sxg · HackerTrans

9 gün öncediscuss

We already routinely ultrasound limbs! This is primarily for muscle, tendon/ligament, and other superficial soft tissue injuries because ultrasound is very good at imaging these structures. Cancers and other subtle yet dangerous pathology disproportionately DO NOT occur in the limbs. So there's really no point in imaging the limbs of healthy people without a specific injury or pain.

sxg

9 gün öncediscuss

Here's my take as a radiologist: this seems like a neat imaging tool that complements existing imaging tools (CT/MR) with new tradeoffs and questionable value. If whole-body ultrasound does provide value, it'll take quite a while (likely decades) for this to become a standard imaging tool offered by hospitals and physicians because the clinical trials to show any positive value take years, and then you have to convince insurance companies and Medicare to pay for it, and then you have to establish guidelines for physicians explaining when whole-body ultrasound may be appropriate to order.

Like the video says, this isn't a replacement for MRI or CT. Ultrasound has amazing superficial spatial resolution, but it falls off dramatically with depth, so the center of your body is essentially un-imageable. Ultrasound also struggles to penetrate air and bone. The video says having multiple probes around your entire body helps mitigate this, but I'm skeptical about how much that helps in practice. Your lungs take up the vast majority of your thoracic cavity, and your partially air-filled GI tract takes up a lot of your abdominopelvic cavity.

Based on how other preventative care and screening tools have panned out in recent years, I think this is going to yield pretty blurry images in relatively healthy patients that push them into getting more conventional imaging (e.g., MRI or CT). This in turn yields more false positives and biopsies with non-zero risk that likely outweighs any potential benefit of whole-body ultrasound. Counterintuitively, it's rare for proactive/preventative interventions in medicine to actually help people.

sxg

13 gün öncediscuss

> But are you all forgetting that they literally injected a homeopathic drug on the author?

I'm no fan of pseudoscience either, but this is where things get blurry. The placebo effect is real even if patients are aware of it. If you give a patient a homeopathic drug while informing them of potential side effects (if any), and then they feel better, have you hurt them? Or have you helped them?

I personally have no interest in trying homeopathic medicines, but the reality is that many patients do take these and are adamant they help. As long as any risks are communicated and there are no serious side effects, it's difficult to make an argument against their use in patients who report a subjective benefit.

sxg

13 gün öncediscuss

I get what you're saying, but I'm not deciding what should and shouldn't count as an alternative to X. I'm trying to answer the counterfactual: how do people behave in an alternative world without Wikipedia but otherwise identical to our world?

sxg

13 gün öncediscuss

It does both: https://www.openevidence.com/user-guide/visits-overview

sxg

13 gün öncediscuss

The specific case doesn't matter--it's meant to make you think about the general question throughout this thread: when an expert isn't available, should non-experts use AI (or other tools) to help themselves? Sometimes the answer is yes because the potential benefits outweigh the potential harms (if any harms exist). But sometimes the answer is no because misleading/incorrect advice can cause a net harm.

sxg

13 gün öncediscuss

We're discussing calcific tendinitis (https://radiopaedia.org/articles/calcific-tendinitis?lang=us). If you think you have it, you can see a doctor and consider shoulder radiographs to start.

sxg

13 gün öncediscuss

I used the phrase "most likely alternative" intentionally. The library is where people should go to get answers in a world without Wikipedia, but the vast majority of people won't. So in practice, most non-experts either learn from Wikipedia or don't try to learn anything at all.

sxg

13 gün öncediscuss

In certain circumstances, the answer is yes. If an airplane's pilots are incapacitated, do you simply give up and crash the plane because there are no other pilots on board? Or would you rather have someone on the ground try to coach a passenger into at least attempting to land the plane?

sxg

13 gün öncediscuss

I see your argument, but it's not exactly news that an expert found a flaw in a popular tool. You could say the same about Wikipedia--experts have tons of issues with it, but Wikipedia still provides value to non-experts. The most likely alternative to Wikipedia for non-experts is simply not trying to learn anything new.

Similarly with LLMs, you can't just write them off entirely because they sometimes provide misleading or incorrect advice. The positive utility maximizing view is to learn when you need to call in an expert. I recently moved in to a new house and have used Claude extensively to figure out basic things (e.g., adjusting the garage door height, how to mount a TV). However, when the HVAC suddenly stopped working, I gave Claude a shot for an hour and tried some non-destructive fixes, but then realized I had to call in an HVAC expert.

sxg

13 gün öncediscuss

They do. Ultrasound in orthopedics is a relatively newer field, and there aren't quite as many sonography techs and radiologists experienced in reading these studies, which is likely why you don't see it offered more widely.

Edit: I should mention that ultrasound is basically unusable for evaluating bones. Sound waves can't penetrate bone, and so you end up just seeing a huge black void. That's a huge orthopedics use case that ultrasound just can't benefit. However, ultrasound is fantastic for evaluating muscles, ligaments, tendons, and other superficial soft tissues.

sxg

13 gün öncediscuss

I'm a radiologist but can't really weigh in without seeing the full 3D MRI dataset. Regarding this point:

> They performed shockwave therapy on my shoulder even though a recent clinical practice guideline says clinicians should not use or recommend shockwave therapy for rotator-cuff tendinopathy without calcification; I was told during ultrasound that there was no calcification.

Ultrasound isn't a great way to assess for calcification. It'll find large calcification but easily miss small ones. Plain radiograph would be more helpful, but the MRI may have revealed it as well. Either way, shockwave therapy isn't harmful in the absence of calcification--it's just not helpful.

Edit: when a radiology report says something isn't present, there's always an implicit caveat that the finding isn't present within the context of the modality and images obtained. So an ultrasound report can state there are no calcifications while a plain radiograph can report the presence of calcifications without being inconsistent. Obviously very confusing to patients and people unfamiliar with medical jargon, but clarifying this in reports would make them sound even more qualified, "hedgey", and annoying to read than they already are.

sxg

25 gün öncediscuss

You can create custom aliases on your own domain. I do this for every log in and am migrating old emails to my custom domain aliases.

sxg

2 ay öncediscuss

I'm a physician and have recently been on both sides of the hiring process for new physicians and residents at a few different institutions. It's absolutely not meritocratic--you'd be shocked at how strong a role connections and pedigree play. The hard requirements are just table stakes, but the selection process from there is completely subjective and susceptible to all kinds of problematic biases. Generally people don't want to rock the boat and discuss this stuff openly, but it's absolutely a problem that needs to be pointed out.

sxg

2 ay öncediscuss

Take a look at how things worked before (and still do): employers decide who get jobs based on a combination of personal biases, nepotism, and ulterior motives while applicants present distorted versions of themselves and network/pull strings to put the odds in their favor. That seems more problematic.

sxg

4 ay öncediscuss

Some of it is lack of imagination, but some of it is because many truly visionary examples would largely sound stupid to most of today's audience. Imagine it's 2007 and you're explaining how the smartphone will change society over the next 20 years:

- A photo sharing app will change restaurants, public spaces, and the entire travel industry across the world

- The smartphone will bring about regime change in Egypt, Tunisia, Lebanon, and other countries in ~4 years

- We'll replace taxis and hotels by getting rides and sharing homes with strangers

- Billions of people across the world will never need to own a desktop or laptop

- A short video sharing app will kill TV

- QR codes become relevant

Most of these would be a hard sell at the time.

sxg

4 ay öncediscuss

KDE was far less mature than macOS and Windows 10 years ago. Of course it’s come a long way.

sxg

4 ay öncediscuss

I think you may have missed the original commenter's point. Residents (and medical students) are highly incentivized to publish unrealistic numbers of papers and case reports. One case report doesn't cut it—you need literally dozens of publications to match into some of the most competitive residency and fellowship programs. The NRMP (match organizer) publishes a document every 2 years that summarizes all of these stats. The 2024 version is in the link below, and page 12 supports what I'm saying.

https://www.nrmp.org/wp-content/uploads/2024/08/Charting_Out...

sxg

5 ay öncediscuss

How can you determine whether it's as good as Opus 4.5 within minutes of release? The quantitative metrics don't seem to mean much anymore. Noticing qualitative differences seems like it would take dozens of conversations and perhaps days to weeks of use before you can reliably determine the model's quality.

sxg

5 ay öncediscuss

Yes, you could early-detect something, but the likelihood of this thing being life-threatening are extremely low. If you choose to manage this thing aggressively anyway, you have to undergo more invasive testing (e.g., biopsies, surgery, anesthesia, etc.) that all have small risks of catastrophic events. In most cases, the risks of more invasive testing outweigh the risks of just not pursuing any further workup.

Nothing in medicine comes for free—everything is a tradeoff.

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