My anecdotal experience from doctor colleagues giving CGM to patients is that it does 3/5ths of fuck all to everyone except those with actual insulin dependent diabetes (T1 or T2) because when you get down to it the insights aren’t that great and most people actually aren’t that invested in shifting the dial on their health that much. But I’m fascinated by examples to the contrary

We have screening programs for a reason. We know the sensitivity and specificity of these. They are widely available in any rich country that doesn’t treat its citizens like shit. There will absolutely be better stuff out there as we progress, with better sensitivity/specificity and lower harm (everything medical has some harm quotient) but I have a hard time wrapping my head around how they will best physics to provide better than state of the art today with this technology (and bow they will beat availability of current screening systems)

Can MRI/CT demonstrate CTE.

Well, like a lot of things which as alzheimers, that is still a pathological diagnosis for the most part, to the best of my knowledge (not post mortem scanning but out some brain tissue on a slide), but this belies the general fact that getting the tissue diagnosis is really not that important to anyone except a pedant, because yes MRI will show changes in grey/white matter differentiation and size compared to age and sex weighted cohort; and CT will show similar; and in fact it is the history and examination that practically matter to both the patients and their family.

So while it’s nice to have a totally 100% bulletproof ‘diagnosis’ for labelling purposes, practically on history and exam it’s not going to change how they are managed or what they and their family do say to day; given that both CTE and basically any of the dementias don’t have any treatment associated with them, and the current neuro imaging we have can deliver much higher resolution than what this is promising anyway (I mean even CT angio, and it’s not using ‘advanced imaging processes’ to create data out of noise)

There is no world where vascular imaging with a methodology like this is better than what I can do today in a GP clinic with a handheld GE or butterfly (or similar) US probe for anything that matters:

- for dvts and thrombus I can already image them

- if it’s in the brain the last thing that is useful for you to do is fuck around in a small clinic when you should be getting to a major tertiary centre as soon as possible

I extremely dislike the way it goes forth and bolts. I don’t trust these tools enough to just point it in the direction and say go, I like to be a human in the loop. Perhaps the use case I was working on then was difficult (quite old react native library upgrade across a medium sized codebase) but I eventually cracked this on Claude; cursor in both entropic and Gemini left me with an absolute mess.

Even repeatedly asking the prompt to keep me in the loop it kept on just running haywire.

Ok, it does, but even when it does that, in order to do that it has been continually maintaining homeostasis