11 ms·

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

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".
groby_b 3y ago
I think that long term, preventative scans do make sense. With that preface, I don't think we should just argue there are no problems, and it's all easily solvable. "Too many false positives leading to wasted time and costs? Raise the costs for the supplemental scans and improve detection precision and recall." You can't improve precision/signal on an inherently weak and noisy signal. There are many things showing up on MRIs that currently require a biopsy. You need alternative DX routes to disambiguate, MRI alone can't do that. As for raising the costs - who pays? Medical costs are already completely bonkers. "That’s a sign to improve medical research in that area. " We know we need to improve search. We don't need to cause negative outcomes to reinforce that signal. "Too much demand for MRI machines pulling away time from patients that need to use them? Build more MRI machines. " Again, who pays? "we should just plow ahead and address new problems as they arise." There is the problem of opportunity cost. Is that the best possible way to spend sparse resources? The medical community currently mostly thinks that it isn't. Targeting wealthy people first does solve the "who pays" problem. It might make the "too few researchers" issue worse. It will cause a lot of unnecessary biopsies (because often that's the only alternative dx route) - but you could certainly lean into informed consent there. You do run the risk of poisoning MRIs as a diagnostic tool, because media will report any inconvenience to sufficiently wealthy people as a major problem. All of this might be solvable, but "let's just press ahead and see" is a very bad approach here.
- gojomo 3y ago
  If the "things showing up on MRIs that currently require a biopsy" don't actually pass cost-benefit analysis on their own, that 'requirement' can & should be adjusted down. Or, new diagnostics with less cost/risk developed. That today's "MRI alone can't do it" isn't a hint what novel techniques might be able to do – once demand created. A sufficiently-flexible & high-res set of downstream decisions can always choose to ignore data that isn't really helpful. Enough scans & experience might discover the new patterns. Our ossified medical system, with those "already completely bonkers" costs, has a hard time adjusting, & sticks with habits & tech that's stale. Thus things the legacy system isn't ready to handle efficiently – novel diagnostics with floods of new data – get blamed. But the only way out is through. Letting those with discretionary funds try speculative things is a way to improve faster than waiting for a burnt-out & bureaucratically-deformed "medical community" to rustle up the will/resources.
ch4s3 3y ago
No medical intervention is without risk. Any drug or surgical intervention has the risk of negative side effects which must be weighed against the benefits of the intervention. Medical research won’t make surgeries much less risky than they are, even highly targeted laparoscopic procedures have risks. Cutting deep into you tissues is just inherently risky. Drugs too, even the safest drugs will have very negative outcomes for some number of people. That you think this is a trivial problem shows that you’re largely ignorant of some 30 years of research and clinical debate.
- jstummbillig 3y ago
  What are the risks involved with getting an MRI?
  - sawert 3y ago
    I believe they're saying that this type of comprehensive early detection leads to subsequent interventions on issues that would never develop into anything serious where they left alone. by increasing the number of interventions happening you could actually be making the patient worse off
    - foogazi 3y ago
      > early detection leads to subsequent interventions on issues that would never develop into anything serious where they left alone. Then wouldn’t these be left alone ? The more research and procedures done the more info gathered on the evidence
      - rawgabbit 3y ago
        At least in the US, that's not how the healthcare system works. Some blame CYA. Some blame the fact that the system only makes money per procedure. The GP is saying in the US, patients often get procedures that are not worth the risk.
        3y ago
specialp 3y ago
I was thinking of this when a friend passed away from pancreatic cancer a couple of weeks ago. One of the reasons pancreatic cancer is so deadly is that it is deeply internal and symptoms of it are not present. This is true with all of the deadliest cancers. We already recommend colonoscopy to older adults which is a fairly invasive procedure to screen for colon cancer with no other history. If we could scan people with low or no ionizing radiation that would be a great tool.
- AlbertCory 3y ago
  > We already recommend colonoscopy You're behind the times. Now it's Cologuard. Not invasive although it is gross. It's the 16% false positive rate, which they helpfully do not provide a dramatic anecdote for, that should give you pause.
EA-3167 3y ago
It isn't just wasted time and costs, it's a risk beyond that. If you scan any middle aged adult you will find abnormalities in their scan. In almost EVERY case those abnormalities will be benign, but once you've found them depending on risk factors a biopsy may be required. Almost all of those biopsies will also be negative, the tiny calcification in your lung or breast isn't a tumor. The swollen lymph node isn't a sign of lymphoma. A spot on a scan is FAR more likely to be down to habitus and scanning issues than some underlying medical issue. But if you scan everyone, biopsy everyone, you're going to end up killing some of them too in addition to the waste of limited resources.
- xwdv 3y ago
  Why not simply do nothing? If you get the scan and do nothing, or you choose not to scan and do nothing, and it turns out to be something fatal, the outcome is the same: you die. The difference, is if you do the scan, you might have an epiphany about your own mortality, and live your life truly savoring every moment, instead of being blindsided and quickly dying someday.
- Auracle 3y ago
  Wouldn’t that be largely solved by doing two scans a few months (or so?) apart? You’d see if any of those potential issues grew, or disappeared.
wahnfrieden 3y ago
are you suggesting controlling the price as a centrally-planned public healthy policy, or that costs drive medical prices? in the US free market the price goes to administrative overhead and profit margins
vanviegen 3y ago
Well, yes, but all of that would need to be optimized for expected patient quality-of-life. If instead it'd be optimized to reduce risks as much as possible, we'd ultimately be spending all of our lives in medical facilities. In non-utopian reality it'd be even worse, as the system would be optimized for shareholder value instead. Shareholders profit by scaring patients into believing they need to buy more medical interventions.
ath92 3y ago
A full body scan is a bit like p-hacking. If you have a hypothesis of what might be wrong and perform a specific test to see if some value is within normal range, there’s relatively little chance of a false positive. If you test everything at the same time, some values are bound to be outside of the normal range, just because you’re measuring so many things at once. Doing any kind of procedure to further investigate or treat the symptoms has a risk associated with it. In the end, doing a full body scan, with current medical technology (both in terms of the test equipment as well as our means to treat anything that comes up as a result of the test) is a risky thing to do. It sounds nice in theory, but unfortunately we do not live in the utopia you speak of.
skybrian 3y ago
Maybe show a little sympathy? It only looks easy because it's not our problem to solve. > Raise the price Although raising a price does lower demand, a different price for a test doesn't make decision-making any easier. Predicting future costs and benefits (based on test results, not the test cost) is the hard part. > a sign to improve medical research in that area Decisions about whether to do a procedure assume current technology, not imagined future technology.
henry2023 3y ago
If you want preventive care. Exercise one more hour a week that what you are already doing. This actually reduces all-cause mortality. Anything else is snake oil. Including full body scans.

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".

groby_b 3y ago

I think that long term, preventative scans do make sense. With that preface, I don't think we should just argue there are no problems, and it's all easily solvable. "Too many false positives leading to wasted time and costs? Raise the costs for the supplemental scans and improve detection precision and recall." You can't improve precision/signal on an inherently weak and noisy signal. There are many things showing up on MRIs that currently require a biopsy. You need alternative DX routes to disambiguate, MRI alone can't do that. As for raising the costs - who pays? Medical costs are already completely bonkers. "That’s a sign to improve medical research in that area. " We know we need to improve search. We don't need to cause negative outcomes to reinforce that signal. "Too much demand for MRI machines pulling away time from patients that need to use them? Build more MRI machines. " Again, who pays? "we should just plow ahead and address new problems as they arise." There is the problem of opportunity cost. Is that the best possible way to spend sparse resources? The medical community currently mostly thinks that it isn't. Targeting wealthy people first does solve the "who pays" problem. It might make the "too few researchers" issue worse. It will cause a lot of unnecessary biopsies (because often that's the only alternative dx route) - but you could certainly lean into informed consent there. You do run the risk of poisoning MRIs as a diagnostic tool, because media will report any inconvenience to sufficiently wealthy people as a major problem. All of this might be solvable, but "let's just press ahead and see" is a very bad approach here.

gojomo 3y ago
If the "things showing up on MRIs that currently require a biopsy" don't actually pass cost-benefit analysis on their own, that 'requirement' can & should be adjusted down. Or, new diagnostics with less cost/risk developed. That today's "MRI alone can't do it" isn't a hint what novel techniques might be able to do – once demand created. A sufficiently-flexible & high-res set of downstream decisions can always choose to ignore data that isn't really helpful. Enough scans & experience might discover the new patterns. Our ossified medical system, with those "already completely bonkers" costs, has a hard time adjusting, & sticks with habits & tech that's stale. Thus things the legacy system isn't ready to handle efficiently – novel diagnostics with floods of new data – get blamed. But the only way out is through. Letting those with discretionary funds try speculative things is a way to improve faster than waiting for a burnt-out & bureaucratically-deformed "medical community" to rustle up the will/resources.

ch4s3 3y ago

No medical intervention is without risk. Any drug or surgical intervention has the risk of negative side effects which must be weighed against the benefits of the intervention. Medical research won’t make surgeries much less risky than they are, even highly targeted laparoscopic procedures have risks. Cutting deep into you tissues is just inherently risky. Drugs too, even the safest drugs will have very negative outcomes for some number of people. That you think this is a trivial problem shows that you’re largely ignorant of some 30 years of research and clinical debate.

jstummbillig 3y ago
What are the risks involved with getting an MRI?
- sawert 3y ago
  I believe they're saying that this type of comprehensive early detection leads to subsequent interventions on issues that would never develop into anything serious where they left alone. by increasing the number of interventions happening you could actually be making the patient worse off
  - foogazi 3y ago
    > early detection leads to subsequent interventions on issues that would never develop into anything serious where they left alone. Then wouldn’t these be left alone ? The more research and procedures done the more info gathered on the evidence
    - rawgabbit 3y ago
      At least in the US, that's not how the healthcare system works. Some blame CYA. Some blame the fact that the system only makes money per procedure. The GP is saying in the US, patients often get procedures that are not worth the risk.
      - 3y ago

specialp 3y ago

I was thinking of this when a friend passed away from pancreatic cancer a couple of weeks ago. One of the reasons pancreatic cancer is so deadly is that it is deeply internal and symptoms of it are not present. This is true with all of the deadliest cancers. We already recommend colonoscopy to older adults which is a fairly invasive procedure to screen for colon cancer with no other history. If we could scan people with low or no ionizing radiation that would be a great tool.

AlbertCory 3y ago
> We already recommend colonoscopy You're behind the times. Now it's Cologuard. Not invasive although it is gross. It's the 16% false positive rate, which they helpfully do not provide a dramatic anecdote for, that should give you pause.

EA-3167 3y ago

It isn't just wasted time and costs, it's a risk beyond that. If you scan any middle aged adult you will find abnormalities in their scan. In almost EVERY case those abnormalities will be benign, but once you've found them depending on risk factors a biopsy may be required. Almost all of those biopsies will also be negative, the tiny calcification in your lung or breast isn't a tumor. The swollen lymph node isn't a sign of lymphoma. A spot on a scan is FAR more likely to be down to habitus and scanning issues than some underlying medical issue. But if you scan everyone, biopsy everyone, you're going to end up killing some of them too in addition to the waste of limited resources.

xwdv 3y ago
Why not simply do nothing? If you get the scan and do nothing, or you choose not to scan and do nothing, and it turns out to be something fatal, the outcome is the same: you die. The difference, is if you do the scan, you might have an epiphany about your own mortality, and live your life truly savoring every moment, instead of being blindsided and quickly dying someday.
Auracle 3y ago
Wouldn’t that be largely solved by doing two scans a few months (or so?) apart? You’d see if any of those potential issues grew, or disappeared.

wahnfrieden 3y ago

are you suggesting controlling the price as a centrally-planned public healthy policy, or that costs drive medical prices? in the US free market the price goes to administrative overhead and profit margins

vanviegen 3y ago

Well, yes, but all of that would need to be optimized for expected patient quality-of-life. If instead it'd be optimized to reduce risks as much as possible, we'd ultimately be spending all of our lives in medical facilities. In non-utopian reality it'd be even worse, as the system would be optimized for shareholder value instead. Shareholders profit by scaring patients into believing they need to buy more medical interventions.

ath92 3y ago

A full body scan is a bit like p-hacking. If you have a hypothesis of what might be wrong and perform a specific test to see if some value is within normal range, there’s relatively little chance of a false positive. If you test everything at the same time, some values are bound to be outside of the normal range, just because you’re measuring so many things at once. Doing any kind of procedure to further investigate or treat the symptoms has a risk associated with it. In the end, doing a full body scan, with current medical technology (both in terms of the test equipment as well as our means to treat anything that comes up as a result of the test) is a risky thing to do. It sounds nice in theory, but unfortunately we do not live in the utopia you speak of.

skybrian 3y ago

Maybe show a little sympathy? It only looks easy because it's not our problem to solve. > Raise the price Although raising a price does lower demand, a different price for a test doesn't make decision-making any easier. Predicting future costs and benefits (based on test results, not the test cost) is the hard part. > a sign to improve medical research in that area Decisions about whether to do a procedure assume current technology, not imagined future technology.

henry2023 3y ago

If you want preventive care. Exercise one more hour a week that what you are already doing. This actually reduces all-cause mortality. Anything else is snake oil. Including full body scans.