8 ms·

https://youtu.be/FzFT-KuE4BQ?si=7-EXbRz1TD4a5leL&t=56 https://youtu.be/FzFT-KuE4BQ?si=7-EXbRz1TD4a5leL&t=56 The video makes the case that the early detection o

https://youtu.be/FzFT-KuE4BQ?si=7-EXbRz1TD4a5leL&t=56 https://youtu.be/FzFT-KuE4BQ?si=7-EXbRz1TD4a5leL&t=56 The video makes the case that the early detection of cancers isn't always a good thing. See 6:30 and 7:00 for specific references to scientific studies. Some cancers (thyroid and skin) can be detected at a much higher rate, but the associated mortality remains constant (we are detecting benign cancers). To be clear: obviously this is dependent on the cancer. Really my point is that we need studies that show that the screening improves outcomes.

brnt 2y ago
This is how Dutch public healthcare motivates its general aversion to medical testing, as many a foreigner finds surprising and incongruent to the generally OK level of healthcare outcomes provided by the system. You can test and detect, but the error margins are often large (so many false positives and/or false negatives), would generate way too much workload to follow up and thereby cost time and money for better leads. Plus, as you say, knowing early doesn't always or even often mean you can actually change the outcomes. Now, this is what they say... I have tried to find the actual literature they use to motivate their protocols, and apart from occasionally, have not been able to find that evidence. I'd love to have a resource that demonstrates these sorts of things.
- fidotron 2y ago
  I am not sure that is unique to the Dutch, it is the line I have heard in several countries. Heavy agreement on your last part - if there is substantial evidence to back this up I would like to see it. As it stands I personally prefer the idea of constant mass testing in order that we learn as much as possible as quickly as possible, including improving the tests from the resulting feedback loop.
  - brnt 2y ago
    When I see the prices of some of that testing, I know that that cannot be the reason, and indeed, establishing personal baselines by regular testing can only be helpful. The aversion to it grounded on taking some average patient, I am convinced. I really wish there was more transparency, because test aversion is exactly the same protocol you'd invent if you were trying to save money. I want to be able to see which of the two we're dealing with.
    - radicalbyte 2y ago
      Given how the Dutch system seems to be designed to maximise paper filling and busywork instead of healthcare - and of course to make the insurance companies rich - it's no surprise that they're against it. Medical experts here have very little say in how things are run. It's all bankers and bureaucrats.
      - brnt 2y ago
        Do you have any sources for that? I've worked for a hospital and I've never been able to find anything approaching a complete balance sheet. Financing it utterly opaque, but I'd love to have something solid before I accuse anyone.
        6510 2y ago
        I'm far from an expert on this topic, more on the contrary. The surgeons use to run the hospital. In contrast with mba's they knew things. I don't know what the difference is precisely but I hear the ziekenfonds use to have people to divide money over treatments (set prices) without their salary depending on their choices. I don't know about the scale but longer ago we would just build hospital buildings and house a workforce of nuns nearby who had their own garden. Now we some how cant afford to put down a building and with realestate prices on the rise the salaries need to follow. We might not like the factory village concept but if you have to be on call all of the time it seems fkn convenient to me. Cut the salary and give the employees a house, seems a great perk. Employee shortage is also costing a fortune. We've created ambitious labor protection laws then we created a loop hole where all you have to do is pay 190% of the salary to a job agencies (uitzendbureu) and no laws apply, anything goes. If you don't like it you can go home. This didn't need to cost 90% of the salary. Unless our labor taxes are now that complicated(?) but that doesn't work as an excuse either. Our taxes not paying for education doesn't mean we don't have to pay for it eventually (+interest) I read they are also lacking the money to streamline the processes.
    - pessimizer 2y ago
      The reason this rings wrong for people is because the reasons early testing is dangerous are entirely social. People are motivated by fear to have every test available, doctors are motivated by fear of being accused of neglect by the patient, doctors are also motivated by the profit that they make from the tests, the manufacturers and patent-holders of tests are motivated to have them done as much as possible, the labs that do tests make money on the number of tests that are done, the nonprofits that campaign based on diseases are expected to message to increase testing for those diseases and accept money from manufacturers and patent-holders, there's motivation to exaggerate the danger of what's detected by the manufacturers and patent-holders of treatments for the disease, and there's motivation by researchers who formulate the criteria for determining whether a particular feature of something detected is potentially dangerous/deserves treatment, and a motivation to give them the most expensive treatment, regardless of whether that treatment is unpleasant; in fact if the treatment is dangerous, it opens up secondary markets. There's just an enormous number of tailwinds pushing overdetection and overtreatment. The sum of that is what's important, which is that when you test earlier, you often objectively end up with more death and suffering. Which is what a state-run national healthcare systems needs to look at, they can't get lost in the trees. You pick an optimum age for testing that shifts the balance to less suffering and death (and costs), and you look for specific exceptions (genetic, lifestyle, comorbidities) and test just those people early. Could there be a way in which all testing would help instead of hurt? Yes, but it's political and psychological and not likely to ever happen. You'd have to (as a patient) trust probability in general, and additionally you'd have to trust the probabilities that they're handing you haven't been distorted by the self-interest of others. Not likely for the foreseeable future; maybe 1000 years from now. If you want to do the study, all you have to do is compare the number of deaths from a thing when people are tested early to the number of deaths when people are tested late. Or just look for other people who have done them. If early testing obviously saved lives, the people who sell testing would tout them everywhere. Instead, they're stuck trying to look for angles to argue that lessening death and suffering isn't the biggest consideration. They recently did this to push breast cancer screening earlier again, by arguing that if you specifically look at black American women, they benefit from early cancer screening. So overall, breast cancer deaths go up, but that's just your privilege talking. Woke conglomerates. Ignore that black people have a unique, neglected, discriminated against, and poverty-ridden situation in the US; in fact, it might even be racist to point that out (in backwards land.) Of course, you definitely don't have to do the studies, plenty have been done. Anybody saying that they've looked and haven't found them has not looked or has seen them and is not telling the truth. Both positive and negative, about every test. The studies that support earlier and more testing are press released and marketed, though, while the others can be suppressed or simply ignored, unless some public health system or insurance company champions them, and of course they would.
  - refurb 2y ago
    The evidence is out there in published papers that do health economic analyses of various interventions. On a population based level it makes perfect sense to not do things even if it could save lives. This is exactly what NICE does in the UK. If it costs more than 30,000 GBP to give one person one more full quality year of life, then it’s not worth it.
    - vidarh 2y ago
      To the point about NICE, it's worth pointing out that this is 1) not how NICE decides. Average cost per QALY being below the preferred level is one factor. Analysis of treatments they approve suggests the "actual" threshold is closer to 45k. 2) These are averages per treatment or protocol and in most areas the NHS spends less than the threshold by simply delivering based on clinical assessment of benefits, and so the threshold is limiting treatment mainly on the fringes where you find a few very expensive treatments with marginal benefits with no cheaper alternative. In practice NICEs threshold is what any insurer would do: You know how much money there is in the system and try to maximise health output with what is available to you.
      - refurb 2y ago
        In practice NICEs threshold is what any insurer would do This is what makes Americans getting upset their insurance rejects coverage for medicines so ironic. Single payer systems do the exact same thing. The difference is in the UK is the option is just isn’t brought up in the first place because the doctor already knows it’s not paid for.
        vidarh 2y ago
        Even then, they'll happily bring it up if you mention you're fine with private referrals or recommendations for something that isn't covered. Almost all single-payer systems are single-payer only in the sense that everyone is covered by the public system, but without preventing people from going outside it. A very few - Norway used to - strictly limits what you can go outside the system for. In the UK about 10% have private insurance on top.
- leto_ii 2y ago
  > would generate way too much workload to follow up and thereby cost time and money for better leads Having lived a decade in NL, my impression was that keeping costs down is the top priority. Unless you have a serious chronic condition or were in an accident, good luck getting somebody to take a look at you. (irl, after a while you learn to push, exaggerate symptoms etc. or just go back home to get tests and treatment).
  - brnt 2y ago
    Yep, the loudest people get the most help. There's no good solution for that other than to become a bitchy 'client'. It's unfortunate that despite the promises, you still have to 'use it correctly' if you want those good outcomes as a patient.
- mort96 2y ago
  It's not just about keeping costs down, but also about increasing quality of life. If you detect a benign cancer in someone, and they then go on to receive chemotherapy, you've massively decreased that person's quality of life for a significant period with no upside.
  - iknowstuff 2y ago
    A benign tumor doesn’t spread and doesn’t warrant chemotherapy I believe? And if it’s actually cancer than I don’t understand how you would not want it gone as soon as possible to avoid metastasis?
    - Fire-Dragon-DoL 2y ago
      Well, this is talking specifically about the case where the cancer is benign. Of course you want a metastatic one gone. For the benign ones, that's going to hurt the person's body quite a bit
      - jvanderbot 2y ago
        I think the jump from "protein blood test" to "Chemotherapy" is a bit of a stretch. There are almost surely additional screenings and diagnoses going on there. And I don't think anyone is going into chemo for benign tumors.
        Fire-Dragon-DoL 2y ago
        Makes sense. Is it possible for the two types of cancer to be confused? Should also point out that tests will negatively affect your life seriously either way, especially if these benign cancers are common. Think of the time spent going to/from the doctor, the incredible stress (am I dying?), the tests itself: it is damaging the person's life. Detection is good, false positives are unacceptable though.
        jvanderbot 2y ago
epistasis 2y ago
This is not about early detection in general, but rather a specific test of dubious utility, specifically full-body MRI, which often leads to tons of follow-on tests and invasive procedures that may have zero benefit. For a test with high enough specificity and sensitivity for early detection, it's likely that it would be quickly adopted, and then studied to show that it actually improves outcomes without undue cost (not merely dollar cost but also health cost) to people in terms of treatment and its side effects.
- zero-sharp 2y ago
  They specifically talk about using the fully body MRI for the purpose of detecting cancers. I'm not sure how you missed that. You literally had to watch 10 seconds of the clip. It's interesting because they explicitly talk about follow up testing (@2:10) which is to say that multiple methods are used if the MRI indicates a problem. So yes, the initial MRI may produce a misdiagnosis and that is a defect of the test. But the commentary in the video obviously suggests that additional testing for early detection is done. That's partly a problem as you pointed out, but then it clearly also indicates the scope of the conversation is more broad.
  - ceejayoz 2y ago
    They didn't miss it at all. You've misunderstood the comment's point, which is "just because prospective full-body MRI is bad doesn't mean all diagnostics are".
    - zero-sharp 2y ago
      It's true that some of the commentary is specific to the full body MRI itself (such as misdiagnosis due to an imaging artifact), however many of the claims in the video are very general. And the scientific study they referenced at 6:30 has nothing to do with fully body MRIs. The study is in regards to thyroid cancer overdiagnosis due to screening (using ultrasound and not MRI). This is clearly a statement regarding the effectiveness of screening. And, yes, it is specific to the cancer. I'm not saying anything that the studies aren't saying. For some kinds of cancers and for some kinds of screening methods, screening can result in overdiagnosis.
Wowfunhappy 2y ago
I can't watch a video at work but I have seen this argument before. I just find it fundamentally hard to believe that having more data is a bad thing. What we choose to do with that data is a different story, and the actual source of these bad outcomes.
- mort96 2y ago
  Are you prepared to make the decision, "I have cancer but statistically it has a relatively low likelihood of killing me before I would die of other causes, so I won't do anything about it"? Are most people?
  - thimkerbell 2y ago
    It might provide enough impetus for getting you to avoid sugar and processed meats though.
    - mort96 2y ago
      Has avoiding those things been shown to stop existing cancer? I thought those foods just increased the chance of getting cancer in the first place. But I'm totally ignorant here, it sounds plausible that some carcinogens work by worsening cancer which would otherwise have been benign, I just haven't heard about that
      - stubish 2y ago
        Depending on the type of cancer, there are correlations with diet changes and slowing growth of cancer. Causation isn't known yet, with the speculations about reasons veganism works I've seen all refuted. Low carb effects seems about increasing ketones and reducing glucose levels in the blood, which I think is being studied with some lung cancers. Type of cancer is important, with different diet changes positively correlated different with cancers not returning (and the wrong change could possibly even promote growth, as different cancers 'feed' on different things). Prostate, breast and lung cancer I'm aware of there being these correlations.
siliconc0w 2y ago
The problem with this is that they haven't done the long term studies (which they admit). They also don't consider that once these are cheap and regular enough you get the change over time which should get you a lot less false in positives.
Spooky23 2y ago
It’s a risk assessment like any other. Probability/impact. My wife ultimately lost her life to metastatic melanoma, which was believed to be in remission. Had there been a way to detect the proteins associated with the mets that developed ahead of symptoms, the odds are she we be alive and thriving. In other scenarios, say most prostate cancers, early knowledge has low or negative benefits.
mensetmanusman 2y ago
The more data the better though. We need to train the models to understand what is worth doing over time.
Fire-Dragon-DoL 2y ago
I don't understand how we don't consider benign cancers false positives? Acting against those cause serious damage to the body for no gain
xpe 2y ago
> we need studies that show that the screening improves outcomes. I would be wary of a study conflating screening with outcomes — that is unnecessarily coupling too many factors. [1] The screening isn’t an intervention, so why would it make sense to study its effects on an outcome? Those effects are indirect, mediated by the causal factors of the choice of treatment. Am I missing something? Perhaps you are looking for psychological effects of getting an early test? [1] Treatment outcomes depend on the current state of technology and the practice of medicine.
- vidarh 2y ago
  Because screening leads to interventions when it is the data used for deciding whether to do an intervention. If a screening procedure leads only to interventions that would be made in time anyway, it doesn't provide a benefit. If it leads to extra interventions and no drop in mortality, it may be a net negative. E.g irradiate enough people to find more cancers and not improve outcomes, and some of your screening may lead to cancers.
IG_Semmelweiss 2y ago
I think Vinay Prasad (MD) has an excellent book or paper on this topic as well. Here is a discussion about it. It really gave me a new perspective on diagnostic testing. https://www.econtalk.org/vinay-prasad-on-cancer-screening/ https://www.econtalk.org/vinay-prasad-on-cancer-screening/
blindriver 2y ago
How are we supposed to increase outcomes if we don't have the screenings? Sure maybe the first few years the outcomes may not change, but what about 20 years from now, when a generation of scientists can detect cancer years earlier? The defeatist attitude of "well it doesn't fix anything right now" is really strange. Once we have reliable detection, it means we can find reliable treatment as well.
- LeafItAlone 2y ago
  Yes, I agree, but it also could lead to over treatment. If you detect and treat cancer that otherwise never would have caused problems, it was all for naught. Cancer rates found in autopsies for other causes of death are probably higher than you think.
  - blindriver 2y ago
    You can fix overtreatment but you need early detection first.
- JackeJR 2y ago
  The screening target should be for malignant cancers, not all cancers.
- fumeux_fume 2y ago
  Do you mean improve outcomes? Assuming that’s what you mean, improvement of outcomes for cancer patients seems more reliant on proper treatment rather than detection.
  - blindriver 2y ago
    That’s right now, because we don’t have early treatment options. Once we can early detect I bet improved outcomes will increase as we develop new ways to fight them.

brnt 2y ago

This is how Dutch public healthcare motivates its general aversion to medical testing, as many a foreigner finds surprising and incongruent to the generally OK level of healthcare outcomes provided by the system. You can test and detect, but the error margins are often large (so many false positives and/or false negatives), would generate way too much workload to follow up and thereby cost time and money for better leads. Plus, as you say, knowing early doesn't always or even often mean you can actually change the outcomes. Now, this is what they say... I have tried to find the actual literature they use to motivate their protocols, and apart from occasionally, have not been able to find that evidence. I'd love to have a resource that demonstrates these sorts of things.

fidotron 2y ago
I am not sure that is unique to the Dutch, it is the line I have heard in several countries. Heavy agreement on your last part - if there is substantial evidence to back this up I would like to see it. As it stands I personally prefer the idea of constant mass testing in order that we learn as much as possible as quickly as possible, including improving the tests from the resulting feedback loop.
- brnt 2y ago
  When I see the prices of some of that testing, I know that that cannot be the reason, and indeed, establishing personal baselines by regular testing can only be helpful. The aversion to it grounded on taking some average patient, I am convinced. I really wish there was more transparency, because test aversion is exactly the same protocol you'd invent if you were trying to save money. I want to be able to see which of the two we're dealing with.
  - radicalbyte 2y ago
    Given how the Dutch system seems to be designed to maximise paper filling and busywork instead of healthcare - and of course to make the insurance companies rich - it's no surprise that they're against it. Medical experts here have very little say in how things are run. It's all bankers and bureaucrats.
    - brnt 2y ago
      Do you have any sources for that? I've worked for a hospital and I've never been able to find anything approaching a complete balance sheet. Financing it utterly opaque, but I'd love to have something solid before I accuse anyone.
      - 6510 2y ago
        I'm far from an expert on this topic, more on the contrary. The surgeons use to run the hospital. In contrast with mba's they knew things. I don't know what the difference is precisely but I hear the ziekenfonds use to have people to divide money over treatments (set prices) without their salary depending on their choices. I don't know about the scale but longer ago we would just build hospital buildings and house a workforce of nuns nearby who had their own garden. Now we some how cant afford to put down a building and with realestate prices on the rise the salaries need to follow. We might not like the factory village concept but if you have to be on call all of the time it seems fkn convenient to me. Cut the salary and give the employees a house, seems a great perk. Employee shortage is also costing a fortune. We've created ambitious labor protection laws then we created a loop hole where all you have to do is pay 190% of the salary to a job agencies (uitzendbureu) and no laws apply, anything goes. If you don't like it you can go home. This didn't need to cost 90% of the salary. Unless our labor taxes are now that complicated(?) but that doesn't work as an excuse either. Our taxes not paying for education doesn't mean we don't have to pay for it eventually (+interest) I read they are also lacking the money to streamline the processes.
  - pessimizer 2y ago
    The reason this rings wrong for people is because the reasons early testing is dangerous are entirely social. People are motivated by fear to have every test available, doctors are motivated by fear of being accused of neglect by the patient, doctors are also motivated by the profit that they make from the tests, the manufacturers and patent-holders of tests are motivated to have them done as much as possible, the labs that do tests make money on the number of tests that are done, the nonprofits that campaign based on diseases are expected to message to increase testing for those diseases and accept money from manufacturers and patent-holders, there's motivation to exaggerate the danger of what's detected by the manufacturers and patent-holders of treatments for the disease, and there's motivation by researchers who formulate the criteria for determining whether a particular feature of something detected is potentially dangerous/deserves treatment, and a motivation to give them the most expensive treatment, regardless of whether that treatment is unpleasant; in fact if the treatment is dangerous, it opens up secondary markets. There's just an enormous number of tailwinds pushing overdetection and overtreatment. The sum of that is what's important, which is that when you test earlier, you often objectively end up with more death and suffering. Which is what a state-run national healthcare systems needs to look at, they can't get lost in the trees. You pick an optimum age for testing that shifts the balance to less suffering and death (and costs), and you look for specific exceptions (genetic, lifestyle, comorbidities) and test just those people early. Could there be a way in which all testing would help instead of hurt? Yes, but it's political and psychological and not likely to ever happen. You'd have to (as a patient) trust probability in general, and additionally you'd have to trust the probabilities that they're handing you haven't been distorted by the self-interest of others. Not likely for the foreseeable future; maybe 1000 years from now. If you want to do the study, all you have to do is compare the number of deaths from a thing when people are tested early to the number of deaths when people are tested late. Or just look for other people who have done them. If early testing obviously saved lives, the people who sell testing would tout them everywhere. Instead, they're stuck trying to look for angles to argue that lessening death and suffering isn't the biggest consideration. They recently did this to push breast cancer screening earlier again, by arguing that if you specifically look at black American women, they benefit from early cancer screening. So overall, breast cancer deaths go up, but that's just your privilege talking. Woke conglomerates. Ignore that black people have a unique, neglected, discriminated against, and poverty-ridden situation in the US; in fact, it might even be racist to point that out (in backwards land.) Of course, you definitely don't have to do the studies, plenty have been done. Anybody saying that they've looked and haven't found them has not looked or has seen them and is not telling the truth. Both positive and negative, about every test. The studies that support earlier and more testing are press released and marketed, though, while the others can be suppressed or simply ignored, unless some public health system or insurance company champions them, and of course they would.
- refurb 2y ago
  The evidence is out there in published papers that do health economic analyses of various interventions. On a population based level it makes perfect sense to not do things even if it could save lives. This is exactly what NICE does in the UK. If it costs more than 30,000 GBP to give one person one more full quality year of life, then it’s not worth it.
  - vidarh 2y ago
    To the point about NICE, it's worth pointing out that this is 1) not how NICE decides. Average cost per QALY being below the preferred level is one factor. Analysis of treatments they approve suggests the "actual" threshold is closer to 45k. 2) These are averages per treatment or protocol and in most areas the NHS spends less than the threshold by simply delivering based on clinical assessment of benefits, and so the threshold is limiting treatment mainly on the fringes where you find a few very expensive treatments with marginal benefits with no cheaper alternative. In practice NICEs threshold is what any insurer would do: You know how much money there is in the system and try to maximise health output with what is available to you.
    - refurb 2y ago
      In practice NICEs threshold is what any insurer would do This is what makes Americans getting upset their insurance rejects coverage for medicines so ironic. Single payer systems do the exact same thing. The difference is in the UK is the option is just isn’t brought up in the first place because the doctor already knows it’s not paid for.
      - vidarh 2y ago
        Even then, they'll happily bring it up if you mention you're fine with private referrals or recommendations for something that isn't covered. Almost all single-payer systems are single-payer only in the sense that everyone is covered by the public system, but without preventing people from going outside it. A very few - Norway used to - strictly limits what you can go outside the system for. In the UK about 10% have private insurance on top.
leto_ii 2y ago
> would generate way too much workload to follow up and thereby cost time and money for better leads Having lived a decade in NL, my impression was that keeping costs down is the top priority. Unless you have a serious chronic condition or were in an accident, good luck getting somebody to take a look at you. (irl, after a while you learn to push, exaggerate symptoms etc. or just go back home to get tests and treatment).
- brnt 2y ago
  Yep, the loudest people get the most help. There's no good solution for that other than to become a bitchy 'client'. It's unfortunate that despite the promises, you still have to 'use it correctly' if you want those good outcomes as a patient.
mort96 2y ago
It's not just about keeping costs down, but also about increasing quality of life. If you detect a benign cancer in someone, and they then go on to receive chemotherapy, you've massively decreased that person's quality of life for a significant period with no upside.
- iknowstuff 2y ago
  A benign tumor doesn’t spread and doesn’t warrant chemotherapy I believe? And if it’s actually cancer than I don’t understand how you would not want it gone as soon as possible to avoid metastasis?
  - Fire-Dragon-DoL 2y ago
    Well, this is talking specifically about the case where the cancer is benign. Of course you want a metastatic one gone. For the benign ones, that's going to hurt the person's body quite a bit
    - jvanderbot 2y ago
      I think the jump from "protein blood test" to "Chemotherapy" is a bit of a stretch. There are almost surely additional screenings and diagnoses going on there. And I don't think anyone is going into chemo for benign tumors.
      - Fire-Dragon-DoL 2y ago
        Makes sense. Is it possible for the two types of cancer to be confused? Should also point out that tests will negatively affect your life seriously either way, especially if these benign cancers are common. Think of the time spent going to/from the doctor, the incredible stress (am I dying?), the tests itself: it is damaging the person's life. Detection is good, false positives are unacceptable though.
        jvanderbot 2y ago

epistasis 2y ago

This is not about early detection in general, but rather a specific test of dubious utility, specifically full-body MRI, which often leads to tons of follow-on tests and invasive procedures that may have zero benefit. For a test with high enough specificity and sensitivity for early detection, it's likely that it would be quickly adopted, and then studied to show that it actually improves outcomes without undue cost (not merely dollar cost but also health cost) to people in terms of treatment and its side effects.

zero-sharp 2y ago
They specifically talk about using the fully body MRI for the purpose of detecting cancers. I'm not sure how you missed that. You literally had to watch 10 seconds of the clip. It's interesting because they explicitly talk about follow up testing (@2:10) which is to say that multiple methods are used if the MRI indicates a problem. So yes, the initial MRI may produce a misdiagnosis and that is a defect of the test. But the commentary in the video obviously suggests that additional testing for early detection is done. That's partly a problem as you pointed out, but then it clearly also indicates the scope of the conversation is more broad.
- ceejayoz 2y ago
  They didn't miss it at all. You've misunderstood the comment's point, which is "just because prospective full-body MRI is bad doesn't mean all diagnostics are".
  - zero-sharp 2y ago
    It's true that some of the commentary is specific to the full body MRI itself (such as misdiagnosis due to an imaging artifact), however many of the claims in the video are very general. And the scientific study they referenced at 6:30 has nothing to do with fully body MRIs. The study is in regards to thyroid cancer overdiagnosis due to screening (using ultrasound and not MRI). This is clearly a statement regarding the effectiveness of screening. And, yes, it is specific to the cancer. I'm not saying anything that the studies aren't saying. For some kinds of cancers and for some kinds of screening methods, screening can result in overdiagnosis.

Wowfunhappy 2y ago

I can't watch a video at work but I have seen this argument before. I just find it fundamentally hard to believe that having more data is a bad thing. What we choose to do with that data is a different story, and the actual source of these bad outcomes.

mort96 2y ago
Are you prepared to make the decision, "I have cancer but statistically it has a relatively low likelihood of killing me before I would die of other causes, so I won't do anything about it"? Are most people?
- thimkerbell 2y ago
  It might provide enough impetus for getting you to avoid sugar and processed meats though.
  - mort96 2y ago
    Has avoiding those things been shown to stop existing cancer? I thought those foods just increased the chance of getting cancer in the first place. But I'm totally ignorant here, it sounds plausible that some carcinogens work by worsening cancer which would otherwise have been benign, I just haven't heard about that
    - stubish 2y ago
      Depending on the type of cancer, there are correlations with diet changes and slowing growth of cancer. Causation isn't known yet, with the speculations about reasons veganism works I've seen all refuted. Low carb effects seems about increasing ketones and reducing glucose levels in the blood, which I think is being studied with some lung cancers. Type of cancer is important, with different diet changes positively correlated different with cancers not returning (and the wrong change could possibly even promote growth, as different cancers 'feed' on different things). Prostate, breast and lung cancer I'm aware of there being these correlations.

siliconc0w 2y ago

The problem with this is that they haven't done the long term studies (which they admit). They also don't consider that once these are cheap and regular enough you get the change over time which should get you a lot less false in positives.

Spooky23 2y ago

It’s a risk assessment like any other. Probability/impact. My wife ultimately lost her life to metastatic melanoma, which was believed to be in remission. Had there been a way to detect the proteins associated with the mets that developed ahead of symptoms, the odds are she we be alive and thriving. In other scenarios, say most prostate cancers, early knowledge has low or negative benefits.

mensetmanusman 2y ago

The more data the better though. We need to train the models to understand what is worth doing over time.

Fire-Dragon-DoL 2y ago

I don't understand how we don't consider benign cancers false positives? Acting against those cause serious damage to the body for no gain

xpe 2y ago

> we need studies that show that the screening improves outcomes. I would be wary of a study conflating screening with outcomes — that is unnecessarily coupling too many factors. [1] The screening isn’t an intervention, so why would it make sense to study its effects on an outcome? Those effects are indirect, mediated by the causal factors of the choice of treatment. Am I missing something? Perhaps you are looking for psychological effects of getting an early test? [1] Treatment outcomes depend on the current state of technology and the practice of medicine.

vidarh 2y ago
Because screening leads to interventions when it is the data used for deciding whether to do an intervention. If a screening procedure leads only to interventions that would be made in time anyway, it doesn't provide a benefit. If it leads to extra interventions and no drop in mortality, it may be a net negative. E.g irradiate enough people to find more cancers and not improve outcomes, and some of your screening may lead to cancers.

IG_Semmelweiss 2y ago

I think Vinay Prasad (MD) has an excellent book or paper on this topic as well. Here is a discussion about it. It really gave me a new perspective on diagnostic testing. https://www.econtalk.org/vinay-prasad-on-cancer-screening/ https://www.econtalk.org/vinay-prasad-on-cancer-screening/

blindriver 2y ago

How are we supposed to increase outcomes if we don't have the screenings? Sure maybe the first few years the outcomes may not change, but what about 20 years from now, when a generation of scientists can detect cancer years earlier? The defeatist attitude of "well it doesn't fix anything right now" is really strange. Once we have reliable detection, it means we can find reliable treatment as well.

LeafItAlone 2y ago
Yes, I agree, but it also could lead to over treatment. If you detect and treat cancer that otherwise never would have caused problems, it was all for naught. Cancer rates found in autopsies for other causes of death are probably higher than you think.
- blindriver 2y ago
  You can fix overtreatment but you need early detection first.
JackeJR 2y ago
The screening target should be for malignant cancers, not all cancers.
fumeux_fume 2y ago
Do you mean improve outcomes? Assuming that’s what you mean, improvement of outcomes for cancer patients seems more reliant on proper treatment rather than detection.
- blindriver 2y ago
  That’s right now, because we don’t have early treatment options. Once we can early detect I bet improved outcomes will increase as we develop new ways to fight them.