Robot dentist performs first human procedure • Hacker News Board

Re: Robot dentist performs first human procedure

#131

Post by whimsicalism » Thu, Aug 01, 2024, 6:42 PM UTC

rscho wrote: post #130

whimsicalism wrote: post #118

Earlier quoted context omitted.

I would like to see RCTs on whether the current approach of care gatekept by doctors (ie. prescription for glasses, can't use this melanoma diagnosis tool unless you visit and pay for a derma) actually has any measurable impact on downstream health. It's interesting that we have all these RCTs for drug interventions, but never conduct the RCTs on policy like letting NPs do more procedures, etc.

Ah, RCTs! The final truth, the end all of all arguments. I've been working for enough profs to know that the best thing to do with 90%+ medical papers is to transfer them directly to the wastebin, and that includes RCTs.

Yeah, what is a randomized controlled trial when we have your 'gut feel' to rely on. Great showing from the physicians in the comments here, now I can clearly see why we should have trust in your evidence-based practice.

Re: Robot dentist performs first human procedure

#132

Post by rscho » Thu, Aug 01, 2024, 6:45 PM UTC

whimsicalism wrote: post #122

rscho wrote: post #120

Earlier quoted context omitted.

Yes, so as usual it's so superior but it's never used. And the people building it say it's stellar, promise! Here's a clue: instead of building a tool, and try teaching people already practicing how and why they should use it, maybe we could actually go see what practitioners are doing and try to integrate into that without requiring 30 additional mouse clicks and the use of a new soft that nobody understands ?

You can find the studies on the recent melanoma classifiers. There are tons showing in various settings that they pretty clearly outperform physicians. If 'additional mouse clicks' is a major barrier to physicians using a tool that leads to far better diagnosis outcomes of a fast-progressing and deadly disease, I'm not sure why that is an argument for why things should continue to be as physician-gated as they are. I…

Yes, we have so many models that completely outclass docs. It's really strange, they're not more widely available don't you think ? Providing so much value, one would think there would be a black market for those, at this point. Or maybe, just maybe, the setting necessary to make things work in large-scale realistic practice is more difficult than what the paper authors would have you believe? No, they would never do that...

Re: Robot dentist performs first human procedure

#133

Post by [deleted] » Thu, Aug 01, 2024, 6:46 PM UTC

rscho wrote: post #39

BenFranklin100 wrote: post #26

Earlier quoted context omitted.

The medical establishment also artificially limits the number of doctors in order to keep salaries high. I live in Boston, arguably the top city for medical care in the US, and it is not uncommon to have a six month waiting list to see a specialist. People talk about prescription drugs being the cause of high medical costs in the US, but it’s really the hospitals and doctors that are driving the majority of the costs…

Maybe I'm mistaken, but I don't think places like Boston are where docs earn the most ?

[deleted]

Re: Robot dentist performs first human procedure

#134

Post by whimsicalism » Thu, Aug 01, 2024, 6:48 PM UTC

Zenzero wrote: post #53

whimsicalism wrote: post #4

It’s going to become increasingly apparent in the US over time the degree to which doctors & the regulatory state are blocking us from getting cheap new care. Already ML algos are more accurate at diagnosing melanomas from an image than dermatologists - but we will never get that tech because doctors are fiercely protective of their salaries and have captured the arm of the state to help them do so.

Doctor here. I know HN loves to hate on doctors, but your framing is just ridiculous. The medical world moves at a glacial pace compared to tech. Complaining that ML algos haven't swept the industry ignores all of the factors pushing it in that direction. "Best medicine" operates on a consensus model of the most prudent decision-making given present knowledge and evidence. That takes time. Pushing boundaries as a doc…

I'm blaming the regulatory apparatus more for that one. These image based algos are ones that could be DTC but of course the FDA (with a side of lobbying) would never ever allow that.

> You also dramatically overestimate the amount of autonomy any given doctor has over the tools they are able to use.

I'm not saying that doctors are mostly choosing not to use these tools - but that lobbying organizations involving collectives of doctors would lobby against it if it ever tried to do a DTC approach or something like that. Please, steelman what I'm saying - I am very aware that doctors who don't own their practice (vast majority of them) cannot simply choose their tools and even those with their own practice are often limited by what they can bill. I know lots of doctors personally.

Re: Robot dentist performs first human procedure

#135

Post by rscho » Thu, Aug 01, 2024, 6:48 PM UTC

whimsicalism wrote: post #108

rscho wrote: post #81

Earlier quoted context omitted.

All countries control rather strictly who can practice medicine. Yes, there is some amount of protectionism, but that happens almost everywhere. The reason is not only money, but also cultural issues. So yes, I expect that to be a valid criticism, but I don't think opening the floodgates would have the result you expect either. Access to care is a complex problem, and IMO not primarily limited by doc counts in the US…

> All countries control rather strictly who can practice medicine To pretend that the restrictions in other countries like Germany are at all comparable to the restrictions in the US is laughable. Just look at the work involved for a German doctor to legally practice in the US vs the reverse if the controls are so similarly strict (they're obviously not). You are very clearly engaging in motivated reasoning in this t…

I agree the US is especially restrictive. But that's just the US doing its usual thing: treating everywhere else as a 3rd world country. Docs from developing countries also have a hard time in Europe. You clearly have an axe to grind with MDs.

Re: Robot dentist performs first human procedure

#136

Post by whimsicalism » Thu, Aug 01, 2024, 6:53 PM UTC

rscho wrote: post #132

whimsicalism wrote: post #122

Earlier quoted context omitted.

You can find the studies on the recent melanoma classifiers. There are tons showing in various settings that they pretty clearly outperform physicians. If 'additional mouse clicks' is a major barrier to physicians using a tool that leads to far better diagnosis outcomes of a fast-progressing and deadly disease, I'm not sure why that is an argument for why things should continue to be as physician-gated as they are. I…

Yes, we have so many models that completely outclass docs. It's really strange, they're not more widely available don't you think ? Providing so much value, one would think there would be a black market for those, at this point. Or maybe, just maybe, the setting necessary to make things work in large-scale realistic practice is more difficult than what the paper authors would have you believe? No, they would never do…

I'm being very specific about melanoma because this is one of the cases with very compelling evidence. You can broaden the discussion if you want - but that is not what I'm discussing. Here's a study of this technology with 67k real-life practitioners showing obvious increases in accuracy. [0]

Apologies if the link to that article is one mouse click too many for you.

[0]: https://med.stanford.edu/news/all-news/2024/04/ai-skin-diagn...

Re: Robot dentist performs first human procedure

#137

Post by rscho » Thu, Aug 01, 2024, 6:54 PM UTC

whimsicalism wrote: post #131

rscho wrote: post #130

Earlier quoted context omitted.

Ah, RCTs! The final truth, the end all of all arguments. I've been working for enough profs to know that the best thing to do with 90%+ medical papers is to transfer them directly to the wastebin, and that includes RCTs.

Yeah, what is a randomized controlled trial when we have your 'gut feel' to rely on. Great showing from the physicians in the comments here, now I can clearly see why we should have trust in your evidence-based practice.

I do clinical statistics. I make such studies. Sorry the sausage is not the way you dreamt it!

Re: Robot dentist performs first human procedure

#138

Post by bluGill » Thu, Aug 01, 2024, 6:55 PM UTC

marinmania wrote: post #10

whimsicalism wrote: post #4

It’s going to become increasingly apparent in the US over time the degree to which doctors & the regulatory state are blocking us from getting cheap new care. Already ML algos are more accurate at diagnosing melanomas from an image than dermatologists - but we will never get that tech because doctors are fiercely protective of their salaries and have captured the arm of the state to help them do so.

And the lowest hanging fruit doesn't even necessarily have to do with AI or robotic tech. In the US you need a prescription within the last year to buy contact lenses. European countries do not require this. Not only does this mean contacts are more expensive and come from fewer suppliers, but demand for appointments with eye doctors would never go down, even though a test of vision could easily be done now by an aut…

The vison test is to ensure your eyes are checked for things other than what correcion you need. Though machines do most of that.

Re: Robot dentist performs first human procedure

#139

Post by supportengineer » Thu, Aug 01, 2024, 6:56 PM UTC

lovethevoid wrote: post #50

BobaFloutist wrote: post #25

Earlier quoted context omitted.

>But also going to the dentist already isn't exactly pleasant, the pokes, scrapes, drill noises, etc. Maybe we improve that first before sticking it in a robot? Dentists are definitely trying. The drills have gotten smaller and gentler, my dentist (and many others) offers a headset so you can listen to music/podcasts while getting your cleaning, and overall they make an effort to be less scoldy and more encouragey. T…

There are a lot of fields like this, where they have mostly been reduced to refinements but ultimately are still very barbaric procedures. All we've done is upgrade the stick (in this case, a nice shiny pick), but the procedure hasn't changed much at all. Too much of dentistry is still stuck on instant fix solutions. Take hard metal, scrape teeth. Something wrong on inside, just drill into it scrape it out and fill i…

If you avoid sugar and floss religiously, and have a decent calcium intake, that takes care of most of the potential problems.

Re: Robot dentist performs first human procedure

#140

Post by rscho » Thu, Aug 01, 2024, 6:59 PM UTC

whimsicalism wrote: post #136

rscho wrote: post #132

Earlier quoted context omitted.

Yes, we have so many models that completely outclass docs. It's really strange, they're not more widely available don't you think ? Providing so much value, one would think there would be a black market for those, at this point. Or maybe, just maybe, the setting necessary to make things work in large-scale realistic practice is more difficult than what the paper authors would have you believe? No, they would never do…

I'm being very specific about melanoma because this is one of the cases with very compelling evidence. You can broaden the discussion if you want - but that is not what I'm discussing. Here's a study of this technology with 67k real-life practitioners showing obvious increases in accuracy. [0] Apologies if the link to that article is one mouse click too many for you. [0]: https://med.stanford.edu/news/all-news/2024/0…

I never denied the performance. Now make it usable to the average doc. That's where we disagree. You believe it's usable, but you've never seen clinicians handle computer stuff.