3 ms·

Okay, I really don’t want the data. I don’t want the data because: (1) if I see something, I have to act on it, despite not actually having the knowledge of wh

Okay, I really don’t want the data. I don’t want the data because: (1) if I see something, I have to act on it, despite not actually having the knowledge of whether it means anything in this information-rich context. I just love things that -look- like information but that don’t actually tell me anything. (2) we have a LOT of data suggesting that we do more harm than good when we try to intervene or investigate everything. For Pete’s sake, hospice patients outlive those who are actually pursuing life extension! Turns out every treatment has harms, and when you’re applying those harms to no benefit (because the patient is asymptomatic, or the anomalous event was never destined to progress to clinical disease), you just accrue harm that -looks- like care. 3) It is not likely to result in useful diagnosis, because catching shit pre-clinically offers little indication of what will or won’t become clinical. We see this in helical CT: a lot of people became “cancer patients” when helical CT came out, before we realized a LOT of growths recede forever without intervention - we just hadn’t seen them before, on the less sensitive tech. If I see the data I have to act on it to cover my (American) ass, and I know I will do net harm to my patients. Thanks but no thanks. Do your due diligence: collect the data, analyze it, stick it in a properly randomized prospective study to see if you just trawled your way into an overfitted model, and prove that the intervention for it does more good than harm. THEN I’ll be delighted to use that specific data to pursue that specific intervention. Don’t just measure everything, throw it at my wall like hot spaghetti, and expect me to turn it into dinner. -my blunt anonymous opinion, since it was asked for

aeorgnoieang 9y ago
You've outlined a cogent rationale for refusing all medical treatment! And there is a lot of evidence that this is in fact not a terrible idea. A lot of medicine is, not just not-beneficial, but actively harmful. So as someone that would be liable to act on this data, I understand and sympathize that receiving this data would be an unfair burden on you. But what about the rest of us? We're being treated by people that we are expected to trust that actively refuse to learn whether they're actually helping. That seems pretty unfair to the rest of us.
- arkades 9y ago
  No, I haven’t. I’ve outlined a rationale for helping when there’s reasonable evidence that the benefit provided will outweigh the harm caused. Eg, antibiotics for the average upper respiratory infection vs antibiotics for sepsis. In the context of diagnostics: if the prior probability of disease is such that the outcome of the test doesn’t meaningfully change the likelihood, it’s bad for the patient to create a situation where for legal purposes I must now act as though the probability is much higher than it is. And no, we aren’t actively refusing to learn if we are helping. We want the data collected in a meaningfully structured way that actually answers the question of whether it’s helping. Garbage In/Garbage Out doesn’t answer that question. You say it’s unfair, but go reread my post. My concern is that my arm gets twisted into doing things that are -bad for you-, not bad for -me-. Whether you like the reasoning or it’s conclusion, nothing in it is about being unfair to you. It’s about trying to do my absolute best to live up to my ethical responsibility to optimize your health outcomes. The only part of it that’s defensive is the part where I don’t ignore test results, because it will get me sued out of medical practice in the rare occasion they’re true positives. And I would like for that not to be the case, but there we are.
  - aeorgnoieang 9y ago
    > if the prior probability of disease is such that the outcome of the test doesn’t meaningfully change the likelihood, it’s bad for the patient to create a situation where for legal purposes I must now act as though the probability is much higher than it is. I don't disagree. I was claiming that both patients and doctors are caught in this trap, i.e. doctors are legally liable for not offering, or recommending, treatment that isn't warranted.

aeorgnoieang 9y ago

You've outlined a cogent rationale for refusing all medical treatment! And there is a lot of evidence that this is in fact not a terrible idea. A lot of medicine is, not just not-beneficial, but actively harmful. So as someone that would be liable to act on this data, I understand and sympathize that receiving this data would be an unfair burden on you. But what about the rest of us? We're being treated by people that we are expected to trust that actively refuse to learn whether they're actually helping. That seems pretty unfair to the rest of us.

arkades 9y ago
No, I haven’t. I’ve outlined a rationale for helping when there’s reasonable evidence that the benefit provided will outweigh the harm caused. Eg, antibiotics for the average upper respiratory infection vs antibiotics for sepsis. In the context of diagnostics: if the prior probability of disease is such that the outcome of the test doesn’t meaningfully change the likelihood, it’s bad for the patient to create a situation where for legal purposes I must now act as though the probability is much higher than it is. And no, we aren’t actively refusing to learn if we are helping. We want the data collected in a meaningfully structured way that actually answers the question of whether it’s helping. Garbage In/Garbage Out doesn’t answer that question. You say it’s unfair, but go reread my post. My concern is that my arm gets twisted into doing things that are -bad for you-, not bad for -me-. Whether you like the reasoning or it’s conclusion, nothing in it is about being unfair to you. It’s about trying to do my absolute best to live up to my ethical responsibility to optimize your health outcomes. The only part of it that’s defensive is the part where I don’t ignore test results, because it will get me sued out of medical practice in the rare occasion they’re true positives. And I would like for that not to be the case, but there we are.
- aeorgnoieang 9y ago
  > if the prior probability of disease is such that the outcome of the test doesn’t meaningfully change the likelihood, it’s bad for the patient to create a situation where for legal purposes I must now act as though the probability is much higher than it is. I don't disagree. I was claiming that both patients and doctors are caught in this trap, i.e. doctors are legally liable for not offering, or recommending, treatment that isn't warranted.