6 ms·

Why is it good for the patient? I think that to claim this, you'd need to show a difference in outcomes. Here, you have a tool with a ~100% false positive rate

Why is it good for the patient? I think that to claim this, you'd need to show a difference in outcomes. Here, you have a tool with a ~100% false positive rate, so if we start administering it to everyone, it will almost certainly cost lives. Botched biopsies, unnecessary treatments, other complications. Not to mention the huge cost that would divert money from other welfare programs. So you need to show that when it actually detects something, it saves at least as many lives. And I doubt that's the case.

mgraczyk 8mo ago
Did you read my two options? Do you agree option 2 is better than option 1? If so, then scans are better than no scan You don't need to show that it's possible to avoid false positives. That's doctors being irrational. You only need to show that it's possible to build a diagnostic system that's better than no testing, and I have shown that already
- lich_king 8mo ago
  No. To argue for the benefit of the procedure, you need to show a difference in outcomes. Not that it can detect something, even if it could (which whole-body MRIs clearly don't). That the detection improves your chances of survival. If you have an growing mass in your body, then if it's cancer, after a year, it might be too late for treatment. Or it may turn out to be nothing: a benign tumor / cyst / fat deposit in an unusual place. Or it may be slow-growing prostate cancer that you can live with for another 20 years, and maybe it's the chemotherapy that will do you in. It's really not that clear-cut in medicine. To give you have another example: let's say that the risk of appendicitis in people who have an appendix is 1%. And the risk in people who had an appendix removed is 0%. Does this justify proactively removing the appendix? No, because the consequences of complications are much higher than the harm you're preventing. The same applies here: detection, even if 100% accurate, doesn't mean anything. You need to show that what you do with the result actually helps.
  - mgraczyk 8mo ago
    The difference in out come is With my change: 95% of people who are shown scans have cancer and are treated earlier. 5% of people do not have cancer and get CT scans. 0.5% of people get useless biopsies Without my change: many of those 95% die, the 0.5% do not get useless biopsies And the beauty of this is you can pick the percentage! > If you have an growing mass in your body, then after a year, it may very well no longer make a difference whether you treat it or not. Or it may be that you would have lived another 20 years just fine This is just wrong for many parts of the body. In your brain? Your lungs? Growing for a year between 3 scans 6 months apart? Extremely unlikely to be benign > The same applies here: detection, even if 100% accurate, doesn't mean anything. You need to show that what you do with the result actually helps. This is wrong. If you had a 100% accurate cancer detector, fewer people would die of cancer with no downside
    - deleted 8mo ago
      [deleted]
    - alexey-salmin 8mo ago
      > With my change: 95% of people who are shown scans have cancer and are treated earlier. 5% of people do not have cancer and get CT scans. 0.5% of people get useless biopsies Without my change: many of those 95% die, the 0.5% do not get useless biopsies You assume that treating cancer automatically improves the outcome. Treating cancer often kills you, so treating a non-fatal tumor can easily be a bad decision. And a lot of the tumors found by agressive scans are like that, but we don't know yet how much exactly and how to tell one from the other. It's a new question that requires decades-long observations to answer. > This is wrong. If you had a 100% accurate cancer detector, fewer people would die of cancer with no downside You're saying it as if detection somehow cures cancer, it doesn't.
      - mgraczyk 8mo ago
        > You're saying it as if detection somehow cures cancer, it doesn't. No, I didn't say the detector would cause cancer to be cured. I said fewer people would die with no downsides. If treatment is sometimes harmful then the detector also fixes that, you'd never treat people without cancer
jml78 8mo ago
I wouldn't argue we should roll this out to everyone. But I am glad it exists. I commented earlier in this topic about how it caught cancer in my wife at the age of 44. She didn't have to go through chemo or radiation treatment because it was caught so early. Surgery removed the whole cancer. Additionally for me, I have a scan that shows what my body currently has. I had something show up that I did get a scope to check out that was a pancreatic rest. No big deal. Now, if I ever have another MRI and somethings is somewhere else, we have a baseline to compare against. Everything is a risk calculation. When I did my MRI, I also had other procedures done like a heart calcium score. I will get a little more personal. We didn't do it out of the blue. My wife and I decided we want to live on a sailboat. That was a big purchase for us and boats take a long time to sell. We didn't want to commit to such a purchase then 1 year later find out either of us had cancer then we have the stress of cancer and the stress of trying to sell a boat. I would never suggest everyone do it, but I am happy we did.
MagicMoonlight 8mo ago
You are deep in the cope here. There is no world in which biopsies cause more harm than detecting every cancer at stage 1 prevents. > Not to mention the huge cost that would divert money from shareholders Ah, that explains it
- dogmatism 8mo ago
  I’ll give you a counter example. I had an MRI of my neck for unrelated reasons. It found a thyroid nodule with suspicious characteristics. Incidentally I had had an MRI of the same areaa few years before and it wasn’t there. So I had a biopsy. Which was equivocal also. So I had it out which involved removing half my thyroid. Turns out it was a cancer but like the least serious kind, in fact the classification of it as actual cancer has gone back and forth over the years But my other half of my thyroid couldn’t produce enough thyroid hormone, and now I have to take thyroid replacement the rest of my life to start alive Also the surgery affected my voice and I sound like RFK jr now. I clearly suffered some harm, and even after having the thing out, it’s unclear if that was beneficial at all. A large proportion of these kind of tumors quit growing and never do anything bad. But some do. So who knows. Was the tradeoff worth it? I don’t think it’s possible to say

mgraczyk 8mo ago

Did you read my two options? Do you agree option 2 is better than option 1? If so, then scans are better than no scan You don't need to show that it's possible to avoid false positives. That's doctors being irrational. You only need to show that it's possible to build a diagnostic system that's better than no testing, and I have shown that already

lich_king 8mo ago
No. To argue for the benefit of the procedure, you need to show a difference in outcomes. Not that it can detect something, even if it could (which whole-body MRIs clearly don't). That the detection improves your chances of survival. If you have an growing mass in your body, then if it's cancer, after a year, it might be too late for treatment. Or it may turn out to be nothing: a benign tumor / cyst / fat deposit in an unusual place. Or it may be slow-growing prostate cancer that you can live with for another 20 years, and maybe it's the chemotherapy that will do you in. It's really not that clear-cut in medicine. To give you have another example: let's say that the risk of appendicitis in people who have an appendix is 1%. And the risk in people who had an appendix removed is 0%. Does this justify proactively removing the appendix? No, because the consequences of complications are much higher than the harm you're preventing. The same applies here: detection, even if 100% accurate, doesn't mean anything. You need to show that what you do with the result actually helps.
- mgraczyk 8mo ago
  The difference in out come is With my change: 95% of people who are shown scans have cancer and are treated earlier. 5% of people do not have cancer and get CT scans. 0.5% of people get useless biopsies Without my change: many of those 95% die, the 0.5% do not get useless biopsies And the beauty of this is you can pick the percentage! > If you have an growing mass in your body, then after a year, it may very well no longer make a difference whether you treat it or not. Or it may be that you would have lived another 20 years just fine This is just wrong for many parts of the body. In your brain? Your lungs? Growing for a year between 3 scans 6 months apart? Extremely unlikely to be benign > The same applies here: detection, even if 100% accurate, doesn't mean anything. You need to show that what you do with the result actually helps. This is wrong. If you had a 100% accurate cancer detector, fewer people would die of cancer with no downside
  - deleted 8mo ago
    [deleted]
  - alexey-salmin 8mo ago
    > With my change: 95% of people who are shown scans have cancer and are treated earlier. 5% of people do not have cancer and get CT scans. 0.5% of people get useless biopsies Without my change: many of those 95% die, the 0.5% do not get useless biopsies You assume that treating cancer automatically improves the outcome. Treating cancer often kills you, so treating a non-fatal tumor can easily be a bad decision. And a lot of the tumors found by agressive scans are like that, but we don't know yet how much exactly and how to tell one from the other. It's a new question that requires decades-long observations to answer. > This is wrong. If you had a 100% accurate cancer detector, fewer people would die of cancer with no downside You're saying it as if detection somehow cures cancer, it doesn't.
    - mgraczyk 8mo ago
      > You're saying it as if detection somehow cures cancer, it doesn't. No, I didn't say the detector would cause cancer to be cured. I said fewer people would die with no downsides. If treatment is sometimes harmful then the detector also fixes that, you'd never treat people without cancer

jml78 8mo ago

I wouldn't argue we should roll this out to everyone. But I am glad it exists. I commented earlier in this topic about how it caught cancer in my wife at the age of 44. She didn't have to go through chemo or radiation treatment because it was caught so early. Surgery removed the whole cancer. Additionally for me, I have a scan that shows what my body currently has. I had something show up that I did get a scope to check out that was a pancreatic rest. No big deal. Now, if I ever have another MRI and somethings is somewhere else, we have a baseline to compare against. Everything is a risk calculation. When I did my MRI, I also had other procedures done like a heart calcium score. I will get a little more personal. We didn't do it out of the blue. My wife and I decided we want to live on a sailboat. That was a big purchase for us and boats take a long time to sell. We didn't want to commit to such a purchase then 1 year later find out either of us had cancer then we have the stress of cancer and the stress of trying to sell a boat. I would never suggest everyone do it, but I am happy we did.

MagicMoonlight 8mo ago

You are deep in the cope here. There is no world in which biopsies cause more harm than detecting every cancer at stage 1 prevents. > Not to mention the huge cost that would divert money from shareholders Ah, that explains it

dogmatism 8mo ago
I’ll give you a counter example. I had an MRI of my neck for unrelated reasons. It found a thyroid nodule with suspicious characteristics. Incidentally I had had an MRI of the same areaa few years before and it wasn’t there. So I had a biopsy. Which was equivocal also. So I had it out which involved removing half my thyroid. Turns out it was a cancer but like the least serious kind, in fact the classification of it as actual cancer has gone back and forth over the years But my other half of my thyroid couldn’t produce enough thyroid hormone, and now I have to take thyroid replacement the rest of my life to start alive Also the surgery affected my voice and I sound like RFK jr now. I clearly suffered some harm, and even after having the thing out, it’s unclear if that was beneficial at all. A large proportion of these kind of tumors quit growing and never do anything bad. But some do. So who knows. Was the tradeoff worth it? I don’t think it’s possible to say