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Comment by voldacar | Hacker News Reader

This is just silly. You are never disadvantaged by knowing more about what's inside your body. What you don't know can easily kill you, though.

Hopefully in the long term future we will have extremely cheap & frequent MRI and blood testing so you can assemble a high resolution digital history of your body. Doctors are generally not very innovative people though and they will probably resist it to the end.

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It's not silly. Look at how the mammogram guidelines are set. If the scans are too frequent, the harm done from false positives (unnecessary surgeries and risks from those surgeries) can become too great. The standards were relaxed to include fewer scans in the last few years because of this.

Apply this to more invasive exploratory surgeries, and you see people dying from internal surgery complications for benign cysts and lumps.

That's because single datapoints are used to trigger intervention. We should be intervening based on growth trends from time-series data. Time-series data which can only be collected by... frequent scans.

Don't discount psychological stress. "You have something growing in your breast which might be cancer, just wait a few months and we'll scan again" is not something that gives people a good nights sleep.

So don't tell them. Like I said, a single datapoint by itself is meaningless — so you wouldn't bring it to the patient's attention. Heck, the software shouldn't flag it for the doctor's attention. (Think: metrics-based alerting thresholds in software systems.)

We do have time series data for mammograms. You may think it doesn't meet whatever standard you are setting, but it is objectively false to say it isn't there.

My standard is "doing it for everything, rather than for one thing"; and more importantly, not acting upon data about chronic disease progression, if it isn't a time-series.

In science, you don't call one datapoint "data." You call it an anecdote. Outside of emergency medicine/urgent care, medical practice should be the same.

I honestly can't imagine how you believe breast cancer is diagnosed and treated, but it's clearly inaccurate. So is the cute phrase about "in science".

You didn't understand what I said. Breast cancer screening is the "one thing" I referred to that we're doing right. But who cares if we're doing one thing right? We're doing screening for literally every other cancer wrong. And not getting any less wrong over time.

We — the medical profession in general — are aware of the proven effectiveness of time-series analysis of regular mammograms as a screening technique. However, we have failed utterly to spread this "obvious" knowledge out from the specialty that understands it and has proven its effectiveness, to literally anywhere else. We've been doing regular mammograms for decades now, but that hasn't sparked (wide) adoption of regular scans + time-series-based screening for any other cancer.

There is a certain moral culpability in that. A certain negligence of duty / not seeing the forest for the trees in what it means to be saving lives. (I hypothesize that doctors in at least some specialties, could save more lives over the course of their career by dropping their practice and instead turning into advocates for wide adoption of periodic-scans + time-series-analysis-based screens. Somewhat like would have been true of a doctor in the 1800s quitting doctoring to instead become an advocate for hand-washing before surgery.)

You're right, I had absolutely no idea that you thought we were doing breast cancer screening right. And I don't know if you're now failing to communicate your awareness of regular screening for prostate and cervical cancer, or skin cancer in higher risk locations, or if that doesn't count somehow, or what. I also don't know if you have any evidence for the existence of these other tests that we could be doing on everyone and the risk-benefit profile that shows we should be doing them, or if you're assuming such tests and evidence exists, or complaining that we haven't invented the tests that must be theoretically possible.

It can be hard to predict how aggressive a tumor will be. It isn't uncommon for people to obtain cancers that they "die with" instead of "die of". In those cases, treatment can be worse for the patient than the cancer. But since you don't know which it'll be, people get the treatment and sometimes wind up worse off than they otherwise would have.

And as the GP post cites, the scans themselves can cause health problems down the road. Performing them on massive scale will increase the occurrences of those side effects.

Knowing that there is something weird in your body sets off a cascade of medical care that easily escalates to surgery, anesthesia, medication to manage complications, side effects of that medication, time in the hospital being at risk for infection, etc. These things absolutely can kill you, or at least put you through hell. When there was actually nothing wrong with you in the first place. That is why the medical establishment is so conservative about it.

Isn't the danger of knowing there's something weird there caused by the rarity of knowing anything at all?

I'd imagine that if there was consistent, good information available, we'd figure out how and when to act on it. The real issue is the massive cost of performing any given scanning procedure to everyone alive.

No. Doctors already think about this. Why do you think they aren't doing prostate scans and mammograms constantly on everyone?

I think modern medical ethics demands a physical treatment for literally everything and anything that's discovered, including quite a few that either aren't physically dangerous (e.g. atypical brains) or are inevitable (a 90+ year old with a laundry list of conditions). And, as other comments have pointed out, a panicked surgical response to a mammogram isn't based on time series data.

I totally understand and agree with trusting that medical professionals "know better", but I also would not conflate current practices with absolute perfection. It's clearly not a perfect profession or practice.

You don't have to conflate current practice with perfection. You just have to bother learning what the current practice is and why - and "it's just so rare to know anything" is not the correct answer. Just to start with basics: yes, actually mammograms are analyzed using time series data of a patients previous scans!

The question is not even what doctors think warrants a follow up. The question is what a malpractice attorney could construe as warranting a follow up, if it turns out later to have been real.

Once a scan exists, doctors are essentially forced to act on it. If an algorithm for deciding which scan results to pay attention to were so solid that it would hold up in court, that might make more scanning reasonable on the margin? I dunno though.

Full body scans, as they currently exist, are not recommended for routine-usage. These scans use large amounts of radiation. This can increase your risk of cancer. If you have more tests, your risk increases.

Further, they are costly, and often times insurance does not reimburse or cover it. They can cost anywhere from $500-1000.

Unless you find a way to make this viable for the general population and lower the radiation exposure, this will never become viable for use.

> You are never disadvantaged by knowing more about what's inside your body.

Yes, you are. This has a name - over-testing, over-diagnosis, and over-treatment. It's a significant cause of harm in healthcare.

https://www.bmj.com/content/358/bmj.j4070

https://qualitysafety.bmj.com/content/31/1/54

https://www.choosingwisely.org/patient-resources/whole-body-...

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