You know, I was not logged in when I posted this and actually planned to have it be anonymous and when I clicked submit it automatically logged me in and attached my name - I certainly did not plan to use my ID for that very reason! Someone would still have to both attach my name to this post and her name to the comment but I agree with what you are saying. Luckily my username does not actually exist according to slashdot.
As for getting patients to give me positive reviews - I spend most of my day in foreign languages with patients who do not have access to computers and the internet. That's what makes the racism thing all the more infuriating!
This is obviously stupid and censorship. But it does suck to have internet feedback as a doctor. When I search for my name on the internet, the first ten hits on google are a doctor ranking site and various copycats that mirror it. I have only one rating - my name shows up with one out of five stars and an angry tirade by a patient with psychiatric problems who became angry with one of our nurses before I even walked in the room. She accuses me of racism (and we are both white!), ignorance, etc. when I actually was quite accommodating to her quite angry demands. And due to health care laws in the US I cannot say anything in my defense.
So, basically it sucks to have your name plastered all over google as a racist without having the ability to mount a defense. But censorship is not the way to go. I think the medical profession just has to grin and bear it. Or start astro-turfing...
Doctors are happy with the current situation. They see a patient and they get paid. You are unhappy with the current situation. You wish it to be different. The onus is on you and those like you to change it. Nothing is missing from this narrative other than self-reflection on your part. Many doctors already respond to e-mail. In fact, we have a patient gateway where people can contact us and review labs/studies. I have been a part of teleconferences with my patients. Apparently your doctors are not utilizing available technology. Maybe you should see a doctor who does.
Until there is a financial incentive for doctors to provide these services they are not going to be widespread. Doctors have a negative monetary incentive at this point (and many have no desire and are Luddites, for sure) to innovate. I will put the blame back upon you and fellow patients for not demanding more for your insurance dollar - you should take initiative and refuse to give money to any insurer who gives money to doctors who do not answer e-mail or provide remote conferencing for your medical examinations. Even better, start your own insurance company or exchange with like-minded individuals who demand more for your health-care dollar. Otherwise you are part of the problem. Stop blaming everyone else when it's your money with the power.
Obviously you have had some negative experiences with doctors. I will only address the last paragraph. The primary reason why doctors have not integrated e-mail into practices is that the people who pay them (insurers, not you) have not developed ways to compensate doctors for answering e-mail. So, basically they would be answering your questions for free. And many actually are accessible by e-mail and answer these and phone calls for free because they value your patronage. Add to this the fact that much of medicine is visual and tactile (you cannot examine someone over the phone/e-mail though some telemedicine allows visual skin exams) and it's going to be awhile until you can skip out going to see a doctor when you have an ailment.
Concierge doctors take on patients who are willing to pay them a yearly fee to be freely available at any time to answer e-mail, etc. The model is not sustainable/scalable but might be something that would interest you.
He makes a lot of good points in his article. Obviously the length of the article limits how much detail he can go into and how much of data he can reference, but there is definitely a lot of tests and procedures which are likely causing more harm than good. He makes note of one good example (prostate cancer screening) that we know causes more harm than good in certain populations. In older men, detection of prostate cancer is far more common but the chances of symptoms from the prostate cancer is low. We actually know that in these men we cause more harm than good due to morbidity from biopsies and from unnecessary surgeries/procedures.
It is unfortunate that he mentions the lower cut-off for diabetes - even if he thinks that 130 is too low, we actually know that even people with fasting sugars of 100 are at increased risk for diabetes and, thus, for death. If the intervention is more intensive couseling of lifestyle changes, then there's not a lot of downside to increasing the diagnosis of diabetes and prediabetes.
But his central point still stands - if the US is going to tame its healthcare costs then it needs to look at overdiagnosis and its causes. In some cases, expert committees and professional societies (with their own biases) are to blame. In other cases, malpractice lawyers, the pharmaceutical industry, greedy doctors, and patients who cannot live with uncertainty are to blame. Luckily, there are entire journals devoted to this aspect of healthcare policy and it has not been ignored by mainstream medicine and those who wish to improve it.
Not only that, but most of us pediatricians who have to deal with these vaccination fear-mongers every day have actually spent a great deal of time reading about vaccination issues simply because it comes up all the time and it's nice to be able to quote the relevant studies.
The parents in the US are actually just being selfish. They rightfully understand that in order to keep a disease at bay, you really only need to have a certain percentage of the population immune. They are therefore able to reap the rewards of herd immunity (their child does not get the disease) while avoiding the small risk posed by the vaccine. If there are enough free riders, the system falls apart.
This is not how vaccination rewards are decided. They are a part of the special VAERS program which is decided by a "vaccine" court NVICP (http://www.hrsa.gov/vaccinecompensation/). There are actually experts who decide compensation. This is all a part of an agreement that recognizes that vaccine makers would not make them if they were liable for litigation in the traditional sense. As a result, the US has set up a special system that pays patients out of a pool of money given by the vaccine makers so that they are protected from the litigation.
The trial lawyers would love to break this system - this is why you see so much misinformation on the internet. It is a potential bonanza for lawyers and patients and as a result there is a lot of pressure to allow open litigation. This would obviously drive up vaccination costs and possibly lead to shortages or incomplete coverage due to the higher costs of providing care.
This money will actually come from a pool of money donated by the vaccine companies in order to pay for known or proven complications of vaccination that was set up so that they are immune from direct litigation. This is not taxpayer money. It doesn't mean it's not a bad decision, however. Or that lawyers aren't trying their hardest to break the current system of vaccination litigation awards so they can make more money in regular courts.
Why does the code even matter? Even if the code contains errors, the fact of the matter is that the machine itself should be held to the gold standard of the blood test. That should be the only metric (as well as one that lets you know when the machine is malfunctioning, I'll give you that). If it reproduces the blood tests, then it can be used as a reliable proxy. Now, obviously you'd want to hold the manufacturers and end-users to quality control measures which consistently reproduce the correlation and testing should be done under a variety of different conditions to identify any measureable failure rate. But whether the code is or isn't beautiful or does or does not make math errors is inconsequential if it is able to reproduce the blood test. That is, assuming the blood test equipment doesn't share the same errors!
You know, there can be some pretty complicated and rare syndromes related to pancreatic hormones insofar as cancer is concerned. However, I have no idea what he is alluding to here. The most likely answer for why a person without part of a pancreas would be losing nutrients would be a deficiency in exocrine pancreatic enzymes leading to steatorrhea and calorie loss. However, the description of hormones instead of enzymes and sophisticated blood tests instead of stool tests is a little confusing. My understanding is that he had a Whipple procedure for a neuroendocrine tumor. He would certainly be at risk for steatorrhea. People with neuroendocrine tumors can overproduce certain hormones (such as glucagon) which can lead to weight loss from chronic diarrhea. However, if his problem was due to such overproduction, that would certainly mean that his cancer had not been cured by the surgery and probably wouldn't be described as an "imbalance."
Anyway, I'm not his doctor and don't know much about his case, but can't really put together what he's given us into a coherent story. Maybe someone else can speculate, but it's a bit of a mystery what he is referring to here.
This is pretty cool - I remember when Kris Olson started talking about this project (he was one of my attendings at MGH). In any event, it's good to see that they have reached their goal. Having spent time in Africa where there's no shortage of newly donated equipment but a dearth of people to fix broken equipment, this should be a huge deal.
Are you arguing that if we have an indication that there might be cancer present, we may decide it is best not to attempt treatment, therefore it is best not to look for it in the first place?
Not only am I arguing this, I am telling you that this kind of practice is actually already standard of care in some instances.
Imagine a device so sensitive for cancer that it detects a single cancerous cell. Imagine that 99 times out of a hundred this cell is killed by the immune system and never causes a more systemic problem. Now, imagine that the treatment for this kind of cancer is a chemotherapeutic agent with a 2% chance of death/disability. Would you feel that identifying the cancer was worthwhile if the treatment caused more problems than the disease? Remember, first do no harm.
This simply needs to be studied and the outcomes need to be known. And I have said nothing about comparing this technology to the current gold standards of mammography, colonoscopy, etc. But that would need to be done in order to establish a new gold standard.
It is important to remember that many cancer proteins have already been identified, are readily available for simple blood testing, and have been rejected for screening because their false positive/negative rates are too high and they have been proven not to affect outcomes at all. This may be more of the same - but we don't know until we do the science.
Understand that I think technology similar to this is the future of cancer detection. In fact, cancer proteins are already being used in clinical trials (and in every day practice) to guide rational chemotherapy decisions. I just don't share the same apparent disdain for the regulatory arm of the FDA.
You are right - the ability to test for ovarian cancer is a big story here (if this works). That was more my intention with my reply. The ability to do this in the first place is more important than the ability to do it so quickly. I should have been more careful with my wording.
Yes, but the human body is generally in an equilibrium with many different cancers. Rogue cells develop and are killed by our immune system. It is not known whether treating cancer at the 1-10 cell level is necessary or will save lives - we've simply never been able to detect it that early. What would you recommend - chemo and radiation? It's quite dangerous to assume that cancer detected in this way is the same as cancer detected in the traditional way or that the possible over-treatment of cancer that would otherwise be handled by the natural immune system will end up saving lives. There are risks to cancer treatment just as there are risks to failing to detect cancer at an early stage. These studies MUST be performed before something like this is released for general use. The FDA "kills" people by championing the scientific method which ends up "saving" far more people from dangerous therapies.
There is no guarantee that this will save lives. That's what studies are for. You are confusing cancer detection (or in this case cancer related protein detection) with cancer therapy.
Take two examples now available to detect cancer/cancer related proteins. The first, prostate specific antigen (PSA) is elevated in most cases of prostate cancer. This simple blood test was recommended for all men above a certain age to screen for cancer. However, it does its job too well. It finds cancer in so many men that people started wondering whether finding all of this cancer is a good thing. A lot of men are old enough (and prostate cancer grows slowly enough) that they would certainly have died from other causes without ever having a single symptom of prostate cancer. Additionally, the number of biopsies done to find early cancer (or to find that there was no cancer after all!) combined with the amount of morbidity from current modalities of prostate cancer therapy have led many organizations to conclude that screening for prostate cancer does more harm than good.
A second example comes from the detection of thyroid cancer. Above a certain age, a simple thyroid ultrasound has a fairly good chance of detecting a thyroid nodule. There's a fairly good chance that this nodule will be cancer. However, the risk from dying from this thyroid cancer end up being very low - low enough that the risks from detecting and treating it are higher than the risks of just leaving it be.
When this has been proven to save lives or improve the quality of life of people with asymptomatic cancer, I will join you in criticizing an admittedly slow and often overly burdensome system. But at this point you can't criticize when the device is so far from proven.
This technology is not currently available in the marketplace. There are blood tests that look for tumor markers such as PSA, CEA, CA19-9, etc. and they generally are sent to a large reference laboratory for analysis. This can take up to a week. Traditionally cancer is diagnosed pathologically by looking at a tissue sample underneath a microscope. Aside from the obvious need to undergo a biopsy, this can often be done quickly (pathologist standing in the OR, the surgeon hands the sample over, they read it then and there). However, the hour time frame is not the real story here - it's the ability to combine all of this screening in the first place.
I agree - studies like this are quite common in the medical literature and, while exciting to think about, have a long way to go before they find their way into the clinic. For instance, this chip is looking for many different kinds of proteins. Each protein will have a specific false positive and false negative rate of detection. Because the chip has so many proteins it looks for, the total false positive/negative rate for cancer detection of the chip will have to be determined and, likewise, a decision made as to whether this is an acceptable rate for clinical practice. For instance, it might do well for each individual cancer/protein, but when you are looking for so many different cancers, you might find that an unacceptably high number of chips return an answer of "CANCER." Since this might necessitate costly evaluations with their own inherent risks, you will need to insure before this comes to market that the results are clinically relevant and have an acceptable positive/negative predictive value.
But I don't think that it should be a pre-med requirement. I was a physics major, loved math, and found chemistry exciting. However, I look at what a doctor does on a daily basis and realize that I rarely if ever use the skills I learned in organic chemistry. And this isn't just about what a doctor should learn in school - organic chemistry is a major component of the MCAT medical school entry examination.
I've read a lot of the arguments (here and elsewhere) for organic chemistry.
"Doctors need to know the basic science behind what they do" - as a physicist, I realize that undergraduate organic chemistry does not accurately represent the basis for chemical reactions. It certainly gives you a language for lab and industrial synthesis. But until you take at least physical chemistry, the rest is hand-waving. I think that chemistry should be taught to pre-meds, but feel that biochemistry is best matched to actually understanding the way that drugs work, for instance.
"We need a weed out course for all the idiots" - fair enough. But there are many potential weed out courses with equally compelling claims to relevance. Take differential equations, for instance. It's one of the first places in math that you learn how to ask a scientific equation and actually have the skills to construct an appropriate model. And I guarantee you that it would weed out a lot of people. Or physical chemistry - if you really want people to know the basis of chemistry (as chemists see it), you should use the traditional chemistry major weed-out course. Or take an advanced statistics course - much more applicable to the actual accumulation of new knowledge as a doctor. The ability to critically read journal articles is probably the most important scientific skill for most practicing clinicians.
"Doctors need to be more scientific and understand how basic science works" - couldn't agree more. But organic chemistry does not accomplish this. The best way to learn how basic science works is to do basic science. Research in a basic science lab would be an excellent pre-med requirement. Not a class focused on using pre-derived reactions to create a final product. That's just a mathematical proof in another name.
"Organic chemistry is mentally challenging and builds mental rigor" - this is not really true as it's normally taught in the first two semesters. It's mostly an exercise in memorizing individual pieces of a language and then being able to use that language to create a previously unknown sentence. To that end, logic classes are more helpful to form a generalized framework for approaching new problems. And plenty of classes challenge the mind - pick pretty much any math class, any upper level physics class. Heck, being able to critically read a work of literature or critically view a work of art challenges the mind. That's what college is for.
Anyway, pre-medical education is an interesting topic which is currently being debated in medicine. The most recent comprehensive treatment of the subject was in the New England Journal July 17th by Jules Dienstag, head of medical education at Harvard. From personal experience under him, I can say that he is well qualified to help plan for a future where physician-scientists will have to incorporate ever more vast expanses of knowledge in order to treat patients effectively.
Wow, I'm not sure that I deserved that! It seems that you should focus more on people correctly diagnosing PPCM, whether they use Google or not. I support decision making software, I just know that for the most part what's out there now is not helpful to a practicing doctor. PPCM - Peripartum cardiomyopathy? I got that from searching google, by the way. In any event, if you think that close to 100% of cases of PPCM are misdiagnosed, you are misinformed. Heart failure is not a difficult diagnosis to make. As for google, a search for "fatigue, post-partum, dyspnea" does bring up PPCM, though I'd be treating chronic fatigue syndrome and depression first if I went by google.
Slashdot Mirror
You know, I was not logged in when I posted this and actually planned to have it be anonymous and when I clicked submit it automatically logged me in and attached my name - I certainly did not plan to use my ID for that very reason! Someone would still have to both attach my name to this post and her name to the comment but I agree with what you are saying. Luckily my username does not actually exist according to slashdot.
As for getting patients to give me positive reviews - I spend most of my day in foreign languages with patients who do not have access to computers and the internet. That's what makes the racism thing all the more infuriating!
This is obviously stupid and censorship. But it does suck to have internet feedback as a doctor. When I search for my name on the internet, the first ten hits on google are a doctor ranking site and various copycats that mirror it. I have only one rating - my name shows up with one out of five stars and an angry tirade by a patient with psychiatric problems who became angry with one of our nurses before I even walked in the room. She accuses me of racism (and we are both white!), ignorance, etc. when I actually was quite accommodating to her quite angry demands. And due to health care laws in the US I cannot say anything in my defense.
So, basically it sucks to have your name plastered all over google as a racist without having the ability to mount a defense. But censorship is not the way to go. I think the medical profession just has to grin and bear it. Or start astro-turfing...
Doctors are happy with the current situation. They see a patient and they get paid. You are unhappy with the current situation. You wish it to be different. The onus is on you and those like you to change it. Nothing is missing from this narrative other than self-reflection on your part. Many doctors already respond to e-mail. In fact, we have a patient gateway where people can contact us and review labs/studies. I have been a part of teleconferences with my patients. Apparently your doctors are not utilizing available technology. Maybe you should see a doctor who does.
Until there is a financial incentive for doctors to provide these services they are not going to be widespread. Doctors have a negative monetary incentive at this point (and many have no desire and are Luddites, for sure) to innovate. I will put the blame back upon you and fellow patients for not demanding more for your insurance dollar - you should take initiative and refuse to give money to any insurer who gives money to doctors who do not answer e-mail or provide remote conferencing for your medical examinations. Even better, start your own insurance company or exchange with like-minded individuals who demand more for your health-care dollar. Otherwise you are part of the problem. Stop blaming everyone else when it's your money with the power.
Haha you can read my prior posts you so funny
Obviously you have had some negative experiences with doctors. I will only address the last paragraph. The primary reason why doctors have not integrated e-mail into practices is that the people who pay them (insurers, not you) have not developed ways to compensate doctors for answering e-mail. So, basically they would be answering your questions for free. And many actually are accessible by e-mail and answer these and phone calls for free because they value your patronage. Add to this the fact that much of medicine is visual and tactile (you cannot examine someone over the phone/e-mail though some telemedicine allows visual skin exams) and it's going to be awhile until you can skip out going to see a doctor when you have an ailment.
Concierge doctors take on patients who are willing to pay them a yearly fee to be freely available at any time to answer e-mail, etc. The model is not sustainable/scalable but might be something that would interest you.
He makes a lot of good points in his article. Obviously the length of the article limits how much detail he can go into and how much of data he can reference, but there is definitely a lot of tests and procedures which are likely causing more harm than good. He makes note of one good example (prostate cancer screening) that we know causes more harm than good in certain populations. In older men, detection of prostate cancer is far more common but the chances of symptoms from the prostate cancer is low. We actually know that in these men we cause more harm than good due to morbidity from biopsies and from unnecessary surgeries/procedures.
It is unfortunate that he mentions the lower cut-off for diabetes - even if he thinks that 130 is too low, we actually know that even people with fasting sugars of 100 are at increased risk for diabetes and, thus, for death. If the intervention is more intensive couseling of lifestyle changes, then there's not a lot of downside to increasing the diagnosis of diabetes and prediabetes.
But his central point still stands - if the US is going to tame its healthcare costs then it needs to look at overdiagnosis and its causes. In some cases, expert committees and professional societies (with their own biases) are to blame. In other cases, malpractice lawyers, the pharmaceutical industry, greedy doctors, and patients who cannot live with uncertainty are to blame. Luckily, there are entire journals devoted to this aspect of healthcare policy and it has not been ignored by mainstream medicine and those who wish to improve it.
http://www.ncbi.nlm.nih.gov/pubmed/3874868
Perforin has been known for 25 years to be the mechanism by which immune cells kill other cells.
Not only that, but most of us pediatricians who have to deal with these vaccination fear-mongers every day have actually spent a great deal of time reading about vaccination issues simply because it comes up all the time and it's nice to be able to quote the relevant studies.
The parents in the US are actually just being selfish. They rightfully understand that in order to keep a disease at bay, you really only need to have a certain percentage of the population immune. They are therefore able to reap the rewards of herd immunity (their child does not get the disease) while avoiding the small risk posed by the vaccine. If there are enough free riders, the system falls apart.
This is not how vaccination rewards are decided. They are a part of the special VAERS program which is decided by a "vaccine" court NVICP (http://www.hrsa.gov/vaccinecompensation/). There are actually experts who decide compensation. This is all a part of an agreement that recognizes that vaccine makers would not make them if they were liable for litigation in the traditional sense. As a result, the US has set up a special system that pays patients out of a pool of money given by the vaccine makers so that they are protected from the litigation.
The trial lawyers would love to break this system - this is why you see so much misinformation on the internet. It is a potential bonanza for lawyers and patients and as a result there is a lot of pressure to allow open litigation. This would obviously drive up vaccination costs and possibly lead to shortages or incomplete coverage due to the higher costs of providing care.
This money will actually come from a pool of money donated by the vaccine companies in order to pay for known or proven complications of vaccination that was set up so that they are immune from direct litigation. This is not taxpayer money. It doesn't mean it's not a bad decision, however. Or that lawyers aren't trying their hardest to break the current system of vaccination litigation awards so they can make more money in regular courts.
Why does the code even matter? Even if the code contains errors, the fact of the matter is that the machine itself should be held to the gold standard of the blood test. That should be the only metric (as well as one that lets you know when the machine is malfunctioning, I'll give you that). If it reproduces the blood tests, then it can be used as a reliable proxy. Now, obviously you'd want to hold the manufacturers and end-users to quality control measures which consistently reproduce the correlation and testing should be done under a variety of different conditions to identify any measureable failure rate. But whether the code is or isn't beautiful or does or does not make math errors is inconsequential if it is able to reproduce the blood test. That is, assuming the blood test equipment doesn't share the same errors!
My second post today!
I personally look forward to Slashdot's April Fools jokes each year. There's often some quite funny self-deprecating humor they report on...
You know, there can be some pretty complicated and rare syndromes related to pancreatic hormones insofar as cancer is concerned. However, I have no idea what he is alluding to here. The most likely answer for why a person without part of a pancreas would be losing nutrients would be a deficiency in exocrine pancreatic enzymes leading to steatorrhea and calorie loss. However, the description of hormones instead of enzymes and sophisticated blood tests instead of stool tests is a little confusing. My understanding is that he had a Whipple procedure for a neuroendocrine tumor. He would certainly be at risk for steatorrhea. People with neuroendocrine tumors can overproduce certain hormones (such as glucagon) which can lead to weight loss from chronic diarrhea. However, if his problem was due to such overproduction, that would certainly mean that his cancer had not been cured by the surgery and probably wouldn't be described as an "imbalance."
Anyway, I'm not his doctor and don't know much about his case, but can't really put together what he's given us into a coherent story. Maybe someone else can speculate, but it's a bit of a mystery what he is referring to here.
This is pretty cool - I remember when Kris Olson started talking about this project (he was one of my attendings at MGH). In any event, it's good to see that they have reached their goal. Having spent time in Africa where there's no shortage of newly donated equipment but a dearth of people to fix broken equipment, this should be a huge deal.
Are you arguing that if we have an indication that there might be cancer present, we may decide it is best not to attempt treatment, therefore it is best not to look for it in the first place?
Not only am I arguing this, I am telling you that this kind of practice is actually already standard of care in some instances.
Imagine a device so sensitive for cancer that it detects a single cancerous cell. Imagine that 99 times out of a hundred this cell is killed by the immune system and never causes a more systemic problem. Now, imagine that the treatment for this kind of cancer is a chemotherapeutic agent with a 2% chance of death/disability. Would you feel that identifying the cancer was worthwhile if the treatment caused more problems than the disease? Remember, first do no harm.
This simply needs to be studied and the outcomes need to be known. And I have said nothing about comparing this technology to the current gold standards of mammography, colonoscopy, etc. But that would need to be done in order to establish a new gold standard.
It is important to remember that many cancer proteins have already been identified, are readily available for simple blood testing, and have been rejected for screening because their false positive/negative rates are too high and they have been proven not to affect outcomes at all. This may be more of the same - but we don't know until we do the science.
Understand that I think technology similar to this is the future of cancer detection. In fact, cancer proteins are already being used in clinical trials (and in every day practice) to guide rational chemotherapy decisions. I just don't share the same apparent disdain for the regulatory arm of the FDA.
You are right - the ability to test for ovarian cancer is a big story here (if this works). That was more my intention with my reply. The ability to do this in the first place is more important than the ability to do it so quickly. I should have been more careful with my wording.
Yes, but the human body is generally in an equilibrium with many different cancers. Rogue cells develop and are killed by our immune system. It is not known whether treating cancer at the 1-10 cell level is necessary or will save lives - we've simply never been able to detect it that early. What would you recommend - chemo and radiation? It's quite dangerous to assume that cancer detected in this way is the same as cancer detected in the traditional way or that the possible over-treatment of cancer that would otherwise be handled by the natural immune system will end up saving lives. There are risks to cancer treatment just as there are risks to failing to detect cancer at an early stage. These studies MUST be performed before something like this is released for general use. The FDA "kills" people by championing the scientific method which ends up "saving" far more people from dangerous therapies.
There is no guarantee that this will save lives. That's what studies are for. You are confusing cancer detection (or in this case cancer related protein detection) with cancer therapy.
Take two examples now available to detect cancer/cancer related proteins. The first, prostate specific antigen (PSA) is elevated in most cases of prostate cancer. This simple blood test was recommended for all men above a certain age to screen for cancer. However, it does its job too well. It finds cancer in so many men that people started wondering whether finding all of this cancer is a good thing. A lot of men are old enough (and prostate cancer grows slowly enough) that they would certainly have died from other causes without ever having a single symptom of prostate cancer. Additionally, the number of biopsies done to find early cancer (or to find that there was no cancer after all!) combined with the amount of morbidity from current modalities of prostate cancer therapy have led many organizations to conclude that screening for prostate cancer does more harm than good.
A second example comes from the detection of thyroid cancer. Above a certain age, a simple thyroid ultrasound has a fairly good chance of detecting a thyroid nodule. There's a fairly good chance that this nodule will be cancer. However, the risk from dying from this thyroid cancer end up being very low - low enough that the risks from detecting and treating it are higher than the risks of just leaving it be.
When this has been proven to save lives or improve the quality of life of people with asymptomatic cancer, I will join you in criticizing an admittedly slow and often overly burdensome system. But at this point you can't criticize when the device is so far from proven.
This technology is not currently available in the marketplace. There are blood tests that look for tumor markers such as PSA, CEA, CA19-9, etc. and they generally are sent to a large reference laboratory for analysis. This can take up to a week. Traditionally cancer is diagnosed pathologically by looking at a tissue sample underneath a microscope. Aside from the obvious need to undergo a biopsy, this can often be done quickly (pathologist standing in the OR, the surgeon hands the sample over, they read it then and there). However, the hour time frame is not the real story here - it's the ability to combine all of this screening in the first place.
I agree - studies like this are quite common in the medical literature and, while exciting to think about, have a long way to go before they find their way into the clinic. For instance, this chip is looking for many different kinds of proteins. Each protein will have a specific false positive and false negative rate of detection. Because the chip has so many proteins it looks for, the total false positive/negative rate for cancer detection of the chip will have to be determined and, likewise, a decision made as to whether this is an acceptable rate for clinical practice. For instance, it might do well for each individual cancer/protein, but when you are looking for so many different cancers, you might find that an unacceptably high number of chips return an answer of "CANCER." Since this might necessitate costly evaluations with their own inherent risks, you will need to insure before this comes to market that the results are clinically relevant and have an acceptable positive/negative predictive value.
But I don't think that it should be a pre-med requirement. I was a physics major, loved math, and found chemistry exciting. However, I look at what a doctor does on a daily basis and realize that I rarely if ever use the skills I learned in organic chemistry. And this isn't just about what a doctor should learn in school - organic chemistry is a major component of the MCAT medical school entry examination.
I've read a lot of the arguments (here and elsewhere) for organic chemistry.
"Doctors need to know the basic science behind what they do" - as a physicist, I realize that undergraduate organic chemistry does not accurately represent the basis for chemical reactions. It certainly gives you a language for lab and industrial synthesis. But until you take at least physical chemistry, the rest is hand-waving. I think that chemistry should be taught to pre-meds, but feel that biochemistry is best matched to actually understanding the way that drugs work, for instance.
"We need a weed out course for all the idiots" - fair enough. But there are many potential weed out courses with equally compelling claims to relevance. Take differential equations, for instance. It's one of the first places in math that you learn how to ask a scientific equation and actually have the skills to construct an appropriate model. And I guarantee you that it would weed out a lot of people. Or physical chemistry - if you really want people to know the basis of chemistry (as chemists see it), you should use the traditional chemistry major weed-out course. Or take an advanced statistics course - much more applicable to the actual accumulation of new knowledge as a doctor. The ability to critically read journal articles is probably the most important scientific skill for most practicing clinicians.
"Doctors need to be more scientific and understand how basic science works" - couldn't agree more. But organic chemistry does not accomplish this. The best way to learn how basic science works is to do basic science. Research in a basic science lab would be an excellent pre-med requirement. Not a class focused on using pre-derived reactions to create a final product. That's just a mathematical proof in another name.
"Organic chemistry is mentally challenging and builds mental rigor" - this is not really true as it's normally taught in the first two semesters. It's mostly an exercise in memorizing individual pieces of a language and then being able to use that language to create a previously unknown sentence. To that end, logic classes are more helpful to form a generalized framework for approaching new problems. And plenty of classes challenge the mind - pick pretty much any math class, any upper level physics class. Heck, being able to critically read a work of literature or critically view a work of art challenges the mind. That's what college is for.
Anyway, pre-medical education is an interesting topic which is currently being debated in medicine. The most recent comprehensive treatment of the subject was in the New England Journal July 17th by Jules Dienstag, head of medical education at Harvard. From personal experience under him, I can say that he is well qualified to help plan for a future where physician-scientists will have to incorporate ever more vast expanses of knowledge in order to treat patients effectively.
Wow, I'm not sure that I deserved that! It seems that you should focus more on people correctly diagnosing PPCM, whether they use Google or not. I support decision making software, I just know that for the most part what's out there now is not helpful to a practicing doctor. PPCM - Peripartum cardiomyopathy? I got that from searching google, by the way. In any event, if you think that close to 100% of cases of PPCM are misdiagnosed, you are misinformed. Heart failure is not a difficult diagnosis to make. As for google, a search for "fatigue, post-partum, dyspnea" does bring up PPCM, though I'd be treating chronic fatigue syndrome and depression first if I went by google.