3 ms·

Wait, so the argument against having more data is that sometimes that data is misinterpreted or misunderstood? That does not seem like a good argument.

by toxik 8y ago

eli 8y ago
The cost to a false positive in terms of stress alone should not be underestimated.
ufo 8y ago
If you are not going to act on the information, then the extra expense of the exam is wasted. If you are going to act on the information, then you must weight the benefit of early detection against the damage caused by unnecessary exams and treatment when there are false positives. False positives are specially problematic when screening a large number of healthy people.
- manicdee 8y ago
  The persistent monitoring afforded by devices such as Apple Watch will directly lead to an increase in the detection rate of any condition that they are capable of detecting. These new detections will be conditions that had been previously undetected. Whether you class these as false positives (because the existing test suite doesn't detect them) or false negatives (because the existing test suite should have detected them) is perhaps a matter for debate. The practical outcome is more people living healthier lives because their persistent malaise has finally been identified. At first I was wondering how scheduling someone for a long-term ECG would cause damage, then I remembered that this feature will only become available in the USA soon. Given that the USA is a country where unexpected health care can destroy a person's life through either bankruptcy or the curse of being a woman/person of colour, yes I agree that detecting a previously undetectable condition could cause damage.
  - toast0 8y ago
    There has been a lot of recent research and recommendations for policy change around reducing the frequency of screenings for various things. Time and data will surely tell if this type of ECG screening is helpful or harmful on a population level. Certainly, some people will get a secondary ECG indicating intervention is required, and the intervention will improve their lives. Others may have a negative result from the intervention, and may never have found their way into this intervention without this screening. For some, this screening indicating a problem but a full screening indicating nothing will drive persistent anxiety. It is absolutely not the case that more medical intervention is an unqualified good, even ignoring the economic costs.
Barrin92 8y ago
it's a very reasonable argument if the outcomes of this are overtreatment or serious health scares and increased cost with little payoff as a result. More data is useless if your data is mostly noise and if as a result error rate in treatment and costs rise. Add to this the strong incentive for doctors, especially in a profit-driven healthcare system to suggest action, this could easily lead to the rise of unnecessary treatment of benign abnormalities in otherwise healthy people. This is also not speculation. Ever since the rise of diagnostics in medicine overtreatment has become more and more common. This study[1] estimates that almost a fifth of all procedures in the US are not necessary. [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/
- toxik 8y ago
  Interesting standpoint, one which I disagree with. You are making a causal connection of rise in diagnostic tools => overtreatment. What is your evidence for that, apart from overtreatment increasing? I think sea levels have risen since then too, are they also an effect of too much diagnostics? Clearly, if the data was just noise, people would eventually stop caring. But you'd have to be pretty cynical to think one of the major tech companies of the world releases a diagnostic device that has an S:N ratio that high. A more likely explanation for the overtreatment is simply that people are getting richer, and society is providing more care -- to a fault. I know this first hand, I have had invasive surgery done that I would've been better without -- because the doctor thought it maybe might be a good thing for the future. Spoiler: it worsened the problem. I think if it were the case that we all suffer from a bit of a-fib every now and then, and that these diagnostic tools will give false positives for this reason, then that would be news to the medical community and thus progressing our understanding. People would be told, "your watch is telling you this but we know better now." Apple might update their detection algorithm. It's such a small price to pay for the obvious advantage of preventing loss of life.
ghufran_syed 8y ago
Who is arguing against more data? Even the author of the article is essentially saying “buy it if you like it, just don’t buy it as a medical device” On the other hand, maybe more data could be harmful? You might be interested to read a classic article (Bergman, 1967, [“The morbidity of cardiac nondisease in children”](http://dabamirror.sci-hub.tw/4363/be7b5e26e14c6389108fbdc70febc077/bergman1967.pdf http://dabamirror.sci-hub.tw/4363/be7b5e26e14c6389108fbdc70f...) It discusses the harm to children of their parents believing their child has a “heart problem” when they have a completely benign murmur - which raises the issue of whether you should tell a parent there is a benign heart murmur when that information might actually be harmful - and whether that risk of harm is sufficient to override the parent’s right to know. Another example will soon be genetic testing for risk of Alzheimer’s disease - if, at present we have no way of reducing the risk, is it fair to give people that information, when we know based on many studies that such knowledge lowers patient’s quality of life? I think free adults should have the right to do all sorts of things that others think might be harmful - but it also seems reasonable (as this article does) to make people aware of the risks of “more data”, as well as the assumed benefits
- toxik 8y ago
  I think it's a stretch to call this murmuring anecdote a case of more data => negative outcome. It's more like telling an individual about their specific instance and then having them extrapolate from uncertain statistics and overcorrecting. Acting on bad intel, as it were, where n=1. If you want to argue against gathering information in this way, then perhaps phrenology serves as an interesting example. We know now that most likely, it was a croc. The use of phrenology was to draw a boundary around a certain ethnicity so that it could be upheld above all other ethnicities, and so it is hard to say that the data collection itself was the problem. Sweden is having a similar but opposite problem right now -- assault and sexual assault perps are predominantly Arabic immigrants, for one reason or another -- maybe it's in part Middle Eastern culture, almost assuredly it's a lot about socioeconomic factors, but nonetheless, it is true. The powers that be have decided that the news should not mention ethnicity or citizenship for fear of racist backlash, they have decided that the annual crime statistics reports should not mention ethnicity or citizenship, again citing fear of racist backlash. I now invite you to consider, what will the population think then, if there are no facts to refer to, nothing to dissuade the racist's viewpoint that "Muslims are bad people?" Facts are sometimes inconvenient or inflammatory, but that doesn't make them less true. For your case, I think the problem is not one of information gathering. Doctors should still be examining the kids, I think you agree -- the problem is giving the wrong impression to the parents, or not knowing that it is in fact the wrong impression.
zoomablemind 8y ago
This watch is not a prescription, nor a doctor ordered monitor. Even more, as mentioned its detection quality/history is not as reliable as to what currently a doctor would trust (as in case of 12-probe ecg). Heart risk is serious and by itslef warrants a GP visit or at least a question. Yet a recreational health monitoring looks similar to someone's reading a GP's handbook for fun - suddenly lots of descriptions seem to apply due to uninformed perceptions. Either way, if one has reasons to believe being at heart risk, watch is not the first thing to buy to be pro-active/preventive.To have the watch does not mean to take care of the risk. Just like having a fitbit does not mean one is actively fit.

Wait, so the argument against having more data is that sometimes that data is misinterpreted or misunderstood? That does not seem like a good argument.

by toxik 8y ago

Wait, so the argument against having more data is that sometimes that data is misinterpreted or misunderstood? That does not seem like a good argument.

eli 8y ago

The cost to a false positive in terms of stress alone should not be underestimated.

ufo 8y ago

If you are not going to act on the information, then the extra expense of the exam is wasted. If you are going to act on the information, then you must weight the benefit of early detection against the damage caused by unnecessary exams and treatment when there are false positives. False positives are specially problematic when screening a large number of healthy people.

manicdee 8y ago
The persistent monitoring afforded by devices such as Apple Watch will directly lead to an increase in the detection rate of any condition that they are capable of detecting. These new detections will be conditions that had been previously undetected. Whether you class these as false positives (because the existing test suite doesn't detect them) or false negatives (because the existing test suite should have detected them) is perhaps a matter for debate. The practical outcome is more people living healthier lives because their persistent malaise has finally been identified. At first I was wondering how scheduling someone for a long-term ECG would cause damage, then I remembered that this feature will only become available in the USA soon. Given that the USA is a country where unexpected health care can destroy a person's life through either bankruptcy or the curse of being a woman/person of colour, yes I agree that detecting a previously undetectable condition could cause damage.
- toast0 8y ago
  There has been a lot of recent research and recommendations for policy change around reducing the frequency of screenings for various things. Time and data will surely tell if this type of ECG screening is helpful or harmful on a population level. Certainly, some people will get a secondary ECG indicating intervention is required, and the intervention will improve their lives. Others may have a negative result from the intervention, and may never have found their way into this intervention without this screening. For some, this screening indicating a problem but a full screening indicating nothing will drive persistent anxiety. It is absolutely not the case that more medical intervention is an unqualified good, even ignoring the economic costs.

Barrin92 8y ago

it's a very reasonable argument if the outcomes of this are overtreatment or serious health scares and increased cost with little payoff as a result. More data is useless if your data is mostly noise and if as a result error rate in treatment and costs rise. Add to this the strong incentive for doctors, especially in a profit-driven healthcare system to suggest action, this could easily lead to the rise of unnecessary treatment of benign abnormalities in otherwise healthy people. This is also not speculation. Ever since the rise of diagnostics in medicine overtreatment has become more and more common. This study[1] estimates that almost a fifth of all procedures in the US are not necessary. [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5587107/

toxik 8y ago
Interesting standpoint, one which I disagree with. You are making a causal connection of rise in diagnostic tools => overtreatment. What is your evidence for that, apart from overtreatment increasing? I think sea levels have risen since then too, are they also an effect of too much diagnostics? Clearly, if the data was just noise, people would eventually stop caring. But you'd have to be pretty cynical to think one of the major tech companies of the world releases a diagnostic device that has an S:N ratio that high. A more likely explanation for the overtreatment is simply that people are getting richer, and society is providing more care -- to a fault. I know this first hand, I have had invasive surgery done that I would've been better without -- because the doctor thought it maybe might be a good thing for the future. Spoiler: it worsened the problem. I think if it were the case that we all suffer from a bit of a-fib every now and then, and that these diagnostic tools will give false positives for this reason, then that would be news to the medical community and thus progressing our understanding. People would be told, "your watch is telling you this but we know better now." Apple might update their detection algorithm. It's such a small price to pay for the obvious advantage of preventing loss of life.

ghufran_syed 8y ago

Who is arguing against more data? Even the author of the article is essentially saying “buy it if you like it, just don’t buy it as a medical device” On the other hand, maybe more data could be harmful? You might be interested to read a classic article (Bergman, 1967, [“The morbidity of cardiac nondisease in children”](http://dabamirror.sci-hub.tw/4363/be7b5e26e14c6389108fbdc70febc077/bergman1967.pdf http://dabamirror.sci-hub.tw/4363/be7b5e26e14c6389108fbdc70f...) It discusses the harm to children of their parents believing their child has a “heart problem” when they have a completely benign murmur - which raises the issue of whether you should tell a parent there is a benign heart murmur when that information might actually be harmful - and whether that risk of harm is sufficient to override the parent’s right to know. Another example will soon be genetic testing for risk of Alzheimer’s disease - if, at present we have no way of reducing the risk, is it fair to give people that information, when we know based on many studies that such knowledge lowers patient’s quality of life? I think free adults should have the right to do all sorts of things that others think might be harmful - but it also seems reasonable (as this article does) to make people aware of the risks of “more data”, as well as the assumed benefits

toxik 8y ago
I think it's a stretch to call this murmuring anecdote a case of more data => negative outcome. It's more like telling an individual about their specific instance and then having them extrapolate from uncertain statistics and overcorrecting. Acting on bad intel, as it were, where n=1. If you want to argue against gathering information in this way, then perhaps phrenology serves as an interesting example. We know now that most likely, it was a croc. The use of phrenology was to draw a boundary around a certain ethnicity so that it could be upheld above all other ethnicities, and so it is hard to say that the data collection itself was the problem. Sweden is having a similar but opposite problem right now -- assault and sexual assault perps are predominantly Arabic immigrants, for one reason or another -- maybe it's in part Middle Eastern culture, almost assuredly it's a lot about socioeconomic factors, but nonetheless, it is true. The powers that be have decided that the news should not mention ethnicity or citizenship for fear of racist backlash, they have decided that the annual crime statistics reports should not mention ethnicity or citizenship, again citing fear of racist backlash. I now invite you to consider, what will the population think then, if there are no facts to refer to, nothing to dissuade the racist's viewpoint that "Muslims are bad people?" Facts are sometimes inconvenient or inflammatory, but that doesn't make them less true. For your case, I think the problem is not one of information gathering. Doctors should still be examining the kids, I think you agree -- the problem is giving the wrong impression to the parents, or not knowing that it is in fact the wrong impression.

zoomablemind 8y ago

This watch is not a prescription, nor a doctor ordered monitor. Even more, as mentioned its detection quality/history is not as reliable as to what currently a doctor would trust (as in case of 12-probe ecg). Heart risk is serious and by itslef warrants a GP visit or at least a question. Yet a recreational health monitoring looks similar to someone's reading a GP's handbook for fun - suddenly lots of descriptions seem to apply due to uninformed perceptions. Either way, if one has reasons to believe being at heart risk, watch is not the first thing to buy to be pro-active/preventive.To have the watch does not mean to take care of the risk. Just like having a fitbit does not mean one is actively fit.