If 99% of adults have an abnormality, it ceases to be abnormal regardless of its effects

On the one hand, that's the point of the article. That it ceases to be a useful diagnostic indicator.

On the other hand, if there are 100 places in the shoulder where you can have an abnormality, and most people have just one or a couple but the other 98-99 are normal, then each one individually really is abnormal.

So it's complicated, and then it becomes important to figure out which abnormalities are medically relevant, in which combinations, etc.

I went to a doctor for something unrelated and ended up getting an MRI that happened to show my upper spine. The neurologist read it and determined that I have a Chiari I malformation[0]. I have no symptoms from this whatsoever. I never have. It's unlikely that I ever will. If it weren't for the MRI, I'd never have known.

Doctors use to think that the degree of it that I have meant I'd have problems with it. After all, people who came in with the symptoms and then had an MRI or CT scan tended to show that level of herniation. Thus, it was assumed, that level of herniation was considered a diagnostic indicator. And then MRIs became cheaper and more accessible, and patients had them for all sorts of other reasons — like I did. Doctors discovered that the degree of "malformation" I have is very common among asymptomatic adults. In fact, you're many times more likely to be perfect fine with it than to experience symptoms.

Well, huh. That doesn't sound like much of a malformation anymore. Or at least, by itself it doesn't mean anything, other than that perhaps you're more likely to have problems than otherwise. On its own? It's more of a normal variation.

[0] https://en.wikipedia.org/wiki/Chiari_malformation

That's actually what the article points out. But I do think the language of normal vs abnormal obfuscates some of the intent. It's a 'deviation from healthy baseline' that they're talking about, and there are multiple such deviations in the grouped 'anomalies'.

From the article:

The language in particular should change given that “abnormalities” are ubiquitous—thus normal—and shouldn’t be described in terms that indicate a need for repair, like “tear.”

99% of adults have abnormal faces, they all look different!

Right, it's clearly aging related deterioration. It's like saying facial wrinkles are an abnormality.

I think the conclusion they're eluding to in the article is that: "if MRI says 99% of people have abnormalities, MRI is not trustworthy".

Yes in one sense, but it also points to the insufficency of "normalness". See also: The Average Soldier.

no it doesn’t. not at all. “abnormality” is a measure vs. the median… what else could “abnormal” possibly even mean? how could anyone ever be abnormal in any way otherwise, given the number of possible avenues of abnormality in the universe? this logic can only even “play ball” with a singular “is this person abnormal or not?” boolean… if there existed even two axes of abnormality then by your folksy definition it cannot actually exist. QED.

only if the abnormality is in the same spot

"1% of adults over 40 have abnormally normal shoulders"

But seriously, the article addressed that

> The authors argue that the findings suggest clinicians should rethink MRI findings, changing not just how they’re used, but also how they’re explained to patients. The language in particular should change given that “abnormalities” are ubiquitous—thus normal—and shouldn’t be described in terms that indicate a need for repair, like “tear.”

Abnominal (not abdominal)

If you ignore the time dimension, sure.

But if 99% of adults today have an abnormality that 99% of adults historically didn't, it's abnormal.

It's a poor term but it's talking about a healthy baseline for any human as far as I'm aware. It's not adjusted for expected deterioration due to age. 100% of organs eventually fail if given enough time, but it's still fine to call the resulting failed organ a defect.

Presumably, some of this is just it's pretty damn inevitable you're going to accumulate at least some level of detectable injury that doesn't completely heal over the course of 40 years. I needed shoulder reconstruction because I fell off a skateboard trying to bomb a hill a year and a half ago and it's healed to the point there isn't any functional impairment, but given there's metal in there now, it's obviously going to look abnormal on an image. There's just an impedance mismatch here between what imaging finds and what people actually care about. Any detectable deviation from expected tissue configuration is going to show up and get reported, but there is no reason for a patient to give a shit. Functional impairment and/or pain is what they care about, though those are both also universal if you live long enough. No 90 year-old walks without a limp but it's still completely fair to call a limp an "abnormal" gait.

Not if they are all different and produce negative effects

Dunno man. When enough people overweight, 1-2 alcoholic drink become healthy (alcohol is a blood thinner): this happened, but as we know now it's not true.

if they all have the same abnormality yeah but if they all have different abnormalities then they're still abnormalities.

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