4 ms·

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 solva

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.
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- groby_b 3y ago
  'If the "things showing up on MRIs that currently require a biopsy" don't actually pass cost-benefit analysis on their own,' So if we can't tell if it's malignant or not, you're saying we should start cancer treatment just in case? It's not a question of "tech that's stale" or "an ossified system" - it's a question of not being able to tell all malignant and benign cells apart until you look at them under a microscope. The last thing that space needs is a bunch of uninformed tech folks going "I don't know, let the market solve it, tech is great". I really recommend getting at least a basic education on the subject.
  - gojomo 3y ago
    If it looks bad enough that you'd risk starting cancer treatment right away (!) with no further confirmation, it's definitionally something they'll have been glad to detect early. But for most things, the advice would be: watch & maybe run some other tests, if cheap & low-risk, if and only if the preponderance of the data implies it's a net-gain. If the MRIs become cheap enough, high-resolution enough, and the ML/stats-assisted classification becomes good enough – possible with more imaging/progression data – the most common thing might be: reimage in a month or two, compare results. Do more if and only if that calcs out for maximum welfare. These are ultimately probabilistic equations, not things you can hand-wave off based on old anecdotes and mere hunches about what's net worthwhile, and what's not. You have to run the tests, run the numbers, and reach a data-driven answer. On the other hand, people who don't trust the numbers, or their own ability to dispassionately follow the numbers if more data arrives, should absolutely be free to remain in blissful non-knowing. Many people can – and many more with proper coachin should be able to – use new info only if it improves their welfare. They don't have to follow automated scripts from a less-informed era.
kragen 3y ago
> There are many things showing up on MRIs that currently require a biopsy they don't require a biopsy; you're still free to not get the biopsy after the mri sometimes getting the biopsy is actually worse for you, on average, than the small chance that you'll have a very rare disease. probably in those cases you shouldn't get the biopsy, which means the mri didn't actually help you, but it didn't hurt you much either; you're US$650 poorer and worried, that's all in other cases getting the biopsy is better for you, in which case the mri did help you > Is that the best possible way to spend [scarce] resources? fortunately, we have private property, so we already have a system for allocating scarce resources: their owner decides how to spend them. this turns out to work much better than the alternatives that have been tried, which routinely result in famines and genocides. so we don't need to come to a global community-wide consensus on that question; instead we can consider each case as it comes up
- groby_b 3y ago
  > they don't require a biopsy; you're still free to not get the biopsy after the mri Have you ever talked through a scan with an oncologist? Or are you just reasoning in the abstract because you feel you can first-principle it? Also, seriously, you want to turn this into a communism debate? fwiw, capitalism has already decided. The vast majority of resources goes to anything but full-body scans, because actual experts made the call what's more effective. Repeatedly. On many cases. But you are right, you are of course free to make bad decisions with your money, and there will always be somebody happy to separate fools from their money. Capitalism does work.
  - kragen 3y ago
    > Have you ever talked through a scan with an oncologist? yes, earlier this year also, fuck you people like you are why i always regret succumbing to the temptation to participate 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.

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groby_b 3y ago
'If the "things showing up on MRIs that currently require a biopsy" don't actually pass cost-benefit analysis on their own,' So if we can't tell if it's malignant or not, you're saying we should start cancer treatment just in case? It's not a question of "tech that's stale" or "an ossified system" - it's a question of not being able to tell all malignant and benign cells apart until you look at them under a microscope. The last thing that space needs is a bunch of uninformed tech folks going "I don't know, let the market solve it, tech is great". I really recommend getting at least a basic education on the subject.
- gojomo 3y ago
  If it looks bad enough that you'd risk starting cancer treatment right away (!) with no further confirmation, it's definitionally something they'll have been glad to detect early. But for most things, the advice would be: watch & maybe run some other tests, if cheap & low-risk, if and only if the preponderance of the data implies it's a net-gain. If the MRIs become cheap enough, high-resolution enough, and the ML/stats-assisted classification becomes good enough – possible with more imaging/progression data – the most common thing might be: reimage in a month or two, compare results. Do more if and only if that calcs out for maximum welfare. These are ultimately probabilistic equations, not things you can hand-wave off based on old anecdotes and mere hunches about what's net worthwhile, and what's not. You have to run the tests, run the numbers, and reach a data-driven answer. On the other hand, people who don't trust the numbers, or their own ability to dispassionately follow the numbers if more data arrives, should absolutely be free to remain in blissful non-knowing. Many people can – and many more with proper coachin should be able to – use new info only if it improves their welfare. They don't have to follow automated scripts from a less-informed era.

kragen 3y ago

> There are many things showing up on MRIs that currently require a biopsy they don't require a biopsy; you're still free to not get the biopsy after the mri sometimes getting the biopsy is actually worse for you, on average, than the small chance that you'll have a very rare disease. probably in those cases you shouldn't get the biopsy, which means the mri didn't actually help you, but it didn't hurt you much either; you're US$650 poorer and worried, that's all in other cases getting the biopsy is better for you, in which case the mri did help you > Is that the best possible way to spend [scarce] resources? fortunately, we have private property, so we already have a system for allocating scarce resources: their owner decides how to spend them. this turns out to work much better than the alternatives that have been tried, which routinely result in famines and genocides. so we don't need to come to a global community-wide consensus on that question; instead we can consider each case as it comes up

groby_b 3y ago
> they don't require a biopsy; you're still free to not get the biopsy after the mri Have you ever talked through a scan with an oncologist? Or are you just reasoning in the abstract because you feel you can first-principle it? Also, seriously, you want to turn this into a communism debate? fwiw, capitalism has already decided. The vast majority of resources goes to anything but full-body scans, because actual experts made the call what's more effective. Repeatedly. On many cases. But you are right, you are of course free to make bad decisions with your money, and there will always be somebody happy to separate fools from their money. Capitalism does work.
- kragen 3y ago
  > Have you ever talked through a scan with an oncologist? yes, earlier this year also, fuck you people like you are why i always regret succumbing to the temptation to participate here