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Comment by maxander | Hacker News Reader

I’m sure doctors are looking forward to ultrasound scanners being common household devices, and getting 50 emails a day from panicked people convinced that their gallbladder is a tumor.

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I’m not saying that wouldn’t happen, but we need to get away from the idea that non-professionals shouldn’t have access to their own medical information. More education and empowerment is the answer, not less.

> More education and empowerment is the answer, not less.

The crux lies in determining the boundary between education and quackery. The resurgence of antivaxxers, homeopathy believers and friends doesn't exactly help the case for deregulation here.

Is there any evidence anti-vaccine and homeopathy movements are bigger than they were in the past?

Google Trends suggests homeopathy is up a bit recently, but way down from its pre-internet peak.

https://trends.google.com/trends/explore?date=all&q=homeopat...

> Is there any evidence anti-vaccine and homeopathy movements are bigger than they were in the past?

I'm talking about Germany here as I can't really speak for the US, where from 2011 to 2013 prescriptions rose 3.8% and OTC sales went up 23% (https://de.wikipedia.org/wiki/Hom%C3%B6opathie#Bundesrepubli...).

As for antivaxers, Europe as a whole has a huge measles problem which has risen in the last years (http://theconversation.com/whats-behind-the-sudden-rise-in-m...).

Are you saying proponents of quackery might misread somebody's home ultrasound or give misleading advice on how to read it? That doesn't sound any worse than what could happen with thermometers, stethoscopes, blood pressure meters, athlete wristbands, and inspecting the color of phlegm, poo, urine, skin, etc. Nobody would want to hide those things from people for their own safety.

With most of what you mentioned, the local quacker is not able to say "OMG YOU GOT CANCER, HERE TAKE THIS $1000/pill HOMEOPATHIC CRAP"... with an ultrasound image he is very well able to do so. And people will do it, thanks to human greed - if you need a confirmation google for "miracle mineral supplement" aka chlorine dioxide and the "industry" surrounding this.

This is why we can't have nice things, the potential of abuse is just too high :(

   > More education and 
   > empowerment is the answer,
   > not less

More empowerment and more choice is why the US healthcare system is so damn expensive compared to the rest of the world.

No that would be regulatory capture.

Explain?

He might be comparing with France where rich people can not pay for better cure than poor ones.

That'll be a nice worry for doctors to have in reaction to the spread of consumer-available precision imagery equipment.

Right now I think it's more valid to worry about the patients who can't receive care due to whatever host of valid economic/social/cultural reasons prevent them from doing so -- and one of the best ways to help that struggle seems to be the creation of cheaper and more available diagnostics and therapies.

I don't know about this specific device -- but any competition in the medical diagnostics market that may drive device price down seems to be a benefit.

For now, this isn't a consumer device [0]

0. https://twitter.com/matthewherper/status/923897406776889344

The benefits of portable units at a non-devastating price have more implications for democratization of quality of care than anything else. WebMD and Google have already let the other genie well and truly out of the bottle.

Edit: By the way years ago I read an article which talked about the price of ultrasound devices, and the bottleneck was the price of the transducers. Obviously that’s changed, but when did that change? Does anyone here know?

I work for a competitor to Butterfly, and the main difference between this device and other ultrasound transducers is the use of a CMUT array instead of the typical piezoelectric crystal. CMUT arrays are MEMS devices, made in a semiconductor fab using the same processes as other ICs. This makes them cheaper to produce than traditional arrays where the elements have to individually sliced and wired to the electronics. CMUT isn't new, it's been being worked on for 20 years, but it isn't used because it is much less sensitive than the piezoelectric arrays. Either Butterfly has made a breakthrough and are choosing growth over profit margins, or they are trying to make up for worse performance with a much cheaper price. We won't know which until their device is actually on sale.

Incredibly informative answer, thanks so much. One last thing, do you personally believe “breakthrough” or “discount” in this case?

20 years of CMUT being the next big thing in ultrasound has left me a sceptic, but I know some really smart people at Butterfly. I don't think they would bring a device to market that they didn't think was competitive. My guess is that it'll be okay, not the best imaging handheld device on the market but better than several of our competitors.

As an internal medicine phsysician who has been using a handheld daily for the past few years I would only add that high image quality is not always needed for many of our most important applications: Lung, IVC, bladder, DVT, abscess. US is dramatically more accurate than physical exam and stethoscope In these cases.

Agreed. I was talking specifically about CMUT vs Piezoelectric. If high image quality was always a requirement, the handheld market probably wouldn't exist at all.

Butterfly is right to focus on getting an answer over image quality. As a startup they will likely be able to iterate quickly on machine learning, which is critically important to growing the ultrasound market. Right now the biggest barrier to adoption is the difficulty of reading ultrasound images, and machine learning is the most promising solution to that. I think that is more likely to be their competitive differentiator than their use of CMUT.

It changed this week, this is the first commercially available device that uses silicon chip rather than piezoelectric crystals, thus the buzz.

I'm looking forward to having an inexpensive portable USS to help find veins. I doubt consumers will pay for one of these, except maybe for pregnancy.

Yeah, this sort of thing is making quick inroads in prehospital care (this is far from the first portable ultrasound). Finding veins, FAST[1] scans, assessing the heart more directly during cardiac arrest, etc.

[1]: https://en.wikipedia.org/wiki/Focused_assessment_with_sonogr...

We've been using portable USS machines for years but I suppose what I meant is one I can keep in my pocket and one that doesn't cost $150000.

The GE Vscan has been around for years.

That's interesting. I've not seen that before. Still seems to be far more expensive than what I'm thinking of, though.

I'm looking forward to the day when every junior doctor can have one around their neck like every doctor has a stethoscope.

Why? What gap do you think it fills in the routine assessment?

I'm all for expanding access to US, but I'm very wary of throwing gadgets for the sake of gadgets at doctors...

Patients who need an IVC and have brittle veins and peripheral oedema.

It comes up a lot.

I never said anything about routine assessment.

Sure, I would love a portable ultrasound in the back of my ambulance for that very reason. I still use my stethoscope _way_ more often than I start an IV where US would be handy.

I don't know why you keep putting words into my mouth. I never suggested it would replace a stethoscope.

You said every doctor should have one with them "like a stethoscope". I don't know where you got "replace" from...

My point is that a stethoscope is an essential tool for assessing every patient. An ultrasound is a specialized tool for assessing a very small subset of patients.

I said "can". I don't know where you got "should" from.

Thats technology. At some point you can see remote doctor sessions being a thing, and robotic doctors carrying out some basic surgeries.

easy solution: charge per review of ultrasounds.

If I can go get a device, and somebody qualified to read the images I produce can also inform me how and where to take pictures - I'd pay for that kind of a service. Seems like a business model to me :)

Problem is that if you've ever had an ultrasound, it's not really something you can just tell someone how to do. They manipulate the transducer in real time, angling it just right, giving it just the right amount of pressure on the skin. Even if you did it in real time I can't imagine the frustration of a physician over the phone going "No move it to your right, now up, now back further, ok less pressure, now more pressure."

I'm not convinced that the subset that would do that with an ultrasound device is really any different from the subset that does this kind of thing already.

This is a non issue IMO, it would probably self correct in a few months. Also you could still take advantage of that.

The patient who made a few ultrasound videos along a period of time and still has pain worth seeing a doctor, can now spare the doctor some time by showing him a bit more data. Could be a data hell too I must admit, but somewhere somehow I'd hope people to learn a bit about biology and physics in the process and 1) know more 2) know when not to panic 3) know how to take care of their bodies

Maybe we can use machine learning to train a computer to identify these diseases. That would lot cheaper than a doctor and with enough data it could do a pretty good job.

ultrasound is pretty much the worst imaging modality to do this in all of medical imaging.

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