Silicon Valley's quest to live forever now includes $2,500 full-body MRIs
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The framing of expanded early detection as "Silicon Valley's quest to live forever" seems uncharitable.
> My mum discovered she had breast cancer through a routine mammogram.
These two are not the same thing. We do mammograms, and only in women over a certain age, because they're a high risk population.
CT scans, especially chest CT scans, expose you to huge amounts of radiation. The odds that you randomly stumble on a super low-incidence tumor is dwarfed by the fact you're exposing people - especially children in your case - to large doses of ionizing radiation.
A chest CT scan smacks you with 7 mSv which is about the same as spending an hour at Chernobyl, or 7X the EPA annual dose limit for radiation exposure. [1]
Lest we not forget Bayes theorem. We only do tests on people who are likely to have the condition otherwise the risks associated with a false positive outweigh the benefits of early detection.
What nobody has suggested is that "rich tech folks" are having lots of x-rays in a quest for early detection.
(This is poorly phrased on my part, btw - not trying to attack you, trying to show a chain of logical thought).
> We do mammograms, and only in women over a certain age, because they're a high risk population.
raises hand I'm a cis male who had to go for a mammogram (got some weird looks in the waiting room). It's not just for cancer screening high risk women.
Never get more radiation exposure that you need to but also the EPA numbers are in addition to normal, basically unpreventable, exposure. 7 mSv is not 7x the total.
> while average Computer Tomography (CT) scan would equal to 105 BED or one hundred thousand eaten bananas
https://etn.redmud.org/banana-equivalent-dose/#:~:text=The%2....
Totally agree.
Also, we should be encouraging those with the means to spend on medical technology! It'll bring down the cost for everyone over time.
I would imagine this is downplayed because us insurance companies are generally not huge fans of expensive preventative care procedures with little evidence base (and to the last point, fair). And additionally I’d imagine physicians and radiologists have some worry about the potential liability of things being incorrectly being labeled as benign or to be monitored and turning into malpractice claims.
So the evidence base gets established by rich people who can afford to cut insurance out of the equation and hire physicians that are open to these kinds of procedures. Unfair and something I’ll be very bitter about if I ever die of a cancer that could have been detected earlier if I was lucky enough to get imaged in the area for whatever reason.
Sure this but also: the evidence does exist and it will be a huge expensive, inconvenience, and maybe dangerous unnecessary tests/surgery for >90% of the population. Really someone has to do the math to determine the inflection point; X% of people will get some early cancer/positive result found early, Y% will get a false-positive and undergo expensive and unnecessary procedures, and Z% will still get a false result but have cost some amount of money and time.
From a public health perspective, this is unlikely to be the best-next-thing because so many people die from more preventable diseases/things or lack access to health care at all. Is it a obvious service for the upper class in SF? Certainly, because the market thinks they are 5-30x more valuable than the average person so 2.5k is nothing to be extra certain of their survival.
Does that sound weirdly dystopian? Sure, but it is just moving your chance of living (for the next year as our unit) by 0.00001% or less. Most people would not spend 2.5k on a 1/100k outcome.
The problem is birds vs rabbits vs turtles (I didn't invent this; it's a classic metaphor [1]).
For any given finding on an MRI, they're going to be, tautologically, in one of three categories, in descending order of frequency:
* turtles (i.e. slow growth tumors). Most people of a certain age have them, and they'll never be an issue. MRIs will find them. You can't know they're turtles.
* rabbits (faster-growth, non-metastasized tumors). Maybe we can catch these, because they're slower than birds, and maybe can make a difference. Everyone wants to believe they're finding rabbits, but just because of the nature of the distribution, they're most likely finding turtles.
* birds (i.e. fast metastasizing tumors; think days or weeks). This is what you want to catch, because they're metastasizing. They're deadly. They're rare. You'd like to catch these before they fly away, but how often are you going to run an MRI? Daily?
Asymptomatic screening almost always catches turtles, sometimes catches rabbits, and rarely catches birds. You can't tell the difference from a single scan...so when do you choose to go further? At what cost?
[1] https://lactobacto.com/2018/02/13/viewing-cancers-as-birds-r...
[1] https://www.northcoastjournal.com/humboldt/cancer-part-2-tur...
[1] https://www.thedailybeast.com/all-these-cancer-screenings-pr...
I included that third link -- even though it's from the Daily Beast -- because it really drives home the practical implications of the metaphor. Consider this:
> In 2012, Archie Bleyer and Gilbert Welch published a study in the New England Journal of Medicine titled, “Effect of Three Decades of Screening Mammography on Breast-Cancer Incidence.” They found that, with the advent of screening mammographies, the incidence of breast cancer in the U.S. had doubled. For every 100,000 women screened, the number of women diagnosed with breast cancer had increased from 112 to 234. At the same time, the number of women presenting with late-stage breast cancer (the kind that often results in death), decreased from 102 to 94 (per 100,000). In other words, only eight of the 122 women diagnosed with breast cancer appeared to benefit from the screening. Eight. The others had been treated with mastectomy, radiation therapy, and chemotherapy without clear benefit.
This is a common story in the world of cancer diagnostics.
Far easier said than done. What actually happens when you get caught in one of these screening programs, is that you're suddenly in a universe of "continuous monitoring"...because they're trying to find the birds, and reason that since they looked at you once, they need to look at you more intensely than before.
Anyone who has ever had a mole biopsied for skin cancer will be familiar with this. They'll just keep looking for stuff, until you tell them to stop. If you get a positive, it's even worse. Everyone is acting with good intentions. It's just impossible to know the right answer, so the emergent behavior of the system is to harm people.
Additionally, MRI doesn't have the radiation side effects that other forms of imaging do
Take a look at individual tests to see if they make sense.
A PSA urine test, for example, is insanely cheap and catches many expensive prostate cancers in early stages. Mammograms are the similar (less cheap, but still life saving).
For those specific tests, the evidence is clear.
It also gets people treatment when none was required: https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
ETA: this is the page I was looking for actually: https://sciencebasedmedicine.org/the-early-detection-of-canc...
[1] https://info.blockimaging.com/bid/92623/mri-machine-cost-and...
MRI techs and radiologists aren’t cheap.
> They may be expensive, but they don't get $100 an hour
Radiology is one of the highest paying medical specialties. My cousin is one of the radiologists who interprets scans. He makes about $500k per year. Searching online, about $170/hr is average.
https://www.ziprecruiter.com/Salaries/Radiologist-Salary-per...
https://www.salary.com/research/salary/alternate/radiologist...
In surgical procedures all those people have to physically be there for hours
The longest part is often just the paperwork and noting what was not seen.
There is a big heavy spinning magnet that spins around your whole body at like 50 rpm. It's not an easy thing to make.
Magnet is fixed in an MRI and you just pulse fields in the XYZ directions to create gradients of magnetic field. The pulse emission and receiving antennas are fixed too.
In a CT scan, what is rotating is one or many xray sources and one or many detectors plus some electronics and cooling systems if needed.
PET scans have fixed rings of pairs of detectors. But they can also be combined with a CT in the same instrument.
Revising my point to be that phasing those fields and controlling the power, is expensive and complicated
And when you don't have any particular symptoms it is hard to put as much effort into checking every millimeter of the body
While I didn’t end up moving forward with one, I was struck by how weak the arguments against having one done were. They amounted to:
- There’s a strong chance you’ll be sent on a wild goose chase or two after seeing something on the scan that is meaningless
- They only find something that actually turns out to be concerning in a small percentage of people
- This isn’t a cost effective approach to early diagnosis for most people
I’m sorry, but if I’m at a place in my life where this is a reasonable expense, even 1% odds such a scan turns up something genuinely troublesome is very worth it. It’s a life we are talking about.
That's actually not how diagnostic tests work.
Because of Bayes theorem, tests that have a high likelihood of returning a positive result in a high-incidence population are totally useless when applied to asymptomatic random people in the general public.
Your likelihood of being harmed by one of these wild goose chases exceeds the chance that an early diagnosis will help you. First, you don't know there's a 1% chance that it'll turn something up - you don't know the chance at all. And you also don't know the likelihood and magnitude of harm chasing down false positives.
That's why we don't test people randomly for things they likely don't have.
It's just a logical fallacy and cognitive bias to think that doing something, anything, is better than doing nothing. Often that isn't the case.
> It’s a life we are talking about.
Which is why we shouldn't let our biases pull us in unhelpful directions.
If you don't have symptoms and a scan showed an incidental something, you don't have to act. Personally, I'd rather know. And, if something does go wrong in the future you can say "I have an X in my left Y." Might give the doctor a place to start debugging.
The fact is there's no evidence such testing improves outcomes - if there was we'd just be doing it as part of the standard course of care. Folks are just demanding access to noise. Just go flip some coins instead, and save the medical resources for the people who need them.
at my wits end on other alternatives
Let's say you have a test that's 80% accurate in telling you that you have cancer given you have cancer. Let's say the false positive rate is 10%.
- If 100% of the population has cancer, then a positive test means you're 80% likely to have cancer. This makes sense.
- If 10% of the population has cancer, then a positive test means you're only 50% likely to have cancer because of all the false positives in the general population.
- If 1% of the population has cancer, then a positive test means you're only 7% likely to have cancer.
- If 0.1% of the population has cancer, then a positive test means you're only 0.83% likely to have cancer.
Basically, the false positives dominate the results once you start applying the test to a low-incidence population. Which is why we don't.
[1] https://betterexplained.com/articles/an-intuitive-and-short-...
Am I missing something?
Dr. McCoy's tricorder was kind of a vision of tech enhancing the old fashioned "doctor making house calls with a little black bag" idea. Reality: Tech has created increased pressure for patients to travel to the medical facility rather than care coming to them.
One side effect: Doctors who don't do house calls can't incidentally notice things about your lifestyle that may contribute to the problem and may not know to ask or may not ask because it's an offensive thing to say and you may not know to volunteer the info. (If you knew, you might just fix it without seeing a doctor.)
I remember a scene from some TV show that made a powerful impression on me in my youth where the doctor burns a fur after seeing several patients. I think he realized it was a tick borne illness and the bear skin (iirc) was the source (of ticks).
It came very out of left field for me, but I've seen stories that suggest this is in part how medicine used to operate -- by the doctor noticing and fixing the cause of the problem in some cases -- and mostly doesn't anymore. Now we go in for drugs and surgeries and for some people that just means the start of an endless nightmare of chronic illness while doctors question their mental health and imply they are hypochondriacs.
My parents (expats, living in the US for over 50 years) flew back and got routine scans (MRI, PET, CT) in February for about $1000 USD total.
Similar to this story, they found a tumor on my dad's pancreas. A biopsy confirmed it, and he had surgery in August. They caught it at stage I. We're very lucky.
The latency from February til August was entirely convincing the US medical system to take his Taiwanese images seriously. They finally gave up and went back to Taiwan to get the procedure done.
I'm getting older myself and will absolutely be paying for any sort of imaging available.
This should be more broadly available to everyone. I'd be happy for more of my tax dollars to go to preventative care rather than rear guard action.