4 ms·

MDs are idiots in this regard. Mainly because they've been thought medicine by other idiots. They have this stupid idea that "too much data" is bad, also stuff

by nnq 7y ago

MDs are idiots in this regard. Mainly because they've been thought medicine by other idiots. They have this stupid idea that "too much data" is bad, also stuff being a sign that you're a bad doctor if you order too much tests etc. It's a whole can of worms of crappy rationalizations here, that also hides the fact that doctors are not capable or trained to correctly deal with large volumes of data, so they know they will make mistakes that they will be liable for if they are handed more data! More data is always better. Period. Problem is that we lack some kind of protocols of "calculated ignorance" that they could follow, like be allowed to ignore large classes of semi-normal findings that would show up often and lead people on wild goose chases, and be safe from malpractices and stuff if they follow this "calculated ignorance". This is because in the end medicine is not about doing "the best thing at all cost", but at doing the best thing that can be done at population scales, under limits of financial cost and "comfort cost" (there are limits after most of us would prefer (high risk of) death instead of further investigations and treatments and these limits vary (wildly) by individual). There's two things that should be drilled down into the heads of all domain experts: (1) more data is always better, and (2) it's ok to ignore as much of the data as you want if it doesn't make sense cost-wise to investigate it further. But it's always better to fish in a larger lake!

louden 7y ago
More data is not always better. The collection process itself can be dangerous or unpleasant for the patient. Several years ago I worked on a study looking at the spread of bacterial lung infections in long term hospital patient. In order to get the data, we would have to intubate patients that did not need it. In this case, the people who approve these studies rightfully ruled that getting that data would be too painful for the patients to allow. Biopsies caused by benign findings from a full body scan are not without pain, emotional distress, risk or cost to the patient. Period. It must be weighed against the benefit that the patient would recieve (all in the aggregate, or course).
- Brakenshire 7y ago
  > The collection process itself can be dangerous or unpleasant for the patient. That’s asinine, obviously he doesn’t mean more data is always better even if the test is invasive or dangerous. > Biopsies caused by benign findings from a full body scan are not without pain, emotional distress, risk or cost to the patient. Period. It must be weighed against the benefit that the patient would recieve (all in the aggregate, or course). Both need to be judged on time and cost, but only the biopsy needs to be weighed against risk, not the scan. If people see a scan with anomalies and want dangerous procedures even if the risk is not demonstrated that is a cultural, education, and legal problem. Both for doctors wanting to avoid malpractice ordering unjustified tests, and for patients “wanting it out”. But if the scan can demonstrate some marginal elevated risk, not the need for immediate intervention but for increased screening, that data could potentially save many lives, and it should be used, not hidden away because of the possibility of overreaction. Researchers need to find how best to use the data and patients and doctors need to be educated in our current best understanding, not pandered to.
  - epistasis 7y ago
    > but only the biopsy needs to be weighed against risk, not the scan. You're setting an arbitrary boundary because you don't want to consider the downsides. If you set the same boundary on the benefits of the MRI, then you wouldn't be able to include treatment of cancer as part of the upside to doing an MRI scan. Doctors are far wiser about these things than HN commenters that have never dealt with the complex tradeoffs of dealing not only with populations of people, but also with dealing with the psychology of humans beyond people that prioritize rationality over everything else. Doctors are responsible for treating all of humanity, not just the subset that behave the way we want them to.
    - Brakenshire 7y ago
      People can (and did) make the same case against the thermometer.
  - tellak 7y ago
    > That’s asinine, obviously he doesn’t mean more data is always better even if the test is invasive or dangerous. With him classifying all MDs as idiots, no it is not asinine. I’ve known few academic physicians that would turn down data if it can be ethically obtained. The difference between the medical profession and, say Google, is that we as a general rule do not consider the populace one big lab to experiment on as we please. The consequences are more than a little different. It’s not like things were always this way in medicine either.
- koboll 7y ago
  >In order to get the data, we would have to intubate patients that did not need it. In this case, the people who approve these studies rightfully ruled that getting that data would be too painful for the patients to allow. I wonder what the patients who died because they had especially fast-spreading infections whose pace was not detected quickly enough would think of these altruists' wise decision to weigh the median level of "emotional distress" more highly than their lives.
  - louden 7y ago
    People have commited suicide because of medical test results that turned out to be wrong. A decision has to be made about how many tests are performed and under what conditions. Unfortunately, that will cause harm to people no matter where we, as a society, draw that line.
outlace 7y ago
Let’s just assume for sake of argument that that is true, more data is always better. And let’s assume collecting more data is not cost prohibitive on a population scale. In the real world, physicians have a major incentive to practice defensive medicine to avoid litigation. If you order an unnecessary test and it shows something abnormal, even though in your clinical judgement it is not likely to be worrisome, you now feel a strong impulse to spend thousands more dollars to completely rule out it’s not some 1 in a million rare cancer lest you get sued. So some systemic issues at play here, not that “doctors are idiots.” In data science, sure more data is always better but you’re not worried that more data is going to lead you to a traumatizing malpractice lawsuit.

by nnq 7y ago

louden 7y ago

More data is not always better. The collection process itself can be dangerous or unpleasant for the patient. Several years ago I worked on a study looking at the spread of bacterial lung infections in long term hospital patient. In order to get the data, we would have to intubate patients that did not need it. In this case, the people who approve these studies rightfully ruled that getting that data would be too painful for the patients to allow. Biopsies caused by benign findings from a full body scan are not without pain, emotional distress, risk or cost to the patient. Period. It must be weighed against the benefit that the patient would recieve (all in the aggregate, or course).

Brakenshire 7y ago
> The collection process itself can be dangerous or unpleasant for the patient. That’s asinine, obviously he doesn’t mean more data is always better even if the test is invasive or dangerous. > Biopsies caused by benign findings from a full body scan are not without pain, emotional distress, risk or cost to the patient. Period. It must be weighed against the benefit that the patient would recieve (all in the aggregate, or course). Both need to be judged on time and cost, but only the biopsy needs to be weighed against risk, not the scan. If people see a scan with anomalies and want dangerous procedures even if the risk is not demonstrated that is a cultural, education, and legal problem. Both for doctors wanting to avoid malpractice ordering unjustified tests, and for patients “wanting it out”. But if the scan can demonstrate some marginal elevated risk, not the need for immediate intervention but for increased screening, that data could potentially save many lives, and it should be used, not hidden away because of the possibility of overreaction. Researchers need to find how best to use the data and patients and doctors need to be educated in our current best understanding, not pandered to.
- epistasis 7y ago
  > but only the biopsy needs to be weighed against risk, not the scan. You're setting an arbitrary boundary because you don't want to consider the downsides. If you set the same boundary on the benefits of the MRI, then you wouldn't be able to include treatment of cancer as part of the upside to doing an MRI scan. Doctors are far wiser about these things than HN commenters that have never dealt with the complex tradeoffs of dealing not only with populations of people, but also with dealing with the psychology of humans beyond people that prioritize rationality over everything else. Doctors are responsible for treating all of humanity, not just the subset that behave the way we want them to.
  - Brakenshire 7y ago
    People can (and did) make the same case against the thermometer.
- tellak 7y ago
  > That’s asinine, obviously he doesn’t mean more data is always better even if the test is invasive or dangerous. With him classifying all MDs as idiots, no it is not asinine. I’ve known few academic physicians that would turn down data if it can be ethically obtained. The difference between the medical profession and, say Google, is that we as a general rule do not consider the populace one big lab to experiment on as we please. The consequences are more than a little different. It’s not like things were always this way in medicine either.
koboll 7y ago
>In order to get the data, we would have to intubate patients that did not need it. In this case, the people who approve these studies rightfully ruled that getting that data would be too painful for the patients to allow. I wonder what the patients who died because they had especially fast-spreading infections whose pace was not detected quickly enough would think of these altruists' wise decision to weigh the median level of "emotional distress" more highly than their lives.
- louden 7y ago
  People have commited suicide because of medical test results that turned out to be wrong. A decision has to be made about how many tests are performed and under what conditions. Unfortunately, that will cause harm to people no matter where we, as a society, draw that line.

outlace 7y ago

Let’s just assume for sake of argument that that is true, more data is always better. And let’s assume collecting more data is not cost prohibitive on a population scale. In the real world, physicians have a major incentive to practice defensive medicine to avoid litigation. If you order an unnecessary test and it shows something abnormal, even though in your clinical judgement it is not likely to be worrisome, you now feel a strong impulse to spend thousands more dollars to completely rule out it’s not some 1 in a million rare cancer lest you get sued. So some systemic issues at play here, not that “doctors are idiots.” In data science, sure more data is always better but you’re not worried that more data is going to lead you to a traumatizing malpractice lawsuit.