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And yes getting frequent full body MRIs is still overwhelming the right thing for the patient.
by mgraczyk 8mo ago
And yes getting frequent full body MRIs is still overwhelming the right thing for the patient.
- tptacek 8mo agoNo? The point of the article, and of the preceding comments, echoing a pretty common tenet of evidence-based medicine, is that frequent full-body MRIs are a bad idea for the patient.
- deleted 8mo ago[deleted]
- mmaunder 8mo agoThis guy has never heard the term 'scanxiety'. Go ask what it means on a cancer forum. The real OG's are the VHL folks. Bet we have a few here on this thread. Respect.
- mgraczyk 8mo agoI have, it's the fault of how medicine is practiced to reduce cost. It's completely avoidable, you can just not tell people their scan results if they have no symptoms and the detection is less than 95% likely to be cancer. This is strictly better than the status quo because the only difference is some people who almost certainly have cancer learn that they have cancer and nothing else changes
- tptacek 8mo agoAgain, you're assuming the only downside of a routine scan is anxiety. No, the real downside is that you'll trigger needless invasive procedures.
- mgraczyk 8mo agoHow can you trigger an invasive procedure if nobody learns the result of the scan?
- tptacek 8mo agoObviously, the doctor does. Nobody was ever claiming that the problem with full-body scans was that patients were demanding biopsies!
- mgraczyk 8mo agoRight, the problem in your model is that the doctors do! I am pointing out that this is a problem with the doctors, not the scan. Scans are a tool, doctors are not allowed to use them rationally because it would be too expensive, so they don't use them. With an ideal doctor, patient outcomes would be better with a scan than without one, but my claim is that doctors are not ideal. No doctor would order a full body MRI just to throw out the result in 99% of cases, because *it's too costly*
- tptacek 8mo agoDoctors are not ordering biopsies to salvage the value of a scan they just ordered.
- mgraczyk 8mo agoI agree, but they are failing to order scans when the probability of finding anything worth biopsying is low because of cost. This is so obvious it's crazy, our entire world view is misshaped around saving money. When you walk into a doctor's office, why do they take your blood pressure and temperature? Why do they look at the back of your throat and listen to you breath? These are all diagnostic procedures with extremely high false positive rates. The reason doctors do these but do not do MRIs is because MRIs are expensive. If MRIs were free you would get one automatically every time you go to the doctor.
- 8mo ago
- kube-system 8mo ago> you can just not tell people their scan results if they have no symptoms This article is about services like Prenuvo, where the entire point of the service is to get the results of elective scan not related to any symptoms.
- lostlogin 8mo agoHere in NZ an Australia, the college of radiologists disagree and say ‘don’t do it’ for screening the worried well. https://www.ranzcr.com/college/document-library/2024-position-statement-on-whole-body-mri https://www.ranzcr.com/college/document-library/2024-positio...
- mgraczyk 8mo agoSeems like their main concern is "substantial downstream healthcare costs"
- lostlogin 8mo agoYes, and needless biopsy can be a big deal. It’s a great document, I’m an MR tech and we now have something to lean on when we say no to these scans. We can then scan people with problems rather than people with too much money.
- mgraczyk 8mo agoGreat document? I just read the entire thing, it contains no evidence or justification for their claims. > We can then scan people with problems rather than people with too much money. Right, this is what it's really about. MRIs are a scare resource and providers need to manage cost. Fortunately I can afford to pay out of pocket, but I'm just annoyed that doctors are so irrational about this To be clear, it's up to a doctor whether or not to do a "needless biopsy". That has nothing to do with a scan.
- lostlogin 8mo ago… they do it based on the scan result. Avoiding a biopsy that wasn’t needed is a good thing.
- mgraczyk 8mo agoYou're imagining that the doctor is required to act irrationally or against the patient's interest. I understand that they do act this way, but I'm pointing out that they don't have to! You walk into a doctor's office and meet for the first time. Case 1. You have 3 full body MRIs taken 6 months apart in hand and give them to your doctor. Nobody has opened or looked at the scans yet. Case 2. You do not have a scan yet You are claiming case 1 will lead to worse outcomes in expectation. I claim that's impossible because the doctor can simply do the following: Without opening the scans, email them to the world's best radiologist. Tell that radiologist "only reply if it is nearly certain the patient has an operable cancer with the information available" Now there are 4 possibilities. Case 1 without cancer: nothing happens Case 2 without cancer: nothing happens Case 1 with cancer: you maybe survive Case 2 with cancer: you die The only reasonable objection to this is "that's expensive"