5 ms·

Depends on your values. Some people may think it's worth it for them, and that's valid.

by im3w1l 6y ago

cycomanic 6y ago
I don't think it's as easy as "let the patient decide". First, probabilities are very abstract concepts for people, that's why people respond very differently to the dangers of things when given the probability. Some people are scared if there is a 1:1000 chance of something happening, others are reassured, but both might have very similar reactions if they actually get hit by the chance event. Secondly, also there is significant evidence of high incidence of depression for people with side effects, such as incontinence and impotence. I don't think people have the ability to assess that effect based on their values. To use an extreme example, should we operate something that has a 1:1000 change of killing you before something else, if it increases your suicide risk to 1:500? Should we allow patient to make that decision?
- edmundsauto 6y ago
  Yes, patients should be making all decisions regarding their own health. Am I misreading you? Are you really suggesting they shouldn’t have these options because they might make a bad decision?
  - google234123 6y ago
    This article is about screening which is a public health policy. Policies shouldn't promote things that are not effective. Anyway, patients can't make all decisions regarding their own health since most drugs need a medical prescription. And doctors won't just do any procedure that you ask them to.
- jjk166 6y ago
  Yes, the unwashed masses can't handle abstract concepts like 1:1000 being smaller than 1:500. We certainly know better than them the value of years with the kids versus a physically satisfying romantic life, and if they think differently they are clearly just irrational plebs who should be hoodwinked for their own protection. We can't let a lifetime of unique experience and perspective stand in the way of a good one-size fits all system that produces better (for our definition of better) results on average.
  - tweetle_beetle 6y ago
    The problem is that when handed numbers by a professional with years of training in an emotionally vulnerable state many people err on the side of being conservative on the issue at hand to avoid feeling like they may be judged. This is further encouraged by modern western medicine being highly compartmentalised - to oversimplify, the cancer doctor has succeeded if you don't get cancer, but will probably never even find out if you get severe depression as a side effect of a side effect and certainly won't have to deal with it. Specialists also have their own professional and personal bias when they deliver their options, which is not apparent when presenting as a patient. Is a scenario where the patient and the doctor are both acting based on short term benefit, rather than a holistic view, good for either party? There is a role for large scale public health policy in my opinion, as morally complicated as it is.
    - jjk166 6y ago
      I would not call general statistical data which takes no accounting of the details of the actual circumstances "holistic" The fact is there are tons of people for whom the side effects are a non-issue, and many for whom they would be far worse than the disease, and the statistics give no indication as to who is in which category. The role of public health is to provide information so that doctors and patients can make better informed decisions. But the idea that decisions should be made by some third party that "knows better" is predicated entirely on the false belief that such an entity exists.
      - tweetle_beetle 5y ago
        I'm not sure how looking at large scale trends and scenarios experienced by thousands/millions is anything but holistic, especially when talking about individual patients with individual specialists dealing with individual . > Holism (from Greek ὅλος holos "all, whole, entire") is the idea that various systems (e.g. physical, biological, social) should be viewed as wholes, not merely as a collection of parts. Of course it would be best if there was a universal language which everyone was proficient in, every patient had unlimited healthcare resources, had a strong understanding of medicine and every doctor was an excellent communicator, was under no personal/professional pressure to deliver specific outcomes, always took all the time a patient needed to understand every aspect of their case and care in the present and into the future and personally consulted with every possible specialist that may be involved with the potential outcomes. Putting aside the strawman, there are significant compromises with the highly personalised approach you suggest (some of which I tried to outline, but have not been responded to), just as there are with national level approaches (which are self evident). I feel that there are applications for both.

Depends on your values. Some people may think it's worth it for them, and that's valid.

by im3w1l 6y ago

Depends on your values. Some people may think it's worth it for them, and that's valid.

I don't think it's as easy as "let the patient decide". First, probabilities are very abstract concepts for people, that's why people respond very differently to the dangers of things when given the probability. Some people are scared if there is a 1:1000 chance of something happening, others are reassured, but both might have very similar reactions if they actually get hit by the chance event. Secondly, also there is significant evidence of high incidence of depression for people with side effects, such as incontinence and impotence. I don't think people have the ability to assess that effect based on their values. To use an extreme example, should we operate something that has a 1:1000 change of killing you before something else, if it increases your suicide risk to 1:500? Should we allow patient to make that decision?

edmundsauto 6y ago
Yes, patients should be making all decisions regarding their own health. Am I misreading you? Are you really suggesting they shouldn’t have these options because they might make a bad decision?
- google234123 6y ago
  This article is about screening which is a public health policy. Policies shouldn't promote things that are not effective. Anyway, patients can't make all decisions regarding their own health since most drugs need a medical prescription. And doctors won't just do any procedure that you ask them to.
jjk166 6y ago
Yes, the unwashed masses can't handle abstract concepts like 1:1000 being smaller than 1:500. We certainly know better than them the value of years with the kids versus a physically satisfying romantic life, and if they think differently they are clearly just irrational plebs who should be hoodwinked for their own protection. We can't let a lifetime of unique experience and perspective stand in the way of a good one-size fits all system that produces better (for our definition of better) results on average.
- tweetle_beetle 6y ago
  The problem is that when handed numbers by a professional with years of training in an emotionally vulnerable state many people err on the side of being conservative on the issue at hand to avoid feeling like they may be judged. This is further encouraged by modern western medicine being highly compartmentalised - to oversimplify, the cancer doctor has succeeded if you don't get cancer, but will probably never even find out if you get severe depression as a side effect of a side effect and certainly won't have to deal with it. Specialists also have their own professional and personal bias when they deliver their options, which is not apparent when presenting as a patient. Is a scenario where the patient and the doctor are both acting based on short term benefit, rather than a holistic view, good for either party? There is a role for large scale public health policy in my opinion, as morally complicated as it is.
  - jjk166 6y ago
    I would not call general statistical data which takes no accounting of the details of the actual circumstances "holistic" The fact is there are tons of people for whom the side effects are a non-issue, and many for whom they would be far worse than the disease, and the statistics give no indication as to who is in which category. The role of public health is to provide information so that doctors and patients can make better informed decisions. But the idea that decisions should be made by some third party that "knows better" is predicated entirely on the false belief that such an entity exists.
    - tweetle_beetle 5y ago
      I'm not sure how looking at large scale trends and scenarios experienced by thousands/millions is anything but holistic, especially when talking about individual patients with individual specialists dealing with individual . > Holism (from Greek ὅλος holos "all, whole, entire") is the idea that various systems (e.g. physical, biological, social) should be viewed as wholes, not merely as a collection of parts. Of course it would be best if there was a universal language which everyone was proficient in, every patient had unlimited healthcare resources, had a strong understanding of medicine and every doctor was an excellent communicator, was under no personal/professional pressure to deliver specific outcomes, always took all the time a patient needed to understand every aspect of their case and care in the present and into the future and personally consulted with every possible specialist that may be involved with the potential outcomes. Putting aside the strawman, there are significant compromises with the highly personalised approach you suggest (some of which I tried to outline, but have not been responded to), just as there are with national level approaches (which are self evident). I feel that there are applications for both.