151–160 of 290 posts
Arguments against proactive MRI scanning always seem to have a whiff of status quo bias to them. Yes, right now MRIs are expensive and false positives are common, but if regular scans were widespread, it's likely this result in innovations that would drive down costs, improve accuracy, as well as producing a much larger corpus of data with which to guide diagnosis and reduce false positives. To use a software analogy…
Even ignoring the overdiagnosing problem (I don't understand how they can determine from MRI when a cancer is a cancer; there are also benign growth and often when they are a certain size, people notice them, but how would MRI help here? Too small areas could be classified as malign; any further procedures can be dangerous - see that Dawson Creek actor recently, the cost of clinical intervention did not help), I think that medicine is increasingly becoming a "only affordable for those who have money". You can see this with regards to gene therapy too - if we ignore the success ratio, many of these therapies are impossible to acquire for Average Joe. Granted, the prices will go down for various reasons (we saw this with Moore's law and many other inventions too), but at the end of the day I feel we are stepping closer and closer to a very unfair society model - more and more superrich, but prices also go up immensely for average people. That model is not sustainable; people will be angry since this is not fair.
Doctors here are cognitively captured by a system designed to limit cost (and that's mostly a good thing) But scanning frequently is overwhelmingly good for the patient. The problem is the doctors. Imagine two possibilities. 1. You scan every six months and a doctor reviews your scans but never tells you anything no matter what 2. You scan every six months and a doctor reviews your scans and only tells you results if…
“ One study in 2020 found that 95% of asymptomatic patients had some type of "abnormal" finding, but just 1.8% of these findings were indeed cancer.” This has been my experience. And I’ve had oncologists echo exactly this. In the words of one: MRIs find too much. The CT and the PET/CT are the gold standards for finding cancer, finding recurrences, and staging cancer. The trouble is the radiation dose. MRI provides ve…
But saying MRIs "suck at cancer" feels off. They're actually first-line or gold standard for certain cancers
IMO MRI needs to become cheaper; and more reliable too.
Can someone ELI5 why false positives on a MRI are so bad? From a pure Bayesian PoV, you're better off with a noisy additional observation. At worst it doesn't get much weight. At a pragmatic level, can't you say, hey here's something thats probably nothing, let's scan it again in 6 months? Why does an MRI necessarily lead to invasive follow ups? I get that ideally we'd have a crystal ball with 0 type I / type II erro…
“ One study in 2020 found that 95% of asymptomatic patients had some type of "abnormal" finding, but just 1.8% of these findings were indeed cancer.” This has been my experience. And I’ve had oncologists echo exactly this. In the words of one: MRIs find too much. The CT and the PET/CT are the gold standards for finding cancer, finding recurrences, and staging cancer. The trouble is the radiation dose. MRI provides ve…
> MRIs are great for certain things like herniated disks in your back. I have had a lot of experience with MRIs on both myself (back and knee [1]) and my dogs with herniated discs. The doctors always make it sound like MRIs are great to confirm what's suspected because of other symptoms like pain, but a point in time MRI alone is not that valuable. Everyone's bodies (including animals!) are surprisingly different ins…
When I last looked the full body scans for sale seemed to used 1.5T setup, which seems like a waste. The 3T advanced scans looks much more detailed, but it just depends on where you live - I couldn’t find any around.
Earlier quoted context omitted.
I 100% agree. The UK recently recommended to not scan for prostate cancer because it sometimes detects cancers that don't need treatment: https://www.bbc.com/news/articles/cm20169gz44o.amp This seems super dumb to me. If the test detects cancer that doesn't need treatment, don't treat it!! It's still better to know it's there and that you need to monitor it. > Before you know it, you are on the operating table having…
The question is how can you know if it needs treatment or not. I guess you either need to do a biopsy, or check if it's grown after N months (leaving patient scared and anxious during that time). Neither are great if most cases end up not needing treatment.
This is much more sensible than just not testing at all and letting people die from cancer.
> leaving patient scared and anxious during that time
This seems to be the actual motivation. We don't want to scare people with test results so we're just not going to test them. I think that should be up to the patient.
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I had a CT scan last year for some stomach issues they wanted to look at. Doctor warned me up front that the odds the images find something that looks weird is high but not to panic because of how many false positives there are when looking inside someone’s body. While I am happy to report they didn’t find anything serious, I do take slight offense to the following at the top of my results: Last name, First name: Unr…
> I do take slight offense to the following at the top of my results: No offense for me, just confusion. One of the status reports started as follows: > OptionOfT is a very pleasant 36-year-old gentleman 6 weeks status post left anterior total hip arthroplasty done by Dr. _ on _. I asked my wife whether I was particularly friendly (I sometimes fail to adjust my demeanor in certain situations). She said: nah, they wri…
She said “It’s just not often I hear that here.”
“ One study in 2020 found that 95% of asymptomatic patients had some type of "abnormal" finding, but just 1.8% of these findings were indeed cancer.” This has been my experience. And I’ve had oncologists echo exactly this. In the words of one: MRIs find too much. The CT and the PET/CT are the gold standards for finding cancer, finding recurrences, and staging cancer. The trouble is the radiation dose. MRI provides ve…
That can also be reframed as 1.71% of asymptomatic people having cancer, which is a really good argument for better screening.
Earlier quoted context omitted.
There's a softer component to healthcare which is that people can overreact to medical results. If a doctor administers a scan, finds a handful of likely benign things but wants to administer another scan later on down the line, I'm probably much more likely to look for a second opinion that tells me to cut them out (even if it may not be medically necessary) than trust my doctor that "it's probably fine". It's proba…
No, this is more like disabling logging because people are concerned the server is going down. “Don’t worry about it, I don’t think it’s a real issue so we’re just going to ignore it”