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Comment by anon291 | Hacker News Reader

The link between NSF and gadolinium-based agents has been known for almost two decades and is common knowledge in the industry.

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Yes. The problem is that it's common in the industry. But it's ultimately up to the patient. Maybe alone. Pretty much guaranteed scared. Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress.

What are you proposing instead? Should patients just die of their illness instead?

Medical procedures have risk, some are small risk some are higher risk. There are none that are 100% safe. Doctors are supposed to evaluate if the risk is worth the value the procedure would supply.

What is the alternative to the status quo that you would propose?

There's a big difference between not getting the MRI and getting the MRI without gadolinium. My suggestion is to ensure that people know the risks outside of just the people who work in it. I'm not sure how that didn't get across in my original comment. With your comprehension skills, you are at an increased risk of falling victim to this exact scenario

>>> Yes. The problem is that it's common in the industry. But it's ultimately up to the patient. Maybe alone. Pretty much guaranteed scared. Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress.

> There's a big difference between not getting the MRI and getting the MRI without gadolinium. My suggestion is to ensure that people know the risks outside of just the people who work in it. I'm not sure how that didn't get across in my original comment. With your comprehension skills, you are at an increased risk of falling victim to this exact scenario

I don't see anything wrong with the GP's comprehension skills.

Anyway, every procedure has risk - and no procedure is recommended if there is not an offsetting clinical benefit. There are clear guidelines for when gadolinium is to be used for an MRI and the guidelines factor in risk for 'NSF'.

My understanding was that gadolinium was already only used in cases where a normal MRI would be ineffective.

I don't know how the risk is actually communicated to patients. I imagine it varries by country. However, normal medical ethics would be to explain risks to the patients. Is there a reason to believe that isn't happening?

Nobody explains shit like this. They will turn down the risks because if they were honest, most wouldn't accept that risk. Because the risk is PERMANENT life changing condition.

There is a risk of a permanent life changing condition when you take a bite of food, or have your blood drawn.

There’s really a risk vs benefit. If you have a brain tumour you need contrast to assess the type of tumour, its growth, if it’s a glioma whether it’s transformed and so on. If someone is being given contrast it is going to change their clinical management.

It seems an odd fixation of just MR contrast when the same could be said of all drugs. Does your doctor/surgeon go into the minutiae of all drugs and possible consequences? By this line of thinking, saline is not without risks, should they go into depth about that?

People already poorly retain information or even comprehend it at appointments or interventions, is there any point adding more burden onto their attendances?

During COVID people were losing their minds about one in a million chance of complications caused by vaccination. I did some research (but actually), and found that that’s comparable to the rate of complications for any use of an injected drug or even saline. Just piercing the skin with a tiny needle is a “medical procedure” with a non-zero risk, especially in the elderly and the immunocompromised.

I had a couple of MRIs recently and got curious about gadolinium contrast. Again, there is a non-zero risk, but if you eliminate the cohort with reduced kidney function and those getting regular repeated MRIs, the risk is comparable to the use of an I/V, which is how it’s administered.

The only thing that upset me was that the staff didn’t ask me verbally about kidney issues to double-check. They also didn’t remind me to drink a bunch of water to flush it out of my system. (Some articles recommend administering a diuretic.)

For that matter they didn’t check me properly form metal fragments either!

Similarly, I’ve had vaccinations administered where I had to remind the doctor to clean the area with alcohol first and to tap the syringe to get rid of the bubbles.

Bad procedures are more dangerous than the drugs being administered!

The risk with gadolinium is that it is never fully removed from your system and if you are allergic to it, it means a PERMANENT whole body allergic reaction. Skin itching and incurable chronic pain. It has nothing to do with kidney function.

I got familliar with this condition by a random persons blog who go affected by this during normal MRI and also didn't expect to be part of 1-2%. Unfortunately the blog is now gone, and that post now only lives inside my RSS reader.

Are you saying that 1-2% of people are allergic to gad and get this side effect?

Well no one should get MRIs with contrast for fun. Moreover, doctors regularly use contrast off label.

My dad was in this industry when nsf first came out. We would be dragged along to after hours family things at conferences. Doctors openly said they gave contrast off label at dosages not approved by the FDA for organ systems not approved by the Fda. Even children. I'm sure they had their reasons, but I'm also sure they never disclosed the possibility of nsf and just told parents their kids needed it, because they admitted it.

> people were losing their minds about one in a million chance of complications caused by vaccination

Bit different. & under the context of vaccination being an aggressive, government-led, initiative to enforce a medical procedure on their body.

Well, there are manganese-based contrast agents under development. Maybe we should give those a little more funding.

Like Gd, Mn is toxic, but unlike Gd, Mn is naturally present in the body (and also in pineapples) which means that long-term accumulation is less likely. The main difficulty is the lack of strong enough complexing agents because of the tendency for zinc (naturally present at relatively high concentrations in the body) to steal the ligand from Mn, a problem currently being studied:

https://onlinelibrary.wiley.com/doi/full/10.1002/ange.202115...

There have been no cases of NSF in over ten years after newer gadolinium contrast agents have displaced the problematic ones.

I went hunting for a reference for your statement, and was successful.

Clevland Clinc says "There haven’t been any new reports of NSF in almost 15 years" [1]

[1] https://my.clevelandclinic.org/health/diseases/17783-nephrog...

That's somewhere between a Hobson's choice and Russian roulette.

> Undereducated, worrying about their likely life threatening potential illness or injury. That's basically under duress

I was never communicated about gadolinium pollution. Not once.

And yes, on my recent MRI, I explicitly asked why there was metal particulate in my joint. "I dont know, sometimes it happens'... No you fucking tool of a doctor. Its gadolinium.

And I finally find out here.

Are you certain it is gadolinium? As I recall from a family member's health issues you can get particulates in joints from arthroscopic surgery or from the metal implants. Not saying that is what happened in your case, but I'm just curious because I remember reading about metal in joints as a potential side effect of the surgery.

People getting MRIs frequently have bigger fish to fry.

When my wife was under cancer treatment she had them frequently. Risking some minor reaction, which in her case was disclosed many times, was well worth the value in managing the acute and long term treatment plan.

When I had mine I got the form with warnings about side effects. When I saw the allergic reaction I was a bit concerned, I asked the tech and was told it wasn't a big deal. Since I was in the basement I didn't have service and I decided to trust them given the large number of my friends who've had MRIs. It was fine, but it seemed like a major thing to toss in the patients lap right before they get strapped down in a tube.

But there’s a potential risk of an allergic reaction to any drug you take, any food or drink you consume, even environmental substances - perfumes; hayfever is an allergic reaction to pollens. You don’t know you have one until you have the reaction. I didn’t know I was allergic to penicillins until I needed them for an infection and it turns out I am.

Good point, I wasn't clear. The warning was about the systemic reaction inside the veins and arteries. Or something along those lines. Whatever it was the warning struck me as much more drastic than the usual allergic reaction warning.

I find it odd that when I happen across an article talking about some negative links between x and y being discovered, there's always someone in the comments saying this was known for some decades.

In my case, my dad was in this industry so I had heard about it since day one. And I know doctors knew about it too

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