I was wrong about the Midjourney ultra-sound scanner

I was wrong about the Midjourney ultra-sound scanner.

Well, maybe not wrong, but at a minimum I missed something obvious because I was thinking like a doctor who’s been practicing for 25 years.

And I didn’t explain my point well.

First, where I was wrong:

All historical precendent that showed that widespread screening imaging is net neutral or harmful was imaging that was expensive, inconvenient, gated by physicians and couldn’t practically be repeated frequently short term.

If the Midjourney ultrasound is high resolution, harmless, inexpensive and convenient, people can get an initial scan, then if there are abnormalities concerning for cancer, they can get weekly follow up scans to see if it’s growing/changing, and if it’s not, they can leave it alone.

In retrospect, that is obvious but it never occurred to me.

Now, you’d assume that that approach would have to lead to it being useful and saving lives, and it probably will. But we won’t really know it does until we have a couple years of data. Lots of things that seem obvious in medicine end up being wrong once we collect data.

Second, what I didn’t explain well:

It’s not that I think non-doctors are ‘too dumb’ to use the results effectively.

Its that historically it was literally impossible to use the results effectively, and that is super, super counterintuitive. It seems obvious that finding stuff early is beneficial, but experience has shown that it isn’t.

Here’s why:

The vast majority of abnormalities (i.e. possible cancer) isn’t cancer - like over 90% of them, ends up being harmless - something thay your body could have handled on it’s own.

But the only way to find out was to have invasive, risky procedures to biopsy or remove what was found.

And overall, the side effects from all the risky, invasive procedures to track down the over 90% of stuff that was harmless equal or outweigh the benefit from removing the less than 10% of stuff that wasn’t harmless.

If the MIdjourney device can be repeated frequently, like weekly, at a low cost and is harmless, it could negate the need for the risky, invasive procedures.

Not saying it will, but it seems like it could and I confidently posted yesterday that it was a bad idea.

I was wrong to confidently post that.

Fair. My change was from ‘from past research we already know screening like this doesn’t work’ to ‘this is different from the screening tools we’ve had in the past, so maybe it could work’

Interesting and I’d agree generally true.

But even though MRIs got way cheaper and more convenient, I don’t know that it’s possible for them to get truly inexpensive and convenient.

But that’s more the outlier.

Yes it is.

My original thought was ‘we know how this goes, sounds good, won’t work’

Now it’s ‘sounds good, could work, needs to be studied to find out’

Fair.

It’s why we need data.

The problem is the Dr has no idea what advice to give in today’s scenario.

In general you’re right about the medical system and its problems.

But for the most part, with screening imaging there’s just been no advice to give, no matter how much time and trust and thought went into it.

Thanks.

Being wrong and admitting it is my favorite way to learn.

Agree, but cancer detection is the first use case everyone jumps to.

That is exactly how it should work.

Part of the concern was that if 200M people get a scan and 70M need onc visits to discuss the results there’d be a 30 year wait list.

But if the Midjourney is accurate, cheap and easy to repeat frequently, it potentially overcomes the problem.

It’s going to be fascinating to see how it plays out.

For example, if it gives a detailed 3-D topography of the skin, it might be better at diagnosing rashes than dermatologists are currently.

But I’m so tuned into this because in derm we’ve demonstrated pretty conclusively that in increasing screening as currently done, even with something pretty accurate and extremely safe, like a dermatologist looking at your skin, just increases biopsies, increases diagnosis of things that are called melanoma but don’t act like melanomas, and saves no lives.

But a skin exam every two weeks? That could do something and has never been tested.

Yes, the tools we have now are terrible. A few have been published that should be really good at making biopsies higher yield, but hard to make the economic case to derms to buy an expensive device that leads to less revenue.

Very perverse incentives.

Honestly depends on the resolution of the ultrasound, size of the data set and how it’s used.

I’d bet Melafind and other tools would be way, way better if millions of people got all of their moles analyzed by it every month and it was mostly monitoring for changes.

Syphylis.

That’s always my answer on rashes I’m asked about outside the office.

Then I tell them what I really think.

Probably a much better use case, at least early on.

But it’s still going to find ‘maybe cancer’ lesions and you’ll have to decide what to do.

But if follow-up scans to look for change are easy, that might be an easy decision.

Agree. It’s going to be sooooo much fun seeing where we are in 3 years and having all the debates along the way.

Thanks