关于 Midjourney 超声波扫描仪,我错了。
I was wrong about the Midjourney ultra-sound scanner

原始链接: https://twitter.com/MattZirwas/status/2068365802491834541

作者重新评估了他们之前对“Midjourney风格”消费级超声扫描仪的批评。起初,他们认为大规模筛查是有害的,因为这会导致绝大多数良性病变被进行侵入性且不必要的活检。 然而,他们现在意识到,如果这些设备价格实惠、无害且便捷,它们可能会改变诊断模式。临床医生无需对每一种异常情况都进行高风险手术,而是可以进行频繁的非侵入性随访扫描,以监测病灶生长情况。这种从立即干预转向纵向追踪的转变,可能会抵消过去过度诊断带来的危害。 虽然作者承认医学直觉往往会被经验数据所推翻,但也承认自己之前的立场过于轻率。他们提醒道,尽管该技术前景广阔,但仍需要数年的数据来证明它究竟是真正挽救了生命,还是仅仅将医疗不确定性带来的经济和心理负担转移到了消费者身上。

Hacker News 的一个讨论帖正在热议一款所谓的“Midjourney 超声扫描仪”。讨论反映出截然不同的两种观点:一方认为该项目是医疗创新领域充满雄心壮志的尝试,另一方则持强烈的怀疑态度。 乐观者认为,实验对于进步至关重要。他们指出,许多现有的医疗技术——如 Butterfly iQ 或机器人手术系统——在最初阶段都需要投入与冒险,才能打破现状。他们认为该设备可能提供诸如精准体脂分析等实用功能。 相反,怀疑者警告称,该项目带有当前科技圈常见的“营销泡沫”色彩。批评人士认为该项目缺乏临床证据、学术论文或专业背书,并将其称为潜在的“Theranos 事件”,指责其重炒作而轻医疗实用性。还有人认为,即便这项技术并非欺诈,也可能只是医疗行业早已认定不切实际的无用技术或陈词滥调。 归根结底,这场对话反映了一种更深层的矛盾:对于医疗保健而言,这种风投驱动下“快速行动、打破常规”的模式,究竟是一条可行的路径,还是仅仅引向空洞的投机与欺诈。
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原文

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.

I usually agree with Dr. Locasale. But not on this. A $100 full-body ultrasound on asymptomatic people, sold as a wellness service, will open a massive can of financial worms for individuals. You’ll pay around $100 for the scan, there’s a 90% chance they find something you’ll

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