6 ms·

I've never understood this argument, more information should always be better. The real problem seems to be the knee-jerk biopsy/surgery. If a QA engineer poi

I've never understood this argument, more information should always be better. The real problem seems to be the knee-jerk biopsy/surgery. If a QA engineer points out a potential bug, it's foolish immediately/blindly delete chunk of code containing the bug. It's just as foolish to say we're randomly deleting too much good code, so let's fire the QA engineers.

arrosenberg 6y ago
That’s a fine sentiment and all, but if you are looking for a logical response from most people in that situation, you’re gonna have a bad time.
dehrmann 6y ago
> more information should always be better It's not, though. There's a cost to collecting the information, it's not always actionable, and it can be wrong. On the human side, there's a reason they say "ignorance is bliss."
jedberg 6y ago
Think of it more like this: A QA engineer finds a bug. You spend a bunch of time diagnosing and fixing the bug. But it turns out that no user actually hit that bug because they never used that feature, and in fact that feature gets taken out in the next release. That's a lot of wasted time. Time better spent having the QA engineer only look at bugs reported by users and not looking for them on their own. In the case of the mammogram, it's even less clear cut. The mammogram only shows spots. A biopsy is necessary to determine if it's cancer. A biopsy is surgery and could have complications. And could in fact make the problem worse. So the idea is that you only do the test if you actually have symptoms or a family history of breast cancer, until the risk level gets high enough that it warrants going to look for cancer without symptoms.
- aeternum 6y ago
  Just because a QA engineer finds a bug does not mean you should spend a bunch of time diagnosing and fixing it. In either case you can choose to do nothing. Knowing that the bug exists should put you in a better place to make the right call.
tasty_freeze 6y ago
An under 3-minute video by a funny and informative doctor explaining this (youtube handle "medlife crisis"): https://www.youtube.com/watch?v=7kQk9-KLPfU https://www.youtube.com/watch?v=7kQk9-KLPfU
- ejolto 6y ago
  This one is even more relevant as he talks about dangers of over screening for beast cancer, and side effects of mastectomy+chemo: https://youtu.be/yNzQ_sLGIuA https://youtu.be/yNzQ_sLGIuA
  - aeternum 6y ago
    Even in his examples, the screening itself does not seem to be the problem. It's relatively cheap and quick. The problem was the decision to undergo treatment when the complications outweighed the benefit. What if we did more screening but also less treatment?
    - allturtles 6y ago
      Unfortunately you can't know the benefit in advance. It's not generally possible to tell from a MRI/CT that detects a tumor if it will kill you soon if not treated, if it will kill you no matter what you do, or if it will just sit there for a decade and do nothing.
      - aeternum 6y ago
        The only way we will figure that out is to collect lots of data on it. Perhaps there are correlations in the MRI/CT that determine lethality/malignancy. Even if we perform zero treatment, this data argument should be sufficient reason to increase rather than decrease the number of MRIs we do. CT is different since there is some radiation exposure risk that must be considered.
        jedberg 6y ago
rzzzt 6y ago
"Let's operate before the patient gets better" or something close was an in-half-jest quote I have read in one of the articles linked here on HN (it was about how surgery does not directly heal people, but makes conditions ideal for the body to repair itself). Now if I could find its source... Edit: a search revealed that it was about knee surgeries that do not always make things better.
inglor_cz 6y ago
"more information should always be better" Should it? Running around with a known cancer that your doctors refuse to treat (because they expect it to go away), is a major stress factor and may, in the end, damage your own immune response. Actually, "more information may lead to worse performance" has been shown in another psychologically heavy field: the stock market. [0] Humans are complicated. [0] https://behaviouralinvestment.com/2019/01/09/can-more-information-lead-to-worse-investment-decisions/ https://behaviouralinvestment.com/2019/01/09/can-more-inform...
- aeternum 6y ago
  Then maybe the problem is the human. Perhaps an algorithm should take in the test information and determine the most logical path forward (do nothing, increased future testing, surgery). From a Bayesian/logical POV, more information should still allow for a better decision.
fifteenforty 6y ago
All tests have false positives and false negatives. Whether we explicitly say it or not, most clinical decision making algorithms are based on a Bayesian approach. If you have next to no risk of a disease, don’t get tested for it. You might get treated for it!
- aeternum 6y ago
  >If you have next to no risk of a disease, don’t get tested for it. You might get treated for it! If this is true, then clinical decision makers don't understand or are not correctly applying Bayesian priors.
LorenPechtel 6y ago
The problem is that information comes with risk. And I don't understand your comment about knee-jerk biopsy--if you're not going to do the biopsy why did you even bother with the mammogram??? My wife has been through that: Routine mammogram--it got read while she was still there. The radiologist didn't like a spot. Ultrasound. They still didn't like the spot. An hour of sitting around while they get authorization, then they do a biopsy there in the radiology facility. That came back abnormal but not cancer. At that point the urgency was over, she was referred to a surgeon who removed what pathology said was a precancerous lump.

arrosenberg 6y ago

That’s a fine sentiment and all, but if you are looking for a logical response from most people in that situation, you’re gonna have a bad time.

dehrmann 6y ago

> more information should always be better It's not, though. There's a cost to collecting the information, it's not always actionable, and it can be wrong. On the human side, there's a reason they say "ignorance is bliss."

jedberg 6y ago

Think of it more like this: A QA engineer finds a bug. You spend a bunch of time diagnosing and fixing the bug. But it turns out that no user actually hit that bug because they never used that feature, and in fact that feature gets taken out in the next release. That's a lot of wasted time. Time better spent having the QA engineer only look at bugs reported by users and not looking for them on their own. In the case of the mammogram, it's even less clear cut. The mammogram only shows spots. A biopsy is necessary to determine if it's cancer. A biopsy is surgery and could have complications. And could in fact make the problem worse. So the idea is that you only do the test if you actually have symptoms or a family history of breast cancer, until the risk level gets high enough that it warrants going to look for cancer without symptoms.

aeternum 6y ago
Just because a QA engineer finds a bug does not mean you should spend a bunch of time diagnosing and fixing it. In either case you can choose to do nothing. Knowing that the bug exists should put you in a better place to make the right call.

tasty_freeze 6y ago

An under 3-minute video by a funny and informative doctor explaining this (youtube handle "medlife crisis"): https://www.youtube.com/watch?v=7kQk9-KLPfU https://www.youtube.com/watch?v=7kQk9-KLPfU

ejolto 6y ago
This one is even more relevant as he talks about dangers of over screening for beast cancer, and side effects of mastectomy+chemo: https://youtu.be/yNzQ_sLGIuA https://youtu.be/yNzQ_sLGIuA
- aeternum 6y ago
  Even in his examples, the screening itself does not seem to be the problem. It's relatively cheap and quick. The problem was the decision to undergo treatment when the complications outweighed the benefit. What if we did more screening but also less treatment?
  - allturtles 6y ago
    Unfortunately you can't know the benefit in advance. It's not generally possible to tell from a MRI/CT that detects a tumor if it will kill you soon if not treated, if it will kill you no matter what you do, or if it will just sit there for a decade and do nothing.
    - aeternum 6y ago
      The only way we will figure that out is to collect lots of data on it. Perhaps there are correlations in the MRI/CT that determine lethality/malignancy. Even if we perform zero treatment, this data argument should be sufficient reason to increase rather than decrease the number of MRIs we do. CT is different since there is some radiation exposure risk that must be considered.
      - jedberg 6y ago

rzzzt 6y ago

"Let's operate before the patient gets better" or something close was an in-half-jest quote I have read in one of the articles linked here on HN (it was about how surgery does not directly heal people, but makes conditions ideal for the body to repair itself). Now if I could find its source... Edit: a search revealed that it was about knee surgeries that do not always make things better.

inglor_cz 6y ago

"more information should always be better" Should it? Running around with a known cancer that your doctors refuse to treat (because they expect it to go away), is a major stress factor and may, in the end, damage your own immune response. Actually, "more information may lead to worse performance" has been shown in another psychologically heavy field: the stock market. [0] Humans are complicated. [0] https://behaviouralinvestment.com/2019/01/09/can-more-information-lead-to-worse-investment-decisions/ https://behaviouralinvestment.com/2019/01/09/can-more-inform...

aeternum 6y ago
Then maybe the problem is the human. Perhaps an algorithm should take in the test information and determine the most logical path forward (do nothing, increased future testing, surgery). From a Bayesian/logical POV, more information should still allow for a better decision.

fifteenforty 6y ago

All tests have false positives and false negatives. Whether we explicitly say it or not, most clinical decision making algorithms are based on a Bayesian approach. If you have next to no risk of a disease, don’t get tested for it. You might get treated for it!

aeternum 6y ago
>If you have next to no risk of a disease, don’t get tested for it. You might get treated for it! If this is true, then clinical decision makers don't understand or are not correctly applying Bayesian priors.

LorenPechtel 6y ago

The problem is that information comes with risk. And I don't understand your comment about knee-jerk biopsy--if you're not going to do the biopsy why did you even bother with the mammogram??? My wife has been through that: Routine mammogram--it got read while she was still there. The radiologist didn't like a spot. Ultrasound. They still didn't like the spot. An hour of sitting around while they get authorization, then they do a biopsy there in the radiology facility. That came back abnormal but not cancer. At that point the urgency was over, she was referred to a surgeon who removed what pathology said was a precancerous lump.