Comment by tptacek
4 days ago
The people arguing against routine MRI scans are the checklist people!
But, look: if you think routine prostate screening is a good idea, I don't have a counterargument. You're right: there's already an emerging discipline of watchful waiting with prostate pathologies.
The argument being made here is about full body MRI scans: doing a dragnet sweep looking for neoplasms anywhere and everywhere. Not the same thing! Similarly: my belief that the EBM people are right about full-body scans doesn't mean I oppose colon cancer screening!
> The people arguing against routine MRI scans are the checklist people!
Are they? They seem to be exactly the same set of people who resisted them ( https://pubmed.ncbi.nlm.nih.gov/22069112/ ).
> The argument being made here is about full body MRI scans: doing a dragnet sweep looking for neoplasms anywhere and everywhere. Not the same thing!
It's exactly the same thing, but on a larger scale. Yes, it will likely require at least some adjustment to the standards of care and development of more stringent criteria for follow-up procedures. But we're already talking about fine-tuning, rather than something fundamental.
Here's a study from one of the providers:
> Prenuvo's recent Polaris Study followed 1,011 patients for at least one year following a whole-body MRI scan. Of these patients, 41 had biopsies. More than half of the 41 were diagnosed with cancer. Of these cancers, 68% didn't have targeted screening tests and 64% were localized when detected. The company says it finds possibly life-threatening conditions in 1 in 20 people.
So we're talking about the real-world 4% rate for biopsies, with about 50% false positive rate. This is not that far removed from the current clinical 30% false positive rate. And this is far from the apocalyptic scenarios of multiple biopsies for every patient.
And the psychological burden appears to be modest: https://pubmed.ncbi.nlm.nih.gov/33279799/
While the negatives cited by doctors are:
> To date, no study has been performed that rigorously investigates the impact on disease-specific survival following whole body MRI in asymptomatic patients without specific risk factors, and no study has been performed to confirm that a ‘negative’ whole body MRI excludes significant disease 5 or more years’ later.
I read most of the studies that are cited here: https://www.ranzcr.com/college/document-library/2024-positio... And I have not found a single one that had anything really negative about the MRI consequences. And half of them are outright positive endorsements: https://pubmed.ncbi.nlm.nih.gov/33216779/
The only real remaining argument is cost effectiveness of MRI, especially for government-based healthcare. It is a valid argument, but it's beside the point for people who are self-paying. And it's also missing the implications of economy of scale.
So I'm pretty sure in this particular case the geeks indeed know more than doctors.