7 ms·

I think a lot of medical diagnosis could be solved with mass data collection if it was cheap enough. Right now, blood draws are somewhat routinely done because

I think a lot of medical diagnosis could be solved with mass data collection if it was cheap enough. Right now, blood draws are somewhat routinely done because they provide a lot of human-interpretable indicators from a small number of values, and there is some evidence that e.g. "dogs can smell cancer" etc. (i.e. some diseases cause detectable odors). With a big enough data set of [all kinds of bio values, including ones considered irrelevant for that disease] labeled with diagnoses, I suspect we could get very fast and accurate automatic diagnoses, even from a limited data set currently considered uncorrelated. Rather than going to your primary care physician, you'd go into the standardized, mass-produced and thus reasonably cheap everything-scanner, and you could likely get a more accurate diagnosis (or at least "things to check") than the average doctor would be able to give you under the practical constraints they typically operate under (time, available information/diagnostics). This goes in that direction, and I'm really excited to see where it goes. I could imagine that given enough training data, ML models will be able to pick up on minute details that make it possible to diagnose diseases that weren't historically considered ultrasound-diagnoseable from this kind of detailed ultrasound. I think combining it with gas chromatography/mass spectrometry of e.g. breath or blood/sweat/urine samples would also have the potential to be a cost-effective diagnosis method - lots of data, probably not all too useful for human interpretation, but would open the potential to walk up to a machine, breathe into it, spit into it, pee into it, give it a swab, and have it come up with an accurate diagnosis without invasive testing. If mass produced, the cost of something like this could easily drop below the cost of a typical doctor's visit. (I googled it and it seems like GCMS is already used for some diagnoses, but screening only for a few specific diseases rather than "throw ML at it and try to diagnose everything").

kilbuz 4mo ago
false positives are a real problem
- adastra22 4mo ago
  Only if you let them. The false positive thing is a nonissue that only arises from assuming you would respond to information a certain way.
  - deleted 4mo ago
    [deleted]
  - Forgeties79 4mo ago
    I don't really get what this means. A false positive causes issues inherently - you don't know if it's right or wrong. It's noise which is bad for care, and it's anxiety-inducing for patients which is also bad. It produces worse outcomes for everyone. There isn't a "choice" or assumption here, you respond to a positive as if it's accurate until you know it isn't. This is a known issue. Hell Scrubs did an episode about the negative impact of full, generalized body scans on a patient's wellbeing decades ago.
    - adastra22 4mo ago
      The medical industry should NOT be paternalistic towards patients. People have a right to decide for themselves and be treated as adults capable of informed consent. Thankfully that model is starting to change, although there is much inertia. Any test that is approved for use would have a better-than-random outcome distribution. Preconditioned on that, a test result is still useful no matter how uncertain. It is never the case that more information leaves you in a worse position. I have personal experience here: Every year I have elected to have ultrasounds done of my major internal organs. In the past two visits, the technicians spotted multiple developing growths in my liver and now kidneys. These are very likely to be benign cysts, but one piece of blood work that could be a marker for cancer is inconclusive. The odds are still high that this is totally benign and will either clear up on its own, or at least stop growing and cause no further issue. Still: 1. I'm getting my blood work done now far more frequently (twice per year instead of every other year), with specialized/not typically ordered screening tests; 2. I am redoing the ultrasound every year to track progress; and 3. I am actually taking advice about losing weight and exercise far more seriously than I otherwise would, as these issues often resolve with weight loss. I am actually healthier now than I was two years ago, and feel better about my physical and mental well-being. All while staying on top of what could have be a life threatening issue if left untreated and ignored. I look forward to the day when I can go get a monthly MRI-like scan. That would be wonderful.
- simianwords 4mo ago
  ??? how is more information worse than less? if you know the extent of false positives -- use it! its better than having no information. the question should be: does cost of obtaining extra information pay off in lives saved. i would say yeah obviously.
jrflowers 4mo ago
> pee into it, give it a swab, and have it come up with an accurate diagnosis without invasive testing. Somebody should make a startup based around the idea of diagnosing diseases through eg. a drop of blood. Probably need a bunch of big name investors though
aquafox 4mo ago
The problem is: Since we don't regularly full-body scan healthy people, we don't know how healthy, or say, still ok, looks like. This will create a lot of false positives and potential harm from unneccessary follow-up procedures and treatments.
- wkoszek 4mo ago
  The idea here is to make scans very common and regular, hopefully from early age of the patient. It could be like a blood pressure measurement at CVS.
CJefferson 4mo ago
Even at a smaller scale, I was shocked to go to the hospital in China and literally the first thing done was a blood sample, scanned under about 30 metrics, took about 15 minutes after the same was take. The results were sent straight to my phone. That sample had some horrendous results, so I then skipped the queue and got straight to see a doctor who already had all my numbers up on screen before he spoke to the for the first time, meaning he could immediately put me on an antibiotic drip.
- kranke155 4mo ago
  Why is this shocking ?
  - CJefferson 4mo ago
    In the UK I see a medical practitioner before any tests, always.
arcticbull 4mo ago
Don’t make me tap the sign. Bayes Theorem: https://en.wikipedia.org/wiki/Bayes'_theorem https://en.wikipedia.org/wiki/Bayes'_theorem There’s a very good reason we don’t test asymptomatic people in low incidence populations. Basically all positives are false positives when you do that, no matter how accurate the test is. When you’re testing healthy randos for everything the odds of a positive being false have so many 9s it would make an SRE weep. Unless this is accurate to a degree previously unheard of in medical science it’s a boondoggle, and I can’t help but notice there’s no mention of accuracy. Unfortunately that’s just basic statistics.
- moralestapia 4mo ago
  Many smaht people have already pointed that out. It's news to no one that tests are imperfect. Do you have any concrete solution to that? Anything of value?
  - arcticbull 4mo ago
    Yes, don’t do tests on asymptomatic low-risk people until you can demonstrate that a positive result has any meaning whatsoever.
    - aipatselarom 4mo ago
      Hypertension is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause stroke, heart attack, or organ damage through long-term vessel strain, by which time damage may be irreversible; detecting it on time can prevent this with lifestyle changes and medication. Diabetes is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause damage to blood vessels, nerves, kidneys, and eyes through chronic high blood sugar, by which time complications may be advanced; detecting it on time can prevent or delay this with treatment and lifestyle changes. Hyperlipidemia is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause artery blockage through cholesterol buildup, by which time heart attack or stroke may occur; detecting it on time can prevent this with diet and medication. Kidney disease is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause kidney failure through gradual loss of function, by which time dialysis may be needed; detecting it on time can slow progression. Glaucoma is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause irreversible vision loss through optic nerve damage, by which time blindness may be permanent; detecting it on time can preserve vision. -------- I'm SO glad you're not my family doctor!
convnet 4mo ago
It's a controversial and complicated idea. The downside, and the reason why most doctors do not recommend full body scans, is that every human body is a bit weird and there will almost always be something "wrong" that will be visible in a full body scan. This can lead to unnecessary testing, anxiety, and even unnecessary procedures. Many of these oddities flagged by the scan would never have caused any actual issues had the patient never been aware. While there are many individual stories of full-body scans detecting early-stage cancer before it became symptomatic, there seems to be a general sense among doctors that implementing full-body scanning on a population level would lead to overall more harm than good. The thinking is that it is better to do regular targeted screenings for diseases that you're in a risk group for (e.g. colonoscopies, mammograms, cancer marker blood tests, etc.) rather than full-body scans. I'm not a doctor, and I personally do find the idea of full-body scans very appealing, but I also know that if the scan detects a possible cancer, I wouldn't be able to just ignore it if the doctor tells me it's likely ok. Any time I felt any pain or any sort of symptom in that general area, I know I would worry about it. Maybe that's worth it for the potential life-saving results, but it definitely is a cost of this type of scan that needs to be acknowledged.
- sroussey 4mo ago
  If the whole population had a full body scan every quarter, the “weird” things would feel more like the noise they are. But we would have great data over time, both individually (weird tends to only matter if they are changing) and as a population.
  - blensor 4mo ago
    How do you measure the body regularly without potentially introducing problems just by measuring it?
    - bialpio 4mo ago
      My understanding is that both MRIs and ultrasounds do not introduce problems.
mrtksn 4mo ago
In the rest of the world diagnostics aren’t expensive at all and medical data is centralized already (blood, MRI are almost routine for hospital visits, all data stored in govt systems). During Covid it was useful for improving protocols.
friendzis 4mo ago
There's a ton of variation within medical testing and tons of different conditions affect test results in similar ways. VERY FEW tests (test classes maybe: biopsy, microbiology, skeletal Rö) can yield diagnoses in the first place. Most testing is used to support (not confirm!) and reject possible interpretations. This non-invasive everything-scanner sounds more like science fiction.
- wkoszek 4mo ago
  Other tests should be solved too (fecal/urine/blood). Perhaps we need more R&D in here to accelerate progress. We already have patients trying to track their own health over longer time which is great. We then just have to make AI good enough to spot warning signs (without patients asking). Or parhaps we need to make those tests easy and cheap and regular.
  - friendzis 4mo ago
    > Perhaps we need more R&D in here to accelerate progress. In general yes, just that "more" is monstrously massive to the point of it being closer to science fiction than reality, IMO. To reiterate, various assays fluctuate rather wildly over the course of various body cycles. The reason(-s) your doctor should remind to get a blood drawn in the morning after a period of fasting is that the sample is taken at a somewhat steady state and the result is comparable to reference values without too much of a margin. Anyone with a requirement to manage blood glucose levels will tell you that CGMs are vastly superior to finger pricks first and foremost due to the sample rate available and comfort reasons secondarily. With a finger prick test the patient is only somewhat aware where in the curve they are, which makes the test only a rough estimate due to this temporal error margin. A lot of people do not zero in their readings with finger pricks as they are mostly interested in the deltas. Suppose you manage to make urine sampling relatively accurate and super cheap (e.g. tens of eurodollars per analyzer or cents per test strip) so you can have poorly-supervised, long-term studies with huge cohorts. However, unless you somehow control for sample collection conditions, all this baseline variability suddenly infects your whole dataset and effectively raises noise floor. It's not unreasonable to expect that whatever was found to be a useful signal under controlled conditions to fall below noise floor under uncontrolled conditions. That's basically THE problem with the hypothetical test-it-all machine. Again, maybe in some cases that could be extremely useful, but in a lot of cases that would be counter productive. However, what CGMs hint us at is that various kinds of Continuous X Monitors could provide insights into body reactions to things, which is, currently, effectively not a signal in general medicine. Once the test-it-all machine is reframed as an array of continuous monitors and the useful signal is reframed from long-term drifts to short-term deltas it may unlock some additional diagnostic pathways.
khutorni 4mo ago
> walk up to a machine, breathe into it, spit into it, pee into it, give it a swab Maybe take it out to dinner first?
cleaning 4mo ago
[dead]
EEBio 4mo ago
There is this infamous DANCAVAS study [1] in which they ran cardiovascular screening on older population and found absolutely no benefit in doing so. Note that while the linked study claims there was a benefit to screening (reduced mortality in men aged 65-69), the apparent effect was caused by improper statistics (primary endpoint did not show benefit, only subgroup analysis, which however lacked statistical power to be reliable). And indeed, their follow up study showed that there was no benefit in the subgroup. [2] Many a dollar is wasted every year on trying to prove population-wide screening prevents mortality or increases patients’ quality of life and every time we don’t cheat with statistics we get the same answer - population-wide screening isn’t effective. 1: https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 2: https://www.escardio.org/news/press/press-releases/No-significant-reduction-in-death-following-an-invitation-to-undergo-comprehensive-cardiovascular-screening-in-men-aged-60-to-64-years/ https://www.escardio.org/news/press/press-releases/No-signif...
seydor 4mo ago
Theranos2
RandomLensman 4mo ago
What does "solved" mean here? Identifying "the disease" correctly every time? On average identifying the right course of action? For each individual identifying the right course of action? Probabilistically or with certainty?
FridgeSeal 4mo ago
> With a big enough data set of [all kinds of bio values, including ones considered irrelevant for that disease] labeled with diagnoses > > labeled with diagnoses I know you’re not suggesting this is easy, but I can absolutely promise that the land of medical reporting, diagnosis and imagery is about a 1000x more complicated and unhinged than you might expect.

kilbuz 4mo ago

false positives are a real problem

adastra22 4mo ago
Only if you let them. The false positive thing is a nonissue that only arises from assuming you would respond to information a certain way.
- deleted 4mo ago
  [deleted]
- Forgeties79 4mo ago
  I don't really get what this means. A false positive causes issues inherently - you don't know if it's right or wrong. It's noise which is bad for care, and it's anxiety-inducing for patients which is also bad. It produces worse outcomes for everyone. There isn't a "choice" or assumption here, you respond to a positive as if it's accurate until you know it isn't. This is a known issue. Hell Scrubs did an episode about the negative impact of full, generalized body scans on a patient's wellbeing decades ago.
  - adastra22 4mo ago
    The medical industry should NOT be paternalistic towards patients. People have a right to decide for themselves and be treated as adults capable of informed consent. Thankfully that model is starting to change, although there is much inertia. Any test that is approved for use would have a better-than-random outcome distribution. Preconditioned on that, a test result is still useful no matter how uncertain. It is never the case that more information leaves you in a worse position. I have personal experience here: Every year I have elected to have ultrasounds done of my major internal organs. In the past two visits, the technicians spotted multiple developing growths in my liver and now kidneys. These are very likely to be benign cysts, but one piece of blood work that could be a marker for cancer is inconclusive. The odds are still high that this is totally benign and will either clear up on its own, or at least stop growing and cause no further issue. Still: 1. I'm getting my blood work done now far more frequently (twice per year instead of every other year), with specialized/not typically ordered screening tests; 2. I am redoing the ultrasound every year to track progress; and 3. I am actually taking advice about losing weight and exercise far more seriously than I otherwise would, as these issues often resolve with weight loss. I am actually healthier now than I was two years ago, and feel better about my physical and mental well-being. All while staying on top of what could have be a life threatening issue if left untreated and ignored. I look forward to the day when I can go get a monthly MRI-like scan. That would be wonderful.
simianwords 4mo ago
??? how is more information worse than less? if you know the extent of false positives -- use it! its better than having no information. the question should be: does cost of obtaining extra information pay off in lives saved. i would say yeah obviously.

jrflowers 4mo ago

> pee into it, give it a swab, and have it come up with an accurate diagnosis without invasive testing. Somebody should make a startup based around the idea of diagnosing diseases through eg. a drop of blood. Probably need a bunch of big name investors though

aquafox 4mo ago

The problem is: Since we don't regularly full-body scan healthy people, we don't know how healthy, or say, still ok, looks like. This will create a lot of false positives and potential harm from unneccessary follow-up procedures and treatments.

wkoszek 4mo ago
The idea here is to make scans very common and regular, hopefully from early age of the patient. It could be like a blood pressure measurement at CVS.

CJefferson 4mo ago

Even at a smaller scale, I was shocked to go to the hospital in China and literally the first thing done was a blood sample, scanned under about 30 metrics, took about 15 minutes after the same was take. The results were sent straight to my phone. That sample had some horrendous results, so I then skipped the queue and got straight to see a doctor who already had all my numbers up on screen before he spoke to the for the first time, meaning he could immediately put me on an antibiotic drip.

kranke155 4mo ago
Why is this shocking ?
- CJefferson 4mo ago
  In the UK I see a medical practitioner before any tests, always.

arcticbull 4mo ago

Don’t make me tap the sign. Bayes Theorem: https://en.wikipedia.org/wiki/Bayes'_theorem https://en.wikipedia.org/wiki/Bayes'_theorem There’s a very good reason we don’t test asymptomatic people in low incidence populations. Basically all positives are false positives when you do that, no matter how accurate the test is. When you’re testing healthy randos for everything the odds of a positive being false have so many 9s it would make an SRE weep. Unless this is accurate to a degree previously unheard of in medical science it’s a boondoggle, and I can’t help but notice there’s no mention of accuracy. Unfortunately that’s just basic statistics.

moralestapia 4mo ago
Many smaht people have already pointed that out. It's news to no one that tests are imperfect. Do you have any concrete solution to that? Anything of value?
- arcticbull 4mo ago
  Yes, don’t do tests on asymptomatic low-risk people until you can demonstrate that a positive result has any meaning whatsoever.
  - aipatselarom 4mo ago
    Hypertension is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause stroke, heart attack, or organ damage through long-term vessel strain, by which time damage may be irreversible; detecting it on time can prevent this with lifestyle changes and medication. Diabetes is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause damage to blood vessels, nerves, kidneys, and eyes through chronic high blood sugar, by which time complications may be advanced; detecting it on time can prevent or delay this with treatment and lifestyle changes. Hyperlipidemia is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause artery blockage through cholesterol buildup, by which time heart attack or stroke may occur; detecting it on time can prevent this with diet and medication. Kidney disease is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause kidney failure through gradual loss of function, by which time dialysis may be needed; detecting it on time can slow progression. Glaucoma is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause irreversible vision loss through optic nerve damage, by which time blindness may be permanent; detecting it on time can preserve vision. -------- I'm SO glad you're not my family doctor!

convnet 4mo ago

It's a controversial and complicated idea. The downside, and the reason why most doctors do not recommend full body scans, is that every human body is a bit weird and there will almost always be something "wrong" that will be visible in a full body scan. This can lead to unnecessary testing, anxiety, and even unnecessary procedures. Many of these oddities flagged by the scan would never have caused any actual issues had the patient never been aware. While there are many individual stories of full-body scans detecting early-stage cancer before it became symptomatic, there seems to be a general sense among doctors that implementing full-body scanning on a population level would lead to overall more harm than good. The thinking is that it is better to do regular targeted screenings for diseases that you're in a risk group for (e.g. colonoscopies, mammograms, cancer marker blood tests, etc.) rather than full-body scans. I'm not a doctor, and I personally do find the idea of full-body scans very appealing, but I also know that if the scan detects a possible cancer, I wouldn't be able to just ignore it if the doctor tells me it's likely ok. Any time I felt any pain or any sort of symptom in that general area, I know I would worry about it. Maybe that's worth it for the potential life-saving results, but it definitely is a cost of this type of scan that needs to be acknowledged.

sroussey 4mo ago
If the whole population had a full body scan every quarter, the “weird” things would feel more like the noise they are. But we would have great data over time, both individually (weird tends to only matter if they are changing) and as a population.
- blensor 4mo ago
  How do you measure the body regularly without potentially introducing problems just by measuring it?
  - bialpio 4mo ago
    My understanding is that both MRIs and ultrasounds do not introduce problems.

mrtksn 4mo ago

In the rest of the world diagnostics aren’t expensive at all and medical data is centralized already (blood, MRI are almost routine for hospital visits, all data stored in govt systems). During Covid it was useful for improving protocols.

friendzis 4mo ago

There's a ton of variation within medical testing and tons of different conditions affect test results in similar ways. VERY FEW tests (test classes maybe: biopsy, microbiology, skeletal Rö) can yield diagnoses in the first place. Most testing is used to support (not confirm!) and reject possible interpretations. This non-invasive everything-scanner sounds more like science fiction.

wkoszek 4mo ago
Other tests should be solved too (fecal/urine/blood). Perhaps we need more R&D in here to accelerate progress. We already have patients trying to track their own health over longer time which is great. We then just have to make AI good enough to spot warning signs (without patients asking). Or parhaps we need to make those tests easy and cheap and regular.
- friendzis 4mo ago
  > Perhaps we need more R&D in here to accelerate progress. In general yes, just that "more" is monstrously massive to the point of it being closer to science fiction than reality, IMO. To reiterate, various assays fluctuate rather wildly over the course of various body cycles. The reason(-s) your doctor should remind to get a blood drawn in the morning after a period of fasting is that the sample is taken at a somewhat steady state and the result is comparable to reference values without too much of a margin. Anyone with a requirement to manage blood glucose levels will tell you that CGMs are vastly superior to finger pricks first and foremost due to the sample rate available and comfort reasons secondarily. With a finger prick test the patient is only somewhat aware where in the curve they are, which makes the test only a rough estimate due to this temporal error margin. A lot of people do not zero in their readings with finger pricks as they are mostly interested in the deltas. Suppose you manage to make urine sampling relatively accurate and super cheap (e.g. tens of eurodollars per analyzer or cents per test strip) so you can have poorly-supervised, long-term studies with huge cohorts. However, unless you somehow control for sample collection conditions, all this baseline variability suddenly infects your whole dataset and effectively raises noise floor. It's not unreasonable to expect that whatever was found to be a useful signal under controlled conditions to fall below noise floor under uncontrolled conditions. That's basically THE problem with the hypothetical test-it-all machine. Again, maybe in some cases that could be extremely useful, but in a lot of cases that would be counter productive. However, what CGMs hint us at is that various kinds of Continuous X Monitors could provide insights into body reactions to things, which is, currently, effectively not a signal in general medicine. Once the test-it-all machine is reframed as an array of continuous monitors and the useful signal is reframed from long-term drifts to short-term deltas it may unlock some additional diagnostic pathways.

khutorni 4mo ago

> walk up to a machine, breathe into it, spit into it, pee into it, give it a swab Maybe take it out to dinner first?

cleaning 4mo ago

[dead]

EEBio 4mo ago

There is this infamous DANCAVAS study [1] in which they ran cardiovascular screening on older population and found absolutely no benefit in doing so. Note that while the linked study claims there was a benefit to screening (reduced mortality in men aged 65-69), the apparent effect was caused by improper statistics (primary endpoint did not show benefit, only subgroup analysis, which however lacked statistical power to be reliable). And indeed, their follow up study showed that there was no benefit in the subgroup. [2] Many a dollar is wasted every year on trying to prove population-wide screening prevents mortality or increases patients’ quality of life and every time we don’t cheat with statistics we get the same answer - population-wide screening isn’t effective. 1: https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 2: https://www.escardio.org/news/press/press-releases/No-significant-reduction-in-death-following-an-invitation-to-undergo-comprehensive-cardiovascular-screening-in-men-aged-60-to-64-years/ https://www.escardio.org/news/press/press-releases/No-signif...

seydor 4mo ago

Theranos2

RandomLensman 4mo ago

What does "solved" mean here? Identifying "the disease" correctly every time? On average identifying the right course of action? For each individual identifying the right course of action? Probabilistically or with certainty?

FridgeSeal 4mo ago

> With a big enough data set of [all kinds of bio values, including ones considered irrelevant for that disease] labeled with diagnoses > > labeled with diagnoses I know you’re not suggesting this is easy, but I can absolutely promise that the land of medical reporting, diagnosis and imagery is about a 1000x more complicated and unhinged than you might expect.