Biobanked! By Dr P Welsby

Biobank is an organisation that has been following health developments “tracking health rather than screening” in a cohort of about 500,000 people since about 2006. I had agreed to have my parameters followed up until I am unavailable. Like 100,000 others I had also volunteered for enhanced surveillance. Accordingly I travelled 100 miles recently to attend an enhanced assessments centre mostly for MRI and other scans. Being scanned was surprisingly relaxing I was encouraged, told, instructed and commanded to lie still for 20 minutes in sweet repose. I found such instructions very helpful as I usually rush about too much.
Most of us experience a slow decline in most functions but, to put a positive spin on it, an accumulation of negative aspects could be (mis) interpreted as experience and wisdom. Most things get worse with age (the Second Law of Thermodynamics) that I hope to invalidate by achieving immortality. Perhaps a first for Biobank?.
Bloods were taken and I delivered a urine specimen which the receiving nurse, let me rephrase that, the nurse to whom I gave the container, described as “Perfect.” Off to a good start then.
Scans followed. An MRI of chest and abdomen was noisy as the scanning apparatus altered the rate my protons spin (apparently between tens to hundreds of MHz – the lady operator must have had very rapid fingerwork to attain this frequency of switch operation). There was no background music, presumably to ensure consistency over many scans. Also might protons spin faster if I heard Flight of the Bumblebee rather than Barber’s famous Adagio? After my unexpected, and unprecedented demise I shall ignore all requests for follow up scans although my protons will still be spinning although they will not be mine.
A DEXA scan assessed the anatomical integrity of some of my bones. The right hip and the left hip were compared to make sure they were both composed of the right stuff and not just to confirm the song lyrics “The thigh bone is connected to the hip bone…”
My mental abilities were then assessed. Quizzes were used to test my reaction times. There were tests to ascertain the status of my, my, my, er, memory (yes that’s what it was). At the start of one series of tests I was told “At the end you will be asked to click on a red circle but you should click the blue circle. Or was it an orange circle? That struck me as very a very useful practical function test. Playing pairs (identifying matching pairs of identical cards out of 20 that had to be overturned in pairs to reveal their identity was a farce. My daughters used to beat me at this when they were about five.
I left with a printout of certain numerical values obtained but not with scan results –biobank is a long-term screening exercise rather than a health check up (we would only be informed about the scans if there were abnormalities that required medical attention). My blood pressure was described as good as was my BMI. “Good” is rather judgemental. For those at extremes of BMI would similar judgemental terms be used? “Not good, bad or appalling” for example.
At the end of the session I volunteered to wear a small black box that monitors cardiac function on the front of my chest. This led to an interesting discussion in the sauna of the gym I attended next day. “What’s that?” asked a friend.
I told him “It’s a heart monitoring device. No, I lie, it measures my sex appeal.” He asked a follow up question “So it will be a Richter scale measuring device then?”
One-off screenings might reveal incidental findings, most of which will be harmless but all of which may require further elucidation. Screening may throw up many associations that may or may not be causal, but which should surely prompt interesting questions. Often statements that “associations do not imply causality” is used to dismiss without thought all possible significance implications. All associations have explanations, even if only trivial aetiology. Biobank will be tracking my decline (!) rather than my ascent into immortality (as you will know doubt agree with me would be a desirable outcome but presumably my scans would presumably be screened by artificial intelligence computers that might throw up curious problematical associations because self-learning AI can deliver results the cause of which humans may find difficult to ascertain. For example self-learning AI can predict higher risk groups for myocardial infarction on ECG evidences that were unrecognised by cardiologists and no one quite knows how AI was achieving this. Strikingly in much the same way that some human decisions defy explanation!

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