4 ms·

I agree, but obviously it depends on how many people is "too many". From the article it looks like 10% of those who went to the doctor were diagnosed with a car

I agree, but obviously it depends on how many people is "too many". From the article it looks like 10% of those who went to the doctor were diagnosed with a cardiac condition, but what if it was 1%? A 90% false positive rate is already fairly high.

henriquez 6y ago
Maybe it’s just more common to have heart “anomalies” than people think. Historically it’s never been common for people having heart monitors strapped to them all the time, so now we’re In uncharted territory. Maybe there’s some scientific learning we still have to do about how the heart works, and what is considered “in spec.”
- cratermoon 6y ago
  It is common! I know as a heart patient I once wore a Holter monitor (https://www.mayoclinic.org/tests-procedures/holter-monitor/about/pac-20385039 https://www.mayoclinic.org/tests-procedures/holter-monitor/a...) and in the process learned that your heartbeat isn't perfect. Pre-beats are pretty common and completely harmless.
closetohome 6y ago
Another way of looking at it is that 1 in 10 people who were alerted to a potential health issue ended up needing medical assistance. That's actually pretty good for a basic non-medical screening.
- acdha 6y ago
  That's true with a big caveat: how many of those people get invasive treatments for things which would not have actually become problems? They've backed away from screening as aggressively for certain cancers because the risks of aggressive treatment turned out to be significant and it turned out that more people than expected had tumors which didn't develop into a problem before they died of something else. I don't know how plausible that is with heart issues — maybe aggressive prescription of something like statins with significant side-effects? — but it's very important to consider the cost of false-positives.
  - ebg13 6y ago
    > how many of those people get invasive treatments for things which would not have actually become problems? That's really the doctor's issue to address, not the device's. Sticking your head in the sand isn't the right solution to the problems of dealing with information too aggressively. > They've backed away from screening as aggressively for certain cancers because the risks of aggressive treatment turned out to be significant and it turned out that more people than expected had tumors which didn't develop into a problem before they died of something else. Literally the only way to build viable metrics for which tumors will develop into problems is for _everyone_ get screened, not for no one to get screened. The problem of treating too aggressively is a treatment problem, not a measurement problem. If we avoid measuring, we have no way to learn how to treat better. If we decide to never look because we don't yet know how to handle the information, then we will never know how to handle the information.
    - DanBC 6y ago
      > The problem of treating too aggressively is a treatment problem, not a measurement problem. One of the most important questions you can ask your doctor is "what happens if I don't have this test?" and "What happens if I don't have this treatment?" But most people don't ask these questions. And so it really is a measurement problem. Over-testing, over-diagnosis, and over-treatment are well understood mechanisms of harm. https://ebm.bmj.com/content/23/1/1 https://ebm.bmj.com/content/23/1/1 https://www.bmj.com/content/362/bmj.k2820 https://www.bmj.com/content/362/bmj.k2820 The harm caused by inappropriate screening is so severe that we (UK) have a committee to weigh up the harm vs benefit of different screening programmes. https://www.gov.uk/government/groups/uk-national-screening-committee-uk-nsc https://www.gov.uk/government/groups/uk-national-screening-c...
      - ebg13 6y ago
        > But most people don't ask these questions. And so it really is a measurement problem Putting the burden of asking these questions on the patient is wrong because patients don't go through a decade of training to become patients. And expecting the doctors to always ask these questions is wrong because I guess now we're not supposed to trust our doctors. But that doesn't mean we should suddenly live in a world without patient advocacy. It means you need to put it in the right place, in the hands of neither the patient nor the doctor directly. But if you never measure, and you need to be clear that, modulo epsilon, nobody ever measures heart rhythms despite heart disease being the #1 cause of death, then you definitely have no chance for anyone to ask those questions. > over-diagnosis and over-treatment are well understood mechanisms of harm. So are under-diagnosis and under-treatment. Both can only ultimately be solved by more information, not less.
deleted 6y ago
[deleted]

henriquez 6y ago

Maybe it’s just more common to have heart “anomalies” than people think. Historically it’s never been common for people having heart monitors strapped to them all the time, so now we’re In uncharted territory. Maybe there’s some scientific learning we still have to do about how the heart works, and what is considered “in spec.”

cratermoon 6y ago
It is common! I know as a heart patient I once wore a Holter monitor (https://www.mayoclinic.org/tests-procedures/holter-monitor/about/pac-20385039 https://www.mayoclinic.org/tests-procedures/holter-monitor/a...) and in the process learned that your heartbeat isn't perfect. Pre-beats are pretty common and completely harmless.

closetohome 6y ago

Another way of looking at it is that 1 in 10 people who were alerted to a potential health issue ended up needing medical assistance. That's actually pretty good for a basic non-medical screening.

acdha 6y ago
That's true with a big caveat: how many of those people get invasive treatments for things which would not have actually become problems? They've backed away from screening as aggressively for certain cancers because the risks of aggressive treatment turned out to be significant and it turned out that more people than expected had tumors which didn't develop into a problem before they died of something else. I don't know how plausible that is with heart issues — maybe aggressive prescription of something like statins with significant side-effects? — but it's very important to consider the cost of false-positives.
- ebg13 6y ago
  > how many of those people get invasive treatments for things which would not have actually become problems? That's really the doctor's issue to address, not the device's. Sticking your head in the sand isn't the right solution to the problems of dealing with information too aggressively. > They've backed away from screening as aggressively for certain cancers because the risks of aggressive treatment turned out to be significant and it turned out that more people than expected had tumors which didn't develop into a problem before they died of something else. Literally the only way to build viable metrics for which tumors will develop into problems is for _everyone_ get screened, not for no one to get screened. The problem of treating too aggressively is a treatment problem, not a measurement problem. If we avoid measuring, we have no way to learn how to treat better. If we decide to never look because we don't yet know how to handle the information, then we will never know how to handle the information.
  - DanBC 6y ago
    > The problem of treating too aggressively is a treatment problem, not a measurement problem. One of the most important questions you can ask your doctor is "what happens if I don't have this test?" and "What happens if I don't have this treatment?" But most people don't ask these questions. And so it really is a measurement problem. Over-testing, over-diagnosis, and over-treatment are well understood mechanisms of harm. https://ebm.bmj.com/content/23/1/1 https://ebm.bmj.com/content/23/1/1 https://www.bmj.com/content/362/bmj.k2820 https://www.bmj.com/content/362/bmj.k2820 The harm caused by inappropriate screening is so severe that we (UK) have a committee to weigh up the harm vs benefit of different screening programmes. https://www.gov.uk/government/groups/uk-national-screening-committee-uk-nsc https://www.gov.uk/government/groups/uk-national-screening-c...
    - ebg13 6y ago
      > But most people don't ask these questions. And so it really is a measurement problem Putting the burden of asking these questions on the patient is wrong because patients don't go through a decade of training to become patients. And expecting the doctors to always ask these questions is wrong because I guess now we're not supposed to trust our doctors. But that doesn't mean we should suddenly live in a world without patient advocacy. It means you need to put it in the right place, in the hands of neither the patient nor the doctor directly. But if you never measure, and you need to be clear that, modulo epsilon, nobody ever measures heart rhythms despite heart disease being the #1 cause of death, then you definitely have no chance for anyone to ask those questions. > over-diagnosis and over-treatment are well understood mechanisms of harm. So are under-diagnosis and under-treatment. Both can only ultimately be solved by more information, not less.

deleted 6y ago

[deleted]