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).

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 believe the only commercially available one in the US is Grail's Galleri (https://www.galleri.com).

More info on this category of tests: https://www.cancer.org/cancer/screening/multi-cancer-early-d...

There are many tests in the pipeline -- although the technology is there, the regulatory and evidence process is slow. (Data relating to detecting cancer early, by its nature, takes a long time and a lot of people to prove out.)

> Will Overture use afterburners like Concorde?

> No. Overture will fly without the use of afterburners, meeting the same strict regulatory noise levels as the latest subsonic airplanes. The airliner will be powered by the Symphony propulsion system. Symphony will be a medium-bypass turbofan engine designed and optimized for environmentally and economically sustainable supersonic flight.

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.

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.

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.

Rice cookers (usually) make clever use of 1) alloys whose magnetism depends on temperature and 2) the fact that boiling water occurs at a fixed temperature. With a "trigger" temperature just above the boiling point of water, the rice cooker automatically turns off the heating element when all the water is gone (and thus the temperature starts to rise above boiling point).

More detail here: https://youtu.be/RSTNhvDGbYI

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.

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.)

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.

> 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.

These tests on the other hand detect circulating tumor DNA (ctDNA), among other things. It is well known that tumors shed DNA and other material more than normal cells, even at early cancer stage. (Of course, later stage and more aggressive tumors are more indeed likely to shed more.) The detection limit for some of these tests is in the range of single digit copies of DNA fragment per mL of plasma.

Furthermore, the goal isn’t necessarily to detect every cancer as small as it could possibly be. Even if you don’t do a great job at finding all cancers at stage I, you may still save lives by detecting cancers at an earlier stage than they otherwise would have been found. Finding something at stage II instead of III or stage III instead of IV may well mean the difference of a shot for curative resection / radiation. (Whether these tests would be remotely cost-effective at attempting this at population scale... I leave as an exercise to the reader & healthcare system.)

Grail had a paper with some scant info on their test performance in multiple cancer types across all cancer stages. https://www.annalsofoncology.org/article/S0923-7534(21)02046...

This is not cheap but not also not insane. Grail’s test screens for 50 different cancers (at a range of test performances, sure, but as the article mentions, many cancers currently have no screening mechanism). As comparison, the non-insured price of things like MRI and CT scans can run into the tens of thousands of dollars.

PET scans are limited in resolution when you get down to the sub-5 mm or so range due to scanner technology and fundamental limits of the physics of positron/electron annihilation & photon emission.

A typical MRI (i.e. alas, not what this article is describing) can usually resolve something at that size and identify characteristics like diffusion restriction or contrast enhancement which can confirm metastasis.

Also, in the brain, PET scans (at least the most common, FDG, which is based on glucose) are extremely limited in utility because of the baseline high glucose metabolism of the brain, which makes it hard to distinguish from the metabolic activity of a tumor.

CAR-T cells, on the other hand, is essentially making a fairly small (but kind of insidious) modification to T cells in the lab. These T cells when put back in the body then do their normal T cell thing and proliferate and recruit more of the immune system, but to try to eliminate a target you've chosen for them. The most useful/successful target thus far has been CD19, another B cell surface protein.

Your thought about the drugs maybe limiting the effect of the CAR-T is an interesting one and the subject of ongoing investigation. One common drug used for CAR-T related cytokine release syndrome, tocilizumab, does not appear to have negative effects on CAR-T proliferation or efficacy. However, it doesn't seem to do as much for neurotoxicity (which seems to be a separate mechanism from the cytokine system), and they often have to resort to steroids for that. Steroids do dampen T-cell activity, but to what degree that impacts CAR-T effectiveness is not clear. However, as you mention, sometimes you are left without much choice.