81–90 of 149 posts
Alternate title: Man encourages his wife to go through unnecessary surgery for a benign and symptomless meningioma after she had an unnecessarily complicated thyroid removal in order to avoid a 4cm scar on her neck. Oh, he also made a shitty 3D model of her skull in the process.
Did we read the same article? The neurosurgeon discovered that the tumor was starting to entangle her optic nerves, and told her that if she had waited six months, she would have had severe, and possibly permanent, degradation of her sight. Because I'd really like to think you're being this insensitive out of ignorance, rather than malice.
There's also the publication that printed the article - a magazine known for its superficial interest in new and shiny tech, not its scientific accuracy. There's nothing in the very low res plastic 3D model that was not already visible on the radiologist's computer monitor.
I'm being this insensitive because I'm an adult and I let reason ruin a good story.
My recommendation: If you ever have a CT scan, ask the imaging facility for a copy of the data. Make an archival backup for posterity and then download some free tools and spend some time exploring and learning about your own body. The DICOM format is widespread and you can find plenty of tools with a quick search.
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There are multiple problems. The biggest problem in my mind is that outcomes are not tracked well. That means that there's no medical feedback loop to measure the long-term effectiveness of... anything. And no good way to do retrospective studies to prove new measurement techniques. And also the laws for patient protection makes it incredibly difficult to get even anonymized data for researchers to use. The next bigg…
Medicine has a data problem. It is multifaceted and far more difficult to fix than it should be. I've worked on these problems for years and it is immensely frustrating. Incentives just aren't set properly to solve them. For example with outcomes tracking, even if you had a good software system for it, you won't get reimbursed for it.
I coauthored a paper a few years ago on the intra-observer variability of measurements of brain tumors when using the bidimensional product. An increase of 25% in the BP is taken as an indicator of brain tumor progression. We found that the intra-observer variability is so high, you can get that 25% increase purely by chance. The first recommendation of the medical team, to wait and see, is understandable.
Having been to three ultrasounds for my children, I'm amazed how casually they use a 2D length to estimate the baby's age, and therefore delivery date, and therefore when it is overdue and calls for a cesarean, etc. Your results seem like they confirm my suspicions that this can't possibly be very accurate.
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There are multiple problems. The biggest problem in my mind is that outcomes are not tracked well. That means that there's no medical feedback loop to measure the long-term effectiveness of... anything. And no good way to do retrospective studies to prove new measurement techniques. And also the laws for patient protection makes it incredibly difficult to get even anonymized data for researchers to use. The next bigg…
This. 1000 times this. It's not even about automated diagnosis. The software used by most radiologists is more than two decades behind the state of the art, lacking even basic image registration and segmentation capabilities. (source: I've worked with radiologists who review brain images at several tier-one, top-10 hospitals). If you are lucky, some eager, tech-savvy resident will use 3D Slicer or OsiriX on their per…
You may not be able to get insurance to reimburse for it, but my impression is that there is no shortage of people ready to pay cash money, easily into 4 figures, for someone providing this service in a 'personalized medicine' context.
As far as packaging a tool-chain that actually makes these state-of-the-art measurements and applying it in this domain, it's not clear what the FDA approval / requirements would be.
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It seems that health care professionals don't have a nuanced problem solving attitude. They make a diagnosis, see how this diagnosis fits into a preconceived treatment bin, then just solve from that position without understanding what's different, what's unique to each case. And, in their defense, they probably just don't have the time for that extra work. That's where I see technology as most useful....how to automa…
I come from a long line of docs, though I'm a software dev. Let me tell you that the vast majority of patients can easily be sorted into these pre-formed category bins. Rare conditions are rare by definition. Most of medicine is dreary repetition.
A string of anecdotes of "I double-checked and it turned out the doctor was wrong" remains less than a trickle compared to the flood of patients doctors have to deal with, and a tiny fraction of the hypochondriacs they must deal with. Our medical system is broken enough without adding doubts on the competence of its medical professionals.
By all means, people should double-check what the doctors say, but realize the much worse consequences of sowing doubt.
This is a classic example of hyperbolic reporting to try and show physicians as some kind of incompetent lot whereas this 'guy working in his basement with passion and talent' figured out how to hack the entire field of Medicine.
The fact is, nearly all Meningiomas are treated this way because they are overwhelmingly benign and the surgery to remove them is not. If the woman had lost her sight getting this surgery, then our Monday morning quarterbacking would've been entirely different... or not even reported. Also, surgeons in general SHOULD NOT improvise new techniques unless it's specifically warranted because their skill is in their muscle memory and if you upset what would otherwise be a routine craniotomy and turn it into something experimental, you are risking the chance of running into an unexpected complication.
Granted, Radiology can be imprecise at measuring progression of tumors but this is mostly because of inter-observer reliability, sampling errors, etc. that could easily be mitigated by a software-side solution. In fact, there's a lot of research into measuring lung tumors this way. However, issues related to the FDA needing to approve all the diagnostic technology involved are why these are not implemented more quickly--some nifty program to measure the volume of a tumor would probably be against the law to use in a diagnostic setting (IANAL though, I am a physician).
Edit: Another case in point, there is a great technique of placing a new Aortic (heart) valve in place using a catheter from a small puncture in an artery in the leg. This technique (seemingly paradoxically) has a GREATER risk of morbidity to the patient than the open heart surgery approach. There are many hypothesized reasons for this, but it is also a fact that the surgeons are simply better trained in the older open technique and its complications.
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I come from a long line of docs, though I'm a software dev. Let me tell you that the vast majority of patients can easily be sorted into these pre-formed category bins. Rare conditions are rare by definition. Most of medicine is dreary repetition.
This ought to be highlighted, before people start an echo chamber of "doctor's don't know what they're doing!" that ultimately undermines everyone (guess what argument the anti-vaxxers use). A string of anecdotes of "I double-checked and it turned out the doctor was wrong" remains less than a trickle compared to the flood of patients doctors have to deal with, and a tiny fraction of the hypochondriacs they must deal…
"What happens if we do nothing? If we do watchful waiting?"
"What happens if I don't take these meds?"
"How likely is that bad event? Tell me in terms of numbers per 10,000 people rather than percentages".
Alternate title: Man encourages his wife to go through unnecessary surgery for a benign and symptomless meningioma after she had an unnecessarily complicated thyroid removal in order to avoid a 4cm scar on her neck. Oh, he also made a shitty 3D model of her skull in the process.
The supposed 'invasion of the optic nerve' is dubious at best. Meningiomas only 'invade' if they are malignant and this would've required radiation therapy, which she did NOT get. Therefore, the pathology must have shown a typical benign meningioma. I'm thinking this surgeon got into some fibrous tissue or mass effect on the nerve... certainly could've caused a complication in the distant future if it grew, but you are dealing with probabilities now and not certainties.