AI used for skin cancer checks at London hospital(bbc.com)
bbc.com
AI used for skin cancer checks at London hospital
https://www.bbc.com/news/articles/czd3ygd7mrno
90 comments
This would be such a beautiful use of AI
I last heard it's a pretty darn helpful tool, from a radiologist acquaintence/undergrad friend (who works from home in USA).
I'm attending a course with some goat professors, that aim to teach this kind of things. Chances are, given it's a small course you won't produce anything of real value, but the aim should be to analyze 3 datasets from 3 different neurodegenerative diseases, find some common markers and eventually make a ml model to better diagnose people with these diseases. It's not exactly easy, but given it's a real world problem it's extremely motivating
(we've been also allowed to use a university vm with 3tb of ram and that's nice)
(we've been also allowed to use a university vm with 3tb of ram and that's nice)
No, it's a horrible use, relying on something entirely unreliable to make medical diagnoses. All the AI safety people who pretend to worry about killer robots or whatever should actually be up in arms about these kind of uses, but you can see where actual priorities lie.
The best use of AI in medicine would be to automate away administrative bloat to let people get proper medical care.
The best use of AI in medicine would be to automate away administrative bloat to let people get proper medical care.
What if it was really reliable? Would you still be against it?
The question doesn't make sense imo because it, meaning neural network or other ML computer vision classification, doesn't have a mechanism to be trustworthy. It's just looking for shortcuts with predictive power, it's not reasoning, doesn't have a world model, it's just an equation that mostly works, etc, all the stuff we know about ML. It's not just about validation set performance, you could change the lighting or some camera feature or something, have some unusual mole shape, and suddenly get completely different performance. It can't be "trusted" the way a person can, even if they are less accurate.
These limitations are often acceptable but I think as long as it works how it does, denying someone a person looking at them in favor of a statistical stereotype should be the last thing we do.
I can see if this was in a third world country and the alternative was nothing, but in the developed world the alternative is less profit or fewer administrators. We should strongly reject outsourcing the actual medical care part of healthcare to AI as an efficiency measure.
These limitations are often acceptable but I think as long as it works how it does, denying someone a person looking at them in favor of a statistical stereotype should be the last thing we do.
I can see if this was in a third world country and the alternative was nothing, but in the developed world the alternative is less profit or fewer administrators. We should strongly reject outsourcing the actual medical care part of healthcare to AI as an efficiency measure.
I understood that you don't believe it can be made reliable. But my question was: what if it were?
Let me put it differently. Suppose I don't tell you it's ML. It's a machine that you don't know how it works, but I let you do all the tests you want, and turns out they're great. Would you then still be against it?
Let me put it differently. Suppose I don't tell you it's ML. It's a machine that you don't know how it works, but I let you do all the tests you want, and turns out they're great. Would you then still be against it?
How trustworthy really are humans?
Anecdotally, when I had a potential skin cancer checked at a London hospital they were completely ill-prepared.
When I came back to Australia, it was checked and immediately removed as an obvious melanoma.
Perhaps the idea of Comparative Advantage also applies to healthcare between countries with natural variances to types of disease?
When I came back to Australia, it was checked and immediately removed as an obvious melanoma.
Perhaps the idea of Comparative Advantage also applies to healthcare between countries with natural variances to types of disease?
Australia, Queensland, Brisbane has the highest incidence of skin cancer in World. So Drs and dermatologists would have more experience detecting it here. UV is probably much less intense in England . This link graph shows skin cancer is over 2x in Australia
https://www.statista.com/statistics/1032114/countries-with-t...
> Australia, Queensland, Brisbane
OT but what an odd way to address a place. I know it's called down under but not everything there is back to front.
OT but what an odd way to address a place. I know it's called down under but not everything there is back to front.
Queenslander here. There’s also a fairly well equipped imaging centre that’s being testing this form of diagnosis for 5 years: https://acemid.centre.uq.edu.au/research/cre-skin-imaging-an...
Sadly, a friend of mine died from this type of problem. He traveled from Ghana to Jordan and fell ill in Jordan, the Jordanian doctors didn't diagnose it as malaria in time to save him because Jordan doesn't have malaria. I'm sure it would have been obvious to a Ghanaian doctor.
Friend did a lot of work in Africa. Got back to the US and starts getting symptomatic and says to himself “I think I got malaria”.
Goes to the biggest university hospital nearby he can find.
Was initially dismissed but waited it out for the infectious diseases specialist and they quickly agreed with his self-diagnosis.
They kept them in hospital for a few days so a parade of clinical students/residents could come by for the specialist to say: “this man has malaria”
Goes to the biggest university hospital nearby he can find.
Was initially dismissed but waited it out for the infectious diseases specialist and they quickly agreed with his self-diagnosis.
They kept them in hospital for a few days so a parade of clinical students/residents could come by for the specialist to say: “this man has malaria”
Weird. Pretty much every time I've gone to a doctor (in the Midwest US, no less) for an illness, the second question they ask is always "have you been out of the country recently?" just to rule out anything caught from abroad.
Then again, my one experience with a university hospital was pretty shitty, so maybe that's it?
Then again, my one experience with a university hospital was pretty shitty, so maybe that's it?
This was decades ago, so maybe getting asked regularly nowadays was because of that previous education.
I came back from Bali and shortly after came down with a really high fever when I was on vacation in Maine. When I got home week later called my primary as I was still running a bit of a fever and got blood work which was pretty bad. Went to ER and my primary care figured it was something tick related. The infectious disease guy on call immediately identified as Dengue Fever. At the end, including sending blood to the Louis Pasteur Institute in Paris I spent something south of $1K to get told I’d recover on my own—the Paris tests came back like weeks later—and there really wasn’t much they could do.
I had a weird cardiac issue, for which they kept me in the hospital for a few days and brought in more and more doctors to hear my story. Added tens of thousands to my bill. Eventually checked myself out "against doctor's advice".
A good family friend caught abdominal TB while abroad, came back to Canada, and was terribly misdiagnosed. TB is very rare here; abdominal TB even more so, and early symptoms look like a lot of other diseases. It took several hospital visits before the doctors realized the actual problem. He very nearly died, and spent nearly a year in the hospital recovering from a parade of complications.
When I first heard the clinical idiom "When you hear hoof-beats, think horses not zebras" I thought it was a precautionary saying about the bias toward assuming the familiar. But it's meant to be instructive!
No, that’s backwards. It means what it says. When you see a symptom first look for the common things it could be, not the one in a million chance.
We have a formal description of this, it's called bayes theorem.
The Jordanian doctors just had poor priors.
The Jordanian doctors just had poor priors.
In this particular case, "when you see stripes with hoofbeats, think zebra, not horse with a paintjob"
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Being a pasty Brit, going to Australia was a real eye opener in how much more on the ball they were about skin cancer, not just in medical terms but culturally. We're getting better here (I was there more than a decade ago) but it's still seen as quite amusing when people get sunburnt here.
Awareness started in the 1980s in Australia with Sid the Seagull:
https://www.youtube.com/watch?v=tGgn5nwYtj0
https://www.abc.net.au/btn/classroom/sun-safety-campaign/103...
https://www.youtube.com/watch?v=tGgn5nwYtj0
https://www.abc.net.au/btn/classroom/sun-safety-campaign/103...
Speaking with some 70 year olds, their opinion on the "best doctor in town for skincare" was basically a doctor who'd simply cut out whatever you like and send it for a biopsy.
At most you had to deal with a stitch or two but often only a bandaid. Nowadays the hydrocolloid bandages seem magic.
At most you had to deal with a stitch or two but often only a bandaid. Nowadays the hydrocolloid bandages seem magic.
It's even more granular than that.
My neighbour who is a doctor moved to another city because that's where he managed to get a spot to train for his field.
It appears that he's learning much more there than he would back home because in this country some procedures are rare outside of his current location.
My neighbour who is a doctor moved to another city because that's where he managed to get a spot to train for his field.
It appears that he's learning much more there than he would back home because in this country some procedures are rare outside of his current location.
Reminds me of that South Korean trauma surgeon who trained in the states and has pushed for Korea to get US-style trauma centers.
Dude got plenty of experience dealing with gunshot wounds, which probably helped him when that one North Korean defector came over the border, riddled with bullets (you may have heard this story, it was big news at the time). The especially weird coincidence was that the surgeon's mentor from the states was in Korea at the time this happened, what are the odds.
https://abcnews.go.com/International/doctor-north-korean-def...
Dude got plenty of experience dealing with gunshot wounds, which probably helped him when that one North Korean defector came over the border, riddled with bullets (you may have heard this story, it was big news at the time). The especially weird coincidence was that the surgeon's mentor from the states was in Korea at the time this happened, what are the odds.
https://abcnews.go.com/International/doctor-north-korean-def...
Similar vein: during The Troubles, physicians in Belfast got particularly good at dealing with managing cranial pressure and making skull plates from bar bombings, and dealing with bone repair from kneecap punishment shootings
https://www.nytimes.com/1987/08/18/world/ulster-doctors-lear...
https://www.nytimes.com/1987/08/18/world/ulster-doctors-lear...
My experience - Having had at least 10 skin cancers cut out over the last 30 ish years, is the only way that it can definitely be determined ( skin cancer or not ) is a biopsy.
Australia has high skin cancer so it's not suprised that doctors there are best in this area.
99% accuracy in diagnosing benign case
I assume whoever is working on this knows that, so this is mostly a criticism of the article. That said, this is a horrible use of AI.
It’s really all about the protocol. AI tends to spot things that doctors don’t, and vice versa. Dermatology is also an area being pillaged by private equity and access is poor for many people.
I lost my wife to melanoma. She noticed a lesion within days of it appearing, and a doctor saw it within 48 hours and felt it was benign. My wife didn’t accept it and had a plastic surgeon remove it and biopsy, then had a margin removed by surgical oncologist, the standard of care at the time. It came back as a brain tumor 4 years later and she was gone in 6 months, even with the incredible advancements today.
So I’d hold the position strongly that anything that improves overall detection rates and access to care is incredibly important and will save lives. Weeks matter with melanoma. Today with immunotherapy Molly would be fine. But if she hadn’t advocated and gotten the original thing removed, it would have cost her 4 important years.
I lost my wife to melanoma. She noticed a lesion within days of it appearing, and a doctor saw it within 48 hours and felt it was benign. My wife didn’t accept it and had a plastic surgeon remove it and biopsy, then had a margin removed by surgical oncologist, the standard of care at the time. It came back as a brain tumor 4 years later and she was gone in 6 months, even with the incredible advancements today.
So I’d hold the position strongly that anything that improves overall detection rates and access to care is incredibly important and will save lives. Weeks matter with melanoma. Today with immunotherapy Molly would be fine. But if she hadn’t advocated and gotten the original thing removed, it would have cost her 4 important years.
Similar story: mom had a melanoma removed from her foot. multiple lymph node biopsies and other tests said it had been successfully removed.
She went back once a year for checks for 4-5 years. It was only when she was called into see an oncologist and told an unrelated x-ray lead them to discover she had stage 4 metastatic melanoma (brain, liver, spine, femur, lungs and i’m sure i’m forgetting something) that we found out that they’d only been giving her visual checkups each year, no PET scans or anything else. The oncologist was shocked that the checks were so basic, mom didn’t know she was supposed to have anything else and she was dead in about 8 weeks.
We were told that the form of melanoma only came back like that in 1% of patients and usually simple visual checkups were enough. I have no idea how true that is.
She went back once a year for checks for 4-5 years. It was only when she was called into see an oncologist and told an unrelated x-ray lead them to discover she had stage 4 metastatic melanoma (brain, liver, spine, femur, lungs and i’m sure i’m forgetting something) that we found out that they’d only been giving her visual checkups each year, no PET scans or anything else. The oncologist was shocked that the checks were so basic, mom didn’t know she was supposed to have anything else and she was dead in about 8 weeks.
We were told that the form of melanoma only came back like that in 1% of patients and usually simple visual checkups were enough. I have no idea how true that is.
My wife had a similar experience, except it was her shoulder. They took a margin, looked at lymph nodes, and did a nuclear test that traced something that I can’t recall.
Another lesson learned is that if at all possible, go to a national cancer center. Even if for a second opinion analysis. The level of care is different and better than what you find in community oncology or hospital practices.
Another lesson learned is that if at all possible, go to a national cancer center. Even if for a second opinion analysis. The level of care is different and better than what you find in community oncology or hospital practices.
So sorry, brother.
I've been told the only way to be sure if skin cancer or not , is a biopsy. I also have been told ... not skin cancer... but Dr decided to send me to a dermatologist. Is thing he said when say it .. is looks like skin cancer ... lets take a biopsy now ... to check . It was skin cancer ... a BCC
Dude that sucks mate. I had a melanoma taken off last year. It was dormant (stage 0) but had been there for 10ish years. But reading shit like this reminds me that even though I'm probably fine, all I can do is just live my best life. Hang out with my family. Enjoy the things I enjoy and not think about it too much. (and get my skin checks every 6 months :D)
Are your skin checks just visual checks? If so, read my other comment in this thread. It was in UK fyi.
> The only thing that matters in this kind of application is false negative rate at some acceptable false positive rate.
It sounds like they are inverting the scenario here. The question is not "do you have skin cancer?", it's "can you safely go home without seeing a doctor?".
For this new question, we set the acceptable false positive rate to zero (we never want to send a real cancer case home), and determine the false negative rate (we accept that some benign cases will be seen by a doctor).
The reason for the interest in identifying benign cases, rather than trying to identify the positive cases, is that it improves the situation for everybody: benign cases identified by AI are sent home almost immediately, everyone else has a shorter waiting time, so benign false negatives can be assessed more quickly by the doctor and given the all clear, and more time is now available for spending with the real cancer cases.
The numbers they're citing are 7000 cases with 5% real, so 350 real cancer, 6650 benign. If we can accurately say that 6500 of those benign cases are benign without wasting the doctors' time, then we're down to only 500 people needing to see a doctor, which is a huge improvement for everyone.
It sounds like they are inverting the scenario here. The question is not "do you have skin cancer?", it's "can you safely go home without seeing a doctor?".
For this new question, we set the acceptable false positive rate to zero (we never want to send a real cancer case home), and determine the false negative rate (we accept that some benign cases will be seen by a doctor).
The reason for the interest in identifying benign cases, rather than trying to identify the positive cases, is that it improves the situation for everybody: benign cases identified by AI are sent home almost immediately, everyone else has a shorter waiting time, so benign false negatives can be assessed more quickly by the doctor and given the all clear, and more time is now available for spending with the real cancer cases.
The numbers they're citing are 7000 cases with 5% real, so 350 real cancer, 6650 benign. If we can accurately say that 6500 of those benign cases are benign without wasting the doctors' time, then we're down to only 500 people needing to see a doctor, which is a huge improvement for everyone.
I went searching for more. The tool is called DERM by Skin Analytics. They have more info on stats:
https://skin-analytics.com/ai-pathways/derm-performance/
A few peer reviewed pubs down the bottom of the page
https://skin-analytics.com/ai-pathways/derm-performance/
A few peer reviewed pubs down the bottom of the page
It's trendy to say "it's horrible to use AI for this" without giving specific reasons. Some reasons it could be good to use AI here:
- this can prioritize urgent patients for the severely overworked doctors
- medical error is a leading cause of death, this serves as a second-opinion (97% true-positive rate and 79% true-negative rate)
- it can be used as evidence by a nurse or physician advocating for a patient's treatment
- this can prioritize urgent patients for the severely overworked doctors
- medical error is a leading cause of death, this serves as a second-opinion (97% true-positive rate and 79% true-negative rate)
- it can be used as evidence by a nurse or physician advocating for a patient's treatment
What do you mean by this being a "horrible" use of AI? (Although as another commenter has mentioned, this should more properly be called ML).
It's quite easy to correctly classify 100% of benign cases as benign.
If it's so easy, then why do people die from having lesions misdiagnosed as benign?
Even if the success rate of the human eye was in the 99.5%+ range, why not have an extra sanity check from an AI model?
Even if the success rate of the human eye was in the 99.5%+ range, why not have an extra sanity check from an AI model?
> If it's so easy, then why do people die from having lesions misdiagnosed as benign?
You're confusing False Negatives with True Negatives. For Non-Benign (Positive) vs. Benign (Negative) classification:
* True Positive Rate (TPR): non-benign classified as non-benign.
* False Positive Rate (FPR): benign misclassified as non-benign.
* True Negative Rate (TNR): benign classified as benign.
* False Negative Rate (FNR): non-benign misclassified as benign.
> It's quite easy to correctly classify 100% of benign cases as benign.
You can engineer a 100% TNR if you just classify everything as the "benign" negative class. The FNR is going to be 100% too, but that doesn't matter -- you correctly classified 100% of benign cases as benign.
> why do people die from having lesions misdiagnosed as benign?
Because the FNR is not 0%. FNR is important. You probably want a decent TPR in there as well. And FPR can be very important too, depending on how life-changing/painful/invasive the treatment for a positive case is!
You're confusing False Negatives with True Negatives. For Non-Benign (Positive) vs. Benign (Negative) classification:
* True Positive Rate (TPR): non-benign classified as non-benign.
* False Positive Rate (FPR): benign misclassified as non-benign.
* True Negative Rate (TNR): benign classified as benign.
* False Negative Rate (FNR): non-benign misclassified as benign.
> It's quite easy to correctly classify 100% of benign cases as benign.
You can engineer a 100% TNR if you just classify everything as the "benign" negative class. The FNR is going to be 100% too, but that doesn't matter -- you correctly classified 100% of benign cases as benign.
> why do people die from having lesions misdiagnosed as benign?
Because the FNR is not 0%. FNR is important. You probably want a decent TPR in there as well. And FPR can be very important too, depending on how life-changing/painful/invasive the treatment for a positive case is!
Because this non-AI function 'correctly diagnoses 100% benign cases as benign':
def is_benign(mole: Image) -> bool:
return True
To contextualize, I think the tool in this article correctly diagnoses 97% benign cases as benign but misdiagnosis 22% of malignant cases.
I don't think its a horrible use of AI at all, in fact it seems like a fairly good use case.
It's a tool that can be used in amongst the current methods to help detect skin cancer, it shouldn't be used at the only method.
It's a tool that can be used in amongst the current methods to help detect skin cancer, it shouldn't be used at the only method.
Not really. It allows you to order your cases from most-likely to least-likely, and get human eyeballs on the most-likely cases first.
This is how most ML in healthcare is used. It's a fantasy to think we can give all patients equal attention, so it often makes sense to prioritize those most at risk. Of course no model is perfect, but ML can be very beneficial when used in the right context (i.e. not like United Healthcare).
Yup. The word I should have used is "triage".
This doesn't seem like nothing new? I remember a talk about this being done some 12+ years ago. Just without the AI label to generate hype.
There has been talk about this pretty much since CNNs got good at object recognition ~2012.
But healthcare is a rather conservative industry (for good reason) so it has taken a while to build confidence in the technology and get regulatory approval.
But healthcare is a rather conservative industry (for good reason) so it has taken a while to build confidence in the technology and get regulatory approval.
Yeah - I don't recall which company (maybe johnson & johnson) it was but my aunt worked for one that produced a portable machine that used a camera to check moles and used some sort of algorithm to give a predicted score. This was 20ish years ago. I remember she brought it to my grandparents and we had fun checking everyones moles for the day.
> The hospital gets about 7,000 urgent skin cancer referrals each year, but only 5% turn out to be cancer.
It seems to be that you could be doing a _much_ better job of filtering this pipeline before it gets to this point. How can so many _urgent_ cases end up being negative?
They're using AI to solve a problem that probably shouldn't exist.
It seems to be that you could be doing a _much_ better job of filtering this pipeline before it gets to this point. How can so many _urgent_ cases end up being negative?
They're using AI to solve a problem that probably shouldn't exist.
The referral is just because a non expert can't be sure. The cost of the referral is relatively small, but the cost of getting it wrong is large.
Someone I know recently had a referral - it's pretty light touch, you just get a prompt appointment, and they do a minor op to remove the mole, and send it to the lab for testing. Luckily in their case, it wasn't cancer. But nothing in the process seemed weird, it was just the way of the GP escalating it because they couldn't be sure. Hypothetically, if the AI had been able to diagnose with higher certainty than the GP, all of this could have been avoided, so definitely room for improvement.
Someone I know recently had a referral - it's pretty light touch, you just get a prompt appointment, and they do a minor op to remove the mole, and send it to the lab for testing. Luckily in their case, it wasn't cancer. But nothing in the process seemed weird, it was just the way of the GP escalating it because they couldn't be sure. Hypothetically, if the AI had been able to diagnose with higher certainty than the GP, all of this could have been avoided, so definitely room for improvement.
Do all cases in the UK start with a GP? No ability to go straight to a dermatologist? And are all dermatologists based out of hospitals?
In the US, we'd just go straight to a dermatologist, who would either remove it on the spot, or for a location that's liable to scar badly, refer to a specialist surgeon. For somebody fair skinned with lots of sun damage like myself, it's an annual "ritual".
In the US, we'd just go straight to a dermatologist, who would either remove it on the spot, or for a location that's liable to scar badly, refer to a specialist surgeon. For somebody fair skinned with lots of sun damage like myself, it's an annual "ritual".
Most UK health stuff starts with a GP appointment.
Even for private health care, you usually see a GP first (could be a private GP or NHS, in-person or video) and they then refer you to the next thing whatever that may be. ( N.B. that a NHS GP can give you a referral that you use for private treatment)
There are some things you can just straight up book an appointment for yourself without a referral from a GP, but 95% of the time you start with a GP.
No idea specifically about dermatologists, but my expectation would be that would be the sort of thing that would need a referral for. Perhaps for some "non-medical" procedures and 100% for cosmetic procedures you don't need a referral, but anything even tangentially close to The C Word would almost certainly be sending you down the normal channels.
Even for private health care, you usually see a GP first (could be a private GP or NHS, in-person or video) and they then refer you to the next thing whatever that may be. ( N.B. that a NHS GP can give you a referral that you use for private treatment)
There are some things you can just straight up book an appointment for yourself without a referral from a GP, but 95% of the time you start with a GP.
No idea specifically about dermatologists, but my expectation would be that would be the sort of thing that would need a referral for. Perhaps for some "non-medical" procedures and 100% for cosmetic procedures you don't need a referral, but anything even tangentially close to The C Word would almost certainly be sending you down the normal channels.
I wonder what % of GP skin consults result in a referral? If it’s even remotely close to a majority, seems like it would be better just going straight to the dermatologist.
Sample of one, but every spot (5+ over the past decade) I’ve asked my dermatologist about has resulted in a biopsy and of those several were cancer.
Sample of one, but every spot (5+ over the past decade) I’ve asked my dermatologist about has resulted in a biopsy and of those several were cancer.
> every spot (5+ over the past decade) I’ve asked my dermatologist about has resulted in a biopsy
Not to be too cynical but... is there a financial incentive for them to do a biopsy?
Of course it might be best practice as well.
Not to be too cynical but... is there a financial incentive for them to do a biopsy?
Of course it might be best practice as well.
I’m sure there is an incentive, but at least in my case the rate of biopsy to confirm cancers is greater than 50% so it certainly seems to me like the biopsies are in fact warranted.
> In the US, we'd just go straight to a dermatologist
In the US, you would go straight to a dermatologist, because your health insurance plan (or high paying job) allows you to do that.
People with an HMO would begin with the GP, because that's what the plan requires.
In the US, you would go straight to a dermatologist, because your health insurance plan (or high paying job) allows you to do that.
People with an HMO would begin with the GP, because that's what the plan requires.
> Do all cases in the UK start with a GP?
yes, and in the entire GP practice they do not have a single device invented in the 21st century. All the tools they have are a stethoscope, oxymeter, otoscope, blood pressure monitor, basically stuff you might have at home
They can't, for example, do a rapid antigen test or a lateral flow test, ultrasound or anything else you may consider a sign of modern medicine and diagnostics. Stuff countries in Eastern Europe and East Asia have already adopted.
Their diagnostic conclusion is heavily influenced by a spreadsheet that lists statistic probability of illness for different demographics, as advised Mckinsey.
If you happen to have a serious condition but fall into a group that is 'suppose to be' healthy (young man with Pneumonia) you will be bounced and told to go home until your condition deteriorates.
They will gatekeep you from getting an X-ray. When your condition deteriorates and is incontrovertible you will be taken seriously, but now you need serious treatment instead of a quick round of antibiotics.
Popular opinion in Britain is that the NHS is great, but it's overburdened. But it's fallen behind - management practices are archaic, diagnostics is poor, and there is lack of accountability and first reaction to medical errors is to brush off the patients / victims.
Over the past few decades, the first reaction of NHS management is to cover up their mistakes.
Just read the Wiki page about Great Ormond Street Hospitalk, the hospital that treats the country's most severely ill children:
> Great Ormond Street Hospital was involved in a scandal regarding the removal of live tissue and organs from children during surgery and onward sale to pharmaceutical companies without the knowledge of parents in 2001
Or the case with bone surgeon Yaser Jabbar, at the same hospital, who caused severe harm to 22 children and the hospital fought the parents and brushed issues under the carpet. Issues like removing wrong organ and getting length of a foot wrong by 20 centimeters. He operated on 700 children before someone put a stop to it
yes, and in the entire GP practice they do not have a single device invented in the 21st century. All the tools they have are a stethoscope, oxymeter, otoscope, blood pressure monitor, basically stuff you might have at home
They can't, for example, do a rapid antigen test or a lateral flow test, ultrasound or anything else you may consider a sign of modern medicine and diagnostics. Stuff countries in Eastern Europe and East Asia have already adopted.
Their diagnostic conclusion is heavily influenced by a spreadsheet that lists statistic probability of illness for different demographics, as advised Mckinsey.
If you happen to have a serious condition but fall into a group that is 'suppose to be' healthy (young man with Pneumonia) you will be bounced and told to go home until your condition deteriorates.
They will gatekeep you from getting an X-ray. When your condition deteriorates and is incontrovertible you will be taken seriously, but now you need serious treatment instead of a quick round of antibiotics.
Popular opinion in Britain is that the NHS is great, but it's overburdened. But it's fallen behind - management practices are archaic, diagnostics is poor, and there is lack of accountability and first reaction to medical errors is to brush off the patients / victims.
Over the past few decades, the first reaction of NHS management is to cover up their mistakes.
Just read the Wiki page about Great Ormond Street Hospitalk, the hospital that treats the country's most severely ill children:
> Great Ormond Street Hospital was involved in a scandal regarding the removal of live tissue and organs from children during surgery and onward sale to pharmaceutical companies without the knowledge of parents in 2001
Or the case with bone surgeon Yaser Jabbar, at the same hospital, who caused severe harm to 22 children and the hospital fought the parents and brushed issues under the carpet. Issues like removing wrong organ and getting length of a foot wrong by 20 centimeters. He operated on 700 children before someone put a stop to it
And why are skin cancers being referred to a hospital at all?
Personal experience in the US... treatment can be done on the spot at the primary dermatologist's office (curettage usually) or referred either to a Mohs specialist or a plastic surgeon (both of whom usually treat at their office). Short of a melanoma that's progressed/metastasized, I don't think I've ever heard of a skin cancer being treated at a hospital (not saying it doesn't happen, only that that would be an exception, based on personal/family/friend experiences).
Personal experience in the US... treatment can be done on the spot at the primary dermatologist's office (curettage usually) or referred either to a Mohs specialist or a plastic surgeon (both of whom usually treat at their office). Short of a melanoma that's progressed/metastasized, I don't think I've ever heard of a skin cancer being treated at a hospital (not saying it doesn't happen, only that that would be an exception, based on personal/family/friend experiences).
I don't really know anything about the UK medical system, but my guess is comparing it with how the US works isn't a good fit.
Just doing a quick google search on dermatologists in the UK mostly pointed at hospitals that offered the service, so may have something to do with that.
Just doing a quick google search on dermatologists in the UK mostly pointed at hospitals that offered the service, so may have something to do with that.
> And why are skin cancers being referred to a hospital at all?
I'm working on deciphering the Google Mock API right now. It's just one of those fucking things you do, you know? Figuring out how to set expectations on parameters, etc. Hundreds of thousands of SDEs and students went through it before it became second nature.
I dream of playing around with some future testing language where I can build mock blocks in a Scratch-like manner. Awesome, eh?
Fuck yeah, Alan Kay.
Maybe I could work on the team that builds it.
But who am I kidding? I get to be pushed into other work while I waste time to filling out unnecessary tax paperwork.
Because to get more medical lab work done, I need to have authentic IRS transcripts.
A written 1040 isn't enough.
Otherwise I have to go to the hospital to get imaging.
It wasn't necessary. Signed fully electronic non-forgible IRS forms for health purposes could have been done with minimal citizen pushback.
With, and this is key, an educated public who understood the economics.
So I'll work on wasting my time educating loved ones on the economics of paper-less forms and all forms of monopolies while I say no to future shows in Chicago or Canada or wherever.
I'm working on deciphering the Google Mock API right now. It's just one of those fucking things you do, you know? Figuring out how to set expectations on parameters, etc. Hundreds of thousands of SDEs and students went through it before it became second nature.
I dream of playing around with some future testing language where I can build mock blocks in a Scratch-like manner. Awesome, eh?
Fuck yeah, Alan Kay.
Maybe I could work on the team that builds it.
But who am I kidding? I get to be pushed into other work while I waste time to filling out unnecessary tax paperwork.
Because to get more medical lab work done, I need to have authentic IRS transcripts.
A written 1040 isn't enough.
Otherwise I have to go to the hospital to get imaging.
It wasn't necessary. Signed fully electronic non-forgible IRS forms for health purposes could have been done with minimal citizen pushback.
With, and this is key, an educated public who understood the economics.
So I'll work on wasting my time educating loved ones on the economics of paper-less forms and all forms of monopolies while I say no to future shows in Chicago or Canada or wherever.
This reminds me of Machine Learning techniques being used at the Policlinico of Bari in collaboration with the Politecnico of Bari, detective cancer, more than 10 years ago
Why go to the hospital at all? Just take the photo at home.
As someone with a phenotype more subject to skin cancer, I have been using an app called SkinVision for years.
From my anecdotal experience it tends to flag the same moles as dermatologists do, and they have actual dermatologists review images where the model has low confidence, so overall pretty happy with it.
Note that I am not affiliated with them in any way.
From my anecdotal experience it tends to flag the same moles as dermatologists do, and they have actual dermatologists review images where the model has low confidence, so overall pretty happy with it.
Note that I am not affiliated with them in any way.
Interesting information snipped from their website .... I'm in Australia so will try it out. Yes specifically says its not available in US
About SkinVision SkinVision was founded in 2012 and provides a mobile phone application, which supports individuals with the early detection of the most common forms of skin cancer (melanoma, squamous cell carcinoma, basal cell carcinoma, and precancerous actinic keratosis). SkinVision is the first CE marked skin cancer application based on extensive clinical trials, conducted in partnership with Erasmus Medical Center (EMC) and the university clinic of Ludwig Maximilian University (LMU). Research shows the app has a sensitivity of 95% and a specificity of 78%. The SkinVision app is commercially available worldwide on iOS and Android except for a few countries, such as the United States and Canada. SkinVision is based in Amsterdam, the Netherlands.
The SkinVision Service is a Medical Device and is registered with the Australian Therapeutic Goods Administration (TGA).
About SkinVision SkinVision was founded in 2012 and provides a mobile phone application, which supports individuals with the early detection of the most common forms of skin cancer (melanoma, squamous cell carcinoma, basal cell carcinoma, and precancerous actinic keratosis). SkinVision is the first CE marked skin cancer application based on extensive clinical trials, conducted in partnership with Erasmus Medical Center (EMC) and the university clinic of Ludwig Maximilian University (LMU). Research shows the app has a sensitivity of 95% and a specificity of 78%. The SkinVision app is commercially available worldwide on iOS and Android except for a few countries, such as the United States and Canada. SkinVision is based in Amsterdam, the Netherlands.
The SkinVision Service is a Medical Device and is registered with the Australian Therapeutic Goods Administration (TGA).
Looks like it’s not available in the US unfortunately.
One of the problems with these sorts of machine learning applications, including this exact use case elsewhere, is that they have been extremely sensitive to the imaging equipment used. Train it on a dataset of images from one source and it is only accurate on images from that source. Possibly only accurate on images from the exact same device. For home use, it needs a huge training set of images taken by all sorts of devices in all sorts of lighting conditions. And then the system will need to be improved until the error rates become useful.
4 years ago I had my partner take photos of moles that had changed colour on my back. I used the MySkinDoctor app https://www.myskindoctor.co.uk/ to send them to my consultant dermatologist (who, at the time, I had never met -- having just moved to a new area). Upon review they arranged for an in-person appointment and I was seen within a week or so. All through the NHS.
So yes, taking the photo at home is perfectly doable. I still went to hospital though.
So yes, taking the photo at home is perfectly doable. I still went to hospital though.
I develop the backend for that. Nice to hear it worked well for you.
Google announced this in 2021, but never released it AFAICT: https://blog.google/technology/health/ai-dermatology-preview...
I assume if you get a positive response you will want to speak with doctor about it
If the thermometer says 39 C/102 F I will want to speak with a doctor about it but that doesn't mean I want to go to the hospital every time I want my temperature checked.
I suspect it has a lot more to do with these lines:
> medical photographers taking photos of suspicious moles and lesions
I.e. it might not be ready enough or validated for an average person snapping their own photo and:
> The images are then transferred to a desktop computer for greater analysis before the tool determines the result
There is more to it than the phone app and it may not be packaged in a way that is currently worthwhile to distribute to home users.
Both of these (and other things) may change with time of course.
I suspect it has a lot more to do with these lines:
> medical photographers taking photos of suspicious moles and lesions
I.e. it might not be ready enough or validated for an average person snapping their own photo and:
> The images are then transferred to a desktop computer for greater analysis before the tool determines the result
There is more to it than the phone app and it may not be packaged in a way that is currently worthwhile to distribute to home users.
Both of these (and other things) may change with time of course.
Article says medical photographers take the pictures. I'd guess a future iteration will have the app direct the patient to take the pictures.
Certain skin cancer detection methods necessitate direct contact with the affected area to identify any abnormalities.
Because you don't know what the lighting is, what the sensor is, and what kind of shit the camera app and ISP are doing to the image without telling you
I recently tried to show some images to a vet. Something in my phone fucked up the amount of red in the image, making them useless (guess what, figuring out how much blood is present is pretty important for medical applications)
Probably at some point we will all have a separate medical camera with specified response and with a specified led illuminator. Apple will probably get their phone certified in some medical camera mode. Right now I don't think phone cameras can be trusted
Not all applications need accurate colour, (no idea about cancer checks) but some really do.
I recently tried to show some images to a vet. Something in my phone fucked up the amount of red in the image, making them useless (guess what, figuring out how much blood is present is pretty important for medical applications)
Probably at some point we will all have a separate medical camera with specified response and with a specified led illuminator. Apple will probably get their phone certified in some medical camera mode. Right now I don't think phone cameras can be trusted
Not all applications need accurate colour, (no idea about cancer checks) but some really do.
This is ML. I guess AI term can apply here but I think it's a bit disingenuous to advertise as such. People will conflate the term with llm chat bots.
https://skin-analytics.com/wp-content/uploads/2024/06/Artifi...
https://skin-analytics.com/wp-content/uploads/2024/06/Artifi...
What is AI to you? Neural nets only? LLMs?
I still have my textbook from almost 20 years ago: "Artificial Intelligence: A modern" by Peter Norvig. Lots of topics covered as AI there that surely do not meet your definition.
I still have my textbook from almost 20 years ago: "Artificial Intelligence: A modern" by Peter Norvig. Lots of topics covered as AI there that surely do not meet your definition.
AI is buzzword bingo and has been since introduced to computing in the 60's.
Just clasify the method used as what it is to a supposedly educated crowd. There is no need to classify a marketing term. And yes, for that book it's also just marketing.
Just clasify the method used as what it is to a supposedly educated crowd. There is no need to classify a marketing term. And yes, for that book it's also just marketing.
Agreed, AI is a marketing term. Use the underlying methods and technology.
I've relented, I accept now that AI is an umbrella term to represent many different methods, algorithms and technologies.
Modern day usage of AI is heavily conflated with generative AI such as LLMs and Text-to-* generation systems.
My preference, as someone who works in a very closely relate field to the article, is that science should stay away from non-specific terms like AI. I've had my director approach me seeking grant ideas on using AI. It didn't go down very well when I suggested we should try to use image recognition to automate data entry. That seemed 'old', they wanted a chat bot to do... something.
Modern day usage of AI is heavily conflated with generative AI such as LLMs and Text-to-* generation systems.
My preference, as someone who works in a very closely relate field to the article, is that science should stay away from non-specific terms like AI. I've had my director approach me seeking grant ideas on using AI. It didn't go down very well when I suggested we should try to use image recognition to automate data entry. That seemed 'old', they wanted a chat bot to do... something.
> "At the moment that technology is limited because you need a dermoscopic lens which the public wouldn't necessarily have access to, but I'm sure with time the technology will advance and we will have effective apps that patients can access from the comfort of their own home."