[tgsovlerkhgsel]

I think a lot of medical diagnosis could be solved with mass data collection if it was cheap enough. Right now, blood draws are somewhat routinely done because they provide a lot of human-interpretable indicators from a small number of values, and there is some evidence that e.g. "dogs can smell cancer" etc. (i.e. some diseases cause detectable odors).

With a big enough data set of [all kinds of bio values, including ones considered irrelevant for that disease] labeled with diagnoses, I suspect we could get very fast and accurate automatic diagnoses, even from a limited data set currently considered uncorrelated. Rather than going to your primary care physician, you'd go into the standardized, mass-produced and thus reasonably cheap everything-scanner, and you could likely get a more accurate diagnosis (or at least "things to check") than the average doctor would be able to give you under the practical constraints they typically operate under (time, available information/diagnostics).

This goes in that direction, and I'm really excited to see where it goes. I could imagine that given enough training data, ML models will be able to pick up on minute details that make it possible to diagnose diseases that weren't historically considered ultrasound-diagnoseable from this kind of detailed ultrasound.

I think combining it with gas chromatography/mass spectrometry of e.g. breath or blood/sweat/urine samples would also have the potential to be a cost-effective diagnosis method - lots of data, probably not all too useful for human interpretation, but would open the potential to walk up to a machine, breathe into it, spit into it, pee into it, give it a swab, and have it come up with an accurate diagnosis without invasive testing. If mass produced, the cost of something like this could easily drop below the cost of a typical doctor's visit. (I googled it and it seems like GCMS is already used for some diagnoses, but screening only for a few specific diseases rather than "throw ML at it and try to diagnose everything").

[convnet]

It's a controversial and complicated idea. The downside, and the reason why most doctors do not recommend full body scans, is that every human body is a bit weird and there will almost always be something "wrong" that will be visible in a full body scan. This can lead to unnecessary testing, anxiety, and even unnecessary procedures. Many of these oddities flagged by the scan would never have caused any actual issues had the patient never been aware.

While there are many individual stories of full-body scans detecting early-stage cancer before it became symptomatic, there seems to be a general sense among doctors that implementing full-body scanning on a population level would lead to overall more harm than good. The thinking is that it is better to do regular targeted screenings for diseases that you're in a risk group for (e.g. colonoscopies, mammograms, cancer marker blood tests, etc.) rather than full-body scans.

I'm not a doctor, and I personally do find the idea of full-body scans very appealing, but I also know that if the scan detects a possible cancer, I wouldn't be able to just ignore it if the doctor tells me it's likely ok. Any time I felt any pain or any sort of symptom in that general area, I know I would worry about it. Maybe that's worth it for the potential life-saving results, but it definitely is a cost of this type of scan that needs to be acknowledged.

[seer]

Exactly - I had switched to a one meal per day setup and have been mostly following it for a few years.

Then after a routine “heart health” check all my indicators were super out of whack - the doctors thought I was on my deathbed - but I am perfectly happy pain free, in shape, physically active person…

Then _i myself_ had to dig into all these tests and figure out that they were measuring the wrong thing - since they try to time where your body is “just about to eat after a fast” - normally for most people in the morning before breakfast, but since my first meal of the day is usually around 20:00 - my body had adopted to have higher levels of various things just to stay on top of my lifestyle choices.

Anyway I had to educate some doctors since they haven’t really had a case like mine, so they weren’t thinking critically of how to interpret the results…

I imagine an automated test _could_ take these things into account with large enough dataset, but it would need to do a lot more reasoning than statistical correlation.

I do believe current sota models should be good enough to come to the correct conclusions with the right harness though.

[Dathuil]

Reminds me that a few years ago my wifes grandfather (80+) was wondering if he should cut back on the amount of exercise he was doing. He would regularly be knocking on our door at 6am to see if one of us would want to got for a quick 10k run or to hit the gym.

He was a firefighter in NY in his youth and had never stopped exercising even after retirement.

He went to his GP explained his workout routine and was basically told there is no precedent for it as people his age tend to not be running 10km a day. In short he was told if you're not in pain or fatigued keep at it.

I think he's nearly 90 now and has cut back the running to only a day or so a week, but last time we went to visit he was in his garage bench pressing 50kg

[powerapple]

Sorry to branch out: How does this one meal per day work for you? There is recommended calories for a person, do you have to follow it somehow to make sure you have enough energy and exercise?

[seer]

I just eat double portion at dinner, and then nibble on snacks before bed - I haven’t had breakfast in decades, then since I moved to India, with the carby nature of the food it was hard to stay in shape with 2 meals, so I decided to try and skip the lunch too. With fun work it is actually quite easy, and babysitting 4 claudes and helping out colleagues is very entertaining.

Now I either do gym before dinner (heavy exercise) or social dance after.

I’ve been given a lot of advice how I “should” be structuring it - like “don’t eat too much before bed” or “never eat before exercise” … but I haven’t had any issues with what I’m doing so far (~2 years)

[ngc248]

One meal ... many snacks?

[potamic]

What parameters were higher than expected? The critical ones, glucose, electrolytes, lipids should stay low when fasting.

[moffkalast]

If the current state is anything to go by, an automated test would not only flag your out of distribution results but try to gaslight everyone reading its output with additional false indicators to map you into an area that's in distribution. Statistical models cannot accept the existence of extremely rare edge cases.

[ACCount37]

Modern LLMs routinely beat human doctors at diagnosing "extremely rare edge cases".

They have unmatched breadth of knowledge by default, and can maintain attention across entire medical histories.

[multjoy]

Citation very much needed.

[fragmede]

https://www.reddit.com/r/ChatGPT/comments/1iz4iwm/chatgpt_is...

or

https://www.reddit.com/r/ChatGPT/comments/1oesnix/chatgpt_di...

or if you prefer from this site,

https://news.ycombinator.com/item?id=43171639

and

https://news.ycombinator.com/item?id=42999632

If you were looking for a published paper or something more official though, I don't have one.

[fn-mote]

> Modern LLMs routinely beat human doctors at diagnosing "extremely rare edge cases".

There is a selection bias here. Not saying it wouldn’t work, but right now you hear about exceptional cases, not when the LLM wants to amputate for a wart.

We all work with LLMs, right? It hasn’t been long at all since an LLM gaslit me while attempting to recover an unbootable laptop. I should have been recommended a few simple steps to try; instead, it was unable to ignore the irrelevant details and led me on an hours-long chase. To me that means the LLM will also struggle to ignore irrelevant medical information.

[sroussey]

If the whole population had a full body scan every quarter, the “weird” things would feel more like the noise they are.

But we would have great data over time, both individually (weird tends to only matter if they are changing) and as a population.

[jibal]

The fundamental problem is that you generally can't diagnose simply from shapes. Scans show shapes, shapes cause concern, concern leads to invasive procedures, results are negative.

[user43928]

Are people really going to perform invasive procedures over mere concern if there are no symptoms and the doctor recommends against it?

[jibal]

There are numerous comments here from experienced people addressing this. Yes, that happens and a doctor who dismisses the concern can be sued for malpractice if something actually does show up, so they are put in a difficult position. For some reason you just assume that doctors will recommend against an invasive procedure when there is a positive tomography result.

Review the numerous comments that address this as a statistical issue -- which it very much is when talking about the scale that Midjourney is claiming.

[icantevenhold]

People take horse dewormer against COVID so yes they will do all kinds of irrational things

[rlt]

Oh we're still doing the "horse dewormer" thing despite 250 million humans taking it each year?

[stalfie]

It's worse then that unfortunately. Even when invasive tests are positive, and we think we caught a cancer early, we know from population statistics that the reality is that often nothing would have happened. So we don't even truly know how to tell a cancer that will kill you from one won't. And we don't really know what it is that we don't know.

This is more true for some cancers then other though. Prostate, breast, and maybe melanoma are the worst in this regard. This is why prostate and breast cancer screening programmes are controversial, although the needle is swinging towards them being more useful as surgeries and treatments get better. Some other cancers like pancreatic cancer will always kill you eventually, so it's always good to catch them. It's a nuanced problem.

This whole issue is called "overdiagnosis", and personally I used to be obsessed with it. Being aware of it mostly caused a lot of hand wringing and grief, it's just easier to believe that every cancer you catch is a good thing. However, one of the broader issues is that we will never know what we don't know if we don't look. So there exists another perspective that all the suffering caused by overdiagnosis will eventually pay off in the long term. This is the "collect all the data for science/AI" perspective, and I've personally tentatively adopted it myself, although perhaps that's just because it's nicer to believe that you do some good even when you do harm. I think it's more likely that [novel cancer therapies](https://www.nature.com/articles/s41586-026-10738-7) will solve the "harm" part of treatment before we solve overdiagnosis.

The reality is that important breakthroughs are often entirely unrelated to the data for you are collecting, and even worse that possibly helpful data is locked away due to regulation and never used. This is kinda why I've come to make some kind of peace with private clinics scamming people with whole body MRIs, as I'm sure they're secretly selling the data which might lead to some good. However, they would probably do even more good if they didn't exist so they didn't jack up the prices for MRI machines by inflating demand. The marketing they do is the most morally reprehensible part of the whole deal, as it's usually just lying and creating health anxiety for profit. The fact that midjourney here is marketing themselves in this direction is giving me some serious Theranos vibes. Quick and cheap MRI equivalents would be really useful in the clinic, and it would have to spend a few decades there to prove it is useful before moving on to the "spa" stage. That they are trying to market a render of an idea directly to the wellness crowd firmly puts this in the "scam" folder for me. The fact that midjourney is mostly irrelevant now also fits well with this, making it likely that this is either a marketing stunt or a desperate pivot to get funded. Hopefully there are not that many suckers who will put their VC money down on this loosing bet.

[stymaar]

Maybe it would end up fine “in the long run” but you cannot ignore the significant issues arising at the beginning (and at each release of a more performant tool): what do you do if you find something that “shouldn't be there".

[sroussey]

With enough data, it might change our idea of what shouldn’t be there. Like an appendix. But personalized!

[stymaar]

That's exactly what I'm talking about when I say “in the long run” the problem comes in the meantime (and no, I don't think people in the present should endure bad things because it's going to make the future better).

[aswegs8]

Without clear hypotheses you will have a lot of false positives. Which are quite costly in healthcare.

[unholiness]

Overdiagnosis will be a major problem long after we have the data.

It's just hard convince people with a general feeling something's wrong and a specific picture of something wrong that the two are almost certainly unconnected.

[blensor]

How do you measure the body regularly without potentially introducing problems just by measuring it?

[bialpio]

My understanding is that both MRIs and ultrasounds do not introduce problems.

[ahtihn]

MRIs by themselves no, but depending on what you want to actually see you need to inject a contrast agent which is probably not something you want to do too frequently.

[bialpio]

Good point, I was not thinking about MRIs with contrast.

[Levitz]

Nobody is proposing this though

[friendzis]

> If the whole population had a full body scan every quarter, the “weird” things would feel more like the noise they are.

That's a tautology. We already have quite robust methods for detecting developed anomalies, treating every anomaly below standard human-to-human variation effectively raises the noise floor to already developed anomalies, defeating the purpose of population wide routine scans.

[ramblerman]

If you think the premise and conclusion of Op's statement form a tautology then you agree with him strongly.

[wkoszek]

All doctors say this, and that sort of drove me away from healthtech. As if there were absolutely no way to take a step in a direction of fixing it.

The faster and earlier we start to scan everyone regularly, as long as scanning methods aren't invasive, the more certainty we'll have what to warn people about and what not to tell them. Perhaps with the regular screening (imaging quarterly, if the scan is fast) you could see what is growing and what isn't.

[poilcn]

Healthcare resources are very limited, you'd overwhelm it with lots of "yeah that's a defect, but 40% have it", things that would go away on its own, false positives, things that do not require urgent intervention, 10x increase of hypochondriacs and health deterioration caused by anxiety

You'd have a system where every resource is allocated for diagnostics, but no medical staff to treat it

Also a significant part of population avoids screening even if they are not required to paid anything from their pocket

[moffkalast]

Yeah I'm wondering where exactly people think we'd find the millions of additional MRI machines and technicians to run them to make this somehow viable, as if the current ones are not pretty much at 100% capacity at all times.

[dmurray]

MRI machines cost in the six figures [0], last 10+ years and could reasonably do thousands of full-body scans a year. That's basically free by healthcare standards. Rent for the room to put it in would cost more in most cities.

MRI operators are specially trained technicians, because these are complicated machines. But like, semi trucks and photocopiers are fantastically complicated machines, and we seem to be able to keep a pipeline of people trained to operate and maintain them.

So I don't think there's an economic blocker for giving everyone a full-body MRI scan every year or two.

[0] https://www.blockimaging.com/bid/92623/mri-machine-cost-and-...

[luesterklemme]

What are you reasonably expecting to find in a full body MRI? Besides the notion that a "full body MRI" is not a procedure that is routinely done anyway and lasts upwards of an hour. It's not the scanner that is the limiting economic factor.

[ben_w]

The website is calling for their full-body MRI-replacing ultrasonic scanners to be so cheap they're part of a spa session.

TBH, this is already a red flag for me, like so many other "tech bro invents X" stories, though I am also aware of stories were "company realises Y is overpriced in medical purchases, makes Y cheaper, finds all hospitals think it is a scam and refuse to buy unless they raise prices".

[zarzavat]

Conventional ultrasound scanners are already cheap. Why can't a big ultrasound scanner be cheap too?

What makes MRI machines expensive is that they are big helium-cooled superconducting magnets that have to be continuously kept at a few Kelvin.

[rlt]

Maybe it's not a coincidence an AI company is building this thing...

[mommys_little]

That's the real problem! That healthcare costs are a goldmine for Big Pharma instead of being a cheap and widely available service. And, as someone said before, the huge amount of data it produces, would decrease the rate of false positives to zero in no time! And your arguments about hypochondriacs are very similar to those that were once given against teaching reading to all people!

[nxobject]

> That's the real problem! That healthcare costs are a goldmine for Big Pharma instead of being a cheap and widely available service.

I thought we were railing against Big Hospital/Big Insurance here? They'd love a cheap diagnostic.

[KingMob]

It's more statisticians saying this, and not doctors per se. You run into issues of signal detection theory, false positives, and the lay confusion that Bayesian P(A|B) !== P(B|A).

You're right that we could take steps to fix it, but unfortunately, those steps involve mass education that every human body has anomalies, and many of those should just be ignored.

We'd get a wave of anxiety, lawsuits, and unnecessary interventions, until humanity collectively internalized this.

[andreareina]

It's also doctors. Medlife Crisis on YouTube, Barbell Medicine, others. BBM have an article on priorities for overall health and they link to a tool maintained by one of the professional bodies on what routine screens to have done and it's pretty conservative. Even my doctor on seeing an "abnormal" lab result said it was likely spurious given my lack of complaints and all the rest of the results. That said they still recommended a follow-up because they kind of have to given professional ethics. BBM (again) made a similar point: resistance training is known to cause liver-associated enzymes (AST, ALT, etc) to rise, that doesn't mean you can ignore a high value.

The steps to fixing it is to not take the test that takes you from a prior of 1/100000 to a posterior of 1/1000, because you're going to ignore it anyway. And you can't depend on multiple testing because those test results can be correlated.

ETA: I can be convinced that we can collectively get to a place where broader screening would be indicated. But I think it's going to require both of the tests getting better and being better about what we do with (and feel about) the results.

[theparanoid]

The targeted scans and tests that we already do offer surprising little benefit.

Mammogram screening based on randomized-trial all-cause mortality, has not shown a measurable reduction in total deaths.

Randomized colonoscopy screening has not shown a statistically significant all-cause mortality reduction.

[zarzavat]

> Randomized colonoscopy screening has not shown a statistically significant all-cause mortality reduction.

My grandfather went to the doctor complaining of chest pains, they gave him a colonoscopy, and he died of a heart attack a week later! Clearly colonoscopy doesn't reduce mortality!

There's no reason for almost any medical intervention to have a statistically significant effect on all cause mortality. That doesn't mean it doesn't have any effect on mortality of individuals.

[camillomiller]

This Silicon Valley mentality applied to a mechanistic view of the body is a fucking disgrace. This will fail, and luckily we won’t have to endure more of Silicon Valley’s dunning krueger on steroids about medical solutions. The Silicon Valley has NO CLUE of the complexity of clinical science, yet they hold this populistic view that everything can be foxed with tech and nothing stops the hybris. We all can see where that leads

[nickpp]

Aren't most of the current/latest advancements in health care coming from tech and software?

[rlt]

> every human body is a bit weird and there will almost always be something "wrong" that will be visible in a full body scan

Would this be solved by routine scans, so you have a baseline you can compare against? Ignore anything slightly odd in the first scan but monitor for changes over time?

[ufo]

Wouldn't help much.

* Some kind of scans, like CT scans, use ionizing radiation and should not be done too often. * Looking at only imaging scans it is often impossible to tell apart a cancer and a benign growth. (More invasive tests would still be required, which was what the parent posters were warning about)

[jaggederest]

I think the anodyne to this is - and I admit the degree to which this is indicative of my biases! - more data, especially early on. Getting a good baseline before you have really any significant chance of most cancers to be able to do within-individual diffs, effectively, might be a big deal.

It might also reveal that every MRI shows ghost artifacts a half a dozen times that make it longitudinally useless, of course. I'm not foolish enough to think that epidemiologists haven't thought of this.

[Beijinger]

"It's a controversial and complicated idea. "

It is neither controversial nor complicated to detect some cancers by scent.

Taking the "headspace" of something is also not really complicated.

There are people who can reliably smell/detect Parkinson:

https://www.npr.org/sections/health-shots/2020/03/23/8202745...

[philistine]

You gloom on one aspect, the smell. OP focuses instead on full body scans themselves, and the irrelevant issues with everyone's bodies they would highlight.

[emmelaich]

*glom

[rzwitserloot]

One obvious alternative plan, presupposing that Full Body Scan is dirt cheap, is the following protocol:

- At 25 years old or whatever you get a FBS. Pretty much no matter what, this FBS will not be used to do more checks, procedures, and so on.

- ... and now we give you another FBS every so-many years, and only those things that are different from the previous scan are investigated.

There's still an issue with needless procedures, but the amount of 'weirdness that are not going to cause an actual issue had the patient never been aware' is significantly reduced by looking only at changes. i.e. most 'weirdness' shows up early and is fairly stable.

The difficulty is the moral issue. You cannot show that first scan to the patient. Even if every soul agrees beforehand that the rule is that nothing on that first scan, no matter how scary it looks, is further investigated... any medical issues raised by patients are used as a major information input for diagnosing issues. If I show a patient a scan that has this tumor looking thing on the left lung, then no doubt a few months later they'll be back complaining about shortness of breath and a pain on the left side of the torso. The mind is a powerful thing. At that point you can do a scan and see... the same nasty tumor looking thing we saw on that first FSB, and we're right back to the issue of these scans doing more harm than good.

Is it morally acceptable to hide that first scan from the patient?

[chickenman_98]

I think the issue with this and the proposed ‘spa’ scan model is that the diffs are usually meaningless. We all have cysts, masses, and weird shapes that shift around and show up on imaging. Many of these shapes require biopsy to determine what they are. Without symptoms the false positive rate is ridiculously high.

Modern medicine sort of requires us to suspend the idea that we can know everything happening in our body at any given time. If we could develop a diagnostic technique to instantly determine if shapes in our bodies are malignant or benign something like frequent full body scans could be interesting, but they really just introduce noise right now.

[someothherguyy]

> - ... and now we give you another FBS every so-many years, and only those things that are different from the previous scan are investigated.

The diff can be meaningless as well. All sorts of benign things develop with age.

The resolution is the problem. You can't do the type of cytology and histology needed to understand all disease with just scans.

[newsclues]

All the reasons you’ve listed are excuses why my government healthcare stopped having annual checkups. But to me it’s just worse quality care

[davrosthedalek]

The question is: If you have enough full body scans of many healthy people, and the statistical tools to model it (beyond "this range is OK"), whether this would reduce these false alarms to an acceptable level.

The real crux of it remains though: Let's say it finds something that increases your death risk by x=0.1%. Could you sleep? I'm not sure. Let's say the operation has 2x=0.2% risk. What do you do? What value of x makes this a problem for you?

[vlfig]

You're absolutely right, and I share the frustration.

I'm thinking a possible solution to this signal-to-noise problem is to embrace the longitudinal view: instead of comparing each scan with the normal across the population compare only against past self, unless there's a risk factor that warrants it.

This way we could presumably make use of plentiful scan data and mostly look at the stuff that evolves in suspicious ways, not what looks suspicious.

[RobotToaster]

This always feels like a thinly veiled excuse to ration healthcare. Would these same doctors refuse a full body MRI to a billionaire paying out of pocket?

Anything found can be monitored with focused follow up scans. It doesn't have to be immediately biopsied if it's in a location where that would pose a risk of iatrogenic harm.

[disgruntledphd2]

At a population level, this would be both extremely time-consuming, and rather expensive.

More generally, no test is perfectly accurate, and for low base rate conditions the vast majority of positive tests will be false positives.

Like, again, as a data person I adore this idea in principle, but there would be a lot of details that we'd need to figure out to make it a reality.

[tgsovlerkhgsel]

That sounds like a problem with applying the wrong threshold for a positive finding, possibly due to liability concerns or wrong goals.

To work, it would have to be incredibly accurate (specifically, have an incredibly low false positive rate).

[david_shi]

I've heard this argument before and it's always seemed downstream of capacity constraints and the current incentives of the healthcare industry.

There's a reason why billionaires like David Rockefeller, Larry Ellison, and Rupert Murdoch are able to live much longer lives than average, and having an oncall health team (that I'm sure does frequent testing and monitoring) is a big contributor to that.

More testing and data collection doesn't mean that every single anomaly would need to be investigated or communicated with the patient, but would provide a better longitudinal view that can help with disease prevention and health optimization.

[vasco]

It's obviously a lie to get us to accept no tests due to limited machines. The same as when COVID started masks "didn't help" because they didn't yet secure enough supply for everyone, then when they did, suddenly the masks helped.

Every system that exists as a black box is more understandable with more sensing, not less. Our bodies are not special.

It's also ridiculous that the proposition goes like:

1. Doctor knows some tests will flag tumors or variations that look weird and that we shouldn't then go investigate all of them

2. Doctor shuts off their brain and will then investigate all of them by doing invasive procedures

Just knowing how many such variations there are and if they grow or not is useful information. But the doctors pretend like they are super smart before the test and super dumb right after.

[bigfudge]

This kind of thinking (that it’s an obvious lie, perpetrated by a cabal) is the sort of superstitious bullshit that is going to jet us all killed. Look up Bayes theorem. As yourself how good a test would have to be if the base rate is low. Wonder what the probability of harm might be if the next advised test was invasive and the patients was anxious because a lump had been detected.

[vasco]

You should read til the end! No cabal, just stupidity and believing other people are stupid instead of telling them the truth and expecting them to act smart based on the information.

Ask yourself, do you think billionnaires have yearly MRIs or that they wait for later because the doctor and themselves will be anxious? It's an argument that treats regular people as stupid.

[bigfudge]

First, many regular people are “stupid” in the sense that they do get anxious about things that ar slow probability and are not anxious about things that are high probability.

If you are a billionaire you also have a doctor with the time and expertise to properly evaluate the evidence in a Bayesian framework, and you have time to talk to them and understand and implications. That isn’t scalable.

Also, it’s quite likely that billionaires are having lots of unnecessary procedures and that harm is being caused. The mri scans are not the reason they live longer!

[Paracompact]

It's not the same doctors saying they themselves are simultaneously smart and stupid. It's "smart" doctors saying that as a point of policy, it is not a good idea for biomedical companies to try to make a buck off of popularizing unnecessary diagnostics, because anxious patients will by chance or by intention find a "dumb" doctor who will agree to perform invasive procedures. (Have you ever heard a tech person say that the tech world has a lot of stupid ideas? It's the same thing.) Look up what happened with South Korea diagnosis vs. mortality rates when they instituted national thyroid screenings in the 90s.

> Every system that exists as a black box is more understandable with more sensing, not less.

With perfect humans in a perfect society, maybe. But such is ignoring the elephants in the room here, from the actual experts on the topic.

[lazyasciiart]

So do you think the doctors should hide the data from you so you don’t know anything looks weird, or tell you it looks weird but they don’t think it’s worth investigating it? And do you think the average patient will say “ok that’s fine, I’m not getting a second opinion and if I die my family will sue you into the grave too”?

[vasco]

I believe doctors should tell you the truth and not assume you will do things later that are detrimental with the information as that has a lot of bad consequences.

Case in point, doing that during COVID I think amplified the wave of antivaxxers and medical denialists. Which itself had in my opinion a way worse effect on global health than almost anything else recently because now you have to convince a number of people to trust the medical system again.

[kakwa_]

A sample size of 3 is hardly statistically significant.

From what I could found, billionaires die on average at ~83 years old. ( https://strygin.substack.com/p/how-billionaires-die )

It's not far off what a decent health care system is able to provide in most wealthy countries. It's even somewhat lower actually.

It's difficult to assess the risk factors, but in the end, I have the feeling their additional medical staff and their ability to "cut the queue" (S. Jobs-style) just barely offsets the additional common risk factors (stress, long hours, segregated life), specially if we compare to the upper-middle class.

In the end, there is no magic $100M pill giving you 10 more years. And in truth, access to food, drinking water, a non-toxic environment and really basic healthcare & medicine (vaccines, antibiotics) probably already brings you at a fairly high life expectancy.

[risyachka]

>> It's a controversial and complicated idea

sure, and there will be downsides.

But that data will be valuable nonetheless.

[josefrichter]

Sorry, but that's a morally corrupt idea.

[arcticbull]

Don’t make me tap the sign.

Bayes Theorem: https://en.wikipedia.org/wiki/Bayes'_theorem

There’s a very good reason we don’t test asymptomatic people in low incidence populations. Basically all positives are false positives when you do that, no matter how accurate the test is.

When you’re testing healthy randos for everything the odds of a positive being false have so many 9s it would make an SRE weep.

Unless this is accurate to a degree previously unheard of in medical science it’s a boondoggle, and I can’t help but notice there’s no mention of accuracy.

Unfortunately that’s just basic statistics.

[appplication]

So you are certainly correct but you can also tighten up your definitions for true positives as you have more information on your false positives. There may exist additional signal as well.

To your point though I think there is a difference between collecting and evaluating additional data sources and using them as diagnostic tools.

I suppose I fundamentally disagree with the implication of your post that there is no value in gathering further data for these reasons, it would seem to suggest we’re already diagnostically optimal and could not do better with additional signal.

[jibal]

Positive for what, exactly? Quoting convnet, above:

> The downside, and the reason why most doctors do not recommend full body scans, is that every human body is a bit weird and there will almost always be something "wrong" that will be visible in a full body scan. This can lead to unnecessary testing, anxiety, and even unnecessary procedures. Many of these oddities flagged by the scan would never have caused any actual issues had the patient never been aware.

The fundamental problem is that you generally can't diagnose simply from shapes. Scans show shapes, shapes cause concern, concern leads to invasive procedures, results are negative.

Also, overdependency on "spas" for health information could lead to an atrophy of other sorts of medical information gathering and diagnosis. e.g., there's no mention in the dreamy description of this spa experience of getting a blood draw or a patellar reflex test.

[srdjanr]

The root comment is talking about adding blood, breath, urin, spit... analysis. For body imaging only I agree with you. But if we add all this, I guess we'd be able to rule out many false positives

[jibal]

Your "guess" is not merely incorrect but logically invalid ... such added tests (which ex hypothesi are all negative) have no bearing on false positives from tomography.

[arcticbull]

Sure collecting more data makes sense. We agree there. If that gets you to the required degree of statistical confidence my argument is moot.

[zurfer]

I heard the same argument from my doctor when I wanted a blood scan.

But what's the intention? If you do a scan and then try to find everything that is wrong about you, you're 100% right, there will be false positives and unnecessary panic/medication etc.

However if you just collect data for months and years and WHEN you get a symptom you have a lot more data then we should be able to give better diagnosis faster. If we do that for long enough as humanity and there is data sharing the accuracy of the whole thing will increase a lot.

[tgsovlerkhgsel]

I think it's (at least partly) about the psychological impact of finding something unusual. Even if you know that it's probably nothing and understand the Bayes theorem, there will be a "what if" that might be strong enough to do actual harm (nocebo effect).

Compare: The placebo effect works (at a reduced rate) even if you tell people they're getting a placebo!

[londons_explore]

This. All diagnoses are "given this set of symptoms and test results, which is the most likely issue".

By having a whole slew of test results already, you will have much better priors.

[hereme888]

That's precisely where medicine is headed: personalized medicine.

You [hopefully] won't have to become a rare missed diagnosis because you didn't fit the demographic for this or that screening test.

Cost of genomic analysis is exponentially decreasing, and so much progress is happening so quickly.

Consider for example how in cardiology we advanced from ASCVD's 10-yr prognosis, to the PREVENT 30-yr prognosis. And still most providers are using the ASCVD score for their patients.

[arcticbull]

You’re dealing with populations here. Literally the odds of a positive being false would be over 90%. Much higher in the more rare conditions. I’m not exaggerating. That means every almost every follow up you do is a waste of time, money and limited resources, denying care to those who need it. Including you when you actually do need it. It also exposes you to the risks of unnecessary follow-ups like infection. Your expected outcome is worse this way.

The chance a positive is real is so low you may as well just point to a body part and get it biopsied.

A positive from this kind of test is statistically meaningless.

[munificent]

It's scary in both directions.

If you let it give out tons of false positives, then patients are trained to ignore it when it cries wolf.

If you dial it back so that it gives out fewer positives, then now it starts giving out false negatives and not helping sick people.

[KingMob]

Heh, Signal Detection Theory strikes again! This problem is as old as detecting whether a radar blip is a WW2 bomber on its way or not.

Sadly, there's no perfect threshold when the signal and noise distributions overlap substantially, just different trade-offs.

(Love CI, btw!)

[hereme888]

You're right. I wrote a bad response at midnight. I meant to say something more narrow and specific: genomic assessments and new biomarker tests will become affordable and add information.

For example, single nucleotide polymorphisms. This way doctors spend less time guessing which medication is likely to work best for you when there are many options available.

[charcircuit]

That doesn't sound like a useful test then. Instead use tests with fewer false positives.

[krzat]

If this argument was as solid as you say, then all routine checks would be pointless.

I don't know about traditional blood testing, but a permanent implant which checks HR, pressure, glucose, temperature & oxidation would be pretty useful, not necessarily to diagnose anything, but to provide data for doctor when patient has actual symptomps.

[ricardobayes]

They kind of are. Spain doesn't have yearly physicals, and during a GP visit, they don't even take your blood pressure. Blood tests are extremely uncommon, unlike in British medicine, where they take your blood pressure every time and blood tests are so prevalent people usually request one from time to time despite having no symptoms. Spain's example showed the above (or the lack of) doesn't increase all-cause mortality and even excelling in longevity statistics.

https://www.rieti.go.jp/en/columns/a01_0455.html This japanese article found "No clear-cut evidence exists to determine whether undergoing health checks leads to greater longevity and/or lower medical expenditures."

[arcticbull]

Several published papers agree. There is in fact little evidence to support regular checkups if you’re asymptomatic.

https://pubmed.ncbi.nlm.nih.gov/31642821/

And blood pressure is especially pernicious, basically every doctors office measures it wrong so the results aren’t particularly useful. Many use the wrong size cuff for example, or don’t give people time to relax before a reading. A ton of people have white coat hypertension, high BP only because they’re in a doctors office.

https://pmc.ncbi.nlm.nih.gov/articles/PMC1120072/

I saw a paper that showed only 36% of cardiologists did it right.

[jibal]

Math does indeed make for solid arguments. If you want to make a counterargument then you have to address their math, which you didn't.

[dkbrk]

You've got that completely backwards. Correctly applying Bayes' theorem, if an anomaly is observed you incorporate the prior into the calculation of the posterior probability. You don't just give up and say "the prior is miniscule so the likelihood is useless".

And then, even that's not enough. Decision theory needs to be applied to decide what action to take. That means taking into account the expected QALYs, cost and inconvenience across the distribution of possible outcomes. There's a whole spectrum of possible decisions, from immediately performing surgery, performing an invasive test like a biopsy, performing other less invasive tests, scheduling a follow-up non-invasive test at a later date, or just following a regular schedule of non-invasive tests and looking for any evolution along a longer time period.

The real problem is the binary thinking of either "we think you have X" and therefore tests must be performed or "we think you don't have X" and therefore tests shouldn't be performed. If medical organizations adopted empirically grounded decision frameworks, by applying them consistently doctors would be able to see something anomalous, assess that the risk isn't high enough to warrant immediate investigation, and be protected from a lawsuit in the unlikely case it was, in fact, something. And then we could do away with this "if we look we might find something" nonsense, which is pure fallacy.

[torginus]

This is why you have multiple successive panels. If there's a disease that happens for 1 in 10k people, and you have a test with 1% FPR, 99 of 100 people will be false positive.

But what you can do then, is either run a more expensive, elaborate test or one that's proven to be statistically independent on the positive testing population.

FPR can even be a good thing. Let's say you have an expensive test with a very low false positive rate. Then you can mix together 100 samples, and get a test with a much worse FPR 100 times cheaper. Then you can repeat the same individually on the positive population.

This is fully automatic and you don't even think about it. Btw, this is why mass testing, and public healthcare can be better. You can amortize the cost of things across a large number of people for no disadvantage.

[RobertoG]

The argument has some merits, but we should remember that, from the point of view of Bayes, you could apply the same argument to symptoms, which is only evidence. High odds of a false positive, means that you have not enough evidence, not that you have not useful information.

[gfodor]

You can just run more tests to get increased statistical power.

[cbolton]

No you can't. Statistical tests assume independent data points. Testing the same individual repeatedly would be pseudoreplication, leading to wrong conclusions.

If you mean run different tests, where you collect different kinds of data from the same individual, sure but that's not something you can "just do" in the general case.

[Sankozi]

Testing healthy person for any illness by definition has infinite number of nines in false positive rate.

Problem is we never know who is healthy. That is why we are doing the test.

[ricardobayes]

Medicine is not a statistical field. I've seen many times doctors dismissing someone "you're young, you can't have X". Although there is some truth in what you're saying: full body CT scans are on the rise now.

[tgsovlerkhgsel]

We could test symptomatic people.

[moralestapia]

Many smaht people have already pointed that out.

It's news to no one that tests are imperfect.

Do you have any concrete solution to that? Anything of value?

[arcticbull]

Yes, don’t do tests on asymptomatic low-risk people until you can demonstrate that a positive result has any meaning whatsoever.

[aipatselarom]

Hypertension is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause stroke, heart attack, or organ damage through long-term vessel strain, by which time damage may be irreversible; detecting it on time can prevent this with lifestyle changes and medication.

Diabetes is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause damage to blood vessels, nerves, kidneys, and eyes through chronic high blood sugar, by which time complications may be advanced; detecting it on time can prevent or delay this with treatment and lifestyle changes.

Hyperlipidemia is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause artery blockage through cholesterol buildup, by which time heart attack or stroke may occur; detecting it on time can prevent this with diet and medication.

Kidney disease is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause kidney failure through gradual loss of function, by which time dialysis may be needed; detecting it on time can slow progression.

Glaucoma is asymptomatic for years and is prevalent in every demographic. Leaving it unattended it can cause irreversible vision loss through optic nerve damage, by which time blindness may be permanent; detecting it on time can preserve vision.

--------

I'm SO glad you're not my family doctor!

[arcticbull]

At least the top 4, unclear about the 5th, are strongly associated with obesity. That would make someone high-risk and testing potentially warranted in like 70% of the population. Asymptomatic and low-risk is what I said. The incidence of hypertension is so high in the general population it’s almost always statistically supported (even though basically every doctors office takes it wrong, even cardiologists, amazingly).

On the other end of the spectrum, what doesn’t make sense is testing a random person off the street for Ebola. The prevalence approaches zero and symptoms are fairly noticeable, so any positive test is definitely wrong.

Most diseases are in between and have to be evaluated case by case, not buckshot.

You may be particularly interested to hear that there’s little evidence to support regular checkups in most adults beyond blood pressure testing and cervical cytology.

> Given the lack of favorable evidence and the potential adverse effect, primary care providers should consider the fact that general health checks, beyond the screening interventions shown to have benefit, likely have little or no effect on important health outcomes. Some of the interventions with demonstrated benefit have sufficiently large effects that a uniform application is warranted (blood pressure measurement and cervical cytology screening). In others, the trade‑off between benefits and harms is so close that patients should be involved in fully shared decision making regarding their participation (breast and colon cancer screening).

https://pubmed.ncbi.nlm.nih.gov/31642821/

I suspect your doctor would agree with me. See if they’ll test you for Ebola, for instance. Not because you have symptoms but just cuz.

[bigfudge]

I mostly agree with you by one small wrinkle is that the evaluation of screening is normally against a criteria of cost effectiveness as well as safety. So for some conditions, if cost effectiveness was the barrier to rollout it might still be worth it if you are rich?

[ascorbic]

The decision as to whether mass screening is justified or not is complex, and varies a lot by test/condition/population etc. Luckily there are lots of smart people whose job it is to do these caclulations.

In your list, 1-4 are common enough, the tests are accurate enough, the costs of intervention are low enough and the benefits of early intervention are high enough to justify screening, which is why they do generally screen for them at least in hgiher risk groups. The other two are more mixed, which is why mass screening is less common.

All the evidence for full body scans is that they are not justified for asymptomatic people. The false positives are high, the costs of these false positives are high, and the imporved outcomes are too low to justify them. If you want one, go ahead, but realise that almost anything it finds is likely to be false either positive or not likely to ever cause a problem, and you'd have to deal with the worry and invasive tests and even surgery in aid of something that may never cause any trouble.

[CJefferson]

Even at a smaller scale, I was shocked to go to the hospital in China and literally the first thing done was a blood sample, scanned under about 30 metrics, took about 15 minutes after the same was take. The results were sent straight to my phone. That sample had some horrendous results, so I then skipped the queue and got straight to see a doctor who already had all my numbers up on screen before he spoke to the for the first time, meaning he could immediately put me on an antibiotic drip.

[kranke155]

Why is this shocking ?

[CJefferson]

In the UK I see a medical practitioner before any tests, always.

[aquafox]

The problem is: Since we don't regularly full-body scan healthy people, we don't know how healthy, or say, still ok, looks like. This will create a lot of false positives and potential harm from unneccessary follow-up procedures and treatments.

[wkoszek]

The idea here is to make scans very common and regular, hopefully from early age of the patient. It could be like a blood pressure measurement at CVS.

[EEBio]

There is this infamous DANCAVAS study [1] in which they ran cardiovascular screening on older population and found absolutely no benefit in doing so. Note that while the linked study claims there was a benefit to screening (reduced mortality in men aged 65-69), the apparent effect was caused by improper statistics (primary endpoint did not show benefit, only subgroup analysis, which however lacked statistical power to be reliable). And indeed, their follow up study showed that there was no benefit in the subgroup. [2]

Many a dollar is wasted every year on trying to prove population-wide screening prevents mortality or increases patients’ quality of life and every time we don’t cheat with statistics we get the same answer - population-wide screening isn’t effective.

1: https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 2: https://www.escardio.org/news/press/press-releases/No-signif...

[friendzis]

There's a ton of variation within medical testing and tons of different conditions affect test results in similar ways. VERY FEW tests (test classes maybe: biopsy, microbiology, skeletal Rö) can yield diagnoses in the first place. Most testing is used to support (not confirm!) and reject possible interpretations.

This non-invasive everything-scanner sounds more like science fiction.

[wkoszek]

Other tests should be solved too (fecal/urine/blood). Perhaps we need more R&D in here to accelerate progress.

We already have patients trying to track their own health over longer time which is great. We then just have to make AI good enough to spot warning signs (without patients asking). Or parhaps we need to make those tests easy and cheap and regular.

[friendzis]

> Perhaps we need more R&D in here to accelerate progress.

In general yes, just that "more" is monstrously massive to the point of it being closer to science fiction than reality, IMO.

To reiterate, various assays fluctuate rather wildly over the course of various body cycles. The reason(-s) your doctor should remind to get a blood drawn in the morning after a period of fasting is that the sample is taken at a somewhat steady state and the result is comparable to reference values without too much of a margin.

Anyone with a requirement to manage blood glucose levels will tell you that CGMs are vastly superior to finger pricks first and foremost due to the sample rate available and comfort reasons secondarily. With a finger prick test the patient is only somewhat aware where in the curve they are, which makes the test only a rough estimate due to this temporal error margin. A lot of people do not zero in their readings with finger pricks as they are mostly interested in the deltas.

Suppose you manage to make urine sampling relatively accurate and super cheap (e.g. tens of eurodollars per analyzer or cents per test strip) so you can have poorly-supervised, long-term studies with huge cohorts. However, unless you somehow control for sample collection conditions, all this baseline variability suddenly infects your whole dataset and effectively raises noise floor. It's not unreasonable to expect that whatever was found to be a useful signal under controlled conditions to fall below noise floor under uncontrolled conditions.

That's basically THE problem with the hypothetical test-it-all machine. Again, maybe in some cases that could be extremely useful, but in a lot of cases that would be counter productive. However, what CGMs hint us at is that various kinds of Continuous X Monitors could provide insights into body reactions to things, which is, currently, effectively not a signal in general medicine. Once the test-it-all machine is reframed as an array of continuous monitors and the useful signal is reframed from long-term drifts to short-term deltas it may unlock some additional diagnostic pathways.

[kilbuz]

false positives are a real problem

[adastra22]

Only if you let them. The false positive thing is a nonissue that only arises from assuming you would respond to information a certain way.

[Forgeties79]

I don't really get what this means. A false positive causes issues inherently - you don't know if it's right or wrong. It's noise which is bad for care, and it's anxiety-inducing for patients which is also bad. It produces worse outcomes for everyone. There isn't a "choice" or assumption here, you respond to a positive as if it's accurate until you know it isn't. This is a known issue. Hell Scrubs did an episode about the negative impact of full, generalized body scans on a patient's wellbeing decades ago.

[adastra22]

The medical industry should NOT be paternalistic towards patients. People have a right to decide for themselves and be treated as adults capable of informed consent. Thankfully that model is starting to change, although there is much inertia.

Any test that is approved for use would have a better-than-random outcome distribution. Preconditioned on that, a test result is still useful no matter how uncertain. It is never the case that more information leaves you in a worse position.

I have personal experience here:

Every year I have elected to have ultrasounds done of my major internal organs. In the past two visits, the technicians spotted multiple developing growths in my liver and now kidneys. These are very likely to be benign cysts, but one piece of blood work that could be a marker for cancer is inconclusive. The odds are still high that this is totally benign and will either clear up on its own, or at least stop growing and cause no further issue. Still:

1. I'm getting my blood work done now far more frequently (twice per year instead of every other year), with specialized/not typically ordered screening tests;

2. I am redoing the ultrasound every year to track progress; and

3. I am actually taking advice about losing weight and exercise far more seriously than I otherwise would, as these issues often resolve with weight loss.

I am actually healthier now than I was two years ago, and feel better about my physical and mental well-being. All while staying on top of what could have be a life threatening issue if left untreated and ignored.

I look forward to the day when I can go get a monthly MRI-like scan. That would be wonderful.

[Forgeties79]

Well now we’re going down a different path. Telling people to go burn through mountains of cash to get tests they don’t need is not ethical.

[adastra22]

Costs me less than $1000 so far…

[simianwords]

> I don't really get what this means. A false positive causes issues inherently - you don't know if it's right or wrong. It's noise which is bad for care, and it's anxiety-inducing for patients which is also bad.

No its not. This is extremely paternalistic. Humans know how to understand noise and statistics. You don't get to decide that for me. I want more lives saved with more information.

[Forgeties79]

It’s not paternalistic. It’s reality. Most people are not equipped to vet all the medical information that comes their way. That’s why we should talk to our doctors about results.

I don’t think my mechanic is being paternalistic when he talks through my car and what is/isn’t important. I like that helps me prioritize things. Why is this any different? In the end a person can tell a doctor “I don’t care run the test” or whatever so what’s the big deal? You can still do what you want. Get that biopsy if you need the peace of mind.

[simianwords]

I agree but do you want your mechanic to hide information from you for any reason? For instance, that information can have false positives.

Like, your mechanic hides the fact that your engine may be broken but he's just 70% sure of it. Since he's not 99% sure, he hides it from you. Do you think its a good thing to do?

[jibal]

That makes no sense at all, unless you're saying that people should respond to all such information by ignoring it.

[jibal]

P.S. The responses ignore what I actually responded to, which was a claim that "The false positive thing is a nonissue" -- where the "thing" is 99% false positives. The only way to respond to information such that "the false positive thing" becomes "a nonissue" is to never respond to it at all. The responses to my comment all address some strawman.

[adastra22]

You could repeat the test, perhaps on a more frequent interval to keep an eye on it. You could follow up with a more specific test, or do confirming blood work. In the meantime you can adjust your diet as a precaution, or get motivated to get in shape just in case.

There's plenty of room between "go under the knife" and "ignore altogether."

[tgsovlerkhgsel]

Or only consider it a positive once the confidence is high enough that false positives are not a problem anymore.

Getting a test good enough to still make it useful (detect enough of the true positives) would of course be a challenge, but the more data is available, the more feasible that might be.

[Sankozi]

There is a lot of space between ignoring and doing invasive dangerous operation after some blot was spotted on some imaging diagnosis.

[reverius42]

In which case, why bother getting the information in the first place?

[simianwords]

yeah? give adequate accurate information to people and let them decide what to do with the information.

if someone told you, you had a .01% chance of getting a disease for example, aren't you better off with that information? even if it is noisy?

[simianwords]

??? how is more information worse than less? if you know the extent of false positives -- use it! its better than having no information.

the question should be: does cost of obtaining extra information pay off in lives saved. i would say yeah obviously.

[FridgeSeal]

> With a big enough data set of [all kinds of bio values, including ones considered irrelevant for that disease] labeled with diagnoses

> > labeled with diagnoses

I know you’re not suggesting this is easy, but I can absolutely promise that the land of medical reporting, diagnosis and imagery is about a 1000x more complicated and unhinged than you might expect.

[RandomLensman]

What does "solved" mean here? Identifying "the disease" correctly every time? On average identifying the right course of action? For each individual identifying the right course of action? Probabilistically or with certainty?

[jrflowers]

> pee into it, give it a swab, and have it come up with an accurate diagnosis without invasive testing.

Somebody should make a startup based around the idea of diagnosing diseases through eg. a drop of blood. Probably need a bunch of big name investors though

[mrtksn]

In the rest of the world diagnostics aren’t expensive at all and medical data is centralized already (blood, MRI are almost routine for hospital visits, all data stored in govt systems).

During Covid it was useful for improving protocols.

[khutorni]

> walk up to a machine, breathe into it, spit into it, pee into it, give it a swab

Maybe take it out to dinner first?

[seydor]

Theranos2