
In This Doctor’s Office, a Physical Exam Like No Other - swampthing
https://www.nytimes.com/2019/05/08/science/precision-medicine-overtreatment.html
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blaisio
I'm really conflicted. I don't think this approach will necessarily mesh with
how we traditionally treat medicine. There are many cases where we consider
something a disease, and then we find people who live with it with no issues
for decades. What if, even though those people technically have diabetes,
they're still fine? I guess you have to define what "fine" even is. How much
disease can someone have before they're sick? How good is someone supposed to
feel?

Thinking about this more... I don't think this was a well written article.
They could have gone much more into the larger issues.

It would be nice of general practitioners had better tools though. It should
be trivial for them to see which drug will work best based on someone's genes,
for example. And the way we measure blood pressure these days is stupid.
People's blood pressure goes up just because they're in the doctor's office.
Giving people a glucose monitor, heart rate tracker, and blood pressure
monitor to wear for a week should probably be standard.

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thereisnospork
From an outside perspective:

Imo as a society we should reframe the question from 'how to we cure people?'
to 'how do we make people's quality/quantity of life better?' It feels
somewhat as if there is a gradual creep of what qualifies as a 'disease' and
is therefore worthy of treatment.

It also seems like there is an archaic adverseness to non diagnostic related
measurement and data. The argument e.g. if we detect something that might be a
tumor in a full body scan we have to instigate a series of painful and
probably unnecessary biopsies. Imo (again) this represents an overly
simplistic view of what the appropriate treatment should be. To say nothing of
the dearth of information we have about the day-to-day and hour-to-hour
variation in biomarkers in both the healthy and the sick and all the good that
information might be used for.

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hn_throwaway_99
Here's the main point from the abstract:

 _We discovered more than 67 clinically actionable health discoveries and
identified multiple molecular pathways associated with metabolic,
cardiovascular and oncologic pathophysiology. We developed prediction models
for insulin resistance by using omics measurements, illustrating their
potential to replace burdensome tests. Finally, study participation led the
majority of participants to implement diet and exercise changes. Altogether,
we conclude that deep longitudinal profiling can lead to actionable health
discoveries and provide relevant information for precision health._

While this is an interesting study, I agree with the critical. "Clinically
actionable health discoveries" does not mean that acting on those discoveries
actually prolonged life or improved quality of life. Given the economic
incentives in US medicine this has the huge potential for over-treatment.

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NotSammyHagar
That's true, but I think there is a lot of open space in the idea of
evaluating "does discovering this health issue actually help people".
Discovering prostate cancer often doesn't help because most prostate cancer
grows so slowly you'll die of old age before it matters - but then some people
have faster growing kind.

But I'm following my own health. I have a condition which can be treated well
with simple cheap pills. If I hadn't known about it in my family, I wouldn't
have pushed for blood tests early in my life. For most people that blood test
wouldn't have mattered.

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iandanforth
For several years now I've wondered why we don't have "Health Closets"
(terrible name, I'm sorry) in our homes.

An HC would be a small room dedicated to measuring all the things that can
serve as indicators of health. I'd love to have a room I could step into that
would take high res photos of my skin to send to my dermatologist, analyze
various samples of fluids, maybe take retinal photographs, etc.

With the advent of ML driven diagnosis in medicine there is the potential that
if we collect a huge amount of data it can be processed automatically. In
addition data could be aggregated for population wide analysis.

While this could be correlated with my full genetic profile, I'm much more
interested in how regular measurement with lots of low cost sensors could
impact healthcare.

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DanBC
Because over-testing leads to over-diagnosis, which leads to over-treatment,
which doesn't lead to longer or better life and often leads to reduced quality
of life.

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jl2718
I find this argument hilarious because it is literally admitting widespread
iatrogenic harm, and the solution is not to do less harm, but to keep
information away from the patient. How else would like to prove that the AMA
is a regressive guild with state protection and financial support through the
insurance industry? The only reason many doctors don’t like diagnostics is
that it undermines their witchcraft, similar to how second-rate mechanics hate
consumer OBD-2 port readers, while first-rate mechanics love them. The
argument for less diagnostics is laughable. Diagnostics do not cause harm. The
harm is being caused by doctors.

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apathy
Because there aren’t any systematic perverse incentives baked into US
healthcare or anything.

Like, say, many if not most preventive measures being unreimbursible while
treatment (especially Stone Age chemo protocols) are reimbursed at profitable
rates.

Nope, it’s those fucking physicians greedily trying to gut medicine. Like so:

[https://www.nytimes.com/2018/10/26/health/private-equity-
der...](https://www.nytimes.com/2018/10/26/health/private-equity-
dermatology.html)

Oh, whoops, my bad, it’s the usual malevolent actors and their stooges.

Yes there are shitty doctors (I’ve worked with plenty). However, I would
propose that the majority of the rot in the US system is structural.
Socialized or properly regulated private systems do not have these scale of
problems.

Last but not least, I’m guessing you haven’t added up the cost of running a
Snyderome per person. It’s not sustainable on a large scale at current prices.
That is why cruder methods of risk stratification that cost less are the norm.

