5 ms·

> 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

> 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.
- gridlockd 6y ago
  Subjectively, I may prefer the risk of the false positive scenario to the risk of the missed diagnosis and early death. This is not reflected in statistics, because it is a personal preference. That may or may not be informed by additional information, for instance a person close to me may have had an early death from colon cancer and therefore I value the relief of having done the screening higher than someone else.
  - kerkeslager 6y ago
    > This is not reflected in statistics, because it is a personal preference. What makes you think that personal preferences can't be studied? I'll tell you they can be studied because they are being studied.
    - gridlockd 6y ago
      You asked a similarly misguided question in the other part of the thread. I answered there as well, I'll give you another angle here. There is no "recommendation system" that can predict the right course of action based on my personal preference. There isn't even a good system to record and measure personal preference, because expression of perception is by itself highly subjective. A doctor might ask you "how bad is the pain on a scale of one to ten?" or something of those sorts. That is informed by your entire history of pain experience. You're likely to rate the worst pain you ever felt as 10 - every time. Then, pain does not equal suffering. A child might start crying and get upset about a finger prick. A trained martial artist might be able to emotionally ignore the sensation of most pain stimuli, even though it's felt just as strongly. Could a system measuring and accounting for all this exist in principle? Perhaps. It doesn't exist though, so your point is moot.
      - kerkeslager 6y ago
        > A doctor might ask you "how bad is the pain on a scale of one to ten?" or something of those sorts. That is informed by your entire history of pain experience. You're likely to rate the worst pain you ever felt as 10 - every time. Okay, referencing studies showing that people don't accurately report pain in pain assessments is the second time you've obliquely referenced well-known groups of studies (the first time being a roundabout reference to How Doctors Die[1]). Think about how bad this logic is: you're referencing papers which gather objective evidence on personal perceptions around treatment, and using those papers as evidence that it's impossible to gather objective evidence on personal perceptions. Do you not see how the very evidence you're referencing refutes your point? One fix being studied for pain assessments is to additionally add a question about what the worst pain the patient has ever suffered previously is, and compare that to their rating of the current pain. [1] https://hms.harvard.edu/news/how-doctors-die https://hms.harvard.edu/news/how-doctors-die
kerkeslager 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. Yes, and we can objectively measure what those chances are. Also don't forget, the process of diagnosis often also has consequences. Some percentage of people die on the table during surgical biopsies, for example. > 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. Sure, if you wish to ignore all objective evidence when making life-and-death decisions for yourself as a way of showing off just how gosh-darn free you are, that's your prerogative. > 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. I'm not sure how you've concluded that your perceptions cannot be objectively measured.
- gridlockd 6y ago
  > Yes, and we can objectively measure what those chances are. That's not being questioned. You're missing the point. Let's say you have cancer: You statistically have a 10% chance of surviving if you do treatment, but it will make your remaining time worse, no matter what. What do you do? Delegate your decision to some abstract scoring system? Of course not. It's a personal decision, influenced by all the variables in your life. As matter of fact, our system is set up to endorse more treatments in order to limit liabilities. How are you going to factor that one in? It has nothing to do with you and everything to do with the people treating you. > Sure, if you wish to ignore all objective evidence when making life-and-death decisions for yourself as a way of showing off just how gosh-darn free you are, that's your prerogative. Choosing to get a screening early is probably about as risky as riding a bicycle to work. What if the average person really likes riding a bike so much that it's worth the risk? Shouldn't you also absolutely ride a bike? Of course not. You should ride the bike if you like to. > I'm not sure how you've concluded that your perceptions cannot be objectively measured. Can my perception, which by definition is subjective, be measured objectively, by some technology, at least in theory? Perhaps. Practically speaking, is it going to be measured in this context? Am I going to get a prediction on how I personally will feel when choosing one thing over another? No.

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.

gridlockd 6y ago
Subjectively, I may prefer the risk of the false positive scenario to the risk of the missed diagnosis and early death. This is not reflected in statistics, because it is a personal preference. That may or may not be informed by additional information, for instance a person close to me may have had an early death from colon cancer and therefore I value the relief of having done the screening higher than someone else.
- kerkeslager 6y ago
  > This is not reflected in statistics, because it is a personal preference. What makes you think that personal preferences can't be studied? I'll tell you they can be studied because they are being studied.
  - gridlockd 6y ago
    You asked a similarly misguided question in the other part of the thread. I answered there as well, I'll give you another angle here. There is no "recommendation system" that can predict the right course of action based on my personal preference. There isn't even a good system to record and measure personal preference, because expression of perception is by itself highly subjective. A doctor might ask you "how bad is the pain on a scale of one to ten?" or something of those sorts. That is informed by your entire history of pain experience. You're likely to rate the worst pain you ever felt as 10 - every time. Then, pain does not equal suffering. A child might start crying and get upset about a finger prick. A trained martial artist might be able to emotionally ignore the sensation of most pain stimuli, even though it's felt just as strongly. Could a system measuring and accounting for all this exist in principle? Perhaps. It doesn't exist though, so your point is moot.
    - kerkeslager 6y ago
      > A doctor might ask you "how bad is the pain on a scale of one to ten?" or something of those sorts. That is informed by your entire history of pain experience. You're likely to rate the worst pain you ever felt as 10 - every time. Okay, referencing studies showing that people don't accurately report pain in pain assessments is the second time you've obliquely referenced well-known groups of studies (the first time being a roundabout reference to How Doctors Die[1]). Think about how bad this logic is: you're referencing papers which gather objective evidence on personal perceptions around treatment, and using those papers as evidence that it's impossible to gather objective evidence on personal perceptions. Do you not see how the very evidence you're referencing refutes your point? One fix being studied for pain assessments is to additionally add a question about what the worst pain the patient has ever suffered previously is, and compare that to their rating of the current pain. [1] https://hms.harvard.edu/news/how-doctors-die https://hms.harvard.edu/news/how-doctors-die

kerkeslager 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. Yes, and we can objectively measure what those chances are. Also don't forget, the process of diagnosis often also has consequences. Some percentage of people die on the table during surgical biopsies, for example. > 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. Sure, if you wish to ignore all objective evidence when making life-and-death decisions for yourself as a way of showing off just how gosh-darn free you are, that's your prerogative. > 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. I'm not sure how you've concluded that your perceptions cannot be objectively measured.

gridlockd 6y ago
> Yes, and we can objectively measure what those chances are. That's not being questioned. You're missing the point. Let's say you have cancer: You statistically have a 10% chance of surviving if you do treatment, but it will make your remaining time worse, no matter what. What do you do? Delegate your decision to some abstract scoring system? Of course not. It's a personal decision, influenced by all the variables in your life. As matter of fact, our system is set up to endorse more treatments in order to limit liabilities. How are you going to factor that one in? It has nothing to do with you and everything to do with the people treating you. > Sure, if you wish to ignore all objective evidence when making life-and-death decisions for yourself as a way of showing off just how gosh-darn free you are, that's your prerogative. Choosing to get a screening early is probably about as risky as riding a bicycle to work. What if the average person really likes riding a bike so much that it's worth the risk? Shouldn't you also absolutely ride a bike? Of course not. You should ride the bike if you like to. > I'm not sure how you've concluded that your perceptions cannot be objectively measured. Can my perception, which by definition is subjective, be measured objectively, by some technology, at least in theory? Perhaps. Practically speaking, is it going to be measured in this context? Am I going to get a prediction on how I personally will feel when choosing one thing over another? No.