Thanks. Mainly commenting to bookmark this for an aviation project I’m working on. Let me know if there’s anything that differentiates you - particularly for aviation. Thanks.
So good. But 31kbps? Wow. You guys were spoilt. 28.8 is the best we got and on a very good day when the lines were nice and dry. I think he even nailed the link upgrade sound on the modem.
My first interaction with the internet was an old Windows 3.1 machine with 14.4kbps modem, then we upgraded to a Windows 95 machine with 28.8kbps and later we swapped out the ISA modem for a PCI 56kbps modem. Then ADSL came along and the rest is history. Presumably the modem in this example is a 33.6kbps V.34 modem which had a slightly lower sync negotiated due to a poor line.
Yeah I don't think we ever got that fast in South Africa. I started out on a 1200 baud modem on something called Beltel which is like Prestel which was the UK equivalent. At the time our entire country's international internet connection was via a 9600 modem based at Grahamstown university and the other universities shared that link AFAIK. Then I got a borrowed VMS account at university of cape town which I could use to telnet to a sun unix box and run IRC and my life changed. Was also phone phreaking from Cape Town at a little later on using BlueBeep to connect to a BBS in Orange County called Digital Decay. Was suuuper lucky when I'd get a 14.4 connection on the international trunk. Mostly it was slower. But the AT&T home country directs had the best lines when they were seizable.
Someone needs a hug. Honestly I've started writing only to realize how much code output will be wasted over the next hour or two, so I just go back to coding the amazing product I'm working on with amazing agents, that would simply not be possible if I didn't have access to the AI tools I'm using. It's going to make many humans profoundly more safe. I'm very excited. I hope you are excited about your project too.
Good move. OpenClaw is alpha quality, very dangerous, super useful and super fun - which amplifies the danger. It’s a disaster waiting to happen and a massive risk for a solo dev to take on. So best to trade it for a killer job offer and transfer all that risk.
To get a sense of what this guy was going through listen to the first 30 mins of Lex’s recent interview with him. The cybersquatting and token/crypto bullshit he had to deal with is impressive.
He's not really trading anything though. He was hired by OpenAI. OpenClaw will remain free and open source (it's the first line of his blog post). He says that OpenAI will allow him to work on it and already sponsors it so maybe that means he'll have time to improve it, I guess.
Given he's moving to SF to work in their office I presume part of it is he'll be working in-house on their commercial replacement, and will continue to cover costs on the OSS version which he's free to work on. His recent posts make it clear they've got plans for their own stuff to replace it.
Right, he indicated he's losing $10-20k a month on OpenClaw. Might as well let OpenAI absorb those losses and join the rocket ship.
The guy is a multi millionaire from selling his old software so I'm doubtful it is about the money for him at this point as much as it is the experience working with this tech on another level.
While that might take it a little too far, Lex surely is a dangerous individual. On various occasions did he sympathize with the war and terror that Russia is doing in Ukraine. I do not click on any of his content because I will not support these (and a few other questionable, to say the least) views of his. Also his image of an MIT researcher is hilarious.
> On various occasions did he sympathize with the war and terror that Russia is doing in Ukraine.
I'm not a devotee of his but I've listened to a few of his podcasts when I like the guest. I have an idea of how someone would come away with your impression given lex's interview style but I'd be pretty surprised if anything he said would, to me, fit your impression.
That said, I'd like an example if you have something specific to point to that might change my mind or if it's just a general takeaway you've gotten from a corpus of interviews on the topic (which would be totally valid but wouldn't change my mind).
> That said, I'd like an example if you have something specific to point to that might change my mind
This guy wanted Putin on his podcast to hear his side of the story (let that sink in) and spoke Russian to Zelensky. Willingly wanting to provide a platform for a mass murderer who is best known for large-scale social media propaganda.
This is not an "impression" of his "interview style". This guy implicitly supports terrorist acts.
> This guy wanted Putin on his podcast to hear his side of the story (let that sink in)
Many people have interviewed serial killers and not supported serial killers.
I would very much like to know Putin's actual motivations which would unlikely be spoken but his stated motives would also be enlightening.
I'm sure he'd go on with the standard "Nazis in Ukraine" line but in a 2-3 hour interview, I might get some new insights I don't get from 3 sentence sound bites.
We know so much about Hitler from his own writings and speeches. It seems to me that your philosophy on "platforming" Putin would also apply to making the words of Hitler available to the public.
Is there someone you think _could_ interview Putin responsibly?
> spoke Russian to Zelensky
I don't see the significance of that. They both speak Russian and English fluently. I don't know if Friedman speaks Ukranian but I'm not understanding what the implication is here. Surely the interview was in English since the podcast is?
> This is not an "impression" of his "interview style". This guy implicitly supports terrorist acts.
Implicitly being the key word here and is certainly subjective. If the body of evidence you're presenting is "would interview Putin" and "spoke Russian to Zelensky", I don't find that convincing.
Pretty sure he’s a complete fraud too. He associates himself with MIT despite only having had a short stint teaching non-credit classes. One of his papers was apparently so flawed it’s been wiped from existence. Plenty of info online if you want to go down the rabbit hole.
It really is quite funny though isn't it. Yes, it's a fucking hand grenade that will blow up at any moment. It's perfect for a one man band startup. Because there's massive upside and at the end of the day if it blows up he's just back to sqaure one, what did you expect from a 1 man band.
But wait. Here he comes. Hero of the hour. Sam Altman.
Let's take that wildly dangerous, lightly thought through product, and give it the backing of the leading AI lab. Let's take all that pending liability and slap it straight onto the largest private company in AI.
OpenClaw is more like an art project than a consumer product. It has shown clear consumer product demand. The next step is making it a safer consumer product.
Examining Glenn's work through an ideological lens leads to this kind of rhetoric. It's why he's so good at what he does. He's crossed ideological boundaries constantly in pursuit of the truth of a matter, and in defense of the public.
I think what they are saying is a common sentiment among people who don't belong in any of the major political camps. It's a common experience to take heat from all sides because, surprisingly, neither "side" in politics is perfect nor particularly virtuous.
But we're not criticizng him for not registering for the democratic national convention or the republican one or whatever you think "belonging to a political camp" even means (what does it mean, exactly?)
He's being crticized for repeating lies and refusing to post truths.
If only his ideology was "Republican America bad, Democrat America good", then he would not be aligned with foreign influence and wouldn't be spreading propaganda.
To anyone on Twitter in like 2016-2019, this is a rather funny sentiment to have about him. I can remember my respect for him dissolve day by day. I didn't even remember until now if he was pro- or anti- Trump, probably neither still. But I simply remember that he slowly turned into the worst caricature of a smug Twitter media guy. Just turned into "hot take" haver and seemed to lose his own plot.
If you know you know I guess, but even then, broken clocks and all that. There was a point where he was such a cool guy to me, and I grew up a little in a good way seeing him turn into whatever he did.
It may just be Twitter's fault at the end of the day too!
That’s my impression, too. Not hardcore MAGA so much as falling into the addiction of thinking he was smarter than “the establishment” about everything and taking contrarian stances to show they couldn’t boss him around. Twitter’s algorithm was like a drug for those guys because they’d give a radioactive hot take and get a bazillion notification pings.
Uh, that’s how he likes to style himself but that’s more of an ideological stance than you’re complaining about. A true focus on truth and defense of the public would have included questions like “are the Russians totally unbiased in feeding me this information?” or “am I serving the public by refusing to admit I made a mistake and repeated untrue claims which were highly beneficial to the political party who amplified my claims?”
Laura Poitras' documentary Citizenfour is an excellent introduction to the amazing work that Glenn does and has done, and how he's been personally targeted - although I don't recall whether the doc includes Glenn's partner being harassed by US authorities.
"The math is simple: if it costs almost nothing to build an app, it costs almost nothing to clone an app. And if cloning is free, subscription pricing dies. We're already seeing this play out in the numbers. Apple's App Store got 557K new submissions in 2025, up 24% from 2024 (source: Appfigures). That's not because people suddenly got more creative. It's because building an app went from a $50K project to a weekend with Claude."
No. It's because people got more creative. There are tens of thousands of us who are absolutely on fire creating new products, better versions of old products, new product categories etc. Many of us are burnt out OG programmers who have rediscovered our love for programming. Now we can create without the drudgery.
You're about to see the most tech innovation our species has ever experienced. Hold on to your seat.
Both are true. You’ll see innovation and you’ll see the cost of these very abundant simple apps go to zero. There’s no way around it. Supply and demand. Everyone can make apps, but there isn’t an obvious reason why people would be buying more apps. More apps made + same apps bought = cheaper apps.
This matches what I'm seeing. The AI tooling didn't make building cheaper — it made building fun again. The gap between idea and working prototype collapsed, and that's bringing a lot of experienced builders back off the sidelines.
> No. It's because people got more creative. There are tens of thousands of us who are absolutely on fire creating new products, better versions of old products, new product categories etc.
Nitpicking, but I would argue that people have always been creative, it's a function of our brains. With the ubiquity of camera, videos now show that even birds and animals have levels of creativity. Biological/physical/physics/societal restrictions prevent them from taking it to the next level. Look at what ancient peoples managed to achieve without the benefit of modern tools and techniques; hard to argue people haven't always been creative.
What has changed is the ability to implement our ideas and harness our creativity - that has become significantly simpler in the age of AI.
Perhaps the discrepancy between the OP's framing of what's happening (negative impact to developers because app cost has gone to zero) and your positive perspective (hey, look at all these creative ideas we are now implementing) is a matter of perspective: you're both describing the same phenomenon, just different angles.
“ One study in 2020 found that 95% of asymptomatic patients had some type of "abnormal" finding, but just 1.8% of these findings were indeed cancer.”
This has been my experience. And I’ve had oncologists echo exactly this. In the words of one: MRIs find too much.
The CT and the PET/CT are the gold standards for finding cancer, finding recurrences, and staging cancer. The trouble is the radiation dose.
MRI provides very inconclusive results. You’ll see something but it’ll be unclear what it is. And often what you see is not even visible on a CT. Or it’s visible on a PET/CT and is showing metabolic activity indicating its cancer.
MRIs are great for certain things like herniated disks in your back. They suck at cancer.
It's not that MRIs suck at cancer. They provide fantastic structural and functional data.
The problem is the specificity of the results and the prior.
A full body MRI by definition will provide detailed views of areas where the pretest probability for cancer is negligible. That means even a specific test would result in a high risk of false positives.
As a counter point, MRS means that you can now MRI someone's prostate and do NMR on lesions you find.
Lets say someone has lower urinary tract symptoms. And is 60 years old. An MRI could visualize as well as do a analysis that would otherwise require a biopsy. With the raised prior you can be quite sure suspicious lesions are cancerous.
Similarly for CNS tumours. Where fine detail. Subtle diffusion defects can mark csncers you couldn't even see if you cut the person open.
No sensible doctor would give you a whole body CT unless there was a very good reason. That very good reason is probably "we already think you have disseminated cancer". That pushes the prior up.
And less so for a PET/CT. Lets flood you with x-rays and add some beta radiation and gamma to boot!
The danger of an unnecessary CT/PET is causing cancer, the danger of an unnecessary MRI chasing non existent cancer.
> Lets say someone has lower urinary tract symptoms. And is 60 years old. An MRI could visualize as well as ...
Not a doctor - but maybe start with some quick & cheap tests of their blood & urine, polite questions about their sexual partners, and possibly an ultrasound peek at things?
At least in America, high-tech scans are treated as a cash cow. And cheap & reasonable tests, if done, are merely an afterthought - after the patient has been milked for all the scan-bucks that their insurance will pay out.
> At least in America, high-tech scans are treated as a cash cow. And cheap & reasonable tests, if done, are merely an afterthought - after the patient has been milked for all the scan-bucks that their insurance will pay out.
Maybe it's a regional thing, but that hasn't been my experience. I've had one MRI and one CT scan in the 25+ years that I've been a full-time employed adult with insurance.
I'd have been happy to sign up for more so I could have proactive health information and the raw data to use for hobby projects.
> The danger of an unnecessary CT/PET is causing cancer
You'd have to be massively overexposed to CT or PET scanning to cause cancer, like in the region of spending months being scanned continuously with it at full beam current.
Even if you don't agree with linear no threshold models for cancers induced by radiation (I don't think LNT is accurate).
It comes down to the scan and the age.
3 scans for a 1 year old? Strongly associated with cancers later in life. 5 scans of a 50 year old? Less so.
The 1 year old has an 80 year run way to develop cancer, along with cells already set in a state of rapid division, and a less developed immune system.
There's excellent reason to think LNT is accurate: at low doses, almost every cell is exposed to at most one radiation event. The dose affects how many cells experience a (single) event, but does not affect the level of damage to those exposed cells. Linearity naturally falls out of this.
To abandon linearity you have to imagine some sort of signalling system (not observed) that kicks in at just the dose we're talking about (not lower, not higher) to allow exposure to one cell to affect other cells.
There's also no good evidence that LNT is wrong. The typical things that are pointed to by anti-LNT cranks are cherrypicked, often involving interim results from studies the full results from which do support LNT, which is evidence it was statistical noise.
> You'd have to be massively overexposed to CT or PET scanning to cause cancer
The mean effective dose for all patients from a single PET/CT scan was 20.6 mSv. For males aged 40 y, a single PET/CT scan is associated with a LAR of cancer incidence of 0.169%. This risk increased to 0.85% if an annual surveillance protocol for 5 y was performed. For female patients aged 40 y, the LAR of cancer mortality increased from 0.126 to 0.63% if an annual surveillance protocol for 5 y was performed.
How are they determining "this cancer was caused by the CT scan" versus "this cancer was caused by the cancer we were originally looking for that was there all along"?
Well, you could work backwards and look at your assumptions.
Why is "We think this person has cancer so we gave them a CT scan and look! Now they've got cancer! It must be because of the CT scan!" the conclusion to jump to?
Please just read this article - https://jamanetwork.com/journals/jamainternalmedicine/fullar...
It's funny that you instantly assumed that authors are stupid and did not think about this obvious pitfall. It's extra funny that you also accuse them of jumping to conclusion without actually reading the article.
One caveat is that regular PET isn't so good in the brain - there is so much metabolic activity that everything glows. So I get an MRI Brain to go with my regular full body PET/CT (cancer 5 years ago with recurrence 18 months later, currently NED).
> MRIs are great for certain things like herniated disks in your back.
I have had a lot of experience with MRIs on both myself (back and knee [1]) and my dogs with herniated discs. The doctors always make it sound like MRIs are great to confirm what's suspected because of other symptoms like pain, but a point in time MRI alone is not that valuable. Everyone's bodies (including animals!) are surprisingly different inside making normal be somewhat unique. I think what would be interesting is if scanning technology like MRIs could be made so inexpensive and easy that everyone had one done 4x/year. That way it's the differential being checked and I'm guessing it would be way more valuable. Normalization such as this could also lower anxiety around findings.
[1] Even when I tore my ACL the MRI came back only as probable.
Do you know which MRI you used? Not all are equal.
Most MRI are 1.5T powered, and you can’t get fine details until you hit 3T. And there are differences even in the 3T power range. There are higher powered MRI which are mostly only used in research, whilst it is a bit scary thinking about the sheer power of them but a 7T machine doing a full scan of you, would be guaranteed nearly to find anything wrong with you.
When I last looked the full body scans for sale seemed to used 1.5T setup, which seems like a waste. The 3T advanced scans looks much more detailed, but it just depends on where you live - I couldn’t find any around.
My knee and back was years ago, so probably the 1.5T. No idea on my dogs who have had the more recent MRIs. Their scans are incredibly detailed though, so maybe the 3T?
I had a CT scan last year for some stomach issues they wanted to look at.
Doctor warned me up front that the odds the images find something that looks weird is high but not to panic because of how many false positives there are when looking inside someone’s body.
While I am happy to report they didn’t find anything serious, I do take slight offense to the following at the top of my results:
Last name, First name: Unremarkable
(Kidding of course but still got a chuckle out of me)
2.5 years in of regular PET scans. At this point, I’m almost humored by what gets flagged as suspicious by the radiologist - usually mosquito bites and stomach bugs (kids in daycare means I’m almost always sick). I have a scan Monday and two weeks ago had a re-excision so there’s a two inch gash healing on my back. This week I got three vaccines. And then tonight my toddler bit me hard enough to draw blood. I had asked the oncologist if it made sense to delay the scan because of the re-excision and he said not to worry because he’d know why there’s inflammation in that area. I’m thinking the bite and the shots will probably get flagged too. I just hope I don’t forget any other maladies or mishaps that might get flagged that I can’t explain.
How often are they finding actual positive hits on the PET? If its so unreliably with regards to false positives why do you continue to have PET scans done?
PET Scans feature areas with blood flow so tumors show up as hot spots for follow up. People who are maybe only feeling off or had one confirmed tumor can have a lot of small tumors spread across their body which will show up clearly on a PET scan.
When my brother was at the end of his run fighting cancer he felt a bit under the weather and managed to catch covid so everyone figured he was feeling bad due to that. The PET scan showed he had thousands of small masses converging into the large mass that eventually killed him by cutting off blood flow to his kidneys. His cancer was an aggressive blood cancer that had stood up to conventional and Trial Chemo drugs. There was no way to treat this but other cancers that are less aggressive can be treated at this point and would be treated differently than a single mass.
In a nutshell it’s that level of visibility that makes PET scans worth it.
PET scans are not really unreliable, they’re just very sensitive and lots of anomalies ranging from benign cysts to malignant tumors show up on them. It’s not always possible to differentiate them without other measures like biopsies, so that’s where the false positives come in.
Getting regular scans to track cancer progression is a different matter altogether, since most of the blips can be eliminated over time and there’s a history to compare against.
Anecdotal evidence to confirm: I had two false alarms from an unrelated MRI scan, and beside wasting a lot of time on diagnosing them - it was also extremely stressful.
My father is a part of "full body PET scan every 3 years" program as part of post - cancer treatment, and it worked twice: early detected lung and prostate tumors, both removed.
> My father is a part of "full body PET scan every 3 years" program as part of post - cancer treatment,
These treatments are wonderful and it is great that they exist. But many people fail to understand the difference in terms of pretest probability, etc.
I can absolutely see the heavy psychological impact pending biopsy results may have. People are quick to discount these issues when you raise them as a concern, but only if they never went through this stress themselves
Sorry, I missed a key detail. What you are describing isn’t the ‘whole body mri’ I’m referencing by to.
People in high risk situations like multiple myeloma, or various metastic diseases, or system conditions are a whole different category and there is clear benefit to screening them.
> My father is a part of "full body PET scan every 3 years" program as part of post - cancer treatment, and it worked twice: early detected lung and prostate tumors, both removed.
My mum gets scanned a little more frequently than that, following treatment for an inoperable tumour in her lung around five years ago. During treatment she was getting scanned every three months or so, and it was remarkable watching this thing go from the size of a tangerine, to actually expanding a bit and looking "fuzzy" once the drugs kicked in, to being the size of a plum, then the size of a grape attached with a little thin thread of tissue, to being a thing the size of a pea. Now there's a tiny ripple of scar tissue that no-one wants to investigate further, because if it's not doing anything let's not poke at it.
There is a roughly pea-sized "thing" on her adrenal gland that was a bit worrying because anything like that is going to get intimately involved with your lymphatic system and then it's going to metastasise like hell. But it neither got bigger nor smaller in the nearly six years since the first scan, so it can't be that important.
This is one of the great things about the NHS, especially here in Scotland where we have (possibly as a result of the weirdly high levels of cancer) some of the best oncology services in the world.
If we'd lived in the US, the insurance companies would have taken one look at an 83-year-old about to become a grandmother and sent her home with a bottle of morphine to die. As it is, she's doing very well and got to see both her grandchildren start school.
> in Scotland where we have (possibly as a result of the weirdly high levels of cancer)
Interesting, I had no idea and just looked this up[0]:
> Scotland had the highest overall incidence (446 for men and 379 for women per 100 000), and Wales had the second highest rate (450 and 366 per 100 000), compared with 394 and 338 per 100 000 in England and 394 and 345 per 100 000 in Northern Ireland.
Thanks, she had little to no side effects from the experimental immunotherapy drug. She'd said at the outset she didn't want to be a "chemo zombie" having been through all that about 20 years ago (she's had four different cancers throughout my lifetime, treatment getting better every time).
It's fucking expensive, but immunotherapy is really a miracle cancer treatment. We're not quite at "Oh you've just got a wee bit of cancer, we can give you something for that if you see the pharmacist on your way out" but we're not far off.
MRIs are good if you know what you’re looking for, and usually with contrast, which in a situation like cancer where you need to do them often can result in allergic reactions.
In a full body situation, they are looking for mets, and the uptake of radioactive sugar by the tumors will let a PET scan find them.
That’s completely and 100% false. It’s much easier to characterize things on MRI and MRI is indeed phenomenal for cancer! The problem is with screening, not actual staging or follow-up, and whole-body screening in ct and pet/ct is even worse than MRI screening even if you ignore radiation.
The argument for better screening would require that finding those asymptomatic cancers actually improves survival rates. There are several reasonable scenarios where early screening doesn't improve it:
* The cancer is aggressive and resistant to treatment. Chemo/radiation only pause the growth for a bit, but ultimately the cancer keeps growing and the total survival time is the same (only that the patient spent more time knowing they had cancer).
* The cancer is susceptible enough to treatment that it's still curable when it becomes symptomatic and found through other means.
* The cancer is slow enough that the patient dies from other causes before.
Early screening brings benefits only when the cancer ends up causing issues and responds differently to treatment between the "early screening detection" time and the "normal detection" time.
It's impossible to know beforehand which of the scenarios have more weight, specially because we have very little data on what happens way before cancer is detected via the usual methods. We need better studies on this, and for now the evidence doesn't really point out to these large, indiscriminate screenings being actually helpful.
That’s not the correct framing - your assertion first lacks evidence about why we should screen better. In fact, we aren’t improving longevity in many early diagnoses, and may be treating people whose immune system would resolve the cancers.
Further, the denominator is asymptomatic people who were able to get MRI’s they didn’t need. That doesn’t tell us anything about the normal world.
> we aren’t improving longevity in many early diagnoses, and may be treating people whose immune system would resolve the cancers.
Even assuming your statement is true, if what is detected is small enough for that there's no reason "treatment" can't just be monitoring it's size with follow-up scans.
> if what is detected is small enough for that there's no reason "treatment" can't just be monitoring it's size with follow-up scans.
This is false—it is exactly what the article is trying to convey. There is a risk to any test, and one of the major risks for imaging is getting treatment for things that would never cause symptoms or require intervention.
If the cancer is vizible in MRI or CT scans, the immune system already failed to "resolve" it and will not do so in the future, at least not without external help.
> If the cancer is vizible in MRI or CT scans, the immune system already failed to "resolve" it and will not do so in the future, at least not without external help.
This is false. A simple google search for spontaneous remission (or honestly anything similar) would show/have shown you this.
I wonder how biased the group is though, is the sample truly representative of the general population or is it a group of people who are already undergoing screen for some other health-related reason?
1. I had a chest x-ray
2. It showed a small dark patch, and my lungs over-inflate.
3. Erring on the side of caution, doctor ordered a lung biopsy.
4. Lung biopsy is painful, annoying, expensive, and non-zero-risk.
5. Lung biopsy turns up nothing. "Maybe you aspirated some food?" We learn nothing.
I don’t understand how you’re concluding that the biopsy shouldn’t have happened from that anecdote? Just because a test result is negative doesn’t mean that it shouldn’t have happened. That’s not how practicing medicine works.
Hence the N=1 I started the statement with. If we had a thousand similar situations and it turned out that in, say, 1% of cases there was a lung tumor, then we could debate whether it's worth putting 990 people through a biopsy they don't need so 10 can find out they have a tumor. Maybe that gives us the opportunity to discuss waiting a month and taking another chest x-ray (which has its own negatives) vs. doing an immediate biopsy.
But we don't have 1000 similar cases. As I said, we have 1: mine. And it turned out negative. So 1 person was put through a biopsy they didn't need, and 0 people found out they have a tumor.
I feel that label is actually deserved. Yes, some cancer types are easier to detect with MRI, in particular inside of a body, but at the same time MRI in and by itself isn't great at predicting all cancer types. How could it help with regards to leukemia, for instance? What exactly could MRI detect here better than other diagnostic tools? One has to keep in mind that diagnosis also takes time - plus the cost; and the overdiagnosis problem which means that some cancer that are not really relevant, are hyped up by MRI to be the end of the world for a patient. So there is a trade-off.
IMO MRI needs to become cheaper; and more reliable too.
Basically half of all men have some early form of prostate cancer. Now that does not show up very well on an MRI, but there are quite a few diagnosis like that that are not necessary life saving.
No? The point of the article, and of the preceding comments, echoing a pretty common tenet of evidence-based medicine, is that frequent full-body MRIs are a bad idea for the patient.
This guy has never heard the term 'scanxiety'. Go ask what it means on a cancer forum. The real OG's are the VHL folks. Bet we have a few here on this thread. Respect.
I have, it's the fault of how medicine is practiced to reduce cost. It's completely avoidable, you can just not tell people their scan results if they have no symptoms and the detection is less than 95% likely to be cancer. This is strictly better than the status quo because the only difference is some people who almost certainly have cancer learn that they have cancer and nothing else changes
Right, the problem in your model is that the doctors do! I am pointing out that this is a problem with the doctors, not the scan.
Scans are a tool, doctors are not allowed to use them rationally because it would be too expensive, so they don't use them. With an ideal doctor, patient outcomes would be better with a scan than without one, but my claim is that doctors are not ideal.
No doctor would order a full body MRI just to throw out the result in 99% of cases, because *it's too costly*
I agree, but they are failing to order scans when the probability of finding anything worth biopsying is low because of cost.
This is so obvious it's crazy, our entire world view is misshaped around saving money.
When you walk into a doctor's office, why do they take your blood pressure and temperature? Why do they look at the back of your throat and listen to you breath?
These are all diagnostic procedures with extremely high false positive rates. The reason doctors do these but do not do MRIs is because MRIs are expensive.
If MRIs were free you would get one automatically every time you go to the doctor.
It’s a great document, I’m an MR tech and we now have something to lean on when we say no to these scans. We can then scan people with problems rather than people with too much money.
Great document? I just read the entire thing, it contains no evidence or justification for their claims.
> We can then scan people with problems rather than people with too much money.
Right, this is what it's really about. MRIs are a scare resource and providers need to manage cost. Fortunately I can afford to pay out of pocket, but I'm just annoyed that doctors are so irrational about this
To be clear, it's up to a doctor whether or not to do a "needless biopsy". That has nothing to do with a scan.
You're imagining that the doctor is required to act irrationally or against the patient's interest. I understand that they do act this way, but I'm pointing out that they don't have to!
You walk into a doctor's office and meet for the first time.
Case 1. You have 3 full body MRIs taken 6 months apart in hand and give them to your doctor. Nobody has opened or looked at the scans yet.
Case 2. You do not have a scan yet
You are claiming case 1 will lead to worse outcomes in expectation. I claim that's impossible because the doctor can simply do the following:
Without opening the scans, email them to the world's best radiologist. Tell that radiologist "only reply if it is nearly certain the patient has an operable cancer with the information available"
Now there are 4 possibilities.
Case 1 without cancer: nothing happens
Case 2 without cancer: nothing happens
Case 1 with cancer: you maybe survive
Case 2 with cancer: you die
The only reasonable objection to this is "that's expensive"
A whole body MRI is low resolution and thick slices, they are crap.
Instead you could get thin slices at high resolution of a body site that has issues or is suspected to have them. Do that instead.
Whole body MR is 5-8mm thick slices at low in-plane resolution. A whole body scan has about 512 pixels over a 50-60cm field of view. Usually it’s even less pixels than this.
Something like a knee, or brain is 2-3mm slices, and high in-plane resolution. A knee is 512 or even 720 pixels over 14cm. It’s vastly better. The difference is stark.
A liver scan or other abdominal organ is lower resolution than a joint or brain, but unlike whole body MR is scanned in multiple planes with multiple image weighting (t1 in/out/fat sat, diffusion, t2, t2fs, gadolinium contrast). A liver scan has thin slices.
Whole body scans generally do two coronal images (stir and t1) then call it quits.
Yes the machines should definitely get better, but I recommend you do get it if the cost it truly zero. Based on the data in the article it is still worth it despite the low resolution!
Sorry, I edited my above comment to remove references to myself.
For clarity, I’m an MR tech and I can get scans of myself if I want to.
I generally don’t scan myself as it gets messy fast. If I had concerns and for some reason couldn’t get a proper imaging referral, I’d get a scan with small, good coils with high element counts (not body coils like whole body imaging uses) and scan individuals body regions.
It is not only money, machines and doctors are also a limited resource.
The other bit is that no one follows your protocol, everyone looks at the scans, finds reasons to worry.
Then you have the choice between unnecessary biopsies and psychological stress.
I kinda agree with you and I understand your point but I also think there is a social-ethical reality that if a doctor finds something they must treat it. The two options are 1. doing nothing, or 2. reducing cancer risk and you get unnecessary biopsies.
You're thinking of this as there being an objective positive utility for not dying of cancer and a objective negative utility for biopsies, and there being an objective optimal "rational" tradeoff that the best radiologist can optimize for to get their "nearly certain" detection threshold.
But frankly - the tradeoff for the value of a human life is perhaps the most uncertain thing one could choose. It lies in the eyes of the patient if the worry and time associated with a false detection is worth their reduced chance of death. The ethical uncertainty expressed in the OP - are these unnecessary biopsies worth it - is warranted.
You a-priori do not know if you have cancer. The case 1 branches are:
Case 1 without cancer: you're a guy that knows more than doctors because you're the "I have 3 scans on hand guy", so as soon as you open the scans and the doctor says there's a mass, you will say 'OK what can we do???' And then you had a worthless biopsy.
Case 1 with cancer: you saved the 1 week it would take to schedule the new scan and get results and you're basically in the same situation except one week earlier.
That's not how it works. Without the history of scans spaced out in time, they would typically need a biopsy. Multiple scans over time shows change and growth and improves the likelihood of an accurate triage
And for the first part that doesn't happen in my scenario before the doctor doesn't look at the scans
This. Root for them all!!! Benefit from diversity, price competition, and the innovation driven by competitors snapping at each others heels, driving very long hours for those teams. The whole of humanity benefits from this.
Yes and 5.3 and the latest codex cli client is incredibly good across compactions. Anyone know the methodology they're using to maintain state and manage context for a 12 hour run? It could be as simple as a single dense document and its own internal compaction algrorithm, I guess.
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