3 ms·

> 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 t

by 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.
acdha 6y ago
> 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. Again, it's not that simple. Doctors do not have perfect knowledge and have factors to consider other than the current academic consensus. Some fraction of people will get scared and demand _something_, which will for some people lead to them doing something worse than nothing at all. If you have many people seeking out treatment for a notification which has them scared, some of the patients will try something other than good medical treatments and some of them will have doctors who recommend things which used to be or are no longer best practice, make a recommendation skewed by a financial incentive or what will turn out to be a biased study funded by a company with a financial stake, etc. Engineers building tools like this have a tricky ethical line to walk between making information available and considering how that information could be misinterpreted or faulty. One of the biggest things I'd want to see on a system like this is careful treatment of showing confidence levels and present them in the UX. “️ Heart anomaly detected!” is not the same as “Our sensor reading was unusual but the signal was low-quality. Do you feel okay?”, etc.
- ebg13 6y ago
  You're bringing up very real issues that I think really have nothing to do with whether we decide to measure, report, and learn more about cardiac anomalies or not. I agree that we should be careful about how we report and apply information, but that isn't the same as saying we shouldn't look in the first place. Right now practically nobody ever bothers to look for symptoms of something that we believe full well to be the #1 leading cause of death by a large margin. That should really not be accepted by anyone.

by ebg13 6y ago

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.

acdha 6y ago

> 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. Again, it's not that simple. Doctors do not have perfect knowledge and have factors to consider other than the current academic consensus. Some fraction of people will get scared and demand _something_, which will for some people lead to them doing something worse than nothing at all. If you have many people seeking out treatment for a notification which has them scared, some of the patients will try something other than good medical treatments and some of them will have doctors who recommend things which used to be or are no longer best practice, make a recommendation skewed by a financial incentive or what will turn out to be a biased study funded by a company with a financial stake, etc. Engineers building tools like this have a tricky ethical line to walk between making information available and considering how that information could be misinterpreted or faulty. One of the biggest things I'd want to see on a system like this is careful treatment of showing confidence levels and present them in the UX. “️ Heart anomaly detected!” is not the same as “Our sensor reading was unusual but the signal was low-quality. Do you feel okay?”, etc.

ebg13 6y ago
You're bringing up very real issues that I think really have nothing to do with whether we decide to measure, report, and learn more about cardiac anomalies or not. I agree that we should be careful about how we report and apply information, but that isn't the same as saying we shouldn't look in the first place. Right now practically nobody ever bothers to look for symptoms of something that we believe full well to be the #1 leading cause of death by a large margin. That should really not be accepted by anyone.