sxg

Joined 10 years ago

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330
Member since
Apr 30
undersample.substack.com github.com/sxg
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Recent submissions

Comment · 3 days ago
Why? I'm genuinely curious. Couldn't you simply not touch the screen? It's what you're supposed to do for all non-touchscreen laptops anyway.
Comment · 21 days ago
Non-physicians would be shocked at how many medications we routinely use that have no agreed-upon mechanism of action. It’s not just cancer drugs—we really don’t know how many other drugs including anesthetics work despite their critical importance. Historically in medicine, you just treat these meds like a black box. If a reasonable dose produces a reliable outcome in a large number of people with no major side effects, you consider the drug reasonably safe to use.
Comment · 4 months ago
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.
Comment · 4 months ago
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.

Comment · 4 months ago
> 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.

Comment · 4 months ago
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?
Comment · 4 months ago
Comment · 4 months ago
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.
Comment · 4 months ago
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.
Comment · 4 months ago
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.
Comment · 4 months ago
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?
Comment · 4 months ago
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.

Comment · 4 months ago
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.

Comment · 4 months ago
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.

Comment · 4 months ago
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.

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