12 ms·

It would be nice to have this information to see if any trends are discovered (all of this is theoretical, I question whether measuring excreted compounds rathe

It would be nice to have this information to see if any trends are discovered (all of this is theoretical, I question whether measuring excreted compounds rather than stores is is relevant but that’s a separate point) however it is unclear what value this information will provide and seems unlikely it will generate anything actionable. With that in mind, it’s hard to justify the colossal costs that would be involved in administering such a program. Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) and annual blood work is definitely not indicated. Annual urinalysis is not indicated as part of the general work up for patients of any age, so this would be adding a whole extra step in specimen collection and not just adding on a test. Healthcare is generally a zero sum game and if we divert $ and lab resources to something like this that means other tests and procedures are not being done. A small prospective study as the authors suggest would be interesting, yet still expensive. It’s a huge stretch to say everyone should be getting this and ignores the harm that this would cause.

WFHRenaissance 4y ago
> Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) and annual blood work is definitely not indicated. Tell this to my mom.
- saiya-jin 4y ago
  I am sorry for whatever happened/happens to your mom. That being said, when looking at cold hard data, this is a valid point. We all have various weird stuff in us, the older the more. Cystes, weird bulges, benign cancers that wont kill us for 50 years. If you are a male say above 40 or 50, you probably have some very early (or not) prostate cancer. Often you need an invasive procedure to get more info. Even then its quite often not 100% clear if surgery is overall safer and better than keeping and monitoring. We like this idea of omnipotent medicine but its a pipe dream. Difficult procedures are extremely expensive regardless of location (US stands apart as always but still a valid point), and even ignoring price there simply isnt enough staff/equipment. Covid and often selfish clueless people certainly didnt help. Medicine tries to fix as much as it can, which is mostly not enough. The hard part is accepting that when it becomes about a close one. There is no easy solution. Source: wife is an emergency/gp doctor, went through this countless times. And much worse, even smart people become completely irrational, cruel or selfish very easily in such situations.
  - mdavidn 4y ago
    I interpreted the comment to mean, "my mom always reminds me to go get a checkup that I don't need."
    - WFHRenaissance 4y ago
      LOL yes this is what I meant!
nightski 4y ago
Hmm, you could use that argument to dissuade all of scientific research. Science is zero sum, if we devote resources to it then you are taking them from someone else! But at the end of the day we all know there are significant potential benefits to this type of testing. Not only that, more demand can increase jobs & labs in the first place. Just because the system is dysfunctional is not a good argument for ceasing progress.
- haldujai 4y ago
  Suggesting we perform niche lab examinations annually on the entire population is not scientific research, that’s jumping straight into a screening program. Such an initiative would require more lab resources than currently exists in the US. I’m questioning whether this is the best use of $100-200 billion a year. Instead, I suggested a small study (appropriately powered) to further investigate.
- barry-cotter 4y ago
  > But at the end of the day we all know there are significant potential benefits to this type of testing. Not only that, more demand can increase jobs & labs in the first place. But at the end of the day we all know there are significant potential benefits to [testing cars every year]. Not only that, more demand can increase jobs [in testing centres] in the first place. The question isn’t whether there are benefits. It’s whether the benefits exceed the costs. You need to actually measure those to find out. You can’t just assume it. Jobs in testing centres and labs are not a benefit. If they are doing useless work they don’t just cost money. They cost the potential output from the jobs those people could have done instead. The TSA doesn’t just massively inconvenience millions every year to almost zero benefit. It also wastes the labor of tens of thousands of people who could have done something better and more useful with their lives.
scythe 4y ago
>I question whether measuring excreted compounds rather than stores is relevant I would have to figure that chemicals sitting in fat cells that rarely divide are probably not causing cancer. Cancer occurs mostly in epithelial tissue; in my case, the germ cell. Excreted compounds are probably a better measure of actual blood levels. I'm not a nephrologist or anything, though. >A small prospective study will almost certainly find nothing, because the rate of early-onset cancer is too low to detect changes in a small population. You probably need >100k participants to have a good chance of finding anything. >it is unclear what value this information will provide I mean, that's the billion-dollar question, isn't it? Should probably try to control for obesity first, it's the most obvious candidate (changes since 1990, so not, e.g., smoking), but it certainly wasn't my problem (BMI 21).
- haldujai 4y ago
  A billion dollars is not enough for what’s being proposed here.
vehementi 4y ago
> Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) How does letting people have undiagnosed cancer in their 30s and 40s fit in with this?
- bigfudge 4y ago
  The reason is that many medical tests have high false positive rates, and the follow procedures have side effects (sometimes). When you administer tests and followups at population scale for a disease with a low prior probability you will do more harm than good, on the average.
- haldujai 4y ago
  An annual physical exam isn’t really powered to detect cancer in the modern world, it’s a relic from the past. If you develop cancer in your 30s (sadly too many people) a physical exam or blood test almost certainly wouldn’t have made the difference. We have mammograms for breast cancer and women > 40. Unfortunately there isn’t enough evidence to support a screening program for people younger than that where the pretest probability for malignancy is so low and there are harms associated with tests.
idontpost 4y ago
> Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) and annual blood work is definitely not indicated. Remind me to never use you as a medical provider.
- haldujai 4y ago
  Here are some resources to read. https://europepmc.org/article/nbk/nbk82767#_vaphysical_s5_ https://europepmc.org/article/nbk/nbk82767#_vaphysical_s5_ https://www.cfp.ca/content/cfp/63/11/824.full.pdf https://www.cfp.ca/content/cfp/63/11/824.full.pdf https://www.bmj.com/content/345/bmj.e7191?ijkey=34070a9e7bf5641d5d213113a3eff6c8d8f8ddcf&keytype2=tf_ipsecsha https://www.bmj.com/content/345/bmj.e7191?ijkey=34070a9e7bf5...

WFHRenaissance 4y ago

> Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) and annual blood work is definitely not indicated. Tell this to my mom.

saiya-jin 4y ago
I am sorry for whatever happened/happens to your mom. That being said, when looking at cold hard data, this is a valid point. We all have various weird stuff in us, the older the more. Cystes, weird bulges, benign cancers that wont kill us for 50 years. If you are a male say above 40 or 50, you probably have some very early (or not) prostate cancer. Often you need an invasive procedure to get more info. Even then its quite often not 100% clear if surgery is overall safer and better than keeping and monitoring. We like this idea of omnipotent medicine but its a pipe dream. Difficult procedures are extremely expensive regardless of location (US stands apart as always but still a valid point), and even ignoring price there simply isnt enough staff/equipment. Covid and often selfish clueless people certainly didnt help. Medicine tries to fix as much as it can, which is mostly not enough. The hard part is accepting that when it becomes about a close one. There is no easy solution. Source: wife is an emergency/gp doctor, went through this countless times. And much worse, even smart people become completely irrational, cruel or selfish very easily in such situations.
- mdavidn 4y ago
  I interpreted the comment to mean, "my mom always reminds me to go get a checkup that I don't need."
  - WFHRenaissance 4y ago
    LOL yes this is what I meant!

nightski 4y ago

Hmm, you could use that argument to dissuade all of scientific research. Science is zero sum, if we devote resources to it then you are taking them from someone else! But at the end of the day we all know there are significant potential benefits to this type of testing. Not only that, more demand can increase jobs & labs in the first place. Just because the system is dysfunctional is not a good argument for ceasing progress.

haldujai 4y ago
Suggesting we perform niche lab examinations annually on the entire population is not scientific research, that’s jumping straight into a screening program. Such an initiative would require more lab resources than currently exists in the US. I’m questioning whether this is the best use of $100-200 billion a year. Instead, I suggested a small study (appropriately powered) to further investigate.
barry-cotter 4y ago
> But at the end of the day we all know there are significant potential benefits to this type of testing. Not only that, more demand can increase jobs & labs in the first place. But at the end of the day we all know there are significant potential benefits to [testing cars every year]. Not only that, more demand can increase jobs [in testing centres] in the first place. The question isn’t whether there are benefits. It’s whether the benefits exceed the costs. You need to actually measure those to find out. You can’t just assume it. Jobs in testing centres and labs are not a benefit. If they are doing useless work they don’t just cost money. They cost the potential output from the jobs those people could have done instead. The TSA doesn’t just massively inconvenience millions every year to almost zero benefit. It also wastes the labor of tens of thousands of people who could have done something better and more useful with their lives.

scythe 4y ago

>I question whether measuring excreted compounds rather than stores is relevant I would have to figure that chemicals sitting in fat cells that rarely divide are probably not causing cancer. Cancer occurs mostly in epithelial tissue; in my case, the germ cell. Excreted compounds are probably a better measure of actual blood levels. I'm not a nephrologist or anything, though. >A small prospective study will almost certainly find nothing, because the rate of early-onset cancer is too low to detect changes in a small population. You probably need >100k participants to have a good chance of finding anything. >it is unclear what value this information will provide I mean, that's the billion-dollar question, isn't it? Should probably try to control for obesity first, it's the most obvious candidate (changes since 1990, so not, e.g., smoking), but it certainly wasn't my problem (BMI 21).

haldujai 4y ago
A billion dollars is not enough for what’s being proposed here.

vehementi 4y ago

> Young (< 50) healthy adults shouldn’t even really be getting annual checkups (in my professional opinion and per several guidelines) How does letting people have undiagnosed cancer in their 30s and 40s fit in with this?

bigfudge 4y ago
The reason is that many medical tests have high false positive rates, and the follow procedures have side effects (sometimes). When you administer tests and followups at population scale for a disease with a low prior probability you will do more harm than good, on the average.
haldujai 4y ago
An annual physical exam isn’t really powered to detect cancer in the modern world, it’s a relic from the past. If you develop cancer in your 30s (sadly too many people) a physical exam or blood test almost certainly wouldn’t have made the difference. We have mammograms for breast cancer and women > 40. Unfortunately there isn’t enough evidence to support a screening program for people younger than that where the pretest probability for malignancy is so low and there are harms associated with tests.

idontpost 4y ago

haldujai 4y ago
Here are some resources to read. https://europepmc.org/article/nbk/nbk82767#_vaphysical_s5_ https://europepmc.org/article/nbk/nbk82767#_vaphysical_s5_ https://www.cfp.ca/content/cfp/63/11/824.full.pdf https://www.cfp.ca/content/cfp/63/11/824.full.pdf https://www.bmj.com/content/345/bmj.e7191?ijkey=34070a9e7bf5641d5d213113a3eff6c8d8f8ddcf&keytype2=tf_ipsecsha https://www.bmj.com/content/345/bmj.e7191?ijkey=34070a9e7bf5...