
Using Deep Learning to Inform Differential Diagnoses of Skin Diseases - theafh
https://ai.googleblog.com/2019/09/using-deep-learning-to-inform.html
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hypersoar
My SO is a dermatologist. Her father is also a radiologist, which is probably
the most obvious target for this sort of thing. When I asked her about it, she
said that she's looking at the depth and height of things a lot, a dimension
not really captured in a photograph. This study pit their AI against
dermatologists getting the same photo and information, but I'm curious how
it'd do against an in-person examination.

Google doesn't appear to be claiming that they could replace dermatologists
with AI entirely. Lest anyone's mind start leaping in that direction, here are
a few more reasons why I think her job is safe for the foreseeable future.

\- Much of her work is full-body skin-checks. How able would an AI system be
to provide instant feedback on everything sketchy it sees? How comfortable
will people be with, rather than a doctor inspecting their entire body, having
_pictures_ taken of their entire body?

\- Her cases can get rather complicated. Skin problems can be caused or
complicated by internal illnesses that need to be considered. This point, in
particular, calls on her specialized training beyond what a GP would have.

\- There's a lot more to her work than diagnosing. She's also prescribing
treatments, monitoring progress, performing surgeries, etc.

\- Her time is indeed very expensive (much to by benefit), and more so than a
GP's. But there are a lot of challenges involved in deploying things in
medicine, and our regulations are probably unprepared for diagnosis-by-
computer. I expect it'll be quite a while before, say, a GP augmented by an AI
is price-competitive with a board-certified dermatologist.

~~~
catoc
Dermatologists and radiologists will not be replaced by AI any time soon - for
precisely these reasons.

Geoffrey Hinton personally saying "we should stop training radiologists" just
reflects a complete lack of understanding about what a radiologist does.

~~~
ska
Your broad point is true, but radiology is an odd and relatively new
specialty. It's not going away entirely any time soon but I think will be the
most radically affected over the next 20 odd years.

~~~
catoc
It will indeed radically change; and radiologists not-using-AI will be
replaced by those who do. However the profession itself will only increase in
influence as the radiologists become more and more clinically involved. If
they take on the responsibility of employing and regulating medical imaging
AI, more radiologists rather than fewer will be needed.

~~~
ska
I think that "if" is fairly large, and hasn't been resolved yet. I can also
see a future with more and more imaging work being done by not-radiologists or
hyphenated ones. I guess we'll see.

Bear in mind that there have been some effective ML approaches in radiology
(for certain tasks) for decades now and the radiologists themselves have been
among the largest hurdles to getting them into clinical use. How they respond
to broader and more powerful incursions into "their" space will probably have
a significant effect on what their future role(s) and scope are.

I guess what I'm saying is that we can predict a big growth in the consumption
of imaging (and other signal) data by clinicians in the next decades, but it
is far less clear if the percentage of that mediate through radiology will
remain anywhere near as high as it is now.

~~~
catoc
I certainly agree to your comment on that "if". Up to now there has been a lot
of talk and very little actual action. Although I don't think that it's
because of conservative protective resistance - at least not in academia. The
main issue is not knowing where and how to start. We'll see indeed who will
'win'. Let's hope it's not the Amazon's and Google's of this world

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n1000
In my opinion we have a long way to go before we actually understand many many
of the skin diseases. Dermatologists appear to me as the most clueless doctors
out there. Their only weapons seem to be cortisol and biopsies. Maybe I was
also just unlucky.

~~~
SCUSKU
I live with a eczema with fluctuating severity and have to agree. I have been
prescribed triamcinolone acetonide steroidal cream, which helps, but doesn't
keep me from scratching. I am legitimately waiting for genetic editing to
solve this problem for me.

~~~
bitL
Try sauna with multiple heat (~10 minute) - cold (1-2 minutes; immersed)
cycles; some of my friends with various skin disorders reported significant
improvement after 3 sessions and I could see myself their skin first dried on
affected areas that then quickly recovered to almost perfect state after 3rd
session. YMMV ofc.

~~~
lallysingh
Do you have more information on this? A link perhaps?

~~~
bitL
I don't see any medical journal report, however there seem to be many people
discussing the same online; just a quick search led to this Reddit thread that
describes what I saw on my friends (i.e. damaged skin peeling off with healthy
one underneath):

[https://old.reddit.com/r/eczema/comments/6cci0h/infrared_sau...](https://old.reddit.com/r/eczema/comments/6cci0h/infrared_sauna_holy_cow/)

I believe the "cold shower" mentioned later is necessary for any effect; my
friends usually spend 1-2 minutes immersed in cold water after a heat cycle
(arguably both improved blood circulation and immunity boost).

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specialist
This is very cool. And much needed.

I anticipate three other complimentary technologies which will help many, many
people. (In case anyone is looking for medical startup ideas...)

More sensor data from non visible light. Like the recent popularity of using
ultraviolet light to see cumulative skin damage.

Better ways to register and align (correct) photos, to better compare images
taken over time, to better track progress of conditions over time. Eventually
even full body scans.

Some way to measure the thickness or depth of the various layers of skin.
Think side scanning radar, but for skin.

\--

Source: I've had graft versus host disease greatly affecting my skin for
nearly 30 years. It's been wicked hard to diagnose and monitor.

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dylanz
This is great to see, and I didn’t know that there was a shortage or
dermatologists. Just a few months ago my entire body got all blotchy and I
ended up having to go to a dermatologist to get a biopsy. It ended up being
full body Granuloma Annulare which is both rare an incurable. With no other
options, I’ll be trying to cure it with diet.

That said, it couldn’t be diagnosed by sight alone. It looked very similar to
many other skin diseases, and mine in particular comes in many different
forms. I’ll obviously be following this research!

~~~
n1000
I recommend you try Traditional Chinese Medicine (TCM). I had to drink the
ugliest medicinal tea imaginable for a while, but after that my skin problems
had miraculously disappeared.

~~~
sjg007
Do you know what the ingredients were? I know some people who have creams from
a Chinese medicine doctor that seem to work for them.

~~~
n1000
Unfortunately not. But I remember there was some really weird stuff in there.
Anything from minerals to insect skins. It is customised to whatever the
diagnosis is.

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doctoring
This is great to see. A key part of medicine is generating an appropriate
differential rather than identifying one true diagnosis (as they explain). A
ranked list of diagnoses lets you appropriately incorporate new information
(history, lab data, imaging, etc) and gives you a framework for exploring
further (thinking about value of information and what additional data you'd
need to narrow your list or increase your confidence).

I think in dermatology, radiology, and pathology (and other visual diagnostic
fields) this work is a huge boon, but the conceptual framework is the same for
diagnostics based on laboratory, physical exam, genetic, or any other
findings. I don't think ML is necessary in creating excellent decision support
tools but is increasingly valuable as you include more and more disparate
sources of information.

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buybackoff
My first thought is the context. They mention 26 cases and 45 metadata. What
if one has 27th caused by 46th metadata item.. Just yesterday visited
dermatologist for the first time in 9 years, had to ask him to give me his PC
mouse to explain that my acute eczema is exactly on the region where my hand
touches PC mouse and it started during the heatwave this year in Europe. The
doctor prescribed a lot of common tests, because he had to do so formally. Yet
it was clear for me and him what's going on, especialy when I had the same 9y
ago and the old treatment works, but not very effective this time. But how AI
could ever incorporate such rare contextual coincidences if the learning set
is limited to a close set of conditions?

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ape4
Seems like asking "history of psoriasis?" is cheating

