4 ms·

Why conflate over/unnecessary treatment with availability and evaluation of markers? I guess if neither the patient nor the health care practitioner are uninter

Why conflate over/unnecessary treatment with availability and evaluation of markers? I guess if neither the patient nor the health care practitioner are uninterested in careful consideration of the data, then why bother I suppose. But then why bother at all with seat-belts, environmental laws, or dental visits if there's no value to prevention? We can just react after its too late, for everything. /s in some of this, perhaps all

gillesjacobs 6y ago
There's a multitude of reasons, touched upon in a metastudy of inappropriate lab testing in medicine [1,2]: > “But, unexpectedly, on a per-test basis, we actually found that the main problem was tests being over-ordered during a patient’s initial examination, rather than during repeat tests. This indicates to us that ordering the right test during the initial evaluation may lead to fewer errors and better patient care,” he said. a. Tests are not accurate, a false positive causes alarm and follow-up examination where none was present. b. On the inverse: negative tests provide a false sense of security and good-health. [2] discusses this as the prime motivator for patient blood test requests. c. Economic cost to the insurer or ultimately patient/taxpayer, not of the tests themselves but of the downstream examinations. As a general rule in medicine: Don't treat a patient without signs or symptoms. When a persons feels healthy, they usually are healthy. 1. https://hms.harvard.edu/news/unnecessary-testing https://hms.harvard.edu/news/unnecessary-testing 2. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078962 https://journals.plos.org/plosone/article?id=10.1371/journal... 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769380/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769380/
- calvano915 6y ago
  I appreciate all those considerations but prevention of disease is all about identifying issues that may disrupt ones current feelings of and actual healthy state. We cannot keep waiting for randomized experimental research to identify all the ways health may degrade over time. If we can regularly gather data en masse, we regularly over time can identify more predictors and risk factors for poor (and good) health, and evaluate efficacy of treatments received or effects from lack of treatment. Again, why pay for seatbelts (and get tickets for not having them) in vehicles if I've have no history of accidents, or receive preventative dental care despite no serious current oral issues, etc. Why do we have heat sensors in vehicles? The vehicles I've driven in life have never overheated. Somehow we continue to excuse doctors who practice poorly by treating by markers alone rather than the whole picture (including the patients feelings and desires), or despite contraindications for the treatment being considered. Somehow the only practical solution is to allow health degradation, and then rush to identify and treat and attempt reversal.
  - cloverich 6y ago
    Some tests not only don’t benefit patients when done without reason, they actually harm them. medical interventions and procedures are often invasive and not without side effects, including pain, severe disability, and death. In many cases the studies you allude to us waiting for have arrived, and they show active harm for many cases where you’d think “why not add a test, what’s the harm”. Unfortunately medicine is still way too complex to reason about without the research to back it.
    - calvano915 6y ago
      In my field of nutrition alone, there is tons more we could do to individualize and thus improve the targets for macro and micronutrients, as just one example. RDAs are only a rough starting point (when there is an RDA) as we understand more about individual genetics, food environment, etc. Why is all of medicine just invasive procedures and pharma? I'm not convinced that we somehow just need to sit and wait for some future time before we can jnvest and safely make use of markers over ones life to improve behaviors and health outcomes (for the benefit of an individual and others with similar medical characteristics). Theres room to debate the degree and depth that we would utilize labs and other measures, but a complete non-starter mentality just leaves health outcomes to blind fate and promotes development of complex conditions much more difficult to unwind.

gillesjacobs 6y ago

There's a multitude of reasons, touched upon in a metastudy of inappropriate lab testing in medicine [1,2]: > “But, unexpectedly, on a per-test basis, we actually found that the main problem was tests being over-ordered during a patient’s initial examination, rather than during repeat tests. This indicates to us that ordering the right test during the initial evaluation may lead to fewer errors and better patient care,” he said. a. Tests are not accurate, a false positive causes alarm and follow-up examination where none was present. b. On the inverse: negative tests provide a false sense of security and good-health. [2] discusses this as the prime motivator for patient blood test requests. c. Economic cost to the insurer or ultimately patient/taxpayer, not of the tests themselves but of the downstream examinations. As a general rule in medicine: Don't treat a patient without signs or symptoms. When a persons feels healthy, they usually are healthy. 1. https://hms.harvard.edu/news/unnecessary-testing https://hms.harvard.edu/news/unnecessary-testing 2. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078962 https://journals.plos.org/plosone/article?id=10.1371/journal... 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769380/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769380/

calvano915 6y ago
I appreciate all those considerations but prevention of disease is all about identifying issues that may disrupt ones current feelings of and actual healthy state. We cannot keep waiting for randomized experimental research to identify all the ways health may degrade over time. If we can regularly gather data en masse, we regularly over time can identify more predictors and risk factors for poor (and good) health, and evaluate efficacy of treatments received or effects from lack of treatment. Again, why pay for seatbelts (and get tickets for not having them) in vehicles if I've have no history of accidents, or receive preventative dental care despite no serious current oral issues, etc. Why do we have heat sensors in vehicles? The vehicles I've driven in life have never overheated. Somehow we continue to excuse doctors who practice poorly by treating by markers alone rather than the whole picture (including the patients feelings and desires), or despite contraindications for the treatment being considered. Somehow the only practical solution is to allow health degradation, and then rush to identify and treat and attempt reversal.
- cloverich 6y ago
  Some tests not only don’t benefit patients when done without reason, they actually harm them. medical interventions and procedures are often invasive and not without side effects, including pain, severe disability, and death. In many cases the studies you allude to us waiting for have arrived, and they show active harm for many cases where you’d think “why not add a test, what’s the harm”. Unfortunately medicine is still way too complex to reason about without the research to back it.
  - calvano915 6y ago
    In my field of nutrition alone, there is tons more we could do to individualize and thus improve the targets for macro and micronutrients, as just one example. RDAs are only a rough starting point (when there is an RDA) as we understand more about individual genetics, food environment, etc. Why is all of medicine just invasive procedures and pharma? I'm not convinced that we somehow just need to sit and wait for some future time before we can jnvest and safely make use of markers over ones life to improve behaviors and health outcomes (for the benefit of an individual and others with similar medical characteristics). Theres room to debate the degree and depth that we would utilize labs and other measures, but a complete non-starter mentality just leaves health outcomes to blind fate and promotes development of complex conditions much more difficult to unwind.