4 ms·

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 t

by 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.
      - ch4s3 3y ago
        No, I'm saying that anywhere in the world you might get an unnecessary procedure. It is impossible to know in many cases if small tumors will become malignant, so judgement calls must be made. Finding more of them inevitably leads to more unnecessary procedures across a population. This is well established in European and American public health literature. This is why screening guidelines exist.
    - ch4s3 3y ago
      On an individual level, lets assume a polyp in the colon, there's no way to know which may become individually cancerous and which will remain small and benign. The genes are the same, the size and appearance may be the same. You can't know. At a population level its well established that beyond a certain point you're injuring more people than you are helping by doing the colonoscopies at all. Where to draw that line is where the debate is playing out. The problem is well known, and I'm not aware of ANYONE seriously suggesting that it's possible to eliminate this problem.
    - SketchySeaBeast 3y ago
      If the MRI finds a dozen indicators in your body in a bunch of different locations that might be cancer, all with different likelihoods where would you draw the line on getting them biopsied? Would you be comfortable having heterogeneous masses in your body that have a minor chance of being cancer? Because the MRI is going to say "might be", not "is".
    - pdonis 3y ago
      > Then wouldn’t these be left alone ? The problem is that you don't know which ones would never develop into anything if left alone. The reason they're left alone now is that you don't know they're there, because you never do any test that shows them being there. But once you do a test that shows that something is there, it's a lot harder to just leave it alone. Something is there, and you don't know that it's never going to be a problem, so you end up not leaving it alone. If you were going to leave the thing alone anyway regardless of what the first test showed, there's no point in doing the first test at all.
  - jstummbillig 3y ago
    After getting another answer from them further below in this thread, I am under the impression that they are not entirely forthright about what it is they are claiming, or not claiming.
- ch4s3 3y ago
  It is well established that more MRI lead to more procedures that are ultimately themselves risky and useless. This is extremely difficult to parse out on an individual level but obvious in the data at a population level. Colonoscopies are a great example. As their use increases past a threshold more people are injured by additional surgery than you actually help. This is again at a population level.
  - jstummbillig 3y ago
    Are you claiming that, at population level, the amount of false positives MRIs produce outweigh the benefits in terms of human health benefits?
    - ch4s3 3y ago
      Beyond a certain point all scans will produce more unnecessary procedures than beneficial ones. It's the nature of treating illnesses with uncertain presentations. Everyone has lots of odd bits and small benign tumors that are harmless. But these often look indistinguishable from the early stages of something serious. Even biopsy isn't without risk. There's no free lunch here.
kragen 3y ago
> No medical intervention is without risk no but an mri scan and blood tests are pretty damned close 30 years of research and clinical debate have largely come to the wrong conclusion because medical doctors are, by and large, mathematically illiterate; in some countries, like the usa, they are also strongly motivated by cya, which comes into direct conflict with the patient's well-being in cases like this
- SketchySeaBeast 3y ago
  MRI scans and blood tests are, but what comes next? If they find something there's always a least a follow-up biopsy, and often times what's seen on the screen would have never impacted the person's life. Yes, there are outliers, but if you do enough scans you are guaranteed to find something wrong with you that you would never have known about otherwise.
  - kragen 3y ago
    if the mri scans and blood tests show strong enough evidence of a problem that will impact your life that the risk outweighs the risk of the follow-up biopsy, you should get the biopsy if they don't you shouldn't so either you're better off or you're no worse off unless you have to be dealing with a doctor in cya mode
    - SketchySeaBeast 3y ago
      I have some familiarity with diagnostic imaging - a lot of the time with these scans there's enough to say "yes, there is something there you should definitely get checked out" but you can't make a full assessment without a biopsy. The MRI is going to find things you need to investigate further. It'll also reveal a bunch of stuff you didn't need to know. Do you want to know about that minor slipped disc in your back that wasn't bothering you before? The nocebo effect is very real.
      - kragen 3y ago
        if investigating it further isn't worth the risk, you don't need to investigate further if investigating it further is worth the risk, then it's a good thing you did the scan this superstitious ideology that ignorance is good for you has always been popular; what's surprising is that some people still hold to it despite the industrial and scientific revolutions knowing about the minor slipped disc in your back might be important information if it starts hurting; you'll know it isn't a metastatic bone cancer. you might also be well advised to avoid taking up olympic weightlifting
echelon 3y ago
> No medical intervention is without risk Risk will dramatically decrease with advances. > That you think this is a trivial problem shows that you’re largely ignorant of some 30 years of research and clinical debate. Biologists are still doing punch card-level stuff. If we started cloning monoclonal, antigen-free bodies in massive body farms and performing head transplants, that'd solve almost every non-cranial disease. I could see that becoming a preventative solution to aging, too. Renewed cardiovascular health, clean lungs, thymus, etc.
- SketchySeaBeast 3y ago
  "This isn't a problem because of science fiction" isn't a terribly realistic answer to the concerns being raised.
  - echelon 3y ago
    > "This isn't a problem because of science fiction" isn't a terribly realistic answer to the concerns being raised. This isn't a step function difficult thing to do [1-3]. Nobody is doing it because it's "icky". [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116034/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116034/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511668/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511668/ [3] https://www.nature.com/articles/ncomms15112 https://www.nature.com/articles/ncomms15112
    - SketchySeaBeast 3y ago
      But it is. Giant body farms of clones raised without the benefit of a womb that we then decapitate and reattach our heads to is a non-trivial enterprise.
      - echelon 3y ago
        Here we go: https://news.ycombinator.com/item?id=37308675 https://news.ycombinator.com/item?id=37308675
MengerSponge 3y ago
Again, for the people in the back: There's no such thing as minor surgery. Every surgical procedure carries a real risk, which amortizes over the population of billions of people into thousands to millions of complications and deaths. That's the cost, and an intervention has to be good enough to justify that cost. Vaccines are good enough for that. Some types of cancer screening is good enough for that. Popping yourself in a full-body scan for a fishing expedition? Almost certainly not. The result of this product is that a few more very rich people will die a bit sooner than they would have otherwise. Whether or not you think that's an upside is up to you and your personal politics.
Xcelerate 3y ago
> That you think this is a trivial problem shows that you’re largely ignorant of some 30 years of research and clinical debate. Am I not allowed to criticize decades of research on astrology because I haven’t paid any attention to it? If 30 years of research and clinical debate have led to this situation where you get 5 different opinions from 5 different doctors, then maybe it’s time to kick out the incumbents and replace them with people who adhere a little better to the scientific method. I would rather trust my medical care to a group of particle physicists who had one year to study medicine than the 30 year experts who can’t reproduce any of each others’ work and seem ignorant of any advances in statistics or inference over the same period of time.
- prepend 3y ago
  > 5 different opinions from 5 different doctors No, you get the same opinion from all five doctors. That the scan is unnecessary.

by ch4s3 3y ago

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.
    - ch4s3 3y ago
      No, I'm saying that anywhere in the world you might get an unnecessary procedure. It is impossible to know in many cases if small tumors will become malignant, so judgement calls must be made. Finding more of them inevitably leads to more unnecessary procedures across a population. This is well established in European and American public health literature. This is why screening guidelines exist.
  - ch4s3 3y ago
    On an individual level, lets assume a polyp in the colon, there's no way to know which may become individually cancerous and which will remain small and benign. The genes are the same, the size and appearance may be the same. You can't know. At a population level its well established that beyond a certain point you're injuring more people than you are helping by doing the colonoscopies at all. Where to draw that line is where the debate is playing out. The problem is well known, and I'm not aware of ANYONE seriously suggesting that it's possible to eliminate this problem.
  - SketchySeaBeast 3y ago
    If the MRI finds a dozen indicators in your body in a bunch of different locations that might be cancer, all with different likelihoods where would you draw the line on getting them biopsied? Would you be comfortable having heterogeneous masses in your body that have a minor chance of being cancer? Because the MRI is going to say "might be", not "is".
  - pdonis 3y ago
    > Then wouldn’t these be left alone ? The problem is that you don't know which ones would never develop into anything if left alone. The reason they're left alone now is that you don't know they're there, because you never do any test that shows them being there. But once you do a test that shows that something is there, it's a lot harder to just leave it alone. Something is there, and you don't know that it's never going to be a problem, so you end up not leaving it alone. If you were going to leave the thing alone anyway regardless of what the first test showed, there's no point in doing the first test at all.
- jstummbillig 3y ago
  After getting another answer from them further below in this thread, I am under the impression that they are not entirely forthright about what it is they are claiming, or not claiming.
ch4s3 3y ago
It is well established that more MRI lead to more procedures that are ultimately themselves risky and useless. This is extremely difficult to parse out on an individual level but obvious in the data at a population level. Colonoscopies are a great example. As their use increases past a threshold more people are injured by additional surgery than you actually help. This is again at a population level.
- jstummbillig 3y ago
  Are you claiming that, at population level, the amount of false positives MRIs produce outweigh the benefits in terms of human health benefits?
  - ch4s3 3y ago
    Beyond a certain point all scans will produce more unnecessary procedures than beneficial ones. It's the nature of treating illnesses with uncertain presentations. Everyone has lots of odd bits and small benign tumors that are harmless. But these often look indistinguishable from the early stages of something serious. Even biopsy isn't without risk. There's no free lunch here.

kragen 3y ago

> No medical intervention is without risk no but an mri scan and blood tests are pretty damned close 30 years of research and clinical debate have largely come to the wrong conclusion because medical doctors are, by and large, mathematically illiterate; in some countries, like the usa, they are also strongly motivated by cya, which comes into direct conflict with the patient's well-being in cases like this

SketchySeaBeast 3y ago
MRI scans and blood tests are, but what comes next? If they find something there's always a least a follow-up biopsy, and often times what's seen on the screen would have never impacted the person's life. Yes, there are outliers, but if you do enough scans you are guaranteed to find something wrong with you that you would never have known about otherwise.
- kragen 3y ago
  if the mri scans and blood tests show strong enough evidence of a problem that will impact your life that the risk outweighs the risk of the follow-up biopsy, you should get the biopsy if they don't you shouldn't so either you're better off or you're no worse off unless you have to be dealing with a doctor in cya mode
  - SketchySeaBeast 3y ago
    I have some familiarity with diagnostic imaging - a lot of the time with these scans there's enough to say "yes, there is something there you should definitely get checked out" but you can't make a full assessment without a biopsy. The MRI is going to find things you need to investigate further. It'll also reveal a bunch of stuff you didn't need to know. Do you want to know about that minor slipped disc in your back that wasn't bothering you before? The nocebo effect is very real.
    - kragen 3y ago
      if investigating it further isn't worth the risk, you don't need to investigate further if investigating it further is worth the risk, then it's a good thing you did the scan this superstitious ideology that ignorance is good for you has always been popular; what's surprising is that some people still hold to it despite the industrial and scientific revolutions knowing about the minor slipped disc in your back might be important information if it starts hurting; you'll know it isn't a metastatic bone cancer. you might also be well advised to avoid taking up olympic weightlifting

echelon 3y ago

> No medical intervention is without risk Risk will dramatically decrease with advances. > That you think this is a trivial problem shows that you’re largely ignorant of some 30 years of research and clinical debate. Biologists are still doing punch card-level stuff. If we started cloning monoclonal, antigen-free bodies in massive body farms and performing head transplants, that'd solve almost every non-cranial disease. I could see that becoming a preventative solution to aging, too. Renewed cardiovascular health, clean lungs, thymus, etc.

SketchySeaBeast 3y ago
"This isn't a problem because of science fiction" isn't a terribly realistic answer to the concerns being raised.
- echelon 3y ago
  > "This isn't a problem because of science fiction" isn't a terribly realistic answer to the concerns being raised. This isn't a step function difficult thing to do [1-3]. Nobody is doing it because it's "icky". [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116034/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116034/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511668/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511668/ [3] https://www.nature.com/articles/ncomms15112 https://www.nature.com/articles/ncomms15112
  - SketchySeaBeast 3y ago
    But it is. Giant body farms of clones raised without the benefit of a womb that we then decapitate and reattach our heads to is a non-trivial enterprise.
    - echelon 3y ago
      Here we go: https://news.ycombinator.com/item?id=37308675 https://news.ycombinator.com/item?id=37308675

MengerSponge 3y ago

Again, for the people in the back: There's no such thing as minor surgery. Every surgical procedure carries a real risk, which amortizes over the population of billions of people into thousands to millions of complications and deaths. That's the cost, and an intervention has to be good enough to justify that cost. Vaccines are good enough for that. Some types of cancer screening is good enough for that. Popping yourself in a full-body scan for a fishing expedition? Almost certainly not. The result of this product is that a few more very rich people will die a bit sooner than they would have otherwise. Whether or not you think that's an upside is up to you and your personal politics.

Xcelerate 3y ago

> That you think this is a trivial problem shows that you’re largely ignorant of some 30 years of research and clinical debate. Am I not allowed to criticize decades of research on astrology because I haven’t paid any attention to it? If 30 years of research and clinical debate have led to this situation where you get 5 different opinions from 5 different doctors, then maybe it’s time to kick out the incumbents and replace them with people who adhere a little better to the scientific method. I would rather trust my medical care to a group of particle physicists who had one year to study medicine than the 30 year experts who can’t reproduce any of each others’ work and seem ignorant of any advances in statistics or inference over the same period of time.

prepend 3y ago
> 5 different opinions from 5 different doctors No, you get the same opinion from all five doctors. That the scan is unnecessary.