29 ms·

"More harm than good" cannot be assessed objectively. How could you possibly weigh "one extra death" against "ten unnecessary treatments"? It has to be an indi

"More harm than good" cannot be assessed objectively. How could you possibly weigh "one extra death" against "ten unnecessary treatments"? It has to be an individual decision. Give me the false positive rate and the harm of an unnecessary treatment and I'll weigh that against the risk of my premature death.

kerkeslager 6y ago
I rarely downvote, but I when I do, I always try to leave an explanation. I downvoted this post because you made a claim with great confidence, despite it being clear you don't know how medical research works. > "More harm than good" cannot be assessed objectively. How could you possibly weigh "one extra death" against "ten unnecessary treatments"? Well, a very simple way would be to see how many deaths are caused by those ten unnecessary treatments. If those ten unnecessary treatments cause two deaths, I think the outcome is fairly clear. More specifically, you wouldn't assess this in terms of "deaths" because 100% of people die. Instead, you'd study this in terms of units of time alive, with a probability distribution and a quality factor applied. If a treatment reduces pain and but causes blindness, pain and blindness both correspond to quality factors. The quality factors, right now are generally treated as subjective and left to the patient as you suggest, but this is largely because we haven't gathered enough evidence for a general theory of quality of life based on health factors. Your claim that this "cannot be assessed objectively" is very much not in evidence--a great many scientists are assessing it objectively, looking at happiness, life satisfaction, satisfaction with care, societal effects, etc. There is an entire, mature field of study built around objectively assessing the thing you are claiming cannot be objectively assessed. Hundreds of billions of dollars are invested in the idea that this can be objectively assessed. You might have some criticism of medical research, but throwing out a claim like "this cannot be assessed objectively" with no evidence when millions of people and billions of dollars are invested in the opposite, sounds an awful lot like you aren't aware that strong counterarguments to your point exist which need to be addressed if you make such a claim. This is further supported by you talking about "deaths" when in fact that's not really the metric people use for assessing interventions. Source: worked a at a company that did medical study data warehousing. In a more general sense, I would caution you that just because you can't assess something objectively doesn't mean it cannot be assessed objectively.
- gridlockd 6y ago
  > If those ten unnecessary treatments cause two deaths, I think the outcome is fairly clear. No, it isn't. Deaths are not fungible. My life is not someone else's life. If I get a diagnosis, there is always a chance that it is wrong, that the treatment will kill or injure me, and so on. That doesn't mean I shouldn't get a diagnosis. I'm the person to make the decision here, I can always choose not to get a diagnosis, or to ignore it. > More specifically, you wouldn't assess this in terms of "deaths" because 100% of people die. Instead, you'd study this in terms of units of time alive, with a probability distribution and a quality factor applied. If a treatment reduces pain and but causes blindness, pain and blindness both correspond to quality factors. Again, this can not be objectively assessed. You can not put a number on how bad (risk of) blindness versus pain is for an individual. > There is an entire, mature field of study built around objectively assessing the thing you are claiming cannot be objectively assessed. Hundreds of billions of dollars are invested in the idea that this can be objectively assessed. Just because something can, by simple reasoning, not be done objectively, doesn't mean it can not be done at all. Of course you can "objectively" add up a bunch of numbers and say that this represents the best course of action by some arbitrary metric. That doesn't mean it is the best course of action for the individual. See: https://en.wikipedia.org/wiki/Mere_addition_paradox https://en.wikipedia.org/wiki/Mere_addition_paradox https://en.wikipedia.org/wiki/Utility_monster https://en.wikipedia.org/wiki/Utility_monster > In a more general sense, I would caution you that just because you can't assess something objectively doesn't mean it cannot be assessed objectively. It should stand to reason that no one can assess something objectively that is inherently subjective, like my own value perception of my life and (risk) of death.
  - gotostatement 6y ago
    It sounds like you think the previous comment is making a fallacy of drawing individual conclusions from broad statistics, or prioritizing population-wide rates over individual outcomes. It sounds like you're imagining that looking at your individual case will necessarily break you out of the broader statistical pattern because you have special information, and you should act on that without regard for the broader pattern. This is an error because it's not the case that your individual info. will lead you to be able to escape the false positive rates. TL;DR: If you buck the rule and get screened earlier than recommended, you may end up diagnosing something earlier, but you also may end up hitting the false positive treatment which has its own consequences. The general rates capture these individual possibilities.

kerkeslager 6y ago

I rarely downvote, but I when I do, I always try to leave an explanation. I downvoted this post because you made a claim with great confidence, despite it being clear you don't know how medical research works. > "More harm than good" cannot be assessed objectively. How could you possibly weigh "one extra death" against "ten unnecessary treatments"? Well, a very simple way would be to see how many deaths are caused by those ten unnecessary treatments. If those ten unnecessary treatments cause two deaths, I think the outcome is fairly clear. More specifically, you wouldn't assess this in terms of "deaths" because 100% of people die. Instead, you'd study this in terms of units of time alive, with a probability distribution and a quality factor applied. If a treatment reduces pain and but causes blindness, pain and blindness both correspond to quality factors. The quality factors, right now are generally treated as subjective and left to the patient as you suggest, but this is largely because we haven't gathered enough evidence for a general theory of quality of life based on health factors. Your claim that this "cannot be assessed objectively" is very much not in evidence--a great many scientists are assessing it objectively, looking at happiness, life satisfaction, satisfaction with care, societal effects, etc. There is an entire, mature field of study built around objectively assessing the thing you are claiming cannot be objectively assessed. Hundreds of billions of dollars are invested in the idea that this can be objectively assessed. You might have some criticism of medical research, but throwing out a claim like "this cannot be assessed objectively" with no evidence when millions of people and billions of dollars are invested in the opposite, sounds an awful lot like you aren't aware that strong counterarguments to your point exist which need to be addressed if you make such a claim. This is further supported by you talking about "deaths" when in fact that's not really the metric people use for assessing interventions. Source: worked a at a company that did medical study data warehousing. In a more general sense, I would caution you that just because you can't assess something objectively doesn't mean it cannot be assessed objectively.

gridlockd 6y ago
> If those ten unnecessary treatments cause two deaths, I think the outcome is fairly clear. No, it isn't. Deaths are not fungible. My life is not someone else's life. If I get a diagnosis, there is always a chance that it is wrong, that the treatment will kill or injure me, and so on. That doesn't mean I shouldn't get a diagnosis. I'm the person to make the decision here, I can always choose not to get a diagnosis, or to ignore it. > More specifically, you wouldn't assess this in terms of "deaths" because 100% of people die. Instead, you'd study this in terms of units of time alive, with a probability distribution and a quality factor applied. If a treatment reduces pain and but causes blindness, pain and blindness both correspond to quality factors. Again, this can not be objectively assessed. You can not put a number on how bad (risk of) blindness versus pain is for an individual. > There is an entire, mature field of study built around objectively assessing the thing you are claiming cannot be objectively assessed. Hundreds of billions of dollars are invested in the idea that this can be objectively assessed. Just because something can, by simple reasoning, not be done objectively, doesn't mean it can not be done at all. Of course you can "objectively" add up a bunch of numbers and say that this represents the best course of action by some arbitrary metric. That doesn't mean it is the best course of action for the individual. See: https://en.wikipedia.org/wiki/Mere_addition_paradox https://en.wikipedia.org/wiki/Mere_addition_paradox https://en.wikipedia.org/wiki/Utility_monster https://en.wikipedia.org/wiki/Utility_monster > In a more general sense, I would caution you that just because you can't assess something objectively doesn't mean it cannot be assessed objectively. It should stand to reason that no one can assess something objectively that is inherently subjective, like my own value perception of my life and (risk) of death.
- gotostatement 6y ago
  It sounds like you think the previous comment is making a fallacy of drawing individual conclusions from broad statistics, or prioritizing population-wide rates over individual outcomes. It sounds like you're imagining that looking at your individual case will necessarily break you out of the broader statistical pattern because you have special information, and you should act on that without regard for the broader pattern. This is an error because it's not the case that your individual info. will lead you to be able to escape the false positive rates. TL;DR: If you buck the rule and get screened earlier than recommended, you may end up diagnosing something earlier, but you also may end up hitting the false positive treatment which has its own consequences. The general rates capture these individual possibilities.