6 ms·

I think the only real reason the general public can't access this now is greed and a lack of understanding of technology. They will say that it is dangerous or

by ilaksh 2y ago

I think the only real reason the general public can't access this now is greed and a lack of understanding of technology. They will say that it is dangerous or something to let the general public access it because they may attempt to self-diagnose or something. But radiologists are very busy and this could help many people. Put a strong disclaimer in there. Open it up to subscriptions to everyone. Charge $40 per analysis or something. Integrate some kind of directory or referral service for human medical professionals. Anyway, I hope some non-profit organizations will see the capabilities of this model and work together to create an open dataset. That might involve recruiting volunteers to sign up before they have injuries. Or maybe just recruiting different medical providers that get waivers and give discounts on the spot. Won't be easy. But will be worth it.

ImHereToVote 2y ago
Doctors should be like thesis advisors for their patients. If the patients undergo a minimum competency test. If you can't pass. You don't get a thesis advisor.
arathis 2y ago
You think the only real reason the public don't get to use this tool is because of greed? Like, that's the only REAL reason? Not the technological or ethical implications? The dangers in providing people with no real concept of how any of this works the means to evaluate themselves?
- K0balt 2y ago
  Yeah, we should also limit access to medical books too. With a copy of the MERK manual, what’s to stop me from diagnosing my own diseases or even setting up shop at the mall as a medical “counselor” ? The infantilization of the public in the name of “safety” is offensive and ridiculous. In many countries, you can get the vast majority of medicines at the pharmacy without a prescription. Amazingly, people still pay doctors and don’t just take random medications without consulting medical professionals. It’s only “necessary” to limit access to medical tools in countries that have perverted the incentive structure of healthcare to the point where, out of desperation, people will try nearly anything to deal with health issues that they desperately need care for but cannot afford. In countries where healthcare costs are not punitive and are in alignment with the economy, people opt for sane solutions and quality advice because they want to get well and don’t want to harm themselves accidentally. If developing nations with arguably inferior education systems can responsibly live with open access to medical treatment resources like diagnostic imaging and pharmaceuticals, maybe we should be asking ourselves what is it, exactly, that is perverting the incentives so badly that having ungated access to these lifesaving resources would be dangerous?
  - taneq 2y ago
    Could there be, perhaps, a middle ground between “backyard chop shops powered by YouTube tutorials and Reddit posts” and the U.S.’ current regulatory-and-commercial-capture exploitation?
    - deleted 2y ago
      [deleted]
    - K0balt 2y ago
      I honestly don’t think we need more amateurs performing healthcare services for fun and profit, but I also think that barriers to self-care should be nearly nonexistent while encouraging an abundance of caution. Not sure how to best accommodate those somewhat disparate goals.
  - rscho 2y ago
    Honestly, that's a short-sighted interpretation. Would you get treated by someone who's fresh out of school? If not, why? They're the ones with the most up to date and extensive knowledge. Today, medicine is still mostly know-how acquired through practical training, not books. A good doc is mostly experience, with a few bits of real science inside.
    - pc86 2y ago
      Someone fresh out of medical school is a resident so they're under direct supervision for 3-7 years. And unless you live in an area with an abundance of hospitals, there's a large change your local hospital is a teaching hospital staffed largely by residents and the attendings that supervise them. You can request non-resident care only but it's a request and is not guaranteed. The TLDR is that most people when interacting with anything other than their GP family doctor, are probably interacting with someone "fresh out of school."
      - rscho 2y ago
        So, why do residents need so much supervision? Since they have the most recent, and also usually most extensive knowledge. Granted, specialized knowledge is sometimes acquired during residency. Still, it's mostly taught by attendings instead of being read from books. Medicine is a know-how profession.
- mhuffman 2y ago
  Not to speak of the "greed" on this particular item but in Europe you can buy real time glucose monitors, portable ecg, and low calorie meal replacements over the counter. In the US, all of these require a doctor's prescription. It wouldn't take a leap in logic to think that was greed or pressure from the AMA lobby (one of the most funded lobbies in the US, btw).
  - rscho 2y ago
    > in Europe you can buy real time glucose monitors, portable ecg, and low calorie meal replacements over the counter. True! And, aside from people with chronic conditions like diabetics, who are forced to know how their glucose levels work, nobody uses those. So it certainly does change the cost, but I don't think it would be any more useful in the US.
    - mzmoen 2y ago
      That’s not true at all? There are companies like Levels who sell CGMs to non-diabetics to try and optimize their health.
      - rscho 2y ago
        In my experience, it doesn't seem to be a common occurrence. At least, I personally know no one doing that. YMMV, I guess. Also, it seems to me like a very bad idea to do that.
        delichon 2y ago
        As a type 2 diabetic I used a couple of different glucose monitors and got a lot of benefit from them. I gave one to a friend who I thought had diabetic symptoms. First I tried to get him to go to a doctor but he wouldn't. But he tried the CGM and found numbers well into the diabetic range. Then he immediately changed his diet and started treatment. Not sure but I may have committed a crime. What was the potential harm that was greater than the reward?
- phkahler 2y ago
  >> Like, that's the only REAL reason? Not the technological or ethical implications? The dangers in providing people with no real concept of how any of this works the means to evaluate themselves? On the surface those all sound like additional reasons not to make it available. But they are also great rationalizations for those who want to maintain a monopoly on analysis. Personally I found all the comparisons to other AI performance bothersome. None of those were specifically trained on diagnostics AFAICT. Comparison against human experts would seem to be the appropriate way to test it. And not people just out of training taking their first test, I assume experts do better over time though I might be wrong on that.
  - jarrelscy 2y ago
    Developer here - its a good point that most of the models were not specifically trained on diagnostic imaging, with the exception of Llava-Med. We would love to compare against other models trained on diagnostic imaging if anyone can grant us access! Comparison against human experts is the gold standard but information on human performance in the FRCR 2B Rapids examination is hard to come by - we've provided a reference (1) which shows comparable (at least numerically) performance of human radiologists. To your point around people just out of training (keeping in mind that training for the FRCR takes 5 years, while doing practicing medicine in a real clinical setting) taking their first test - the reference shows that after passing the FRCR 2B Rapids the first time, their performance actually declines (at least in the first year), so I'm not sure if experts would do better over time. 1. https://www.bmj.com/content/bmj/379/bmj-2022-072826.full.pdf https://www.bmj.com/content/bmj/379/bmj-2022-072826.full.pdf
    - rscho 2y ago
      Someone downvoted the author !? This site never ceases to amaze.
xarope 2y ago
putting on my cynical hat, I feel this will just be another way for unscrupulous healthcare organizations to charge yet another service line item to patients/insurance... - X-Ray: $20 - Radiologist Consultation: $200 - Harrison.AI interpretation: $2000
- gosub100 2y ago
  Yep, while justifying a reduction in force to radiology practices and keeping the extra salaries for the CEO and investors. Then when it inevitably kills someone, throw the AI under the bus, have a pre planned escape hatch so the AI company never has to pay any settlements. Have them sell their "assets" to the next third party.
- vrc 2y ago
  Yeah, and the bill will come back adjusted to - X-Ray: $15 - Radiologist Consultation: $125 - Harrison.AI interpretation: $20 The cat and mouse between payer and system will never die given how it's set up. There's a disincentive to bill less than maximally, and therefore to not deny and adjust as much as possible. Somewhere in the middle patients get squished with the burden of copays and uncovered expenses that the hospital is now legally obligated to try and collect on or forfeit that portion for all future claims (and still have a copay on that new adjustment)
rscho 2y ago
Even if this worked as well as a human radiologist, diagnosis is not only made of radiology. That's why radiology is a support specialty. Other specialists incorporate radiology exams into their own assessment to decide on a treatment plan. So in the end, I don't think it'll change as much as you'd think, even if freely accessible.
- crabbone 2y ago
  Absolutely this. Also radiologists are usually given notes on patients that accompany whatever image they are reading, and in cases like, eg. ulstrasound often perform the exam themselves. So, they are able to asses presentation, hear patient's complaints, learn the history of the patient etc. Not to mention that in particularly sick patients problems tend to compound one another and exams are often requested to deal with a particular side of the problem, ignoring, perhaps, the major (but already known and diagnosed) problem etc. Often times factors specific to a hospital play crucial role: eg. in hospitals for rich (but older) patients it may be common to take chest X-rays in a sited position (s.a. not to discomfort the valuable patients...) whereas in poorer hospitals siting position would indicate some kind of a problem (i.e. the patient couldn't stand for whatever reason). That's not to say that automatic image reading is worthless: radiologists are, perhaps, one of the most overbooked specialists in any hospital, and are getting even more overbooked because other specialists tend to be afraid to diagnose w/o imaging / are over-reliant on imaging. From talking to someone who worked as a clinical radiologist: most images are never red. So, if an automated system could identify images requiring human attention, that'd be already a huge leap.
  - robertlagrant 2y ago
    You could imagine imprinting into the scan additional info such as "seated preferred" or "seated for pain". There is more encoding that could be done.
    - crabbone 2y ago
      Current "solutions" generally ignore or don't know how to incorporate any textual data that accompanies the image. You are trying to incorporate non-existent data that nobody ever put into any kind of medical system... Yes, in principle, if people taking the images had infinite time and could foresee what kind of accompanying data will be useful at the analysis time, and then had a convenient and universal format to store that data, and models could select the relevant subsets of features for the problem being investigated... I think you should see where this is going: this isn't going to happen in our lifetime, most likely never.
littlestymaar 2y ago
A model that's accurate only 50% of time is far from helpful in terms of public health: it's high enough so that people could trust it and low enough to cause harm by misdiagnosing stuff.
- CamperBob2 2y ago
  The models are already more accurate than highly-trained human diagnosticians in many areas.
  - littlestymaar 2y ago
    If you want it to be used by the public it doesn't matter if it's more accurate on some things if it's very bad at other things and the user has no idea in which situation we are. As a senior developer I routinely use LLMs to write boilerplate code, but that doesn't mean that the layman can get something working by using an LLM. And it's exactly the same for other professions.
  - rscho 2y ago
    On paper. Not in the trenches.
deleted 2y ago
[deleted]
robertlagrant 2y ago
I don't understand the greed argument. Is the reason you draw a salary "greed"? Would gating it behind $40 not be "greed" to someone? It's more likely that regardless of disclaimers people will still use it, and at some point someone will decide that that outcome is still the provider's fault, because you can't expect people to not use a service when they're impoverished and scared, can you?
rscho 2y ago
> a lack of understanding of technology Unfortunately, it's the other way around. The tech sector understands very little about clinical medicine, and therefore spends its time fighting windmills and shouting in the dark at docs.

by ilaksh 2y ago

ImHereToVote 2y ago

Doctors should be like thesis advisors for their patients. If the patients undergo a minimum competency test. If you can't pass. You don't get a thesis advisor.

arathis 2y ago

You think the only real reason the public don't get to use this tool is because of greed? Like, that's the only REAL reason? Not the technological or ethical implications? The dangers in providing people with no real concept of how any of this works the means to evaluate themselves?

K0balt 2y ago
Yeah, we should also limit access to medical books too. With a copy of the MERK manual, what’s to stop me from diagnosing my own diseases or even setting up shop at the mall as a medical “counselor” ? The infantilization of the public in the name of “safety” is offensive and ridiculous. In many countries, you can get the vast majority of medicines at the pharmacy without a prescription. Amazingly, people still pay doctors and don’t just take random medications without consulting medical professionals. It’s only “necessary” to limit access to medical tools in countries that have perverted the incentive structure of healthcare to the point where, out of desperation, people will try nearly anything to deal with health issues that they desperately need care for but cannot afford. In countries where healthcare costs are not punitive and are in alignment with the economy, people opt for sane solutions and quality advice because they want to get well and don’t want to harm themselves accidentally. If developing nations with arguably inferior education systems can responsibly live with open access to medical treatment resources like diagnostic imaging and pharmaceuticals, maybe we should be asking ourselves what is it, exactly, that is perverting the incentives so badly that having ungated access to these lifesaving resources would be dangerous?
- taneq 2y ago
  Could there be, perhaps, a middle ground between “backyard chop shops powered by YouTube tutorials and Reddit posts” and the U.S.’ current regulatory-and-commercial-capture exploitation?
  - deleted 2y ago
    [deleted]
  - K0balt 2y ago
    I honestly don’t think we need more amateurs performing healthcare services for fun and profit, but I also think that barriers to self-care should be nearly nonexistent while encouraging an abundance of caution. Not sure how to best accommodate those somewhat disparate goals.
- rscho 2y ago
  Honestly, that's a short-sighted interpretation. Would you get treated by someone who's fresh out of school? If not, why? They're the ones with the most up to date and extensive knowledge. Today, medicine is still mostly know-how acquired through practical training, not books. A good doc is mostly experience, with a few bits of real science inside.
  - pc86 2y ago
    Someone fresh out of medical school is a resident so they're under direct supervision for 3-7 years. And unless you live in an area with an abundance of hospitals, there's a large change your local hospital is a teaching hospital staffed largely by residents and the attendings that supervise them. You can request non-resident care only but it's a request and is not guaranteed. The TLDR is that most people when interacting with anything other than their GP family doctor, are probably interacting with someone "fresh out of school."
    - rscho 2y ago
      So, why do residents need so much supervision? Since they have the most recent, and also usually most extensive knowledge. Granted, specialized knowledge is sometimes acquired during residency. Still, it's mostly taught by attendings instead of being read from books. Medicine is a know-how profession.
mhuffman 2y ago
Not to speak of the "greed" on this particular item but in Europe you can buy real time glucose monitors, portable ecg, and low calorie meal replacements over the counter. In the US, all of these require a doctor's prescription. It wouldn't take a leap in logic to think that was greed or pressure from the AMA lobby (one of the most funded lobbies in the US, btw).
- rscho 2y ago
  > in Europe you can buy real time glucose monitors, portable ecg, and low calorie meal replacements over the counter. True! And, aside from people with chronic conditions like diabetics, who are forced to know how their glucose levels work, nobody uses those. So it certainly does change the cost, but I don't think it would be any more useful in the US.
  - mzmoen 2y ago
    That’s not true at all? There are companies like Levels who sell CGMs to non-diabetics to try and optimize their health.
    - rscho 2y ago
      In my experience, it doesn't seem to be a common occurrence. At least, I personally know no one doing that. YMMV, I guess. Also, it seems to me like a very bad idea to do that.
      - delichon 2y ago
        As a type 2 diabetic I used a couple of different glucose monitors and got a lot of benefit from them. I gave one to a friend who I thought had diabetic symptoms. First I tried to get him to go to a doctor but he wouldn't. But he tried the CGM and found numbers well into the diabetic range. Then he immediately changed his diet and started treatment. Not sure but I may have committed a crime. What was the potential harm that was greater than the reward?
phkahler 2y ago
>> Like, that's the only REAL reason? Not the technological or ethical implications? The dangers in providing people with no real concept of how any of this works the means to evaluate themselves? On the surface those all sound like additional reasons not to make it available. But they are also great rationalizations for those who want to maintain a monopoly on analysis. Personally I found all the comparisons to other AI performance bothersome. None of those were specifically trained on diagnostics AFAICT. Comparison against human experts would seem to be the appropriate way to test it. And not people just out of training taking their first test, I assume experts do better over time though I might be wrong on that.
- jarrelscy 2y ago
  Developer here - its a good point that most of the models were not specifically trained on diagnostic imaging, with the exception of Llava-Med. We would love to compare against other models trained on diagnostic imaging if anyone can grant us access! Comparison against human experts is the gold standard but information on human performance in the FRCR 2B Rapids examination is hard to come by - we've provided a reference (1) which shows comparable (at least numerically) performance of human radiologists. To your point around people just out of training (keeping in mind that training for the FRCR takes 5 years, while doing practicing medicine in a real clinical setting) taking their first test - the reference shows that after passing the FRCR 2B Rapids the first time, their performance actually declines (at least in the first year), so I'm not sure if experts would do better over time. 1. https://www.bmj.com/content/bmj/379/bmj-2022-072826.full.pdf https://www.bmj.com/content/bmj/379/bmj-2022-072826.full.pdf
  - rscho 2y ago
    Someone downvoted the author !? This site never ceases to amaze.

xarope 2y ago

putting on my cynical hat, I feel this will just be another way for unscrupulous healthcare organizations to charge yet another service line item to patients/insurance... - X-Ray: $20 - Radiologist Consultation: $200 - Harrison.AI interpretation: $2000

gosub100 2y ago
Yep, while justifying a reduction in force to radiology practices and keeping the extra salaries for the CEO and investors. Then when it inevitably kills someone, throw the AI under the bus, have a pre planned escape hatch so the AI company never has to pay any settlements. Have them sell their "assets" to the next third party.
vrc 2y ago
Yeah, and the bill will come back adjusted to - X-Ray: $15 - Radiologist Consultation: $125 - Harrison.AI interpretation: $20 The cat and mouse between payer and system will never die given how it's set up. There's a disincentive to bill less than maximally, and therefore to not deny and adjust as much as possible. Somewhere in the middle patients get squished with the burden of copays and uncovered expenses that the hospital is now legally obligated to try and collect on or forfeit that portion for all future claims (and still have a copay on that new adjustment)

rscho 2y ago

Even if this worked as well as a human radiologist, diagnosis is not only made of radiology. That's why radiology is a support specialty. Other specialists incorporate radiology exams into their own assessment to decide on a treatment plan. So in the end, I don't think it'll change as much as you'd think, even if freely accessible.

crabbone 2y ago
Absolutely this. Also radiologists are usually given notes on patients that accompany whatever image they are reading, and in cases like, eg. ulstrasound often perform the exam themselves. So, they are able to asses presentation, hear patient's complaints, learn the history of the patient etc. Not to mention that in particularly sick patients problems tend to compound one another and exams are often requested to deal with a particular side of the problem, ignoring, perhaps, the major (but already known and diagnosed) problem etc. Often times factors specific to a hospital play crucial role: eg. in hospitals for rich (but older) patients it may be common to take chest X-rays in a sited position (s.a. not to discomfort the valuable patients...) whereas in poorer hospitals siting position would indicate some kind of a problem (i.e. the patient couldn't stand for whatever reason). That's not to say that automatic image reading is worthless: radiologists are, perhaps, one of the most overbooked specialists in any hospital, and are getting even more overbooked because other specialists tend to be afraid to diagnose w/o imaging / are over-reliant on imaging. From talking to someone who worked as a clinical radiologist: most images are never red. So, if an automated system could identify images requiring human attention, that'd be already a huge leap.
- robertlagrant 2y ago
  You could imagine imprinting into the scan additional info such as "seated preferred" or "seated for pain". There is more encoding that could be done.
  - crabbone 2y ago
    Current "solutions" generally ignore or don't know how to incorporate any textual data that accompanies the image. You are trying to incorporate non-existent data that nobody ever put into any kind of medical system... Yes, in principle, if people taking the images had infinite time and could foresee what kind of accompanying data will be useful at the analysis time, and then had a convenient and universal format to store that data, and models could select the relevant subsets of features for the problem being investigated... I think you should see where this is going: this isn't going to happen in our lifetime, most likely never.

littlestymaar 2y ago

A model that's accurate only 50% of time is far from helpful in terms of public health: it's high enough so that people could trust it and low enough to cause harm by misdiagnosing stuff.

CamperBob2 2y ago
The models are already more accurate than highly-trained human diagnosticians in many areas.
- littlestymaar 2y ago
  If you want it to be used by the public it doesn't matter if it's more accurate on some things if it's very bad at other things and the user has no idea in which situation we are. As a senior developer I routinely use LLMs to write boilerplate code, but that doesn't mean that the layman can get something working by using an LLM. And it's exactly the same for other professions.
- rscho 2y ago
  On paper. Not in the trenches.

deleted 2y ago

[deleted]

robertlagrant 2y ago

I don't understand the greed argument. Is the reason you draw a salary "greed"? Would gating it behind $40 not be "greed" to someone? It's more likely that regardless of disclaimers people will still use it, and at some point someone will decide that that outcome is still the provider's fault, because you can't expect people to not use a service when they're impoverished and scared, can you?

rscho 2y ago

> a lack of understanding of technology Unfortunately, it's the other way around. The tech sector understands very little about clinical medicine, and therefore spends its time fighting windmills and shouting in the dark at docs.