doctoring

I mean, I do? As do most of my friends who are homeowners. We are constantly asking each other for recommendations for people who can do X.

Hire a couple of disasters, and you will appreciate that a good relationship with a good contractor/tradesperson is worth an incredible amount of money (and time).

The not so big secret is that we can detect cancer early in a lot of people, but we also would detect a lot of not-cancer. We don't currently know the cost/benefit of that tradeoff for all these new types of screening, and therefore insurers and health systems are reluctant to pay the cost of the both screening and the subsequent workup. This is not just a financial consideration, though the financial part is a big part -- the workup for those that end up as not-cancer has non-negligible risks for the patients as well (I have had patients of mine suffer severe injury and even die from otherwise routine biopsies), and on top of that, some actual cancers may not really benefit from early discovery in the first place.

This is not to downplay the potential benefit of early cancer detection... which is huge. And in the US/UK anyway, there are ongoing large trials to try to figure some of this stuff out in the space of blood-based cancer screening, as part of the path to convincing regulatory bodies and eventual reimbursement for certain tests. As mentioned, you can currently at least get the Galleri test out of pocket (<$1k, not cheap, but not exorbitant either), as well as whole body MRIs (a bit more expensive, ~$2-5k).

I think this essay touches on but slightly conflates "younger" with "inexperienced". Younger people are inexperienced at more things in life, sure. But if you write essays about things that are new to the world (new technologies? events? societal changes?) then even older people may be inexperienced with it and could learn something, something that surprises the author and the reader.

I don't know for other countries, but for the United States, "medical students are no longer choosing it" is very very untrue, and it is trivial to look up as this information is public from the NRMP (the organization that runs the residency match).

Radiology remains one of the most competitive and in-demand specialties. In this year's match, only 4 out of ~1200 available radiology residency positions went unfilled. Last year was 0. Only a handful of other specialties have similar rates.

As comparison, 251 out of ~900 pediatric residency slots went unfilled this year. And 636 out of ~5000 family medicine residency slots went unfilled. (These are much higher than previous years.)

However, I do somewhat agree with the speaker's sentiment if for a different reason. Radiologist supply in the US is roughly stable (thanks to the US's strange stranglehold on residency slots), but demand is increasing: the number of scans ordered on a per patient continues to rise, as does the complexity of those scans. I've heard of hospital systems with backlogs that result in patients waiting months for, say, their cancer staging scan. One can hope we find some way to make things more efficient. Maybe AI can help.

Whole body MRI is fairly available in major metro areas, though not cheap and not very sensitive or specific.

The Galleri blood test screens for a range of cancers (sensitivity varies by cancer) and is ~$900, although you need a doctor to order it. You also may not technically be within the intended use population unless you have some risk factors (e.g. you are older than 50, or have family history of cancer).

Colonoscopy is a good idea, given the rising rates of colon cancer among younger adults.

> "The tests... cover topics such as U.S. audit standards, professional ethics and independence..."

Ethics, you say?

> "...involved hundreds of professionals, including partners and senior leaders such as the now former head of assurance..."

When the scale of these things is so large in a single firm, and only comes to light after 2(!) whistleblowers, it is hard to imagine that it is an isolated incident in the industry.

Very interesting overview of the technological / materials breakthroughs to enable miniaturization.

From a physician (specifically radiologist) perspective, I'm a big fan of handheld/point-of-care ultrasound and am excited about their potential at democratizing a very useful and low-cost/low-risk imaging technology. (I also own a Butterfly.)

That being said, the "cart-based" ultrasounds will likely always have a place in a hospital; the size of the ultrasound probes is not why the cart is big/expensive/useful. The cart is a big floating screen and also an image/record management system. You (or at least, a trained ultrasound technician) can manipulate ultrasound parameters and annotate images (critical for ultrasound interpretation) way way faster on the cart's set of wonky keys/dials/trackball than on a smartphone.

Also, with the rise of handheld/point-of-care ultrasound, we've noted with amusement in the radiology department the frequency with which patients get referred for additional imaging because the ED or primary doctor saw some pathology on their handheld ultrasound... and when we take a look it is just not there. I think this is probably more of a training issue, as ultrasound is truly quite challenging both to perform AND to interpret (and a major part of using an ultrasound probe is essentially real-time interpretation), which is even more challenging given the lower image quality and field-of-view of smaller probes.

The article mentions: "...sequencing DNA from blood samples and tumour biopsies, to look for mutations that are found in the tumour but not in the blood."

This is pretty common for most cancer genotyping tests. (Sometimes they compare tumor with saliva or some other "benign" source, but the principle is the same.)

Wait, but we do have the tools...

We can (and do) cure so many cancers. Usually with surgery, +/- chemo/radiation. Sometimes just radiation.

It's hard to overstate how curable most cancers are at early stage -- for some it's well over 90% and approaching 100%.

The whole point of these screening tests is to try to find more cancers at more curable stages.

Your original comment stated:

> They won't work for in situ tumors, almost by definition.

Which isn't true. The studies from multiple companies' tests demonstrate that they _can_ detect in situ tumors. Not always super duper well, and not always for every single cancer type, but still.

Whether this is a good idea / cost-effective is another question, and certainly a big deal as you point out.