse off than they otherwise would have. And as the GP post cites, the scans themselves can cause health problems down the road. Performing them on massive scale will increase the occurrences of those side effects.
gzer0 4y ago
Full body scans, as they currently exist, are not recommended for routine-usage. These scans use large amounts of radiation. This can increase your risk of cancer. If you have more tests, your risk increases. Further, they are costly, and often times insurance does not reimburse or cover it. They can cost anywhere from $500-1000. Unless you find a way to make this viable for the general population and lower the radiation exposure, this will never become viable for use.
closeparen 4y ago
Knowing that there is something weird in your body sets off a cascade of medical care that easily escalates to surgery, anesthesia, medication to manage complications, side effects of that medication, time in the hospital being at risk for infection, etc. These things absolutely can kill you, or at least put you through hell. When there was actually nothing wrong with you in the first place. That is why the medical establishment is so conservative about it.
- telchior 4y ago
  Isn't the danger of knowing there's something weird there caused by the rarity of knowing anything at all? I'd imagine that if there was consistent, good information available, we'd figure out how and when to act on it. The real issue is the massive cost of performing any given scanning procedure to everyone alive.
  - lazyasciiart 4y ago
    No. Doctors already think about this. Why do you think they aren't doing prostate scans and mammograms constantly on everyone?
    - telchior 4y ago
      I think modern medical ethics demands a physical treatment for literally everything and anything that's discovered, including quite a few that either aren't physically dangerous (e.g. atypical brains) or are inevitable (a 90+ year old with a laundry list of conditions). And, as other comments have pointed out, a panicked surgical response to a mammogram isn't based on time series data. I totally understand and agree with trusting that medical professionals "know better", but I also would not conflate current practices with absolute perfection. It's clearly not a perfect profession or practice.
      - lazyasciiart 4y ago
        You don't have to conflate current practice with perfection. You just have to bother learning what the current practice is and why - and "it's just so rare to know anything" is not the correct answer. Just to start with basics: yes, actually mammograms are analyzed using time series data of a patients previous scans!
DanBC 4y ago
> You are never disadvantaged by knowing more about what's inside your body. Yes, you are. This has a name - over-testing, over-diagnosis, and over-treatment. It's a significant cause of harm in healthcare. https://www.bmj.com/content/358/bmj.j4070 https://www.bmj.com/content/358/bmj.j4070 https://qualitysafety.bmj.com/content/31/1/54 https://qualitysafety.bmj.com/content/31/1/54 https://www.choosingwisely.org/patient-resources/whole-body-scans-to-screen-for-cancer/ https://www.choosingwisely.org/patient-resources/whole-body-...

bagels 4y ago

It's not silly. Look at how the mammogram guidelines are set. If the scans are too frequent, the harm done from false positives (unnecessary surgeries and risks from those surgeries) can become too great. The standards were relaxed to include fewer scans in the last few years because of this. Apply this to more invasive exploratory surgeries, and you see people dying from internal surgery complications for benign cysts and lumps.

derefr 4y ago
That's because single datapoints are used to trigger intervention. We should be intervening based on growth trends from time-series data. Time-series data which can only be collected by... frequent scans.
- Sebb767 4y ago
  Don't discount psychological stress. "You have something growing in your breast which might be cancer, just wait a few months and we'll scan again" is not something that gives people a good nights sleep.
  - derefr 4y ago
    So don't tell them. Like I said, a single datapoint by itself is meaningless — so you wouldn't bring it to the patient's attention. Heck, the software shouldn't flag it for the doctor's attention. (Think: metrics-based alerting thresholds in software systems.)
- lazyasciiart 4y ago
  We do have time series data for mammograms. You may think it doesn't meet whatever standard you are setting, but it is objectively false to say it isn't there.
  - derefr 4y ago
    My standard is "doing it for everything, rather than for one thing"; and more importantly, not acting upon data about chronic disease progression, if it isn't a time-series. In science, you don't call one datapoint "data." You call it an anecdote. Outside of emergency medicine/urgent care, medical practice should be the same.
    - lazyasciiart 4y ago
      I honestly can't imagine how you believe breast cancer is diagnosed and treated, but it's clearly inaccurate. So is the cute phrase about "in science".
      - derefr 4y ago
        You didn't understand what I said. Breast cancer screening is the "one thing" I referred to that we're doing right. But who cares if we're doing one thing right? We're doing screening for literally every other cancer wrong. And not getting any less wrong over time. We — the medical profession in general — are aware of the proven effectiveness of time-series analysis of regular mammograms as a screening technique. However, we have failed utterly to spread this "obvious" knowledge out from the specialty that understands it and has proven its effectiveness, to literally anywhere else. We've been doing regular mammograms for decades now, but that hasn't sparked (wide) adoption of regular scans + time-series-based screening for any other cancer. There is a certain moral culpability in that. A certain negligence of duty / not seeing the forest for the trees in what it means to be saving lives. (I hypothesize that doctors in at least some specialties, could save more lives over the course of their career by dropping their practice and instead turning into advocates for wide adoption of periodic-scans + time-series-analysis-based screens. Somewhat like would have been true of a doctor in the 1800s quitting doctoring to instead become an advocate for hand-washing before surgery.)

jghn 4y ago

It can be hard to predict how aggressive a tumor will be. It isn't uncommon for people to obtain cancers that they "die with" instead of "die of". In those cases, treatment can be worse for the patient than the cancer. But since you don't know which it'll be, people get the treatment and sometimes wind up worse off than they otherwise would have. And as the GP post cites, the scans themselves can cause health problems down the road. Performing them on massive scale will increase the occurrences of those side effects.

gzer0 4y ago

Full body scans, as they currently exist, are not recommended for routine-usage. These scans use large amounts of radiation. This can increase your risk of cancer. If you have more tests, your risk increases. Further, they are costly, and often times insurance does not reimburse or cover it. They can cost anywhere from $500-1000. Unless you find a way to make this viable for the general population and lower the radiation exposure, this will never become viable for use.

closeparen 4y ago

Knowing that there is something weird in your body sets off a cascade of medical care that easily escalates to surgery, anesthesia, medication to manage complications, side effects of that medication, time in the hospital being at risk for infection, etc. These things absolutely can kill you, or at least put you through hell. When there was actually nothing wrong with you in the first place. That is why the medical establishment is so conservative about it.

telchior 4y ago
Isn't the danger of knowing there's something weird there caused by the rarity of knowing anything at all? I'd imagine that if there was consistent, good information available, we'd figure out how and when to act on it. The real issue is the massive cost of performing any given scanning procedure to everyone alive.
- lazyasciiart 4y ago
  No. Doctors already think about this. Why do you think they aren't doing prostate scans and mammograms constantly on everyone?
  - telchior 4y ago
    I think modern medical ethics demands a physical treatment for literally everything and anything that's discovered, including quite a few that either aren't physically dangerous (e.g. atypical brains) or are inevitable (a 90+ year old with a laundry list of conditions). And, as other comments have pointed out, a panicked surgical response to a mammogram isn't based on time series data. I totally understand and agree with trusting that medical professionals "know better", but I also would not conflate current practices with absolute perfection. It's clearly not a perfect profession or practice.
    - lazyasciiart 4y ago
      You don't have to conflate current practice with perfection. You just have to bother learning what the current practice is and why - and "it's just so rare to know anything" is not the correct answer. Just to start with basics: yes, actually mammograms are analyzed using time series data of a patients previous scans!

DanBC 4y ago

> You are never disadvantaged by knowing more about what's inside your body. Yes, you are. This has a name - over-testing, over-diagnosis, and over-treatment. It's a significant cause of harm in healthcare. https://www.bmj.com/content/358/bmj.j4070 https://www.bmj.com/content/358/bmj.j4070 https://qualitysafety.bmj.com/content/31/1/54 https://qualitysafety.bmj.com/content/31/1/54 https://www.choosingwisely.org/patient-resources/whole-body-scans-to-screen-for-cancer/ https://www.choosingwisely.org/patient-resources/whole-body-...