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Comment by mohn | Hacker News Reader

I read something, maybe here on HN, about a company trying a new preventive medicine policy for their C-level execs, where every one of them would get an annual full body MRI. The rationale was that the execs were so valuable to the company that a few thousand dollars of MRI costs per person per year would be nothing compared to the loss of having one of them die of cancer, get sick and quit, or whatever.

If I recall correctly, the program was discontinued after they determined that it led to a bunch of medical overtreatment. Everybody's a little different, plenty of odd things may show up on an MRI, but the vast majority of unusual findings were benign.

If I can find the specific case I'm thinking of, I'll edit this comment to add it in. Or maybe someone out there recognizes this and can refresh my memory? I think the program was in the '00s, not the current decade.

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I don't know of this specific story, but one thing that House MD tried to drive home at some point, and which my acquaintances in med school confirmed, is that you don't want to do full-body scans without a very good reason, because a full-body scan on a typical adult will always find something. That something will most likely be harmless, but for various reasons, once you know it's there, you'll end up trying to do something about it, and the combined impact of stress and treatment on health may be much worse than if that thing was just left unseen. This thinking, I've heard, applies to many other ideas of running speculative imaging or blood tests. For some reason it does not apply to ultrasound - I hear many doctors are in favour of patients getting ultrasound twice a year or more often, but I don't know what's the rationale.

There's a simple and very obvious solution to this - just don't do any treatment you deem unnecessary or excessive.

Treat anything unambiguously threatening, and just keep an eye on anything else.

That doesn't solve stress for patient, who now keeps wondering whether or not that Thing is a ticking time bomb. It also doesn't solve the legal risk created by the off chance the Thing actually does develop into a health problem later on.

I worked at a startup that dealt with these scanners (sending patient info to them so nothing very sexy) that had a lot of input from radiologists. They also had the same belief as this — there’s always something wrong in the body so if theres not a complaint from the patient about a particular issue they either will gloss over it when looking at the charts or they will flag it to look at some more.

One of the issues here is that a full body scan is typically done at a low resolution to save on time and disk space. These scans aren’t good enough to make a diagnosis from and leave the radiologist in the position of wondering if a couple of pixels could be cancer or is something normal. When your practice is on the line for making a call you will tend to err on the side of caution and recommend everything be looked more closely unless you can absolutely rule out a problem.

I was a little shocked when finding this out. I always thought it was like getting your blood tested and it coming back with a couple of the dozens of items that they look at being high and that could be a concern. It is much more inexact than that.

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