[ilaksh]

I think the only real reason the general public can't access this now is greed and a lack of understanding of technology. They will say that it is dangerous or something to let the general public access it because they may attempt to self-diagnose or something.

But radiologists are very busy and this could help many people. Put a strong disclaimer in there. Open it up to subscriptions to everyone. Charge $40 per analysis or something. Integrate some kind of directory or referral service for human medical professionals.

Anyway, I hope some non-profit organizations will see the capabilities of this model and work together to create an open dataset. That might involve recruiting volunteers to sign up before they have injuries. Or maybe just recruiting different medical providers that get waivers and give discounts on the spot. Won't be easy. But will be worth it.

[arathis]

You think the only real reason the public don't get to use this tool is because of greed?

Like, that's the only REAL reason? Not the technological or ethical implications? The dangers in providing people with no real concept of how any of this works the means to evaluate themselves?

[mhuffman]

Not to speak of the "greed" on this particular item but in Europe you can buy real time glucose monitors, portable ecg, and low calorie meal replacements over the counter. In the US, all of these require a doctor's prescription. It wouldn't take a leap in logic to think that was greed or pressure from the AMA lobby (one of the most funded lobbies in the US, btw).

[lsaferite]

Progress is being made on the glucose monitor front.

https://www.fda.gov/news-events/press-announcements/fda-clea...

[rscho]

> in Europe you can buy real time glucose monitors, portable ecg, and low calorie meal replacements over the counter.

True! And, aside from people with chronic conditions like diabetics, who are forced to know how their glucose levels work, nobody uses those. So it certainly does change the cost, but I don't think it would be any more useful in the US.

[medimikka]

Unfortunately not. There are dozens of companies reselling "old" Libre 2 sensors for "fitness and health" applications. BG has joined HRV and other semi-bogus metrics as one of the numbers that drive a whole subculture of health data.

To correct this, though. You can buy all those in the US as well. Holter and FirstBeat are selling clinically validated and FDA approved mutli-lead ECG, Derxcom is selling an over the counter CGM, as is Abbott with the Libre 2, and a Chinese company has recently joined there, too.

Low calorie meal replacements are all over the store, too.

If you're a member of this orthorexia/orthovivia crowd, you have the same access to tools as you do in the EU, often more so.

[mzmoen]

That’s not true at all? There are companies like Levels who sell CGMs to non-diabetics to try and optimize their health.

[rscho]

In my experience, it doesn't seem to be a common occurrence. At least, I personally know no one doing that. YMMV, I guess. Also, it seems to me like a very bad idea to do that.

[delichon]

As a type 2 diabetic I used a couple of different glucose monitors and got a lot of benefit from them. I gave one to a friend who I thought had diabetic symptoms. First I tried to get him to go to a doctor but he wouldn't. But he tried the CGM and found numbers well into the diabetic range. Then he immediately changed his diet and started treatment. Not sure but I may have committed a crime.

What was the potential harm that was greater than the reward?

[nradov]

Bad idea how? It's expensive but not dangerous. Some people find the results interesting, and serious athletes have had some good results using them to optimize diet and training.

[phkahler]

>> Like, that's the only REAL reason? Not the technological or ethical implications? The dangers in providing people with no real concept of how any of this works the means to evaluate themselves?

On the surface those all sound like additional reasons not to make it available. But they are also great rationalizations for those who want to maintain a monopoly on analysis.

Personally I found all the comparisons to other AI performance bothersome. None of those were specifically trained on diagnostics AFAICT. Comparison against human experts would seem to be the appropriate way to test it. And not people just out of training taking their first test, I assume experts do better over time though I might be wrong on that.

[jarrelscy]

Developer here - its a good point that most of the models were not specifically trained on diagnostic imaging, with the exception of Llava-Med. We would love to compare against other models trained on diagnostic imaging if anyone can grant us access!

Comparison against human experts is the gold standard but information on human performance in the FRCR 2B Rapids examination is hard to come by - we've provided a reference (1) which shows comparable (at least numerically) performance of human radiologists.

To your point around people just out of training (keeping in mind that training for the FRCR takes 5 years, while doing practicing medicine in a real clinical setting) taking their first test - the reference shows that after passing the FRCR 2B Rapids the first time, their performance actually declines (at least in the first year), so I'm not sure if experts would do better over time.

1. https://www.bmj.com/content/bmj/379/bmj-2022-072826.full.pdf

[rscho]

Someone downvoted the author !? This site never ceases to amaze.

[K0balt]

Yeah, we should also limit access to medical books too. With a copy of the MERK manual, what’s to stop me from diagnosing my own diseases or even setting up shop at the mall as a medical “counselor” ?

The infantilization of the public in the name of “safety” is offensive and ridiculous. In many countries, you can get the vast majority of medicines at the pharmacy without a prescription. Amazingly, people still pay doctors and don’t just take random medications without consulting medical professionals.

It’s only “necessary” to limit access to medical tools in countries that have perverted the incentive structure of healthcare to the point where, out of desperation, people will try nearly anything to deal with health issues that they desperately need care for but cannot afford.

In countries where healthcare costs are not punitive and are in alignment with the economy, people opt for sane solutions and quality advice because they want to get well and don’t want to harm themselves accidentally.

If developing nations with arguably inferior education systems can responsibly live with open access to medical treatment resources like diagnostic imaging and pharmaceuticals, maybe we should be asking ourselves what is it, exactly, that is perverting the incentives so badly that having ungated access to these lifesaving resources would be dangerous?

[Calavar]

> If developing nations with arguably inferior education systems can responsibly live with open access to medical treatment resources like diagnostic imaging and pharmaceuticals,

Well, the conditional in this if statement doesn't hold.

Yes, pharmaceuticals are open access in much of the developing world, but it has not happened responsibly. For example, Carbapenem-resistant bacteria are 20 times as common in India as they are in the U.S [1]

I really don't like this characterization of medical resource stewardship as "infantilization" because it implies some sort of elitism amongst doctors, when it's exactly the opposite. It's a system of checks and balances that limits the power afforded to any one person, no matter how smart they think they are. In a US hospital setting, doctors do not have 100% control over antibiotics. An antibiotic stewardship pharmacist or infectious disease specialist will deny and/or cancel antibiotics left and right, even if the prescribing doctor is chief of their department or the CMO.

[1] https://www.fic.nih.gov/News/GlobalHealthMatters/may-june-20...

[rscho]

Honestly, that's a short-sighted interpretation. Would you get treated by someone who's fresh out of school? If not, why? They're the ones with the most up to date and extensive knowledge. Today, medicine is still mostly know-how acquired through practical training, not books. A good doc is mostly experience, with a few bits of real science inside.

[K0balt]

I don’t get The relevance to my comment here,Maybe you replied to the wrong one? Or were you thinking I was Seriously implying that a book was a suitable substitute for a doctor? (I wasn’t)

[pc86]

Someone fresh out of medical school is a resident so they're under direct supervision for 3-7 years. And unless you live in an area with an abundance of hospitals, there's a large change your local hospital is a teaching hospital staffed largely by residents and the attendings that supervise them. You can request non-resident care only but it's a request and is not guaranteed.

The TLDR is that most people when interacting with anything other than their GP family doctor, are probably interacting with someone "fresh out of school."

[rscho]

So, why do residents need so much supervision? Since they have the most recent, and also usually most extensive knowledge. Granted, specialized knowledge is sometimes acquired during residency. Still, it's mostly taught by attendings instead of being read from books. Medicine is a know-how profession.

[pc86]

You don't learn how to be a radiologist, or an orthopedic surgeon, or an OB-GYN, or any other specialty, in med school. You can't learn surgery from a book. Maybe there are large parts of family or internal medicine you can learn from a book but those residencies are already several years shorter than most surgical specialties.

You wouldn't drop a fresh college CS grad by themselves in a group a developers and expect them to just figure it out. Just like medical school doesn't really teach you how to be a doctor, a CS degree doesn't really teach you how to code. They're both much more academic than the day-to-day of the job you're getting that degree for. They'd still get mentorship from colleagues, supervisors, and others. The only difference is medicine has the ACGME and all the government regulations to make it much more structured than what you need for most everything else.

[TeMPOraL]

> Since they have the most recent, and also usually most extensive knowledge.

They've crammed it, yes. They need some extra time learn how to make use of that knowledge in day-to-day practice.

[taneq]

Could there be, perhaps, a middle ground between “backyard chop shops powered by YouTube tutorials and Reddit posts” and the U.S.’ current regulatory-and-commercial-capture exploitation?

[K0balt]

I honestly don’t think we need more amateurs performing healthcare services for fun and profit, but I also think that barriers to self-care should be nearly nonexistent while encouraging an abundance of caution. Not sure how to best accommodate those somewhat disparate goals.

[BaculumMeumEst]

> The infantilization of the public in the name of “safety” is offensive and ridiculous.

It comes from dealing with the public.

> In many countries, you can get the vast majority of medicines at the pharmacy without a prescription. Amazingly, people still pay doctors and don’t just take random medications without consulting medical professionals.

I see people on this site of allegedly smart people recommending taking random medications ALL THE TIME. Not only without consulting medical professionals, but _in spite of medical professional's advice_, because they think they _know better_.

Let's roll out the unbelievably dumb idea of selling self-diagnosis AI on radiology scans in the countries you’re referring to and ask them how it works out. If you want the freedom to shoot from the hip on your healthcare, you've got the freedom to move to Tijuana. We're not going to subject our medical professionals to deal with an onslaught of confidently wrong individuals who are armed with their $40 AI results from an overhyped startup. Those startups can make their case to the providers directly and have their tools vetted.

[whamlastxmas]

Doctors give out wrong and bad advice all the time. Doctors in general make mistakes all the time to the point that there’s some alarming statistic about how preventable medical errors is a scary high percentage of deaths. People should absolutely question their doctors and get more opinions, and in a world where my last 10 minute doctor visit would have cost $650 without insurance, for a NP, I don’t blame them for trying to self diagnose.

[BaculumMeumEst]

You are proving my point talking about the percentage of deaths caused by medical errors. If you had 100,000 people receive medical care, 10 die, and 5 of them are due to medical errors, then sure, you could spin that as "50% of deaths were caused by medical errors". Never mind the context, never mind the fact that we are actually able to identify the errors in the first place!

So again, if you want to ignore the safeguards that we've built for good reason - take your business to Tijuana.

[rscho]

TBF, 'medical error' is a super wide definition. Most aren't diagnostic errors, and they encompass all healthcare professions, not only doctors. It makes a big difference in interpretation and potential solutions.

[ilaksh]

Well.. funny you say that.. I did move to Tijuana some years ago. One time while I was there, I was sick and a neighbor (Mexican) seemed to insist that I go to the doctor. She recommended a hole in the wall office above a pharmacy that looked like a little-league concession stand.

It was a serious 30 something woman who collected something like 50 pesos (around $3), listened to me for about 30 seconds, and told me to make sure I slept and ate well (I think she specifically said chicken soup). I asked about antibiotics or medicine and she indicated it wasn't necessary.

So I rested quite seriously and ate as well as I could and got better about a week later.

During the time that I was in Playas de Tijuana I would normally go to nicer pharmacies though, and they didn't ask for a prescription for my asthma or other medicine which was something like 800% less expensive over there. They did always wear nice lab coats and take their job very seriously if I asked for advice. Although I rarely did that.

I do remember one time asking about my back acne problems at a place in the mall and the lady immediately gave me an antibiotic for maybe $15 which didn't cure it but made it about 75% better for a few months.

Another time at the grocery store I asked about acne medicine and the lady was about to sell me something like Tretinoin cream for a price probably 1/4 of US price. She didn't have anything like oral Accutane of course. It was just a Calimax Plus.

There are of course quite serious and more expensive actual doctors in Tijuana but I never ended up visiting any of them. I was on a budget and luckily did not have any really critical medical needs. But if I had, I am sure it would have cost dramatically less than across the border.

EDIT: not to say the concession-stand office lady wasn't an actual doctor. I don't know, she may have had training, and certainly had a lot of experience.

[K0balt]

I live in the Dominican Republic. People here go to the doctor for things I never would have in the USA. If anything, people here self treat much less Than the USA, even though you can walk into any pharmacy or imaging center and ask for whatever you want.

They go to the doctor because the healthcare system here works, for the most part, and they value and respect the expert counsel in matters of their health.

[BaculumMeumEst]

That's interesting, thanks for the context. I think it takes a unique kind of arrogance to self-diagnose medical problems w/ no knowledge or understanding of what you are talking about, and while I love this country I think that arrogance is in high supply here. Many people here aren't aware that it creates a huge strain on physicians or don't care because they think the world revolves around themselves.

[pc86]

What is your specialty?

I'm curious what you think the problem is, concretely, with a tool like this in the hands of the public which you clearly have such disdain for. Let's assume I buy this thing (the horror). I have to actually get access to my scans, which despite being legally required to provide most providers will be loathe to actually do. So I get my scans, I get this AI tool, I ask it some questions. It's definitely going to get some answers right, and it's very likely going to get some answers wrong. I'd be shocked if it's much less accurate than a resident, and if they're commercializing it there's a decent chance it's more accurate than the average experienced attending.

What is your doomsday scenario now that I have some correct data and some incorrect data? What am I going to do with that information that is so "unbelievably dumb" that I need the AMA to play daddy and prevent me from hurting myself? I can't get medication based on my newfound dangerous knowledge. I can't schedule a surgery or an IR procedure. I can't go into an ER and say "give me a cast here's a report showing I need one."

[K0balt]

While I disagree fundamentally with the premise that people should be kept away from useful tools, I think that there is an understandable fear of dealing with the fallout of certain demographics having access to tools.

Unfortunately we have a lot of people that despite an abundance of ignorance are arrogant enough to think that they know better than most, but still are incapable of applying basic logic and critical thinking in their reasoning. (which if you think about it is sensible, since wisdom is largely a matter of comprehension of the depth of ones ignorance)

These people are a huge PITA to work with and every tool they wield inflicts pain on those trying to help them.

[BaculumMeumEst]

It's not about you.

[pc86]

I don't know what point you think that comment makes but it certainly doesn't answer any of the very legitimate questions I posed, including the first one since I'm willing to bet you have a pretty big conflict of interest here.

[rscho]

Even if this worked as well as a human radiologist, diagnosis is not only made of radiology. That's why radiology is a support specialty. Other specialists incorporate radiology exams into their own assessment to decide on a treatment plan. So in the end, I don't think it'll change as much as you'd think, even if freely accessible.

[crabbone]

Absolutely this. Also radiologists are usually given notes on patients that accompany whatever image they are reading, and in cases like, eg. ulstrasound often perform the exam themselves. So, they are able to asses presentation, hear patient's complaints, learn the history of the patient etc.

Not to mention that in particularly sick patients problems tend to compound one another and exams are often requested to deal with a particular side of the problem, ignoring, perhaps, the major (but already known and diagnosed) problem etc.

Often times factors specific to a hospital play crucial role: eg. in hospitals for rich (but older) patients it may be common to take chest X-rays in a sited position (s.a. not to discomfort the valuable patients...) whereas in poorer hospitals siting position would indicate some kind of a problem (i.e. the patient couldn't stand for whatever reason).

That's not to say that automatic image reading is worthless: radiologists are, perhaps, one of the most overbooked specialists in any hospital, and are getting even more overbooked because other specialists tend to be afraid to diagnose w/o imaging / are over-reliant on imaging. From talking to someone who worked as a clinical radiologist: most images are never red. So, if an automated system could identify images requiring human attention, that'd be already a huge leap.

[robertlagrant]

You could imagine imprinting into the scan additional info such as "seated preferred" or "seated for pain". There is more encoding that could be done.

[crabbone]

Current "solutions" generally ignore or don't know how to incorporate any textual data that accompanies the image. You are trying to incorporate non-existent data that nobody ever put into any kind of medical system...

Yes, in principle, if people taking the images had infinite time and could foresee what kind of accompanying data will be useful at the analysis time, and then had a convenient and universal format to store that data, and models could select the relevant subsets of features for the problem being investigated... I think you should see where this is going: this isn't going to happen in our lifetime, most likely never.

[jarrelscy]

Developer of the model here. We built this model in the form of an LLM precisely to address this problem - to be able to utilize the textual data that accompanies the image such as the order history or clinical background e.g. patient demographics. Images and text are both embedded into the conversation, meaning the LLM can in theory respond using both.

Of course, there are lots of remaining challenges around integration and actually getting access to these data sources e.g. the EMR systems, when trying to use this in practice.

[crabbone]

My experience with working with hospital textual data is that, for the most part, it's either useless, or doesn't exist. The radiologist reading the image is expected to phone the specialist who requested the images to be red in order to figure out what to do with the image.

Hospital systems are atrocious for providing useful information anyways. They are often full of unnecessary / unimportant fields that the requesting side either doesn't know how to fill, or will fill with general nonsense just to get the request through the system.

It gets worse when it's DICOMs: the format itself is a mess. You never know where to look for the useful information. The information is often created accidentally, by some automated process that is completely broken, but doesn't create any visible artifacts for whoever handles the DICOM. Eg. the time information in the machine taking the image might be completely wrong, but it doesn't appear anywhere on the image, but then, say, the research needs to tell the patient's age... and is off by few decades.

Any attempt I've seen so far to run a study in a hospital would result in about 50% of collected information being discarded as completely worthless due to how it was acquired.

Radiologists have general knowledge about the system in which they operate. They can identify cases when information is bogus, while plausible. But this is often so much tied to the context of their work, there's no hope for there to be a practical automated solution for this any time soon. (And I'm talking about hospitals in well-to-do EU countries).

NB. It might sound like I'm trying to undermine your work, but what I'm actually trying to say is that the environment in which you want to automate things isn't ready to be automated. It's very similar to the self-driving cars: if we built road infrastructure differently, the task of automating driving could've been a lot easier, but because it's so random and so dependent on local context, it's just too hard to make useful automation.

[robertlagrant]

I think this is too pessimistic. You can slowly add useful information that makes things more useful, if there's value in incorporating the information. I'm very familiar with EHRs and I get the problem, but it's not insoluble. And the full problem doesn't need to be solved to make progress.

[xarope]

putting on my cynical hat, I feel this will just be another way for unscrupulous healthcare organizations to charge yet another service line item to patients/insurance...

  - X-Ray: $20
  - Radiologist Consultation: $200
  - Harrison.AI interpretation: $2000

[gosub100]

Yep, while justifying a reduction in force to radiology practices and keeping the extra salaries for the CEO and investors. Then when it inevitably kills someone, throw the AI under the bus, have a pre planned escape hatch so the AI company never has to pay any settlements. Have them sell their "assets" to the next third party.

[vrc]

Yeah, and the bill will come back adjusted to

  - X-Ray: $15
  - Radiologist Consultation: $125
  - Harrison.AI interpretation: $20

The cat and mouse between payer and system will never die given how it's set up. There's a disincentive to bill less than maximally, and therefore to not deny and adjust as much as possible. Somewhere in the middle patients get squished with the burden of copays and uncovered expenses that the hospital is now legally obligated to try and collect on or forfeit that portion for all future claims (and still have a copay on that new adjustment)

[littlestymaar]

A model that's accurate only 50% of time is far from helpful in terms of public health: it's high enough so that people could trust it and low enough to cause harm by misdiagnosing stuff.

[CamperBob2]

The models are already more accurate than highly-trained human diagnosticians in many areas.

[littlestymaar]

If you want it to be used by the public it doesn't matter if it's more accurate on some things if it's very bad at other things and the user has no idea in which situation we are.

As a senior developer I routinely use LLMs to write boilerplate code, but that doesn't mean that the layman can get something working by using an LLM. And it's exactly the same for other professions.

[rscho]

On paper. Not in the trenches.

[robertlagrant]

I don't understand the greed argument. Is the reason you draw a salary "greed"? Would gating it behind $40 not be "greed" to someone?

It's more likely that regardless of disclaimers people will still use it, and at some point someone will decide that that outcome is still the provider's fault, because you can't expect people to not use a service when they're impoverished and scared, can you?

[rscho]

> a lack of understanding of technology

Unfortunately, it's the other way around. The tech sector understands very little about clinical medicine, and therefore spends its time fighting windmills and shouting in the dark at docs.

[ImHereToVote]

Doctors should be like thesis advisors for their patients. If the patients undergo a minimum competency test. If you can't pass. You don't get a thesis advisor.