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The real cost of a preventive health scan goes well beyond the price tag

80 points by lxm 3y ago

jauntywundrkind 3y ago
I want one. It feels like having a snapshot to compare against latter just makes hella sense. And I'm a geek who could actually go load up & visualize the data myself. Which would be cool.
- ljf 3y ago
  Where you are, will you actually get access to the Data? Or will they just review and store it for you? Just interested in the output and what you actually get to keep.
  - sidewndr46 3y ago
    I can't find it presently but I read some blog post about a guy getting his MRI data. It's apparently possible but like most things in life, a pain.
  - JimtheCoder 3y ago
    If they are paying for it out of pocket, I assume they would have the option for the raw data. Maybe a small-ish processing fee, because...American healthcare.
  - sturob 3y ago
    Prenuvo give you a link to all the .dcm files downloadable in a zip.
  - tux3 3y ago
    Where I am, they just handed me a CD with the DICOM files inside Loads up fine on Linux. You can move around in 2D slices, or in a reconstructed 3D (albeit the resolutions of the MRI I had wasn't all that great)
  - wiml 3y ago
    As I understand it in the US you legally have access to the data as it's part of your medical records. In my experience it's as simple as asking, they give you a CD-R containing some DICOM files and a freeware DICOM viewer. Maybe more modern health systems will let you just download the files.
spullara 3y ago
Longitudinal data is extremely useful absent discovering something in the scan.
JoshTriplett 3y ago
Seems like having more data can only be a good thing (modulo any degree to which the scan itself has the potential to cause damage), but it's going to make it much more important to be cautious of false positives, as well as to not automatically assume that every potential issue is worth addressing and has no tradeoffs that would motivate choosing to handle it differently.
- seizethecheese 3y ago
  There’s only no harm in more data if you handle false positives perfectly. Surely, this is never the case, so there’s always some harm in more data.
  - Bukhmanizer 3y ago
    I’ve heard it’s quite hard to handle due to lawsuits and such. E.g if you get a scan and they find something that’s benign 99.99% of the time, if it does happen to be malignant, you’re going to find yourself in court.
  - whateverman23 3y ago
    > There’s only no harm in more data if you handle false positives perfectly. Surely, this is never the case, so there’s always some harm in more data. That's not the correct way to think about it. The correct way to think about it is whether or not there's more harm with more data than the status quo. Most medical professionals seem to think there's more harm than the status quo, but that doesn't change the fact that you're thinking about it wrong.
  - JoshTriplett 3y ago
    What I'm suggesting is that the harm is not, then, in having the data; the harm is acting on it in ways that make you worse off than if you hadn't acted, without considering false positives and without considering possible harms caused by the selected treatment.
    - tptacek 3y ago
deleted 3y ago
[deleted]
NickC25 3y ago
I don't see anything unnecessary about getting full body scans, especially if one has a family history of a given disease or aliment. If I'm predisposed for ________, and I find out really early, to the point where I might be able to fight (some of) it with lifestyle changes, why not?
- TaupeRanger 3y ago
  Why not? Because of the well known, widely understood problem of iatrogenic harms. Your conclusion does not follow from your premise. If you have a predisposition to a particular disease, get screened FOR THAT specific thing. Getting a full body scan just opens you up to unnecessary psychological distress, unnecessary treatments, and unnecessary healthcare costs for many things which would have never affected you in the slightest had you avoided getting a full body scan. Do you REALLY want to know that you have an aneurysm that only has a 1/100 chance of rupturing, when you would've otherwise gone your entire life without ever worrying about whether tonight will be the night that it ruptures and you won't wake up tomorrow? Do you really want to know that you have a slow growing cancer that would only affect you when you're already less 12 months from your ultimate death at age 92, but instead you got invasive life-altering surgery at age 65 because it just happened to show up on a scan? If we had instant, easy cures for every disease, then yes, get a full body scan - unfortunately this just isn't the case, and the harms greatly outweigh the benefits.
  - madacol 3y ago
    What I take from your arguments is that medicine is a full shit-show. Don't blame the full-body scan if you think the medical system is the real problem
    - TaupeRanger 3y ago
      The full body scan would be part of the problem, because it's not always clear what medicine should do given a specific finding on a scan, and decisions made on the basis of the scan would then lead to potential harms, as I outlined above. Why advocate for scans that would cause net harm?
bottlepalm 3y ago
It's a tough decision to make even if you have the money - PET scans use a radioactive tracer injected in your blood that's like 5 years worth of radiation in one day. It can detect cancers, but yea that's an unsettling amount of radiation. Then there's the risk of them actually finding something, which is very stressful, requires biopsies, potentially surgery, etc.. for something that could actually be benign. My gf did it already with no issues luckily, but I haven't been able to rationalize doing it myself.
- JimtheCoder 3y ago
  Are they not using MRI primarily?
  - bottlepalm 3y ago
    They offer MRI combined with PET. They give you a high dose of iron for to see things better in the pancreas. PET scan uses like radioactive sugar to find hungry cancer, even tiny ones. MRI is used to find large scale structural problems.
- version_five 3y ago
  It's an MRI, there's no radiation. And I understood these scans look for changes more than specific structures, so have fewer false positives than just a one-of https://archive.md/BDZX8 https://archive.md/BDZX8
  - bottlepalm 3y ago
    In terms of people getting preemptive scans, hospitals around the world offer PET/MRI/CT, etc.. basically an a la carte menu of diagnostics. To find cancer early you want PET.
- deleted 3y ago
  [deleted]
- ttyprintk 3y ago
  This article centers on an MRI company, who I’m sure tout the lack of exposure from MRI. If you’re going to get a PET scan, might as well do full-body, and make it PET/MRI. A PET/CT will reach 5-8 years equivalent of ambient background radiation.
Xcelerate 3y ago
The counterarguments presented in the article are silly. Of course we should have full body scans for preventative purposes. Could you imagine a utopian society where we don’t regularly have full body scans to detect problems early? Any new problems that arise as a result of this trend should be handled as exactly that — new problems. Too many false positives leading to wasted time and costs? Raise the price for the supplemental scans and improve detection precision and recall. Unnecessary procedures that make a benign situation worse? That’s a sign to improve medical research in that area. Too much demand for MRI machines pulling away time from patients that need to use them? Build more MRI machines. This is one of those situations where the ideal end goal seems obvious, and I think we should just plow ahead and address new problems as they arise. In the long run, better preventative medicine will save time, costs, and minimize suffering for everyone. A few road bumps along the way shouldn’t dissuade us from even getting started, otherwise we never will.
- solids 3y ago
  For me the biggest problem is the anxiety it produces. Both false positives as well as the fact itself of waiting for a result.
- duxup 3y ago
  At least in the US consumers really don't have much experience / have a lot of trouble managing medical costs.... even getting the cost. I think raising the price would just mean raised prices and effectively where we are now.
  - icoder 3y ago
    In the spirit of parent post (and for a whole lot of reasons by itself) then change the system.
    - duxup 3y ago
      I think the spirit of the parent post put more thought into it than "change the system".
- 3y ago
lalos 3y ago
Do doctors want to gatekeep technology to make sure they get a cut every time someone uses this machine? This seems to be sending a signal to the market for more competition of scanning technology so I can see this driving the price down for everybody in the long term.
- version_five 3y ago
  People will disagree but I think a lot of it is people angry that some can afford it and some cannot. In Canada we have only public healthcare, so everyone gets the same poor government service (unless you are rich enough to go to the US or know the loopholes). And people fight tooth and nail to keep it that way, in the interest in fairness. We recently has a court rule that even though people will die because of the absence of private options, that's an acceptable trade off to enforce "one-tier" universal healthcare. I'm sure doctors wanting a cut is another root cause, but a lot of it is just jealousy. See https://www.canadianlawyermag.com/practice-areas/litigation/bc-court-dismisses-appeal-of-lower-court-decision-limiting-private-healthcare/368269 https://www.canadianlawyermag.com/practice-areas/litigation/...
  - FpUser 3y ago
    >"people will die because of the absence of private options" Private options are available for Canadians. Just cross the border. Problem is that your generic Joe Six Pack can not afford it. If they open private in Canada the Janes and Joes still would not be able to pay for it.
    - qwytw 3y ago
      Private insurance in countries with a primarily public healthcare system seem to be relatively affordable in general. I guess it makes sense because young professionals who get it as job perk are overrepresented in the pool and pretty much all serious/very expensive issues will still be covered by the private system.
  - pkd 3y ago
    Healthcare in Canada has many problems but being "public" is not the cause of them. For decades conservative governments have underfunded the medical institutions in my municipality as a way of making true on their promise of lower taxes. Now the hospitals here are understaffed for the wave of infections every year and the staff is overworked. Things could be better if people stopped chasing lower taxes every election and actually thought about where that saved money was going to go. It doesn't need to go private. Although the Ford government in Ontario seems set to lead the province in that direction by continuing the legacy of conservative governments.
wrp 3y ago
I've seen discussion about this. It seems the general opinion among doctors is that full-body scans for everyone would be a bad idea, because most people have some structural anomalies inside that shouldn't be a concern but would make people anxious anyway.
- TaupeRanger 3y ago
  It's not just the anxiety and psychological distress either. If we scanned everyone all the time, you would find literally millions of conditions that would never cause symptoms or major health issues, but would nevertheless be treated unnecessarily, incurring massive additional costs and needless interventions with their own risks. It would be a nightmare.
  - shiftpgdn 3y ago
    This doesn't make any sense to me. It's either a problem or it isn't unless doctors are willing to admit they perform lots of unnecessary procedures already.
    - ch4s3 3y ago
      Most doctors will freely admit that they sometimes do unnecessary procedures out of an abundance of caution.
    - duxup 3y ago
      >It's either a problem or it isn't Try looking at a full body scan and make that call.
    - BeetleB 3y ago
      > It's either a problem or it isn't That's vacuously true. The problem is that we humans can't always discern the truth of the situation. Not even doctors. They perform a lot of unnecessary procedures. It's well known and not a conspiracy. Sometimes they do it to make money. Other times it's so they don't get sued. Scan the comments here and you'll see sentiments of people upset that their doctor didn't do a procedure and blaming them for adverse health problems.
jsiepkes 3y ago
Personal anecdote: The wife of someone I know got a full body scan in Germany (because they were outlawed in the Netherlands, don't know if they still are). Clean bill of health. About 4 months later she was in the hospital with cancer.
- yieldcrv 3y ago
  Damn, one of the worst parts about cancers is that there isn’t information on how fast they grow unimpeded, so that messes up knowing what interval would be best Its like a fetus growing in the wrong part of your body, several weeks go by and you’ll have an organ problem
- prepend 3y ago
  I think since the scan practitioners know their customers are all “tourists” and they aren’t regulated for accuracy (they aren’t part of guidelines and medical review) not cost effectiveness (insurance won’t pay) I wonder how seriously the interpretations are. If if you’re a great radiologist, if 999/1000 scans are just of healthy rich people you might not stay vigilant.
- refurb 3y ago
  A full body scan isn’t going to capture 100% of cancers. Especially things like blood cancers where there is no tumor.
  - antoniuschan99 3y ago
    I read the full body scans are not entirely accurate compared to specific/localized scans. But definitely helpful, for example I read x-rays don’t pick up lung cancer until much later. Whereas mri’s will pick it up? CT and the PET scans are the most accurate cuz the liquid will light up but itself has a prevalence of causing cancer, higher chance the younger the individual is. Also this xkcd is great at illustrating radiation doses https://xkcd.com/radiation/ https://xkcd.com/radiation/
cyberax 3y ago
Doing a CT or PET scan just for fun is not a great idea, because of the radiation dose received. However, MRI is completely benign. It doesn't expose patients to any dangerous radiation and is minimally intrusive (you just need an IV for contrast). The justification "but then we'll have to check the findings!" is super-weak.
- tptacek 3y ago
  No, it's not at all a weak justification, and it is the primary reason you shouldn't get these scans done. The problem here is our old friend the Bayesian Base Rate fallacy. The diseases you're looking to intercept and intervene against are, in the general population, pretty rare. That means that even if the indications you'd get from diagnostic imaging are extraordinarily accurate (they aren't), the overwhelming majority of the flags they raise are going to be false positives. The cost of a false positive imaging flag is far worse than having to have an unpleasant chat with your doctor, or worrying for several weeks (do not discount the cost of worrying for several weeks, though; these scares can absolutely fuck up a month of your life). Rather: you'll pay the price in follow-up imaging, which won't be as benign as the MRI, or worse, in unnecessary intrusive diagnostics.
  - jstummbillig 3y ago
    Seems plausible. So what's up with the wealthy? They do not care? They do not know? They get talked into it by greedy physicians? Or is the story more likely just not true?
    - DragonStrength 3y ago
      Well, it's not as if wealthy people are any different from the average Joe. They may go on HN instead of FB for their medical advice (and I've seen these sorts of scans advocated in comments here, to be clear), but that doesn't mean they have any more knowledge of outcomes for these screenings. What they do have is a knowledge of their own (and parents') mortality and means to do anything they can to prevent it. Buy a bunker in NZ, try to build a base on the moon, or spend a couple grand on a frivolous scan? Rich people gonna rich people. Yes, the medical system in the US is for-profit and fee-based. Medical providers make money by building small businesses which do a lot of procedures. Here is another very expensive, uncovered procedure for them to bill.
xwdv 3y ago
Doctors will tell you don’t do this: waste of time, more harm than good, etc. This is all fine as general advice when you see patients as mere statistics and you want to apply broad generally applicable advice for everyone. However, it is more meaningful for the wealthier individual or a VIP to have their body fully documented. Even if no action is taken for some possible tumors, having some knowledge is better than being totally blind. And maybe it’s a waste of money, but if you have the money to waste it’s not a big deal.
- TaupeRanger 3y ago
  Some knowledge actually ISN'T always better than none. Imagine you get a scan and find an aneurysm. The aneurysm has a 1/100 chance of rupturing during your life. Surgery is too risky for the relatively small chance of rupture, so the advice is to "watch and wait". Now you have to go to bed every night wondering if tonight is the night that it ruptures and you don't wake up tomorrow. We know that psychological distress exacts a physical toll on the body. So, on net, assuming no rupture, you gained nothing except the harms associated with knowing about the aneurysm, or the harms associated with unnecessary treatment for a low risk condition. This is the case with all kinds of diseases across the board.
  - xwdv 3y ago
    The stress is temporary. Eventually, you come to terms: You will die and there will be nothing you can do about it. So be grateful for everyday, and take nothing for granted. Then, you will know peace.
sMarsIntruder 3y ago
https://archive.ph/BDZX8 https://archive.ph/BDZX8
intrasight 3y ago
What's funny is that I recall reading an article 30 years ago about rich Japanese forming clubs to purchase MRI access for regular scans. It stuck with me because I thought "someday, we'll all get annual MRIs for baseline data. But now 30 years in the future it still not happening. Because we suck at preventative medicine.
- prepend 3y ago
  > Because we suck at preventative medicine Or because mri scans aren’t good at preventative medicine.
  - intrasight 3y ago
    We don't yet know that. Point me at a study showing health outcomes from a cohort study where one group gets full-body MRIs every 3 months compared to a control group that does not.
version_five 3y ago
I'd like to see a "back of the envelope" analysis of how many MRI scanners would be needed to make this universal, and in particular how much helium we'd need. I'd guess it would be challenging, but the scale might be good for spurring advances in AI (edit, I had meant to say advances in MRI).
- ttyprintk 3y ago
  It absolutely would help train AI. We have a huge amount of CT and little MRI.
  - version_five 3y ago
    I must have AI on the brain, I actually meant to say MRI, as in advances in scanner technology. But of course you're right it would be a very rich source of data
- devilbunny 3y ago
  MRI is good at some things, but is often inferior to CT for other issues. You basically can't MRI the heart, but CT scanners are so fast that you can scan the heart. A typical spine MRI that includes cervical, thoracic, and lumbar takes around 2 hours. A full body CT takes a minute or two even with older machines. So purely logistically, regular scans will be CT, with MRI only used for certain issues (they do well with soft tissue like ligament injuries).
blogornot 3y ago
While on vacation in Korea I received a full work up (MRI, blood labs, echo, CT scan, dental work, etc) for a couple thousand dollars. I wanted to do it because I wanted a clear picture of my health. I get headaches a lot and have expressed concerned to doctors in the USA but they never seemed to care. I honestly wanted the MRI to rule out anything bad. Was it worth? I think so. The doctors ended up seeing something on my thyroid which was then biopsied. It came back benign but something to keep an eye on and check every six months or so. This carried back over to the USA.
- henry2023 3y ago
  So you 1. paid a couple thousand dollars, 2. got a biopsy 3. it was nothing 4. probably are going to get a biopsy in the future because you wan to "keep an eye on it". Are you sure you're not harming yourself?
  - blogornot 3y ago
    I don't need future biopsies, only ultrasounds to keep an eye on its size. I don't think there's any harm.
foogazi 3y ago
Anyone getting these scans. I’d be interested in knowing more
rrsp 3y ago
As a doctor organising a scan is the path of least resistance, patients almost universally think that a scan = good care, and why would they not? More data is better surely as another commentator has noted. So we do the scan and find an ovarian cyst, not to be unexpected, the prevalence of an ovarian cyst is widely quoted as anywhere between 8-15% [1]. You tell the patient that you found an ovarian cyst. Naturally she asks if it’s concerning. It’s a simple cyst, so if we use [1] to inform our figures we can tell her that in 1 years time there’s a 50% chance that the cyst will be gone, a 34% chance it will still be there, a 7.5% chance that there will be more than one cyst and a 5.5% chance that there will be a complex cyst. Simple cysts are not thought to be linked with an increased risk of ovarian cancer, but complex ones are. Now on hearing that there’s a 5.5% chance of finding a complex cyst next year the patient opts for follow up scanning. They of course Google symptoms of ovarian cancer and see that bloating is a symptom. The patient worries, she has very bothersome bloating, she reads about doctors missing ovarian cancer and worries if her cyst has been misdiagnosed. Of course 31% of the population have bloating of significance [2], but how do we know in this case it isn’t ovarian cancer? So she gets an early ultrasound 3 months later. The cyst has now gone from the ovary, but the other ovary now has a cyst. She gets another scan in 3 months time and the cyst is still there, she’s finds herself more and more worried, why didn’t it go like the last cyst? She reads online about a blood test for ovarian cancer, the CA125. She reads survivors stories telling her the importance of having this blood test done early, so she goes to the doctor and asks to have it done. It comes back slightly elevated. Her fear is confirmed, she has cancer. Now a raised CA-125 has a positive prediction rate of about 10%, and with her imaging findings the likelihood is likely lower, but it is not zero. So we proceed to biopsy. A couple of weeks later the result is in, no cancer, in keeping with the most likely outcome in the scenario. The patient elated at the news thanks the doctor and all is well. Her journey has been 6 months all in all, she’s had multiple sleepless nights, her blood pressure has gone up and her stress levels have been higher, slightly invisibly nudging her up risk of a stroke or other cardiovascular disease in the future. Now is this good medicine? I guess that’s up for debate, and like I said at the beginning patients like when we scan them, and appreciate when we tell them that their biopsy is negative. They like seeing things done. The doctor who told her not to the scan was clearly a hack as it showed the cyst. Despite the fact that if she’d listened to them she’d have saved herself months of worry and ultimately her health would have probably been slightly better through having avoided the stress and an invasive biopsy. We also know that screening for ovarian cancer does not change mortality for ovarian cancer, it leads to 1% of all women screened having some form or surgery who do not end up having cancer and 3-15% of these women end up with a major complication from this surgery. [6] Another statistic that I keep in mind is that 11.5% of people under 40 have a thyroid cancer at autopsy and 13.4% of people over 80 [5]. These people lived a good chunk of their lives with this cancer which never caused them any issues or harm, it lay there growing slowly completely undetected and then they died of something else. Now would these people have been better off if they’d got a whole body scan, picked up the cancer and spent the last year of their life having their thyroid gland removed, taking new medication to replace their thyroid hormone, having regular bloods and follow up, all for something that ultimately never would have caused them issues, again I’m not convinced. The patient themselves however if we did go down that route will come in and thank me for saving their life, they’re often so grateful and happy that the cancer was picked up, sometimes they come in with a complication from the surgery, their voice horse from the vocal cord palsy, but they don’t mind as their cancer has been cured. The cancer that would never have caused them any harm. [1]https://ascopubs.org/doi/abs/10.1200/jco.2008.26.15_suppl.5571 https://ascopubs.org/doi/abs/10.1200/jco.2008.26.15_suppl.55... [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264926/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264926/ [3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583394/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583394/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592785/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592785/ [5] https://academic.oup.com/jcem/article-abstract/107/10/2945/6659928?redirectedFrom=fulltext https://academic.oup.com/jcem/article-abstract/107/10/2945/6... [6] https://pubmed.ncbi.nlm.nih.gov/29450530/ https://pubmed.ncbi.nlm.nih.gov/29450530/
liminal 3y ago
Definitely buy your life/disability insurance before you get the scans!
oldgradstudent 3y ago
Has it ever been shown that full body scan reduces mortality or morbidity? The simple answer is No. It may, or it may not. Probably not. It's not even clear that mammography or colonoscopy reduce mortality or morbidity.
ggm 3y ago
I had significant resistance to getting a leg bone length scan from my GP despite explaining this was purely to inform a decision to fit one sided lifts to my rowing shoes. Luckily the practice has a run-on field doctor for one of the local sporting codes who agreed it was low risk of harm and potentially useful. My physio at the gym noticed postural issues some time ago under load. I'm told by an E.P. that almost everyone has some leg length variance, and it's "normal" -and rarely matters. My partner has hypermobile joints, and in her case gait issues meant getting an asymmetric lift helped her enormously. Now, I can sit straighter in the 4 on the water, I can do more legwork on a pilates reformer, I have the choice to get differential height orthodics. I'm not going to do anything quickly because I have no visible gait problems or pain, it's purely biomechanics under load rowing for me. Tl;DR some diagnostic scans are worth it outside of illness.
1letterunixname 3y ago
What happens when profits corrupt the healthcare system. Body scans and yearly checkups don't work because they're healthcare theater primarily set to sell reassurance. We should be spending money on money-saving prophylaxis of common, treatable diseases like CHD and screening all body systems for function and decline. PAC and CT angios lack evidence but they're the obvious tools to assess coronary artery state before there's a problem, rather than waiting until a patient has a heart attack and dies.
bookofjoe 3y ago
>Whole‐body MRI for preventive health screening: A systematic review of the literature (2019) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850647/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850647/

80 points by lxm 3y ago

I want one. It feels like having a snapshot to compare against latter just makes hella sense. And I'm a geek who could actually go load up & visualize the data myself. Which would be cool.

ljf 3y ago
Where you are, will you actually get access to the Data? Or will they just review and store it for you? Just interested in the output and what you actually get to keep.
- sidewndr46 3y ago
  I can't find it presently but I read some blog post about a guy getting his MRI data. It's apparently possible but like most things in life, a pain.
- JimtheCoder 3y ago
  If they are paying for it out of pocket, I assume they would have the option for the raw data. Maybe a small-ish processing fee, because...American healthcare.
- sturob 3y ago
  Prenuvo give you a link to all the .dcm files downloadable in a zip.
- tux3 3y ago
  Where I am, they just handed me a CD with the DICOM files inside Loads up fine on Linux. You can move around in 2D slices, or in a reconstructed 3D (albeit the resolutions of the MRI I had wasn't all that great)
- wiml 3y ago
  As I understand it in the US you legally have access to the data as it's part of your medical records. In my experience it's as simple as asking, they give you a CD-R containing some DICOM files and a freeware DICOM viewer. Maybe more modern health systems will let you just download the files.

spullara 3y ago

Longitudinal data is extremely useful absent discovering something in the scan.

JoshTriplett 3y ago

Seems like having more data can only be a good thing (modulo any degree to which the scan itself has the potential to cause damage), but it's going to make it much more important to be cautious of false positives, as well as to not automatically assume that every potential issue is worth addressing and has no tradeoffs that would motivate choosing to handle it differently.

seizethecheese 3y ago
There’s only no harm in more data if you handle false positives perfectly. Surely, this is never the case, so there’s always some harm in more data.
- Bukhmanizer 3y ago
  I’ve heard it’s quite hard to handle due to lawsuits and such. E.g if you get a scan and they find something that’s benign 99.99% of the time, if it does happen to be malignant, you’re going to find yourself in court.
- whateverman23 3y ago
  > There’s only no harm in more data if you handle false positives perfectly. Surely, this is never the case, so there’s always some harm in more data. That's not the correct way to think about it. The correct way to think about it is whether or not there's more harm with more data than the status quo. Most medical professionals seem to think there's more harm than the status quo, but that doesn't change the fact that you're thinking about it wrong.
- JoshTriplett 3y ago
  What I'm suggesting is that the harm is not, then, in having the data; the harm is acting on it in ways that make you worse off than if you hadn't acted, without considering false positives and without considering possible harms caused by the selected treatment.
  - tptacek 3y ago

deleted 3y ago

[deleted]

NickC25 3y ago

I don't see anything unnecessary about getting full body scans, especially if one has a family history of a given disease or aliment. If I'm predisposed for ________, and I find out really early, to the point where I might be able to fight (some of) it with lifestyle changes, why not?

TaupeRanger 3y ago
Why not? Because of the well known, widely understood problem of iatrogenic harms. Your conclusion does not follow from your premise. If you have a predisposition to a particular disease, get screened FOR THAT specific thing. Getting a full body scan just opens you up to unnecessary psychological distress, unnecessary treatments, and unnecessary healthcare costs for many things which would have never affected you in the slightest had you avoided getting a full body scan. Do you REALLY want to know that you have an aneurysm that only has a 1/100 chance of rupturing, when you would've otherwise gone your entire life without ever worrying about whether tonight will be the night that it ruptures and you won't wake up tomorrow? Do you really want to know that you have a slow growing cancer that would only affect you when you're already less 12 months from your ultimate death at age 92, but instead you got invasive life-altering surgery at age 65 because it just happened to show up on a scan? If we had instant, easy cures for every disease, then yes, get a full body scan - unfortunately this just isn't the case, and the harms greatly outweigh the benefits.
- madacol 3y ago
  What I take from your arguments is that medicine is a full shit-show. Don't blame the full-body scan if you think the medical system is the real problem
  - TaupeRanger 3y ago
    The full body scan would be part of the problem, because it's not always clear what medicine should do given a specific finding on a scan, and decisions made on the basis of the scan would then lead to potential harms, as I outlined above. Why advocate for scans that would cause net harm?

bottlepalm 3y ago

It's a tough decision to make even if you have the money - PET scans use a radioactive tracer injected in your blood that's like 5 years worth of radiation in one day. It can detect cancers, but yea that's an unsettling amount of radiation. Then there's the risk of them actually finding something, which is very stressful, requires biopsies, potentially surgery, etc.. for something that could actually be benign. My gf did it already with no issues luckily, but I haven't been able to rationalize doing it myself.

JimtheCoder 3y ago
Are they not using MRI primarily?
- bottlepalm 3y ago
  They offer MRI combined with PET. They give you a high dose of iron for to see things better in the pancreas. PET scan uses like radioactive sugar to find hungry cancer, even tiny ones. MRI is used to find large scale structural problems.
version_five 3y ago
It's an MRI, there's no radiation. And I understood these scans look for changes more than specific structures, so have fewer false positives than just a one-of https://archive.md/BDZX8 https://archive.md/BDZX8
- bottlepalm 3y ago
  In terms of people getting preemptive scans, hospitals around the world offer PET/MRI/CT, etc.. basically an a la carte menu of diagnostics. To find cancer early you want PET.
deleted 3y ago
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ttyprintk 3y ago
This article centers on an MRI company, who I’m sure tout the lack of exposure from MRI. If you’re going to get a PET scan, might as well do full-body, and make it PET/MRI. A PET/CT will reach 5-8 years equivalent of ambient background radiation.

Xcelerate 3y ago

The counterarguments presented in the article are silly. Of course we should have full body scans for preventative purposes. Could you imagine a utopian society where we don’t regularly have full body scans to detect problems early? Any new problems that arise as a result of this trend should be handled as exactly that — new problems. Too many false positives leading to wasted time and costs? Raise the price for the supplemental scans and improve detection precision and recall. Unnecessary procedures that make a benign situation worse? That’s a sign to improve medical research in that area. Too much demand for MRI machines pulling away time from patients that need to use them? Build more MRI machines. This is one of those situations where the ideal end goal seems obvious, and I think we should just plow ahead and address new problems as they arise. In the long run, better preventative medicine will save time, costs, and minimize suffering for everyone. A few road bumps along the way shouldn’t dissuade us from even getting started, otherwise we never will.

solids 3y ago
For me the biggest problem is the anxiety it produces. Both false positives as well as the fact itself of waiting for a result.
duxup 3y ago
At least in the US consumers really don't have much experience / have a lot of trouble managing medical costs.... even getting the cost. I think raising the price would just mean raised prices and effectively where we are now.
- icoder 3y ago
  In the spirit of parent post (and for a whole lot of reasons by itself) then change the system.
  - duxup 3y ago
    I think the spirit of the parent post put more thought into it than "change the system".
3y ago

lalos 3y ago

Do doctors want to gatekeep technology to make sure they get a cut every time someone uses this machine? This seems to be sending a signal to the market for more competition of scanning technology so I can see this driving the price down for everybody in the long term.

version_five 3y ago
People will disagree but I think a lot of it is people angry that some can afford it and some cannot. In Canada we have only public healthcare, so everyone gets the same poor government service (unless you are rich enough to go to the US or know the loopholes). And people fight tooth and nail to keep it that way, in the interest in fairness. We recently has a court rule that even though people will die because of the absence of private options, that's an acceptable trade off to enforce "one-tier" universal healthcare. I'm sure doctors wanting a cut is another root cause, but a lot of it is just jealousy. See https://www.canadianlawyermag.com/practice-areas/litigation/bc-court-dismisses-appeal-of-lower-court-decision-limiting-private-healthcare/368269 https://www.canadianlawyermag.com/practice-areas/litigation/...
- FpUser 3y ago
  >"people will die because of the absence of private options" Private options are available for Canadians. Just cross the border. Problem is that your generic Joe Six Pack can not afford it. If they open private in Canada the Janes and Joes still would not be able to pay for it.
  - qwytw 3y ago
    Private insurance in countries with a primarily public healthcare system seem to be relatively affordable in general. I guess it makes sense because young professionals who get it as job perk are overrepresented in the pool and pretty much all serious/very expensive issues will still be covered by the private system.
- pkd 3y ago
  Healthcare in Canada has many problems but being "public" is not the cause of them. For decades conservative governments have underfunded the medical institutions in my municipality as a way of making true on their promise of lower taxes. Now the hospitals here are understaffed for the wave of infections every year and the staff is overworked. Things could be better if people stopped chasing lower taxes every election and actually thought about where that saved money was going to go. It doesn't need to go private. Although the Ford government in Ontario seems set to lead the province in that direction by continuing the legacy of conservative governments.

wrp 3y ago

I've seen discussion about this. It seems the general opinion among doctors is that full-body scans for everyone would be a bad idea, because most people have some structural anomalies inside that shouldn't be a concern but would make people anxious anyway.

TaupeRanger 3y ago
It's not just the anxiety and psychological distress either. If we scanned everyone all the time, you would find literally millions of conditions that would never cause symptoms or major health issues, but would nevertheless be treated unnecessarily, incurring massive additional costs and needless interventions with their own risks. It would be a nightmare.
- shiftpgdn 3y ago
  This doesn't make any sense to me. It's either a problem or it isn't unless doctors are willing to admit they perform lots of unnecessary procedures already.
  - ch4s3 3y ago
    Most doctors will freely admit that they sometimes do unnecessary procedures out of an abundance of caution.
  - duxup 3y ago
    >It's either a problem or it isn't Try looking at a full body scan and make that call.
  - BeetleB 3y ago
    > It's either a problem or it isn't That's vacuously true. The problem is that we humans can't always discern the truth of the situation. Not even doctors. They perform a lot of unnecessary procedures. It's well known and not a conspiracy. Sometimes they do it to make money. Other times it's so they don't get sued. Scan the comments here and you'll see sentiments of people upset that their doctor didn't do a procedure and blaming them for adverse health problems.

jsiepkes 3y ago

Personal anecdote: The wife of someone I know got a full body scan in Germany (because they were outlawed in the Netherlands, don't know if they still are). Clean bill of health. About 4 months later she was in the hospital with cancer.

yieldcrv 3y ago
Damn, one of the worst parts about cancers is that there isn’t information on how fast they grow unimpeded, so that messes up knowing what interval would be best Its like a fetus growing in the wrong part of your body, several weeks go by and you’ll have an organ problem
prepend 3y ago
I think since the scan practitioners know their customers are all “tourists” and they aren’t regulated for accuracy (they aren’t part of guidelines and medical review) not cost effectiveness (insurance won’t pay) I wonder how seriously the interpretations are. If if you’re a great radiologist, if 999/1000 scans are just of healthy rich people you might not stay vigilant.
refurb 3y ago
A full body scan isn’t going to capture 100% of cancers. Especially things like blood cancers where there is no tumor.
- antoniuschan99 3y ago
  I read the full body scans are not entirely accurate compared to specific/localized scans. But definitely helpful, for example I read x-rays don’t pick up lung cancer until much later. Whereas mri’s will pick it up? CT and the PET scans are the most accurate cuz the liquid will light up but itself has a prevalence of causing cancer, higher chance the younger the individual is. Also this xkcd is great at illustrating radiation doses https://xkcd.com/radiation/ https://xkcd.com/radiation/

cyberax 3y ago

Doing a CT or PET scan just for fun is not a great idea, because of the radiation dose received. However, MRI is completely benign. It doesn't expose patients to any dangerous radiation and is minimally intrusive (you just need an IV for contrast). The justification "but then we'll have to check the findings!" is super-weak.

tptacek 3y ago
No, it's not at all a weak justification, and it is the primary reason you shouldn't get these scans done. The problem here is our old friend the Bayesian Base Rate fallacy. The diseases you're looking to intercept and intervene against are, in the general population, pretty rare. That means that even if the indications you'd get from diagnostic imaging are extraordinarily accurate (they aren't), the overwhelming majority of the flags they raise are going to be false positives. The cost of a false positive imaging flag is far worse than having to have an unpleasant chat with your doctor, or worrying for several weeks (do not discount the cost of worrying for several weeks, though; these scares can absolutely fuck up a month of your life). Rather: you'll pay the price in follow-up imaging, which won't be as benign as the MRI, or worse, in unnecessary intrusive diagnostics.
- jstummbillig 3y ago
  Seems plausible. So what's up with the wealthy? They do not care? They do not know? They get talked into it by greedy physicians? Or is the story more likely just not true?
  - DragonStrength 3y ago
    Well, it's not as if wealthy people are any different from the average Joe. They may go on HN instead of FB for their medical advice (and I've seen these sorts of scans advocated in comments here, to be clear), but that doesn't mean they have any more knowledge of outcomes for these screenings. What they do have is a knowledge of their own (and parents') mortality and means to do anything they can to prevent it. Buy a bunker in NZ, try to build a base on the moon, or spend a couple grand on a frivolous scan? Rich people gonna rich people. Yes, the medical system in the US is for-profit and fee-based. Medical providers make money by building small businesses which do a lot of procedures. Here is another very expensive, uncovered procedure for them to bill.

xwdv 3y ago

Doctors will tell you don’t do this: waste of time, more harm than good, etc. This is all fine as general advice when you see patients as mere statistics and you want to apply broad generally applicable advice for everyone. However, it is more meaningful for the wealthier individual or a VIP to have their body fully documented. Even if no action is taken for some possible tumors, having some knowledge is better than being totally blind. And maybe it’s a waste of money, but if you have the money to waste it’s not a big deal.

TaupeRanger 3y ago
Some knowledge actually ISN'T always better than none. Imagine you get a scan and find an aneurysm. The aneurysm has a 1/100 chance of rupturing during your life. Surgery is too risky for the relatively small chance of rupture, so the advice is to "watch and wait". Now you have to go to bed every night wondering if tonight is the night that it ruptures and you don't wake up tomorrow. We know that psychological distress exacts a physical toll on the body. So, on net, assuming no rupture, you gained nothing except the harms associated with knowing about the aneurysm, or the harms associated with unnecessary treatment for a low risk condition. This is the case with all kinds of diseases across the board.
- xwdv 3y ago
  The stress is temporary. Eventually, you come to terms: You will die and there will be nothing you can do about it. So be grateful for everyday, and take nothing for granted. Then, you will know peace.

sMarsIntruder 3y ago

https://archive.ph/BDZX8 https://archive.ph/BDZX8

intrasight 3y ago

What's funny is that I recall reading an article 30 years ago about rich Japanese forming clubs to purchase MRI access for regular scans. It stuck with me because I thought "someday, we'll all get annual MRIs for baseline data. But now 30 years in the future it still not happening. Because we suck at preventative medicine.

prepend 3y ago
> Because we suck at preventative medicine Or because mri scans aren’t good at preventative medicine.
- intrasight 3y ago
  We don't yet know that. Point me at a study showing health outcomes from a cohort study where one group gets full-body MRIs every 3 months compared to a control group that does not.

version_five 3y ago

I'd like to see a "back of the envelope" analysis of how many MRI scanners would be needed to make this universal, and in particular how much helium we'd need. I'd guess it would be challenging, but the scale might be good for spurring advances in AI (edit, I had meant to say advances in MRI).

ttyprintk 3y ago
It absolutely would help train AI. We have a huge amount of CT and little MRI.
- version_five 3y ago
  I must have AI on the brain, I actually meant to say MRI, as in advances in scanner technology. But of course you're right it would be a very rich source of data
devilbunny 3y ago
MRI is good at some things, but is often inferior to CT for other issues. You basically can't MRI the heart, but CT scanners are so fast that you can scan the heart. A typical spine MRI that includes cervical, thoracic, and lumbar takes around 2 hours. A full body CT takes a minute or two even with older machines. So purely logistically, regular scans will be CT, with MRI only used for certain issues (they do well with soft tissue like ligament injuries).

blogornot 3y ago

While on vacation in Korea I received a full work up (MRI, blood labs, echo, CT scan, dental work, etc) for a couple thousand dollars. I wanted to do it because I wanted a clear picture of my health. I get headaches a lot and have expressed concerned to doctors in the USA but they never seemed to care. I honestly wanted the MRI to rule out anything bad. Was it worth? I think so. The doctors ended up seeing something on my thyroid which was then biopsied. It came back benign but something to keep an eye on and check every six months or so. This carried back over to the USA.

henry2023 3y ago
So you 1. paid a couple thousand dollars, 2. got a biopsy 3. it was nothing 4. probably are going to get a biopsy in the future because you wan to "keep an eye on it". Are you sure you're not harming yourself?
- blogornot 3y ago
  I don't need future biopsies, only ultrasounds to keep an eye on its size. I don't think there's any harm.

foogazi 3y ago

Anyone getting these scans. I’d be interested in knowing more

rrsp 3y ago

As a doctor organising a scan is the path of least resistance, patients almost universally think that a scan = good care, and why would they not? More data is better surely as another commentator has noted. So we do the scan and find an ovarian cyst, not to be unexpected, the prevalence of an ovarian cyst is widely quoted as anywhere between 8-15% [1]. You tell the patient that you found an ovarian cyst. Naturally she asks if it’s concerning. It’s a simple cyst, so if we use [1] to inform our figures we can tell her that in 1 years time there’s a 50% chance that the cyst will be gone, a 34% chance it will still be there, a 7.5% chance that there will be more than one cyst and a 5.5% chance that there will be a complex cyst. Simple cysts are not thought to be linked with an increased risk of ovarian cancer, but complex ones are. Now on hearing that there’s a 5.5% chance of finding a complex cyst next year the patient opts for follow up scanning. They of course Google symptoms of ovarian cancer and see that bloating is a symptom. The patient worries, she has very bothersome bloating, she reads about doctors missing ovarian cancer and worries if her cyst has been misdiagnosed. Of course 31% of the population have bloating of significance [2], but how do we know in this case it isn’t ovarian cancer? So she gets an early ultrasound 3 months later. The cyst has now gone from the ovary, but the other ovary now has a cyst. She gets another scan in 3 months time and the cyst is still there, she’s finds herself more and more worried, why didn’t it go like the last cyst? She reads online about a blood test for ovarian cancer, the CA125. She reads survivors stories telling her the importance of having this blood test done early, so she goes to the doctor and asks to have it done. It comes back slightly elevated. Her fear is confirmed, she has cancer. Now a raised CA-125 has a positive prediction rate of about 10%, and with her imaging findings the likelihood is likely lower, but it is not zero. So we proceed to biopsy. A couple of weeks later the result is in, no cancer, in keeping with the most likely outcome in the scenario. The patient elated at the news thanks the doctor and all is well. Her journey has been 6 months all in all, she’s had multiple sleepless nights, her blood pressure has gone up and her stress levels have been higher, slightly invisibly nudging her up risk of a stroke or other cardiovascular disease in the future. Now is this good medicine? I guess that’s up for debate, and like I said at the beginning patients like when we scan them, and appreciate when we tell them that their biopsy is negative. They like seeing things done. The doctor who told her not to the scan was clearly a hack as it showed the cyst. Despite the fact that if she’d listened to them she’d have saved herself months of worry and ultimately her health would have probably been slightly better through having avoided the stress and an invasive biopsy. We also know that screening for ovarian cancer does not change mortality for ovarian cancer, it leads to 1% of all women screened having some form or surgery who do not end up having cancer and 3-15% of these women end up with a major complication from this surgery. [6] Another statistic that I keep in mind is that 11.5% of people under 40 have a thyroid cancer at autopsy and 13.4% of people over 80 [5]. These people lived a good chunk of their lives with this cancer which never caused them any issues or harm, it lay there growing slowly completely undetected and then they died of something else. Now would these people have been better off if they’d got a whole body scan, picked up the cancer and spent the last year of their life having their thyroid gland removed, taking new medication to replace their thyroid hormone, having regular bloods and follow up, all for something that ultimately never would have caused them issues, again I’m not convinced. The patient themselves however if we did go down that route will come in and thank me for saving their life, they’re often so grateful and happy that the cancer was picked up, sometimes they come in with a complication from the surgery, their voice horse from the vocal cord palsy, but they don’t mind as their cancer has been cured. The cancer that would never have caused them any harm. [1]https://ascopubs.org/doi/abs/10.1200/jco.2008.26.15_suppl.5571 https://ascopubs.org/doi/abs/10.1200/jco.2008.26.15_suppl.55... [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264926/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264926/ [3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583394/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583394/ [4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592785/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592785/ [5] https://academic.oup.com/jcem/article-abstract/107/10/2945/6659928?redirectedFrom=fulltext https://academic.oup.com/jcem/article-abstract/107/10/2945/6... [6] https://pubmed.ncbi.nlm.nih.gov/29450530/ https://pubmed.ncbi.nlm.nih.gov/29450530/

liminal 3y ago

Definitely buy your life/disability insurance before you get the scans!

oldgradstudent 3y ago

Has it ever been shown that full body scan reduces mortality or morbidity? The simple answer is No. It may, or it may not. Probably not. It's not even clear that mammography or colonoscopy reduce mortality or morbidity.

ggm 3y ago

I had significant resistance to getting a leg bone length scan from my GP despite explaining this was purely to inform a decision to fit one sided lifts to my rowing shoes. Luckily the practice has a run-on field doctor for one of the local sporting codes who agreed it was low risk of harm and potentially useful. My physio at the gym noticed postural issues some time ago under load. I'm told by an E.P. that almost everyone has some leg length variance, and it's "normal" -and rarely matters. My partner has hypermobile joints, and in her case gait issues meant getting an asymmetric lift helped her enormously. Now, I can sit straighter in the 4 on the water, I can do more legwork on a pilates reformer, I have the choice to get differential height orthodics. I'm not going to do anything quickly because I have no visible gait problems or pain, it's purely biomechanics under load rowing for me. Tl;DR some diagnostic scans are worth it outside of illness.

1letterunixname 3y ago

What happens when profits corrupt the healthcare system. Body scans and yearly checkups don't work because they're healthcare theater primarily set to sell reassurance. We should be spending money on money-saving prophylaxis of common, treatable diseases like CHD and screening all body systems for function and decline. PAC and CT angios lack evidence but they're the obvious tools to assess coronary artery state before there's a problem, rather than waiting until a patient has a heart attack and dies.

bookofjoe 3y ago

>Whole‐body MRI for preventive health screening: A systematic review of the literature (2019) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850647/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850647/