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First blood test for dozens of hereditary cancers approved by FDA

insideprecisionmedicine.com

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Re: First blood test for dozens of hereditary cancers approved by FDA

#111

Post by AmericanChopper »

Centigonal wrote: post #105
AmericanChopper wrote: post #102

Earlier quoted context omitted.

> Unlike eugenics, where otherwise perfectly normal humans would have been born, this use case is focused on negative traits that would have resulted in a lifelong tragedy for everyone involved. If the intention was to abort a genetically undesirable pregnancy, then that is literally textbook eugenics.

You're not wrong, that is the dictionary definition of eugenics. However painting "aborting a fetus with CF" and "sterilizing the 'undesirable' races" as equivalent is a pretty massive leap in my opinion. There's historic context to eugenics and a nexus with racism, nationalism, fascism, and physiognomy that makes it a harmful ideology. I don't think those factors are present in the case where people doing the eugeni…

> However painting "aborting a fetus with CF" and "sterilizing the 'undesirable' races" as equivalent is a pretty massive leap in my opinion.

I didn’t make that leap. I was just saying that this is eugenics, because that seems like a factually accurate description to me.

I would agree that not all eugenic systems are created equal, and that while you could debate whether aborting a child with a hereditary condition might be a bad thing to do, it’s at least not bad for all the same reasons as sterilizing populations to achieve some sort of racial purity would be.

I’ve never been confronted with these sorts of decisions, so I can’t be entirely certain how I’d react. But this seems like an important topic to debate as these technologies mature. However one way I can imagine that debate being undermined is if the people developing and advocating for this technology were to succeed in reframing it as somehow being not-eugenics, which to me it seems as though it clearly is. While it might be far less problematic than the Nazi eugenics programs, it’s not clear to me how you could put this technology to use without eventually creating some sort of Gattaca-like situation, which is also deeply problematic, just for different reasons.

Re: First blood test for dozens of hereditary cancers approved by FDA

#112

Post by mschuster91 »

Wohlf wrote: post #96
b112 wrote: post #93

Earlier quoted context omitted.

It may seem great, but what happens if you hit these theoretical markers? No insurance? Higher premiums? No treatment, for a prior "known condition"? Required test prior to getting insurance? Renewing?

You're really out of the loop, Obamacare eliminated excluding due to prior conditions and differing premiums for anything except smoking. In exchange we all got higher premiums, higher deductibles, and worse coverage across the board.

And yet, insurance companies are still making healthy profits [1].

In any case the problem with the US healthcare system is not that now everyone has a sort-of right to insurance, the problem is on the spending side. Y'all spend many thousands of dollars more per capita than the Swiss [2] but have worse metrics across the board.

[1] https://www.beckerspayer.com/payer/the-house-always-wins-hea...

[2] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

Re: First blood test for dozens of hereditary cancers approved by FDA

#113

Post by akoboldfrying »

DanBC wrote: post #104
nsxwolf wrote: post #12

Earlier quoted context omitted.

In what way is any of that actionable? Are there specific recommendations besides "eat right, exercise, don't smoke"? Sounds like something that could just induce anxiety.

Often early detection does very little to change when people die. It will mean that 5 year survival rates get better, because you have earlier detection which means more people know they have cancer for five years before they die, rather than finding out they have cancer 3 years before they die. For lots of people this means they'll get lots of testing, lots of treatment, lots of harm caused by testing and treatment,…

Everything you say is correct, but I think it's easy to come away with the impression that early detection is not helpful in living longer when I'm certain that's not the case.

I'm certain that expected time of death is a nonincreasing function of detection time -- this would necessarily be the case if the treatment never harmed the patient, and even though that's sadly not the case, prescribing a course of treatment that on average shortens patient lives must surely contradict "First do no harm".

If you assign a low quality-of-life score to time spent undergoing certain harsh treatments like chemo, then you could certainly reduce your "total quality of life" (that is, the integral over your lifetime of quality-of-life-at-each-moment) by starting treatment too early. I think that's a reasonable way to frame it. But in terms of maximising lifespan, the earlier you detect it, the better.

Re: First blood test for dozens of hereditary cancers approved by FDA

#114

Post by mike_h »

Wohlf wrote: post #96
b112 wrote: post #93

Earlier quoted context omitted.

It may seem great, but what happens if you hit these theoretical markers? No insurance? Higher premiums? No treatment, for a prior "known condition"? Required test prior to getting insurance? Renewing?

You're really out of the loop, Obamacare eliminated excluding due to prior conditions and differing premiums for anything except smoking. In exchange we all got higher premiums, higher deductibles, and worse coverage across the board.

It still matters for life and disability insurance.

Re: First blood test for dozens of hereditary cancers approved by FDA

#115

Post by jameshart »

Broken_Hippo wrote: post #110
jameshart wrote: post #43

Earlier quoted context omitted.

Or if it turns out you lack the genetic predisposing factors, risk-homeostasis your way into justifying smoking and eating badly and exercising less.

I don't follow. Just because I don't have a genetic risk for some cancers doesn't mean that I'll be OK to smoke. Different cancers have different causes, not all of which are genetic. It's like saying that since you don't live in an area prone to earthquakes, you can also ignore other possible natural disasters (flooding, tornadoes, landslides, etc).

Risk homeostasis is the mechanism by which humans compensate for reduced risks in one dimension by increasing their level of risk taking in others.

https://en.wikipedia.org/wiki/Risk_compensation

Re: First blood test for dozens of hereditary cancers approved by FDA

#116

Post by prometheus76 »

haswell wrote: post #68
prometheus76 wrote: post #66

Earlier quoted context omitted.

What are the moral implications of not knowing your unborn child has a risk of ADHD or diabetes? I am not following your reasoning.

In a scenario where embryo selection is possible, it does seem like new moral/ethical considerations arise if you have the ability to choose an embryo that is at a lower risk for long term issues. That said, other questions arise like: what happens to the broader population when we start manually selecting for certain traits? It seems like unintended consequences could be lurking as well.

To suggest we should choose an embryo that is at lower risk of long-term issues reveals an underlying presupposition that suffering should be avoided or is bad. There are many examples throughout history of people who rose to great heights as a result of facing their suffering bravely.

Re: First blood test for dozens of hereditary cancers approved by FDA

#117

Post by puppymaster »

AmericanChopper wrote: post #111
Centigonal wrote: post #105

Earlier quoted context omitted.

You're not wrong, that is the dictionary definition of eugenics. However painting "aborting a fetus with CF" and "sterilizing the 'undesirable' races" as equivalent is a pretty massive leap in my opinion. There's historic context to eugenics and a nexus with racism, nationalism, fascism, and physiognomy that makes it a harmful ideology. I don't think those factors are present in the case where people doing the eugeni…

> However painting "aborting a fetus with CF" and "sterilizing the 'undesirable' races" as equivalent is a pretty massive leap in my opinion. I didn’t make that leap. I was just saying that this is eugenics, because that seems like a factually accurate description to me. I would agree that not all eugenic systems are created equal, and that while you could debate whether aborting a child with a hereditary condition m…

it also gets into pretty uncomfy territory when you consider hereditary diseases that have a 40-60% percent curable rate in 5 years and most likely 90% rate in 10. Do you still abort under such circumstances?

Re: First blood test for dozens of hereditary cancers approved by FDA

#118

Post by jseliger »

huytersd wrote: post #60
jseliger wrote: post #6

This is great! I got the Invitae test (due to this: https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce... ), and, from what I understand, FDA approval means it'll be covered by insurance. I've been told by oncologists that blood testing is presently the wild west of cancer profiling. Getting blood testing like CARIS: https://www.carislifesciences.com/products-and-services/mole... or Guardant360: https://gua…

On a possibly crass tangent, how are you doing. Has the situation improved?

I'm doing okay right now: on Wednesday I started receiving a bispecific antibody called petosemtamab (https://jakeseliger.com/2023/09/29/clinical-update-about-whe... for details), and it's likely the best shot I have at more time.

Re: First blood test for dozens of hereditary cancers approved by FDA

#119

Post by haswell »

prometheus76 wrote: post #116
haswell wrote: post #68

Earlier quoted context omitted.

In a scenario where embryo selection is possible, it does seem like new moral/ethical considerations arise if you have the ability to choose an embryo that is at a lower risk for long term issues. That said, other questions arise like: what happens to the broader population when we start manually selecting for certain traits? It seems like unintended consequences could be lurking as well.

To suggest we should choose an embryo that is at lower risk of long-term issues reveals an underlying presupposition that suffering should be avoided or is bad. There are many examples throughout history of people who rose to great heights as a result of facing their suffering bravely.

While you will always find stories of people who've overcome great difficulties, there is no virtue in suffering for no reason, and when possible, we use medical interventions to prevent or avoid it. The success scenarios shouldn't imply that the state of suffering is itself desirable, even if it does sometimes lead to inspiring outcomes. There are plenty of examples of the opposite, with suicides providing a counterpoint at the extreme.

The way I see this, suffering is part of life, and isn't something we can entirely eliminate. When suffering happens, there are better and worse ways to handle it, and good can come from it. But most of cultural/societal evolution is focused on finding ways to reduce or avoid it, and that's a good thing. Obvious examples like improving food security and reducing the impact of previously debilitating illnesses come to mind. I personally grew up not knowing where the next meal would come from some days. That early experience influenced the person I am today. Poverty/starvation are still situations we should continue to try to solve.

So the question really becomes: what differentiates the standard ways we avoid unnecessary suffering from preemptive options that are on the horizon, if anything? i.e. if you have a bad knee, it makes sense to see someone and fix it. Given the choice, there's no reason to choose immobility. If an embryo has a high chance of developing lifelong congenital issues and a future parent has the option to choose an embryo that is significantly less likely to suffer the same fate, why not make that choice, especially if the affliction leads to high child mortality rates?

So yes, I think there is a presupposition that suffering should be avoided when possible (it is often not possible). And I think most of the world runs on this presupposition. This should not be conflated with believing that suffering is inherently "bad", nor should the possibility of positive outcomes lead one to believe that suffering is "good".

Re: First blood test for dozens of hereditary cancers approved by FDA

#120

Post by reaperman »

akoboldfrying wrote: post #113
DanBC wrote: post #104

Earlier quoted context omitted.

Often early detection does very little to change when people die. It will mean that 5 year survival rates get better, because you have earlier detection which means more people know they have cancer for five years before they die, rather than finding out they have cancer 3 years before they die. For lots of people this means they'll get lots of testing, lots of treatment, lots of harm caused by testing and treatment,…

Everything you say is correct, but I think it's easy to come away with the impression that early detection is not helpful in living longer when I'm certain that's not the case. I'm certain that expected time of death is a nonincreasing function of detection time -- this would necessarily be the case if the treatment never harmed the patient, and even though that's sadly not the case, prescribing a course of treatment…

False positive rates are a concern for any widespread medical testing. If you test everyone in the USA for a rare disorder, a super great test might have a 1% false positive rate and 1% false negative rate. It's good that you catch 99% of people with the disorder, but that might only be 10,000 people. At the same time, you'll get 3.3 million false positives which will absolutely swamp the medical systems for follow-up tests, some of which will also have false positives. This costs a ton of money at the very least for unnecessary follow-up testing, and realistically would overwhelm the medical systems designed for just those 10,000 people. It also causes a great amount of undue stress and financial burden on the 3.3 million affected families.

Some people will also be unlucky enough to get false positives on the follow-up test, and eventually you may end up performing unnecessary invasive interventions on 30,000 people who don't have the underlying condition.

It's not to say that:

> the earlier you detect it, the better.

Is wrong, per se. But we'll need to narrow down the criteria for who should be recommended to get these tests in order to minimize harms from false-positives. So you'd want to identify risk factors and have a way to check if someone has those risk factors before testing them.

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