I mean, I do? As do most of my friends who are homeowners. We are constantly asking each other for recommendations for people who can do X.
Hire a couple of disasters, and you will appreciate that a good relationship with a good contractor/tradesperson is worth an incredible amount of money (and time).
The not so big secret is that we can detect cancer early in a lot of people, but we also would detect a lot of not-cancer. We don't currently know the cost/benefit of that tradeoff for all these new types of screening, and therefore insurers and health systems are reluctant to pay the cost of the both screening and the subsequent workup. This is not just a financial consideration, though the financial part is a big part -- the workup for those that end up as not-cancer has non-negligible risks for the patients as well (I have had patients of mine suffer severe injury and even die from otherwise routine biopsies), and on top of that, some actual cancers may not really benefit from early discovery in the first place.
This is not to downplay the potential benefit of early cancer detection... which is huge. And in the US/UK anyway, there are ongoing large trials to try to figure some of this stuff out in the space of blood-based cancer screening, as part of the path to convincing regulatory bodies and eventual reimbursement for certain tests. As mentioned, you can currently at least get the Galleri test out of pocket (<$1k, not cheap, but not exorbitant either), as well as whole body MRIs (a bit more expensive, ~$2-5k).
Many prostate cancers, for instance, are slow growing and won't kill you before something else does. If you try to take that kind of cancer out surgically or zap it with radiation or chemo the side effects could be severe.
Treatments for prostate cancer are consistently improving. And what makes sense when you are 55 might be different than what does at 75…like all health care issues.
Yeah, after a detection there is alot of work to determine if what they detected should be worried about. But this doesnt take away from the fact that cancer can be detected very early, and these screenings could easily save your life
There's not a lot of evidence that full body MRIs are beneficial. A lot of people have pre-cancerous growths that may or may not become cancer in the future, so you may just be giving them unnecessary surgery, and surgeries are not risk-free. If you don't operate, they might develop an anxiety disorder.
We do a lot of CT imaging in the emergency department and it sucks if we incidentally find an abnormal growth in a young patient's CT head. These are usually benign and often not worth performing brain surgery to get a biopsy.
Why not just rescan them every few months to see if it's still growing? After all, you wouldn't have to rescan the full body, just the section where the growth is.
No, the potential harm comes from follow-up tests. That's why screening strategies are designed by professionals. It's a pretty complex field, and all the people here fielding their opinions on how we should proceed about tests don't have a single idea about the implications of their theories.
What a ridiculous statement to make. No wonder the US is in the state it is in. Lets let the ignorant and uninformed decide on policy rather than the scientific community and experts. What could possibly go wrong?
Honestly, you don't have access to the necessary data to make rational decisions. That's not gatekeeping, it's logic. I don't have access to it either, although I'm indeed a healthcare pro. Screening strategies are a hyperspecialized domain and only experts somewhat understand what they're doing. It's just like making theories about what the CERN guys should be doing while not having passed physics 101 with no access to experimental data. That's why I'm just saying: you're certainly allowed to question, but you certainly can't make up assertions either.
Get treated for the cancer you will now survive because you just caught early. The answer is so obvious I think I may have misunderstood what you mean here.
The fact that this answer is so obvious to you means you have to read up on diagnostic test performance and how screening works, because it's in fact not obvious at all. I mean that in the nicest way possible. Those companies offering expensive screening are not what they seem. Whether their offering is useful or whether they're just swindling you is a question that needs lots of time, money and sweat to answer.
Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up. The only people who would benefit from these screenings are already unhealthy and cancer might be just one of many potential conditions they could experience—the goal of healthcare is not to dedicate an inordinate amount of resources for procedures that may amount to not much of any long term benefit.
People talk about the “immune system” but they are really referring to a number of systems the body uses to regulate itself, more or less successfully, around environmental pressures. The body is a system under tension, sometimes extreme tension leads to extreme success (success here being growth of power), sometimes it breaks the body, and sometimes the systems have been slowly failing for a while, and most treatments will not help. Medicine is only useful in the specific case where the power of the body would be promoted if not for one thing, that the body would be healthy, at least manageably so, without that issue.
> Most healthy, active people who eat decently, get enough rest, and avoid drinking and smoking, will be able to eliminate cancer as it comes up
Incorrect.
There are tons of cancers that hide and mask with symptoms common to other symptoms. Kidney cancer, for example, presents pretty similarly to both kidney stones and UTIs. Even blood in the urine isn't proof positive that anything is wrong beyond either of those conditions. And, by the time blood is in the urine, it's often too late.
Liver cancer is even worse. The first symptoms you get can be thought of as a simple pulled muscle, just a little ache in the back. By the time you have appreciable problems, like turning yellow, it's quite advanced and too late to really do much.
There are common cancers like colon, skin, breast, and prostate that more fit your description of being mostly harmless so long as you get regular screenings and eat healthy. But, for every part of the body, a cancer can form and the symptoms are very often invisible.
I'm unfortunately all too familiar with how cancer looks. My wife currently has stage 4 cancer that started as kidney cancer. She does not drink or smoke, gets enough rest, and is very active.
No I mean that people who are healthy in general are less likely (or completely unlikely) to “get cancer” in the first place because cancer is something that has more to do with an immune system failure, which happens due to unhealthy lifestyles or genetic problems in general which are unavoidable. Cancer only affects people who generally already have other problems (old, sick, unhealthy lifestyles etc.) and young people because they are growing very quickly.
Thus, in young people cancer presents rapidly as they develop, these screenings are expensive and unnecessary. For old/sick/unhealthy people, or people who are predisposed to certain cancers, they will probably get something else anyway, so its an expensive workup to help treat a disease that won’t actually benefit much in the long term.
I’m not against treating cancer, however let’s recognize that cancer treatment is already an expensive and resource/labor intensive process. And 10yr survival rates are not great for most cancers, we’re only slowing the burn, not stopping it. Sometimes you get lucky and die of something else before the cancer can come back, but nobody is ever “cured,” they are all just delaying the inevitable. Which, as we have seen, can sometimes be worth it (who wouldn’t want another 10 years with a loved one?), but that doesn’t mean our goal should be to find a way to “cure” cancer, it should be to find a way to better manage it, and these screenings don’t seem like they really are, or at least the use-cases for them are minimal.
You should stop presenting your opinions such as “Cancer only affects people who generally already have other problems” and “they will probably get something else anyway” as facts.
IDK TBH. My wife had all the general recommended screenings. The only thing that showed potential problems was slightly elevated WBC. It was ultimately what they thought was a UTI that stayed a little too long that got us to get a CT and ultimately the diagnosis.
I do wonder if a 5 year whole body MRI or CT would be generally beneficial for the population. I don't think it needs to be Annual to have benefits.
The problem is it really isn't uncommon for your body to create random puss fill sacks all over the place. It's one thing our cancer doctor warned us about. My wife is now on a 6 month CT regimen and ultimately, they'll just ignore new lumps.
My NP would tell me "nothing to worry about" whether she knows what's going on or not, but that's beside the point.
GP wasn't asking what they should personally do. They were asking how the doctor would screen for it. (The truth is, the doctor can't/won't-- an annual MRI on every otherwise healthy person, for example, would be prohibitively expensive with how MRIs are currently set up-- and as another commenter pointed out, findings from those can be just as easily ignored or put off until it's too late.)
Imagine a reader who is not one of your lucky “most” majority. Imagine a reader whose cancer was not caused by the bad lifestyle decisions that you listed. Put yourself in the position of somebody who undergoes extensive surgery/radiation/chemotherapy and then lives with the side effects of these treatments. Consider what it’s like to live with the fear of recurrence even after such treatment. Then maybe you’ll understand why people might be excited about the potential of this sort of screening.
I think this essay touches on but slightly conflates "younger" with "inexperienced". Younger people are inexperienced at more things in life, sure. But if you write essays about things that are new to the world (new technologies? events? societal changes?) then even older people may be inexperienced with it and could learn something, something that surprises the author and the reader.
Public service announcement: There are already blood tests for detecting pancreatic cancer and other cancers on the market, and more coming, depending on where you live. So get tested, if this is something you are worried about.
I believe the only commercially available one in the US is Grail's Galleri (https://www.galleri.com).
There are many tests in the pipeline -- although the technology is there, the regulatory and evidence process is slow. (Data relating to detecting cancer early, by its nature, takes a long time and a lot of people to prove out.)
>Assumes screening is available for all prostate, breast, cervical, and colorectal cancer cases and 43% of lung cancer cases (based on the estimated proportion of lung cancers that occur in screen-eligible individuals older than 40 years).
It's expensive, accuracy isn't very high, and no one has done the studies to demonstrate that it actually improves subject outcomes. By its very nature that type of research takes a long time because the investigators have to wait years to detect a difference in subject survival rates or other significant endpoints.
There's a huge amount of funding going into the liquid biopsy space so things will improve. But don't expect rapid changes in clinical practice.
Annual might not be any good. I knew a guy who had a history of colon cancer in his family. He got checked annually from his mid 30s on. At 46, a few months after a clear checkup, he visited his doctor who sent him for another check, and bam: he had cancer.
Absolutely right! This test is hyped. It has abysmally low sensitivity of 16% to detect stage I cancers and overall 44% for cancers of other stages. It is extremely poor sensitivity for any detection test.
If you're feeling like your doctor/PCP is a gatekeeper, get a new one, seriously. Maybe I've been lucky, but my doctors have always written scripts for anything I ask for, assuming there's some validity to my need, and (though I've never tried) we're not talking about controlled substances.
Diagnostic test... they may not know what to do with the results, but I doubt you'll get pushback for a script. Insurance may give you a hard time, however, so assume you're going out of pocket.
> If you're feeling like your doctor/PCP is a gatekeeper, get a new one, seriously.
The problem is that even if they open the gate upon approach, they are still keeping it. It’s not about being denied, it’s about being required to ask permission.
> No. Overture will fly without the use of afterburners, meeting the same strict regulatory noise levels as the latest subsonic airplanes. The airliner will be powered by the Symphony propulsion system. Symphony will be a medium-bypass turbofan engine designed and optimized for environmentally and economically sustainable supersonic flight.
> ... meeting the same strict regulatory noise levels as the latest subsonic airplanes
Extremely dishonest: as far as I can tell (CFR title 14, B36.5) there are no specific noise level regulations for subsonic cruise flight (i.e. not take-off and landing) because you can't hear subsonic aircraft at cruise altitude. On the other hand, however, you will be able to hear sonic booms.
It's intentionally misleading, they are technically saying they will meet the takeoff and landing requirements (which they are required to meet by law) but implying that the plane is going to be quiet at cruise (which they want to perform over the continental United States, not just over the ocean).
Moreover, their statement falsely suggests that Concorde does not "[meet] the same strict regulatory noise levels as the latest subsonic airplanes" but 36.301 says that Concorde also has to meet the same standards as subsonic planes (standards which exclude operation at cruise which didn't matter for Concorde because it was over the Atlantic).
I don't know for other countries, but for the United States, "medical students are no longer choosing it" is very very untrue, and it is trivial to look up as this information is public from the NRMP (the organization that runs the residency match).
Radiology remains one of the most competitive and in-demand specialties. In this year's match, only 4 out of ~1200 available radiology residency positions went unfilled. Last year was 0. Only a handful of other specialties have similar rates.
As comparison, 251 out of ~900 pediatric residency slots went unfilled this year. And 636 out of ~5000 family medicine residency slots went unfilled. (These are much higher than previous years.)
However, I do somewhat agree with the speaker's sentiment if for a different reason. Radiologist supply in the US is roughly stable (thanks to the US's strange stranglehold on residency slots), but demand is increasing: the number of scans ordered on a per patient continues to rise, as does the complexity of those scans. I've heard of hospital systems with backlogs that result in patients waiting months for, say, their cancer staging scan. One can hope we find some way to make things more efficient. Maybe AI can help.
Whole body MRI is fairly available in major metro areas, though not cheap and not very sensitive or specific.
The Galleri blood test screens for a range of cancers (sensitivity varies by cancer) and is ~$900, although you need a doctor to order it. You also may not technically be within the intended use population unless you have some risk factors (e.g. you are older than 50, or have family history of cancer).
Colonoscopy is a good idea, given the rising rates of colon cancer among younger adults.
> "The tests... cover topics such as U.S. audit standards, professional ethics and independence..."
Ethics, you say?
> "...involved hundreds of professionals, including partners and senior leaders such as the now former head of assurance..."
When the scale of these things is so large in a single firm, and only comes to light after 2(!) whistleblowers, it is hard to imagine that it is an isolated incident in the industry.
The problem with KPMG et al. is that you hire a bunch of Machiavellian grads, arbitrage their time for profit, see who clambers to the top of the pile, then obscenely reward those few folks.
While operating under a corporate structure that explicitly geo-fences liability.
This is not a scheme that intrinsically creates strong ethics.
> The problem with KPMG et al. is that you hire a bunch of Machiavellian grads
It's not that hard to get hired at KPMG. Going to a semi-decent public Engineering, Accounting, or Business undergrad in the US will guaruntee you a job there.
It's just another audit shop. If we're being honest, almost every person here on HN has also lied about actually doing their Sexual Harassment HR training and SOC Compliance mandated security training and just clicking through then (or writing scripts to bypass the prompts).
The "ethics" exam mentioned is just another one of those types of exams used as an HR CYA.
Edit: the article is about the Netherlands practice. I don't know that much about their hiring practices and prestige in NL and mainland Europe.
> It's just another audit shop. If we're being honest, almost every person here on HN has also lied about actually doing their Sexual Harassment HR training and SOC Compliance mandated security training and just clicking through then (or writing scripts to bypass the prompts).
Don't skip those:
1. Not skipping doesn't take much longer than skipping.
2. Look for the scenarios that are "taken from actual cases" and look up those cases; great way to find some weird shit that has actually happened.
3. There's plenty of unintentional humor to be mined. The last time I did it, there was a "can you harass your own in-group" section that gave an example of a 1st-generation Punjabi-American harassing a Gujarati immigrant, raising the question of "Is it problematic that the author of this section considers those two individuals to be the same in-group?"
The first time has some informative content, or at least some ironic clip-art to copy to your next presentation. The 3rd time and on it's just repetitive. Makes me jealous of the Microsoft employees from the other story about training videos.
> "When the scale of these things is so large in a single firm, and only comes to light after 2(!) whistleblowers, it is hard to imagine that it is an isolated incident in the industry."
Why would it be an isolated incident when the penalty is so small?
KPMG's global revenue for 2023 was around $23 billion per DDG.
When your fine for doing business the "wrong" way is around 1/1000th of your revenue, it's hard to see that as a meaningful punishment.
There’s some truth to it but a consulting firm like KPMG is like a feudal empire, comprised of many little fiefdoms, all tasked with earning and growing a certain amount. A $25M fine means whichever department responsible has probably been nuked and won’t be doing much of this type of work again. However, you are right that it’s not significant enough to change how the emperor’s court conducts oversight.
I do agree some small group of people within the KPMG empire is going to feel the sting of this. I worry the lesson for the rest is going to be "don't get caught", not "don't do that". I struggle to think of a way to get the right message across that doesn't involve real punishment at the top of the pyramid.
Rice cookers (usually) make clever use of 1) alloys whose magnetism depends on temperature and 2) the fact that boiling water occurs at a fixed temperature. With a "trigger" temperature just above the boiling point of water, the rice cooker automatically turns off the heating element when all the water is gone (and thus the temperature starts to rise above boiling point).
Those are the older ones. The new ones like the "Fuzzy Logic" line are more akin to a PID controller trying to make the temperature/time graph match a specific curve, where the temperature changes at different points in the cooking, if I understand correctly.
I'd like to see a patent that actually confirms this. The Curie temperature of the common ferromagnetic metals is well above the boiling point of water, which raises some questions as to what one would make the alloy out of.
Canadian nickels were made of nickel until 1981. Assuming you have a magnet that's heat resistant, you can do a cool demo with a torch or gas stove: pick up the coin with the magnet and dangle it in the flames. You'll know when it hits the Curie temperature. It'll fall off the magnet.
Very interesting overview of the technological / materials breakthroughs to enable miniaturization.
From a physician (specifically radiologist) perspective, I'm a big fan of handheld/point-of-care ultrasound and am excited about their potential at democratizing a very useful and low-cost/low-risk imaging technology. (I also own a Butterfly.)
That being said, the "cart-based" ultrasounds will likely always have a place in a hospital; the size of the ultrasound probes is not why the cart is big/expensive/useful. The cart is a big floating screen and also an image/record management system. You (or at least, a trained ultrasound technician) can manipulate ultrasound parameters and annotate images (critical for ultrasound interpretation) way way faster on the cart's set of wonky keys/dials/trackball than on a smartphone.
Also, with the rise of handheld/point-of-care ultrasound, we've noted with amusement in the radiology department the frequency with which patients get referred for additional imaging because the ED or primary doctor saw some pathology on their handheld ultrasound... and when we take a look it is just not there. I think this is probably more of a training issue, as ultrasound is truly quite challenging both to perform AND to interpret (and a major part of using an ultrasound probe is essentially real-time interpretation), which is even more challenging given the lower image quality and field-of-view of smaller probes.
Hire a couple of disasters, and you will appreciate that a good relationship with a good contractor/tradesperson is worth an incredible amount of money (and time).