From the intro article for a new series on aging, by Joe Nocera in the Free Press:
Every six months for the last few years, I’ve been getting an MRI scan of my brain. There is a little dot in my left frontal lobe—”subcortical white matter,” my chart says, that “may represent a chronic microhemorrhage perennial.” Which, I admit, sounds pretty bad.
Not knowing anything else, this doesn’t matter.
The dot was discovered after I had an incident in which I blacked out while walking home from lunch one day. It was later diagnosed as a simple partial seizure, which also sounds pretty bad. My doctors—and at age 73, I have plenty of them—aren’t 100 percent sure that the dot is connected to the seizure, but they think it might be. Whether it is or not, they want to keep track of the thing, to see if it has moved or grown or done any other bad thing. So far, I’m happy to report, it hasn’t.
I won’t claim any insight into Mr. Nocera’s health, but a solitary chronic microhemorrhage in a 73-year-old shouldn’t be a cause for concern or be followed with serial scans, no matter what the folks at Prenuvo would like you to think.
Information is not understanding or knowledge. Here we have a patient (and his doctors!) who are distressed and utilizing resources for a non-entity: a practice that, more broadly, all radiologists see all of the time.
(I also know some reader is thinking: you know, an LLM could translate that ludicrously adorable phrasing of a microhemorrage “perennial” into English and explain that it is essentially an incidental age-related finding of little clinical significance. Indeed, I asked ChatGPT and, with a lot of other words, said it was “typically of low clinical concern in an elderly patient” and “most clinicians would note it as an incidental age-related change.” [boldface theirs]
While there are peddled software products marketed to translate jargon for non-physician readers, the reality is that imaging begets more imaging, and findings are psychologically incredibly hard to ignore. [I would also add that medical summaries are a fantastic example of a short-term business. AI is not a competitive moat, and this is a product feature, not a product itself.])
Of course we can (and do!) save lives with pictures. But screening narratives are complicated and full of salient, powerful anecdotes, and medical imaging—like this—is so often full of stressful waste.