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There seems to be a ton of benefits to doing all kinds of blood work - from vitamin deficiencies, hormonal changes, cancer signs, etc. Our system is very reacti

• NotYourLawyer 2y ago
  I mean, you’re supposed to get a yearly checkup. They do blood work.
  • plasticsoprano 2y ago
    Yes but that blood work checks things like cholesterol and vitamin deficiencies. They aren't checking for these types of markers that point toward cancers. They may notice something is out of whack that may lead to more specific testing but I think the overall question is why aren't we just checking for everything more frequently with these blood draws?
    • 6LLvveMx2koXfwn 2y ago
      I had to explicitly ask for Vit D and Iron/Ferritin to be added to the default bunch of tests on my decennial check-up as I was constantly tired. They eventually found out I had iron-deficient anaemia caused by undiagnosed Coeliac disease.
      • OptionOfT 2y ago
        It's very important to advocate for yourself at the doctor. My wife went to the doctor many times complaining about fatigue. Response: "Oh, you're unemployed, you must be just bored...". We moved, new doctor, new yearly checkup, and one attentive doctor noticed something on her. 6 months and a whole battery of tests later she got a diagnosis of EDS. A genetic disease that causes issues with connective tissue. She was always tired because her muscles were compensating in places where people who have normal connective tissue can rely on this tissue as a stabilizer. I'm very glad that you were able to get your diagnosis.
    • kodt 2y ago
      The amount of blood drawn isn't enough to run all of these tests at once. They would need to multiple blood draws for tests that in most cases will end up being unnecessary.
      • plasticsoprano 2y ago
        It's unnecessary until it finds something. My doctor is pretty thorough and I will give 3 vials with my yearly physical bloodwork. I get a pretty comprehensive set of results but my grandfather died of pancreatic cancer and I'd love for this to be included in that testing.
      • mapt 2y ago
        I had a wide panel at one point after a statistically unlikely health event. It was something like 300ml of blood spread over ~40 vials. They tried to charge me $7500. It did lead to a diagnosis.
    • davikr 2y ago
      It's complicated - for screening to be done, the mortality reduction must outweigh the overtreatment and overdiagnosis risks.
  • leetrout 2y ago
    Yes, but insurance does not cover large amounts of screening tests. Last year my A1C check was not covered. In North Carolina my wife's vitamin D test is not covered by her primary or gyno for routine checks.
  • Sloowms 2y ago
    Depends on the country you live in. There are countries that don't do them with similar health results as countries that do them. There is a stereotype that Dutch doctors will prescribe paracetamol for anything because they are really defensive with medication and doctor visits and the result is generally the same as countries that do check ups.
• axus 2y ago
  Theranos tried the "move fast and test blood" approach. Maybe one of the existing testing companies can find a more balanced approach in the current environment.
  • mapt 2y ago
    Widespread pre-emptive testing was not what Theranos tried. Defrauding investors that the technology existed for widespread, inexpensive pre-emptive testing even at small scale is what Theranos tried. There is almost certainly gold in them hills if you dig deep enough and survey systematically enough, but Theranos started with precise coordinates, claiming they'd "found it", and demanded investors for a mine, while privately they were thinking "If we don't find it on the surface, who cares, we got paid, this is how VC works".
  • snowwrestler 2y ago
    Theranos’ specific claim was that they could do existing tests with way less blood and way less cost. One of the ways they kept their fraud under wraps was to simply do the tests the old way behind the scenes. So, blood tests in general were not the controversial part of Theranos. As others have pointed out, the obstacles to large scale prophylactic blood testing are false positives, and general resistance of health insurers to fund anything not strictly reacting to disease or injury.
  • rsynnott 2y ago
    Theranos’s issue was that their tests simply didn’t work. It was more “move fast and pretend to test blood”.
• anonzzzies 2y ago
  For me (eu) the dentist is pricy but these tests are included in public and private; i can ask my doctor any time and i get them, including for markers. Dentist costs, I do it every 6 months, but most people i know maybe once every few years.
• 10729287 2y ago
  The issue is that too much tests could also lead to false negatives and all the impacts that follow, especially on the patient's mind.
• blackeyeblitzar 2y ago
  I find that doctors are very resistant to ordering blood tests. I often get responses saying it isn’t necessary or whatever. I feel patients should be entitled to whatever diagnostics they demand. I don’t know why doctors are even needed to get that done. Other than the scam of insurance coverage of course.
• deleted 2y ago
  [deleted]
• jpeizer 2y ago
  Despite how much we know in medicine we still know too little. Bloodwork will give you a snapshot of that persons blood chemistry. It’s still up to the doctor and lab to put together what that composition means. In other words, if there is too much iron in the blood there could be x number of reasons for that. Most might be benign, and a small handful could be life threatening. (Not a doctor just surrounded by them)
• mlyle 2y ago
  You have to be careful with screening tests. Say that this test has a false positive 1 in 1000 times. If you test 100,000 people, you'll get 100 positives that need invasive further testing and followup, and 5 real pancreatic cancer cases. Society will pay for 100,000 tests, and 105 cases of followup. You may cause lasting harm to some of those 105 people. And then it's not clear if you can improve the survival of the 5 pancreatic cancer cases much. They'll live longer after diagnosis (because you diagnosed earlier) but not necessarily longer overall. (One other screening effect: You'll find more "real cancer" that is so slow growing that it may have always remained subclinical before the more sensitive testing; And the most serious cancers, you won't find so much sooner, because they grow so much in the interval between tests.)
  • GeekyBear 2y ago
    You would need to take into account how aggressive a given cancer is and our ability to treat it. For instance, prostate cancer blood screening often led to radical treatments that are no longer thought to be worth it for most people. > most prostate cancer grows so slowly, if it grows at all, that other illnesses are likely to prove lethal first https://www.nytimes.com/2023/05/08/health/prostate-cancer-screening.html https://www.nytimes.com/2023/05/08/health/prostate-cancer-sc... In the case of pancreatic cancer, it is much more aggressive and you need to catch it early.
    • mlyle 2y ago
      > In the case of pancreatic cancer, it is much more aggressive and you need to catch it early. It's not clear that the cancers that you would find early with a more sensitive test are those more aggressive cancers. The pancreatic cancers we find with our current detection (generally after becoming symptomatic) are typically quite aggressive. But are they all the cancers? Likewise, if the cancer is aggressive, it can grow quite a bit between screening intervals and not be found all that early. (Part of why we think that "finding cancer early" is such a benefit is that because the smaller/earlier cancers we find are less aggressive than the cancers that we first find when they're huge and spread. There is definitely an effect from earlier detection but our estimate of it has been confused by this effect.) As we've increased cancer screening, we've found that survival rates have gone up, as have survival times after detection... but unfortunately we've often also found that the screening doesn't always reduce the number of people dying of that cancer at a certain age. Instead, you find more cancers, and you find them earlier so more people live to 5 years, even if you've changed nothing. Cancer treatment has gotten better, but most of the benefits we have expected from better cancer screening have not materialized. Finding pancreatic cancer early sounds good. And it may be able to reduce mortality from pancreatic cancer, but it's not a sure thing.
• lm28469 2y ago
  It probably all comes down to cost. I remember reading studies about widespread melanoma screening and they were writing things that basically amounted to: "overall it adds ~0.5 day of life expectancy to the average Joe, based on costs &co it's worth it if you consider 1 year of human life worth $30k"
• stuartjohnson12 2y ago
  I was the tech lead at a YC company doing exactly this (Spot Health, W22) until a little while ago. There's a ton of very hopeful things happening in the industry behind the scenes. Insurance via employee benefit schemes is the lever to drive this into people's lives. The industry refers to this as gap closure - care gaps are instances of a patient not receiving care when they should have. For example, not getting treatment for stage 1 cancer because you didn't have a checkup is a care gap. Insurance companies are very incentivised to close care gaps because it results in cheaper premiums. Incentives between health insurance and patients are often not aligned (as we've seen in the news recently), but this is one case where they are radically incentivised to offer additional diagnostics if it results in fewer costly payouts for severe illnesses that come later. In the medium term, the cost of full genome sequencing is quietly experiencing a 10x decrease in cost. Within a decade, I expect it to be the norm that all people are fully genetically sequenced and for the correlations enabled by that dataset to have made the value of being sequenced 10x. So probably a 100x increase or so in the value of genome sequencing over the next few years. (Also, before anyone says it, yes 23&Me should feel very very ashamed for the deanonymised patient record data breaches they've experienced. The whole industry needs a slap in the face when it comes to privacy)
  • hn_acc1 2y ago
    I guess after ~30 years past grad school in the software industry, having had high hopes for the internet and everything back in the 90s, I'm way too cynical. This won't be used to "close the care gap", unless they can charge more $$ for the additional checkups than they'll expect to have to give out in care as a result. And they'll drop anyone suspected of needing too much care in the future based on their genome, even if they aren't sick. Pre-existing conditions times 100 (you know they'll be re-instated by the current administration soon enough). e.g. 17% of the people with that gene had cancer, and you have it, so raise your rates 151%. Oh wait, 37% of the people with this other gene had dementia - you're no longer covered. Eventually, they'll only accept those people with a genomic lifetime 90% profit profile. That's the way this sort of thing works in the "real" world.
    • nradov 2y ago
• MPSimmons 2y ago
  I believe the answer is the false discovery rate - https://en.wikipedia.org/wiki/False_discovery_rate https://en.wikipedia.org/wiki/False_discovery_rate
• mattmcknight 2y ago
  I just order them myself every year at LabCorp. https://www.ondemand.labcorp.com/products https://www.ondemand.labcorp.com/products I definitely prefer doing the testing myself instead of begging the doctor to order things. About the only time I go to doctors is to beg for antibiotics- which they often refuse to give me. They say, "oh, it's probably a virus." Okay, but all of the virus tests I can find came back negative. I have a CBC showing elevated WBC. Coughing up yellow-green slime. Can you order a sputum culture for me? "no, come back if you are still sick after 10 days". Great, $200 and 30 minutes in the waiting room getting exposed to other sickos for nothing, miss another week of work. The gatekeeping of medical care infuriates me. I have plenty of money, let me use it to get better faster.
  • nanomonkey 2y ago
    At this point you just order the same antibiotics off of Amazon for your "fish" and self administer?