The title confused me for most of the article because I assumed they were saying that getting an MRI was equivalently dangerous to a year of smoking.
> So the same effort you would expend to get out of those activities on account of their risk, the same effort you should be willing to expend to get a full-body mri.
I was similarly confused. Saying a MRI is the equivalent of stopping smoking for 1 year earlier, or driving a motorcycle 10,000km less seems actually really good! Go MRIs!
As another point, most of the negative costs of getting full body scans are actually poor reactions to the full body scans. The phrasing is "Hey, if you get more information, we are going to act badly on this information." I think the solution here should be just acting better on the information, not getting less information.
> So the same effort you would expend to get out of those activities [such as one year of smoking] on account of their risk, the same effort you should be willing to expend to get a full-body mri
That's the conclusion of the article, which I didn't immediately understand from the title. I read "earns" as a negative reward, not a positive one.
This doesn't seem to account for the outcome that someone receives testing and treatment for a problem found by the MRI, and is injured in the process, despite the fact that non-treatment would have been harmless; a not-uncommon outcome in the real world.
Things such as a needless biopsy of healthy tissue, leading to an infection and sepsis.
A colonoscopy perforating the bowel and leading to an infection and sepsis.
These things happen, they are not common but they are not zero-chance events either.
And you have to consider the opportunity costs of consuming the doctor's time, the labwork, and the facilities, possibly delaying treatment for someone else who actually needs it.
Yes it would be better if it took these into account but doing so would not change the overall numbers.
Risk of perforation is something like .03% and almost never fatal whereas a colonoscopy reduces colorectal cancer mortality by 60-70%.
>And you have to consider the opportunity costs of consuming the doctor's time, the labwork, and the facilities, possibly delaying treatment for someone else who actually needs it.
That is also rarely true. More often, greater demand for a service soon yields economies of scale, more efficiencies and overall more patients served at a lower price. Low volume is expensive, high volume is cheap.
My guess is unnecessary surgeries which isn't an unreasonable concern. Something like 40% of MRIs showing spinal disc herniation are asymptomatic and the rate of surgeries to fix can be a coinflip.
Having a diagnosis doesn't mean we have to treat. If we find something minor with no symptoms we can ignore it. However there are things with minor symptoms people ignore to their harm. I wish I had my MRI a decade sooner, but the symptoms were the same thing everyone else has that is self treatable and comes and goes over time. When it finally got bad enough that I demanded help the normal help didn't work and only then did they find something major and rare.
Is it cancer or just a 'cyst'? I'm not MD but my understanding is we often cannot tell without the biopsy but mostly it isn't cancer. Of course this is a generic discussion which could go either way depending on where they find something.
> This doesn’t tell me a whole lot, because my intuition for QALYs is weak. How strongly should I prefer an intervention with a net benefit of 0.025 QALYs over other things I might do with my time? No idea!
> However! When marketing the effect of global health interventions, a count of 27 qalys is typically considered “a life saved”. A life also happens to be a million micromorts, and I have a much better intuition for micromorts!
This came across as unintentionally funny to me. It goes from making the joke that one obscure unit of measure is inscrutable to saying, don't worry, because we can put it in another equally obscure unit of measure!
Is the author confusing MRI with a CAT scan? or is there a health risk associated with high flux magnetic fields that I am unfamiliar with.
update: The article is second order analysis. need to read it's linked article to understand it is more about the costs(including psychological) of questionable tests and not a direct health risk of MRI devices.
The title is confusing without context and it doesn't clarify its meaning for a quite a while. I made the same wrong assumption as you at first. Then, before I made it to the end, I made the same wrong new assumption you made in your update to your comment! (it being about negative second-order effects - it's not)
No, what they are saying is that getting an MRI is as good as smoking for a year is bad, using some very fuzzy units of measurement. So getting an MRI "earns" you the reward of being allowed to smoke for a year (the author is being humorous).
I like the linked Scott Alexander post, but I also genuinely wonder what is the rate of change on these tests? The linked test Prenuvo has competition from Ezra + Function and others. It this drops from $2k to $500 over time, it makes it look considerably better. The more we can use different testing modalities, we should be able to reduce false positives in each modality.
I will say, that for cancer specifically, tests like Galleri seem better, but as that cost comes down I could see in 5-10 years an annual $500 scan that offers a full body scan of some kind, plus comprehensive bloodwork including blood cancer screening, and the type of thing that could be done annually by many in the US.
He's saying that a full body MRI is so valuable, that if you got one and then smoked for a year, you'd be in the same place as you were before you started, health wise. No loss.
Obviously you'll come out way ahead if you don't do the smoking part: it's very valuable, in other words.
>The big-medicine industrial complex is always trying to get you to have worse health so they can maximize how much they bill you when you finally break.
Ok, if this is the argument that you want to use, here is a counterargument that completely destroys your viewpoint.
Most civilized countries don't bill the patient, and it is entirely funded by either taxes or mandatory public insurance. So just like how it is in "big-medicine industrial complex's" best interest to maximize profits, it is in the health system's best interest to lower cost. So if whole-body scans for otherwise healthy (as in no symptoms) people means less profit for those companies, it means less cost for the health system, which would mean they would be promoting (or even requiring) whole-body scans. MRI machines are much cheaper than doctors.
The big-medicine industrial complex in this context is not the insurance firm, whether public or private. It is the biomedical firms that are developing expensive new treatments costing five, six, or seven digit dollars per patient per year, and these firms very much would prefer if you didn't take steps to catch conditions early or prevent them cheaply.
Those firms have no say over which treatments are preferred on which patients in single-payer health systems. Actually, it is the exact opposite. When there is a single payer, they can haggle on behalf of the entire population so they have huge leverage over the treatment costs. The government can simply say "You either sell at the price that I want, or lose access to the entire market in this country.". That's why American drugs can be 10-100x more expensive than the rest of the world.
Their employees are here on this site too, downvoting preventative care and anything that grants health at a low cost to individuals. The corresponding gatekeeper organizations like the Endocrine Society and the The Journal of Clinical Endocrinology do their best to shamelessly disinform and seriously harm the people, e.g. via DOI 10.1210/clinem/dgae290. And don't even get me started wrt how corrupt the FDA is, serving the biomedical firms, not the people.
In any case, people like you will get others killed. Like I said previously, with your logic, no one should even be stepping on a weighing scale or getting routine annual blood tests. The higher level goal is to lower the burden of testing to make it cheap and widely available to everyone for routine use.
Consider the case in England where they checked hospital admissions for HIV despite the absence of symptoms calling for it. They found very many patients who were HIV positive and didn't know it. Your misuse of math would've let them stay undiagnosed while the cases mount. Refer to DOI 10.1016/S2352-3018(26)00109-8.
I am surprised that spending a day on the Ukraine front is equivalent to _only_ a year of smoking. That seems to clash either the average life expectancy I read about Russians on the front-line (being measured in hours)
The title confused me for most of the article because I assumed they were saying that getting an MRI was equivalently dangerous to a year of smoking.
> So the same effort you would expend to get out of those activities on account of their risk, the same effort you should be willing to expend to get a full-body mri.
"get out of those activities"
I was similarly confused. Saying a MRI is the equivalent of stopping smoking for 1 year earlier, or driving a motorcycle 10,000km less seems actually really good! Go MRIs!
As another point, most of the negative costs of getting full body scans are actually poor reactions to the full body scans. The phrasing is "Hey, if you get more information, we are going to act badly on this information." I think the solution here should be just acting better on the information, not getting less information.
Title might qualify for a change as "linkbait":
Otherwise please use the original title, unless it is misleading or linkbait
- https://news.ycombinator.com/newsguidelines.html
linkbait?
> So the same effort you would expend to get out of those activities [such as one year of smoking] on account of their risk, the same effort you should be willing to expend to get a full-body mri
That's the conclusion of the article, which I didn't immediately understand from the title. I read "earns" as a negative reward, not a positive one.
This doesn't seem to account for the outcome that someone receives testing and treatment for a problem found by the MRI, and is injured in the process, despite the fact that non-treatment would have been harmless; a not-uncommon outcome in the real world.
Do you have an example? I don’t know of many diagnosis methods leading to significant injury.
Things such as a needless biopsy of healthy tissue, leading to an infection and sepsis.
A colonoscopy perforating the bowel and leading to an infection and sepsis.
These things happen, they are not common but they are not zero-chance events either.
And you have to consider the opportunity costs of consuming the doctor's time, the labwork, and the facilities, possibly delaying treatment for someone else who actually needs it.
Yes it would be better if it took these into account but doing so would not change the overall numbers.
Risk of perforation is something like .03% and almost never fatal whereas a colonoscopy reduces colorectal cancer mortality by 60-70%.
>And you have to consider the opportunity costs of consuming the doctor's time, the labwork, and the facilities, possibly delaying treatment for someone else who actually needs it.
That is also rarely true. More often, greater demand for a service soon yields economies of scale, more efficiencies and overall more patients served at a lower price. Low volume is expensive, high volume is cheap.
My guess is unnecessary surgeries which isn't an unreasonable concern. Something like 40% of MRIs showing spinal disc herniation are asymptomatic and the rate of surgeries to fix can be a coinflip.
Having a diagnosis doesn't mean we have to treat. If we find something minor with no symptoms we can ignore it. However there are things with minor symptoms people ignore to their harm. I wish I had my MRI a decade sooner, but the symptoms were the same thing everyone else has that is self treatable and comes and goes over time. When it finally got bad enough that I demanded help the normal help didn't work and only then did they find something major and rare.
For example, many kinds of biopsy can result in serious infection or other surgical complications.
presumably if they're seeing a cancer worthy of a biopsy the risk justifies cutting in there and checking
yeah there is a risk you get an infection but pancreatic cancer will kill you dead, and is no joke.
Is it cancer or just a 'cyst'? I'm not MD but my understanding is we often cannot tell without the biopsy but mostly it isn't cancer. Of course this is a generic discussion which could go either way depending on where they find something.
Doesn't need to be significant injury from every incident.
My wife had an MRI, incidental find on it caused a PET CT scan.
> This doesn’t tell me a whole lot, because my intuition for QALYs is weak. How strongly should I prefer an intervention with a net benefit of 0.025 QALYs over other things I might do with my time? No idea!
> However! When marketing the effect of global health interventions, a count of 27 qalys is typically considered “a life saved”. A life also happens to be a million micromorts, and I have a much better intuition for micromorts!
This came across as unintentionally funny to me. It goes from making the joke that one obscure unit of measure is inscrutable to saying, don't worry, because we can put it in another equally obscure unit of measure!
Is the author confusing MRI with a CAT scan? or is there a health risk associated with high flux magnetic fields that I am unfamiliar with.
update: The article is second order analysis. need to read it's linked article to understand it is more about the costs(including psychological) of questionable tests and not a direct health risk of MRI devices.
The title is confusing without context and it doesn't clarify its meaning for a quite a while. I made the same wrong assumption as you at first. Then, before I made it to the end, I made the same wrong new assumption you made in your update to your comment! (it being about negative second-order effects - it's not)
No, what they are saying is that getting an MRI is as good as smoking for a year is bad, using some very fuzzy units of measurement. So getting an MRI "earns" you the reward of being allowed to smoke for a year (the author is being humorous).
The title and intro are badly worded.
The conclusion is “you should do MRIs it is equivalently beneficial as all of ___ are bad for you”
Is the commentator not even opening the article before commenting?
Extremely normal on HN.
Click the link.
Try not to respond like this on HN. Better to not respond at all, if this feeling strikes you.
I like the linked Scott Alexander post, but I also genuinely wonder what is the rate of change on these tests? The linked test Prenuvo has competition from Ezra + Function and others. It this drops from $2k to $500 over time, it makes it look considerably better. The more we can use different testing modalities, we should be able to reduce false positives in each modality.
I will say, that for cancer specifically, tests like Galleri seem better, but as that cost comes down I could see in 5-10 years an annual $500 scan that offers a full body scan of some kind, plus comprehensive bloodwork including blood cancer screening, and the type of thing that could be done annually by many in the US.
What is the 'QALY' value of the peace of mind coming from a clean bill of health?
Ok, what should I say to my doctor to order the full-body MRI scan? (Sorry I don't have an MRI machine at home).
2 base jumps? are those really that dangerous?
Depends on if you’re wearing a wing suit or not.
More so than normal life but not horrible.
dogshit title.
Deleted.
Since I think people are getting this confused:
He's saying that a full body MRI is so valuable, that if you got one and then smoked for a year, you'd be in the same place as you were before you started, health wise. No loss.
Obviously you'll come out way ahead if you don't do the smoking part: it's very valuable, in other words.
>The big-medicine industrial complex is always trying to get you to have worse health so they can maximize how much they bill you when you finally break.
Ok, if this is the argument that you want to use, here is a counterargument that completely destroys your viewpoint.
Most civilized countries don't bill the patient, and it is entirely funded by either taxes or mandatory public insurance. So just like how it is in "big-medicine industrial complex's" best interest to maximize profits, it is in the health system's best interest to lower cost. So if whole-body scans for otherwise healthy (as in no symptoms) people means less profit for those companies, it means less cost for the health system, which would mean they would be promoting (or even requiring) whole-body scans. MRI machines are much cheaper than doctors.
The big-medicine industrial complex in this context is not the insurance firm, whether public or private. It is the biomedical firms that are developing expensive new treatments costing five, six, or seven digit dollars per patient per year, and these firms very much would prefer if you didn't take steps to catch conditions early or prevent them cheaply.
Those firms have no say over which treatments are preferred on which patients in single-payer health systems. Actually, it is the exact opposite. When there is a single payer, they can haggle on behalf of the entire population so they have huge leverage over the treatment costs. The government can simply say "You either sell at the price that I want, or lose access to the entire market in this country.". That's why American drugs can be 10-100x more expensive than the rest of the world.
Their employees are here on this site too, downvoting preventative care and anything that grants health at a low cost to individuals. The corresponding gatekeeper organizations like the Endocrine Society and the The Journal of Clinical Endocrinology do their best to shamelessly disinform and seriously harm the people, e.g. via DOI 10.1210/clinem/dgae290. And don't even get me started wrt how corrupt the FDA is, serving the biomedical firms, not the people.
Please look up Bayes' Theorem wrt testing for disease
Did you mean Bayes rule and not Bayes theorem?
In any case, people like you will get others killed. Like I said previously, with your logic, no one should even be stepping on a weighing scale or getting routine annual blood tests. The higher level goal is to lower the burden of testing to make it cheap and widely available to everyone for routine use.
Consider the case in England where they checked hospital admissions for HIV despite the absence of symptoms calling for it. They found very many patients who were HIV positive and didn't know it. Your misuse of math would've let them stay undiagnosed while the cases mount. Refer to DOI 10.1016/S2352-3018(26)00109-8.
I am surprised that spending a day on the Ukraine front is equivalent to _only_ a year of smoking. That seems to clash either the average life expectancy I read about Russians on the front-line (being measured in hours)
The Ukraine side has much better survival rates. I still wouldn't want to be there, but if I was forced to choose.