5 ms·

Sounds amazing, though I don’t know how long it takes for something to go from the “medical research” stage to “a test your doctor can order” stage, and I’m afr

Sounds amazing, though I don’t know how long it takes for something to go from the “medical research” stage to “a test your doctor can order” stage, and I’m afraid that will be >10 years

whatshisface 4y ago
The likelihood of hurting the patient weighs in on how hard it is to get something approved, and blood tests are much less likely to hurt somebody than a lot of other things.
- xattt 4y ago
  Especially with something not quite actionable, like routine PSA testing or back pain, physicians have been historically trained to withhold on testing in the interest of cost-savings and patient anxiety. However, with medical assistance in dying coming on line, at least in Canada, the “actionable” part may be pre-planning.
  - Salgat 4y ago
    If anything, it can give a lot more data on how Alzheimers develops over the years.
  - joshspankit 4y ago
    I’d love to see a future where we test “excessively”. A CT/Ultrasound when someone walks in to emerg, bloodwork for things that are just possibilities, and so-on. The value in catching things early and in having a timeline to look back on is probably massive.
    - danielheath 4y ago
      Tests have a false positive rate. Real suffering is caused by increasing the number of false positives (by increasing testing).
      - mchusma 4y ago
        I've heard this argument often, and it's never articulated correctly. (1) False positives if handled poorly cause suffering. (2) There is problem where we hide the statistics in an attempt to make things more relatable. Tests are often not "positive" or "negative", they just mean something like "given your situation, you have an x% chance of having this issue". Conveying the information more accurately and responding correctly fix most problems. Cancers and some other diseases are almost entirely preventable if fixed early enough, which require more testing with more false positives and this is absolutely worth the tradeoff for most people. Ultimately, we should give patients the information and choice whether to test or not.
        vidarh 4y ago
        False positives, or even the screening itself, if at a large enough scale, causes death. E.g. I had a gastroscopy recently. Endoscopies (e.g. for gastroscopy, colonoscopy) have incidence rates in the 0.1%-1% range. Most incidents are minor. Minor bleeds etc. Some are major. Perforation is a risk. Some performation leads to death. Over-prescribe endoscopies either as a first test or as a followup and you'll be killing more people than you save, even if the risk to any individual patient is tiny. It might seem worth it. E.g. you might catch a prostate cancer early from a colonoscopy. You might catch a hernia that could become a problem from a gastroscopy. Or any number of other things. The problem is that broaden screening too much, and your true positive rate becomes too low, and the true positive rate where the problem would otherwise go undetected and cause problems becomes even lower, and so for many conditions routine screening barely budges survival rates for true positives, but creates a mortality rate for false positives. Sometimes broadening testing is worth it - a serious enough and frequent enough condition can warrant it by saving more than it kills even if you only marginally improve survival rates, or you might have a condition that is rare but where detection can very significantly affect survival rates. But often it isn't. E.g. too broad screening for prostate cancer and breast cancer are both cases where the benefit in terms of nudging survival rates from broad screening vs. more targeted efforts (e.g. screening people who have felt something) is low enough that the advice most places is to focus on limited age groups or other risk factors. Hernias - I turned out to have one - is another one where the proportion that ever becomes a serious problem is so limited that the (tiny) risk of more broadly using gastroscopy to look specifically for that (rather than to investigate potentially more serious problems) is rarely warranted, and where the risk of a portion of patients pushing and getting (a lot more risky) surgical intervention in cases where it is not medically necessary is another reason to discourage too broad screening. There's a continuum here from not allowing patients to choose, via allowing it but discouraging it, to actively encouraging it, to broad screening programs. There are a whole lot of things that'd be fine to allow if a patient has specific fears, that still should be broadly discouraged.
    - roywiggins 4y ago
      Testing everyone might catch some stuff early, at the cost of a boatload of biopsies that turn up nothing. The cost to patients of a false positive and having to wait for a biopsy to clear you is not zero.
      - joshspankit 4y ago
        Are you just talking about cases of possible cancer?
deleted 4y ago
[deleted]

Sounds amazing, though I don’t know how long it takes for something to go from the “medical research” stage to “a test your doctor can order” stage, and I’m afraid that will be >10 years

whatshisface 4y ago

The likelihood of hurting the patient weighs in on how hard it is to get something approved, and blood tests are much less likely to hurt somebody than a lot of other things.

xattt 4y ago
Especially with something not quite actionable, like routine PSA testing or back pain, physicians have been historically trained to withhold on testing in the interest of cost-savings and patient anxiety. However, with medical assistance in dying coming on line, at least in Canada, the “actionable” part may be pre-planning.
- Salgat 4y ago
  If anything, it can give a lot more data on how Alzheimers develops over the years.
- joshspankit 4y ago
  I’d love to see a future where we test “excessively”. A CT/Ultrasound when someone walks in to emerg, bloodwork for things that are just possibilities, and so-on. The value in catching things early and in having a timeline to look back on is probably massive.
  - danielheath 4y ago
    Tests have a false positive rate. Real suffering is caused by increasing the number of false positives (by increasing testing).
    - mchusma 4y ago
      I've heard this argument often, and it's never articulated correctly. (1) False positives if handled poorly cause suffering. (2) There is problem where we hide the statistics in an attempt to make things more relatable. Tests are often not "positive" or "negative", they just mean something like "given your situation, you have an x% chance of having this issue". Conveying the information more accurately and responding correctly fix most problems. Cancers and some other diseases are almost entirely preventable if fixed early enough, which require more testing with more false positives and this is absolutely worth the tradeoff for most people. Ultimately, we should give patients the information and choice whether to test or not.
      - vidarh 4y ago
        False positives, or even the screening itself, if at a large enough scale, causes death. E.g. I had a gastroscopy recently. Endoscopies (e.g. for gastroscopy, colonoscopy) have incidence rates in the 0.1%-1% range. Most incidents are minor. Minor bleeds etc. Some are major. Perforation is a risk. Some performation leads to death. Over-prescribe endoscopies either as a first test or as a followup and you'll be killing more people than you save, even if the risk to any individual patient is tiny. It might seem worth it. E.g. you might catch a prostate cancer early from a colonoscopy. You might catch a hernia that could become a problem from a gastroscopy. Or any number of other things. The problem is that broaden screening too much, and your true positive rate becomes too low, and the true positive rate where the problem would otherwise go undetected and cause problems becomes even lower, and so for many conditions routine screening barely budges survival rates for true positives, but creates a mortality rate for false positives. Sometimes broadening testing is worth it - a serious enough and frequent enough condition can warrant it by saving more than it kills even if you only marginally improve survival rates, or you might have a condition that is rare but where detection can very significantly affect survival rates. But often it isn't. E.g. too broad screening for prostate cancer and breast cancer are both cases where the benefit in terms of nudging survival rates from broad screening vs. more targeted efforts (e.g. screening people who have felt something) is low enough that the advice most places is to focus on limited age groups or other risk factors. Hernias - I turned out to have one - is another one where the proportion that ever becomes a serious problem is so limited that the (tiny) risk of more broadly using gastroscopy to look specifically for that (rather than to investigate potentially more serious problems) is rarely warranted, and where the risk of a portion of patients pushing and getting (a lot more risky) surgical intervention in cases where it is not medically necessary is another reason to discourage too broad screening. There's a continuum here from not allowing patients to choose, via allowing it but discouraging it, to actively encouraging it, to broad screening programs. There are a whole lot of things that'd be fine to allow if a patient has specific fears, that still should be broadly discouraged.
  - roywiggins 4y ago
    Testing everyone might catch some stuff early, at the cost of a boatload of biopsies that turn up nothing. The cost to patients of a false positive and having to wait for a biopsy to clear you is not zero.
    - joshspankit 4y ago
      Are you just talking about cases of possible cancer?

deleted 4y ago

[deleted]