There are physical limits to detection and technical parameters that make some situations indeterminate even for the best of the 'gud'. It is frustrating that, hearing an argument from many different individuals over a long time, you assume that each speaker is missing the critical insight that you possess.
> but the tools to make scalable, calibrated risk estimates based on large data dumps is getting better every year.
So your suggestion for indeterminate scans is more scans? There is no 'large data dump' personalized to you except for your own imaging.
> if we can't stop a doctor from doing bad things with a piece of data we should shield them from it
The doctor isn't the problem, it's the people who would be seeking out monthly imaging without symptoms
If the false positive rate is demonstrably low, I can't see the risk. People who think they need a doctor will go to a doctor with or without a fancy scan. People who want to play armchair physician will play armchair physician with or without a fancy scan.
The false positive rate is the entire risk.
When you go to the doctor for a physical they don't run all of the blood tests they can. They only run them for specific symptoms and for specific preventative measures where we've calculated that the benefits outweigh the risks of a false positive.
Some tests have been removed from routine exams, or at least discouraged, because they were producing more false positives and harm than what they were saving.
Full body scans are deep on the end of the spectrum of tests with high false positive rate when ordered without supporting symptoms. That's the risk.
> People who think they need a doctor will go to a doctor with or without a fancy scan. People who want to play armchair physician will play armchair physician with or without a fancy scan.
Not really how it works in real life. When you get a full body scan, especially with ultrasound, there are a lot of benign things that can show up that vaguely look like non-benign things. Even if the interpretation is "probably nothing", many people start worrying and think they need to get more tests just to be safe. Even people who don't see themselves as "armchair physician" will start thinking that they should at least rule out the worst case because they wouldn't want to die of cancer having known that something might have been there.
True to some extent, but you're ignoring the role that costs and insurance play here. Do you really think the personal physicians of billionaires and heads of state are only running a limited set of blood work because they're worried about false positives?
More often it leads to people thinking they have issues when they don't.
The same thing happens with blood tests: You can order all the blood tests you want if you're willing to pay for them. If you order enough, you will get some that show up as abnormal. You can start spending tens of thousands of dollars ruling things out and never catch any real issues.
https://pmc.ncbi.nlm.nih.gov/ Go right ahead!
I actually don't think we have the data available that I want, and even if we do, as many others here have pointed out, intentionally sticking our heads in the sand forever makes no sense.
> I actually don't think we have the data available that I want
I get the sense you haven't looked...
> intentionally sticking our heads in the sand forever makes no sense.
Because you make statements like this instead of citing the extensive literature on this question.
A new chargeable procedure is for for the hospital but maybe not for patients imo.
Many countries with far better outcomes don’t do this, is it necessary, or is it just the product of an insurance-driven health industry which prioritises interventions over health?
Regardless of how accurate a test is, by Bayes Theorem if it's done on enough healthy people the false positives will swamp the true positives.
> So your suggestion for indeterminate scans is more scans?
The solution to imperfect evidence is consistent and calibrated risk estimation of both disease and intervention.
The trick seems like it would be to strongly incentivize waiting and watching any symptomless anomalies if further investigation is invasive. If you're getting 60 second scans every month then something growing will be catchable and something static or that disappears can be ignored until the next scan.
If Midjourney says "maybe you have cancer" but your doctor doesn't take it seriously, you might sue if you do end up with cancer. You might even win, regardless of whether "wait and see" was the right approach.
Meanwhile, if your doctor gives you an unnecessary CT scan that rules out cancer, hospital both earns $$$ and the doctor doesn't face legal consequences. Your increased chance of cancer risk from the radiation isn't something you can realistically sue over.
Exactly this. I mean, even if the scan is really indeterminate, at a minimum you can simply wait, then scan again. If it's truly something serious, it will become determinate at some point. Doing this is still better than nothing and carries no risks of unnecessary procedures.