10 ms·

Lots of problematic assumptions in your reply. >If finding something that otherwise carries no symptoms is best left untreated, then the fact that you found it

Lots of problematic assumptions in your reply. >If finding something that otherwise carries no symptoms is best left untreated, then the fact that you found it should make no difference to the decision. The doctor should say that the best course of action is to do nothing. More information can never be harmful. Absolutely and demonstratively false. There is an entire field of health policy that destroys this harmful idea. First of all, just because something doesn't carry symptoms NOW doesn't mean it won't carry symptoms LATER, but doctors can't always predict this and aren't perfect decision making machines. Many times the patient will push them for further tests and treatment (or the doctors will advocate for it to ease the mind of the patient) which leads to potential harm from unnecessary treatments. And this is just ONE of the ways patients are harmed by unnecessary screening. There is also the psychological damage of having a condition you wouldn't have otherwise known about, and living with that knowledge (take aneurysms for example). Psychological stress has a real physical toll on the body. Then there's the COST associated with unnecessary screening and treatments, which (especially in the US) can run into the thousands quite easily for even simple interventions as a result of unnecessary screening. Even after that, a screening process can also find something that could be bad, but in some patients doesn't actually decrease their lifespan or quality of life. If we have no way of adjudicating between these cases or predicting which cases will end up bad if left untreated at the present moment, what do you think will happen? People will ask to be treated anyway, and iatrogenics will rear its ugly head. You cannot ASSUME that screening is automatically good. It must PROVE itself as such in a randomized clinical trial. This trial must show that people live longer and/or better as a result of this intervention. In many well documented cases, this turns out NOT to be the case, which entirely destroys your original rebuttal.

throwawaynotmd 5y ago
>Many times the patient will push them for further tests and treatment (or the doctors will advocate for it to ease the mind of the patient) which leads to potential harm from unnecessary treatments. >People will ask to be treated anyway, and iatrogenics will rear its ugly head. I just want to say that you are in agreement with my position here. Your point about psychological problems is interesting, but as long as people know what they’re signing up for, it’s okay. Some people aren’t prone to anxiety. Why should they pay the price because other people are? Part of my original point was that implicit in your argument is that people capable of handling it should be denied something because more people incapable of handling it can’t be stopped from hurting themselves. I think many people do not agree with that moral reasoning, so medical people hide it behind objective looking statistics. And as for cost, I don’t take any arguments from medical people about cost seriously. The reason why costs are so high is because doctors and the medical field as a whole run a massive protectionist racket to keep the supply of medical professionals low. How fresh of them to say that because they’ve limited the supply of medical resources to enrich themselves, patients must pay by having less access to care.
- exdsq 5y ago
  Your point about a protectionist racket doesn't hold for countries in the EU which have the same rules around research data and patients
- novok 5y ago
  I think once you become a doctor, you quickly realize that a large amount of the population do not have the temperament to deal with 'maybe' bad news. Many are not the 135 IQ %1 of the population with a low anxiety personality who accept that they will eventually grow old and die, which happens to coincide with many engineering types on HN.
  - pie420 5y ago
    Lol, i would argue that engineers, many of whose primary job function is to imagine worst case scenarios and engineer around those to prevent accidents, data loss, etc. Are the exact type of people that are prone to hypochondria. It's not about growing old and dying, it's about ignoring a stomach ache for a couple months and then being told you have terminal cancer, and then living with the regret of "if only I got it checked out earlier". In the engineering world, you are almost always rewarded for being extra safe and testing, fixing, and investigating anything that might seem a little off. If you do blood tests, MRIs, and cancer screens for every mole, cough, and stomach pain, you will go insane and develop hypochondria.
    - novok 5y ago
      I guess depends on the mental counter response those engineers take. Because you have to think about every possibility, you create a counter temperment that doesn't implode thinking about every possibility. Some might go the other way, and their anxious personality might help them think about everything, but also make them a stress case. I think the first type tends to last longer in the industry, at least for my coworkers.
fallingknife 5y ago
> but doctors can't always predict this and aren't perfect decision making machines So mass screen healthy people, collect the data, run models, and get better at it. People like you would rather not try, and this is the same reaction I get from doctors. Applying the same tech that we use to improve ad targeting to disease prediction is a no brainer to anyone whose cushy job doesn't depend on the current medieval state of medical technology.
- rackjack 5y ago
  Same vibe as "I would just simply..." What do you think the entire medical, pharmaceutical, bioinformatic, etc. industries have been doing for decades? Are you really so arrogant to think that other people are too lazy and stupid to think of your brilliant idea and that you are simply more intelligent than everybody else? Do you really think people haven't been trying?
  - function_seven 5y ago
    If they aren't mass collecting this data in the first place (for the reasons outlined above), then how can they be doing this? Or, if they are doing this from quality samples of the population, then we have data to show that, for example, "Yes, Mr. Function Seven, your scan shows elevated levels of Widget-5a enzymes. This is often a precursor to Gadget Cancer, but 30% of the population shows this elevation, while only 1% develop the cancer. It's best to do nothing at this time unless we see further elevation. Have a good day, see you next year" So either we have this data and we can give accurate advice, or we don't have this data because we're afraid of over-diagnosing non-problems. I understand the fear, but it's still burying one's head in the sand to not even look.
    - rackjack 5y ago
      They are mass collecting the data. They have more data than they know what to do with. Bioinformatics abuses data science at levels comparable to Google and Facebook. They are getting quality samples from the population. But it's not a simple as "high enzyme = maybe good chance of cancer". How are you going to get those enzymes from their blood in a way that can be applied to the general population? Before that, how do you know there's not confounding factors (of which they are a LOT)? > So either we have this data and we can give accurate advice, or we don't have this data because we're afraid of over-diagnosing non-problems. It's not that easy. Look at this pathway: https://www.pathwaycommons.org/guide/workflows/rna_seq_to_enrichment_map/identify_pathways/figure_idpathways_il5_netpath_diagram.png https://www.pathwaycommons.org/guide/workflows/rna_seq_to_en... From here: https://www.pathwaycommons.org/guide/workflows/rna_seq_to_enrichment_map/identify_pathways/ https://www.pathwaycommons.org/guide/workflows/rna_seq_to_en... This is what people think the activation of genes is. What they THINK the activation of genes is. Note the following: - They don't know all the genes. They are constantly identifying new ones. The number of gene pathways people are pretty sure are complete is small. I don't know if this one is one of the "pretty sure" ones. - Gene pathways are not just complex in terms of size, they are also non-linear. This is not a computer program, this is a horrible biological mess where biological components constantly and probabilistically emit chemicals. I don't even think that the pathway I gave you is super representative - it doesn't feature the ridiculous non-linearity and uncertainty that many pathways at the bleeding edge have. They can get much worse. People are not burying their heads in the sand. They are trying their almighty to dig up from bedrock and reach the sky.
skybrian 5y ago
I have no expertise here but I worry that these trials are studying the decision-making processes around how people decide to use the information from these tests, rather than the tests themselves. How people use information varies, so the data might not have external validity - it’s culture specific, and cultures differ. Cultures can also change through accumulated experience. So do the people studying these things try again with different and possibly better decision-making, or do they conclude that the test itself is no good?
- TaupeRanger 5y ago
  That is a very important point. This is why multiple studies are needed that across time, location, culture, etc. The more data a doctor has the better decisions they can make for their specific patients.
fierro 5y ago
you're conflating "pushing for further tests" with "pushing for further treatment.' IMO, everyone should be entitled to as much data accumulation as they want. Insurance companies can set reasonable thresholds, but if I want to pay out of pocket to get bloodwork done, that should be easy to get. Whether or not a doctor prescribes/advises a certain treatment is still firmly in their domain. The amount of biomarkers/biological evidence a patient has shouldn't sway a doctor's decision to alter a treatment plan. As a reasonably smart non-medical professional, I would rather have more data than less data, and it's paternalistic and a little condescending to say "no, you shouldn't actually take diagnostic tests because 'having that information might freak you out'"
bick_nyers 5y ago
I wonder if the psychological stress you describe is a result of societal expectations, which itself is a result of what has been done historically. I would think that to most people you are either healthy, or you have a problem, because that is often how it is viewed when it comes to healthcare. In the same way your doctor could say "you are a little overweight, and let's keep an eye on it to make sure it doesn't cause problems down the road", a similar perspective could be had for what people commonly associate with more serious issues. You can look at what the correlations say for health policy, or you can consider the actual reasoning as to why people view healthcare as such in the first place. It's normalized for people to not go to a doctor unless they have a problem, it's normalized to not take regular preventative measures and screenings. In addition, there are financial barriers. While insurance companies may benefit in the long run from more regular, personalized, preventative care, they are likely very resistant to paying for it. With the costs of healthcare, only well off people would consider this approach, as most of their costs may be out of pocket because they don't have a problem to point to for these kinds of screenings. Like getting blood work done maybe every 6 months just to make sure everything is doing ok, hormones, etc. If it was normalized, and people less afraid of the doctor, needles, and of the costs attached to being unhealthy, their sources of psychological stress would likely be non-existent.

throwawaynotmd 5y ago

>Many times the patient will push them for further tests and treatment (or the doctors will advocate for it to ease the mind of the patient) which leads to potential harm from unnecessary treatments. >People will ask to be treated anyway, and iatrogenics will rear its ugly head. I just want to say that you are in agreement with my position here. Your point about psychological problems is interesting, but as long as people know what they’re signing up for, it’s okay. Some people aren’t prone to anxiety. Why should they pay the price because other people are? Part of my original point was that implicit in your argument is that people capable of handling it should be denied something because more people incapable of handling it can’t be stopped from hurting themselves. I think many people do not agree with that moral reasoning, so medical people hide it behind objective looking statistics. And as for cost, I don’t take any arguments from medical people about cost seriously. The reason why costs are so high is because doctors and the medical field as a whole run a massive protectionist racket to keep the supply of medical professionals low. How fresh of them to say that because they’ve limited the supply of medical resources to enrich themselves, patients must pay by having less access to care.

exdsq 5y ago
Your point about a protectionist racket doesn't hold for countries in the EU which have the same rules around research data and patients
novok 5y ago
I think once you become a doctor, you quickly realize that a large amount of the population do not have the temperament to deal with 'maybe' bad news. Many are not the 135 IQ %1 of the population with a low anxiety personality who accept that they will eventually grow old and die, which happens to coincide with many engineering types on HN.
- pie420 5y ago
  Lol, i would argue that engineers, many of whose primary job function is to imagine worst case scenarios and engineer around those to prevent accidents, data loss, etc. Are the exact type of people that are prone to hypochondria. It's not about growing old and dying, it's about ignoring a stomach ache for a couple months and then being told you have terminal cancer, and then living with the regret of "if only I got it checked out earlier". In the engineering world, you are almost always rewarded for being extra safe and testing, fixing, and investigating anything that might seem a little off. If you do blood tests, MRIs, and cancer screens for every mole, cough, and stomach pain, you will go insane and develop hypochondria.
  - novok 5y ago
    I guess depends on the mental counter response those engineers take. Because you have to think about every possibility, you create a counter temperment that doesn't implode thinking about every possibility. Some might go the other way, and their anxious personality might help them think about everything, but also make them a stress case. I think the first type tends to last longer in the industry, at least for my coworkers.

fallingknife 5y ago

> but doctors can't always predict this and aren't perfect decision making machines So mass screen healthy people, collect the data, run models, and get better at it. People like you would rather not try, and this is the same reaction I get from doctors. Applying the same tech that we use to improve ad targeting to disease prediction is a no brainer to anyone whose cushy job doesn't depend on the current medieval state of medical technology.

rackjack 5y ago
Same vibe as "I would just simply..." What do you think the entire medical, pharmaceutical, bioinformatic, etc. industries have been doing for decades? Are you really so arrogant to think that other people are too lazy and stupid to think of your brilliant idea and that you are simply more intelligent than everybody else? Do you really think people haven't been trying?
- function_seven 5y ago
  If they aren't mass collecting this data in the first place (for the reasons outlined above), then how can they be doing this? Or, if they are doing this from quality samples of the population, then we have data to show that, for example, "Yes, Mr. Function Seven, your scan shows elevated levels of Widget-5a enzymes. This is often a precursor to Gadget Cancer, but 30% of the population shows this elevation, while only 1% develop the cancer. It's best to do nothing at this time unless we see further elevation. Have a good day, see you next year" So either we have this data and we can give accurate advice, or we don't have this data because we're afraid of over-diagnosing non-problems. I understand the fear, but it's still burying one's head in the sand to not even look.
  - rackjack 5y ago
    They are mass collecting the data. They have more data than they know what to do with. Bioinformatics abuses data science at levels comparable to Google and Facebook. They are getting quality samples from the population. But it's not a simple as "high enzyme = maybe good chance of cancer". How are you going to get those enzymes from their blood in a way that can be applied to the general population? Before that, how do you know there's not confounding factors (of which they are a LOT)? > So either we have this data and we can give accurate advice, or we don't have this data because we're afraid of over-diagnosing non-problems. It's not that easy. Look at this pathway: https://www.pathwaycommons.org/guide/workflows/rna_seq_to_enrichment_map/identify_pathways/figure_idpathways_il5_netpath_diagram.png https://www.pathwaycommons.org/guide/workflows/rna_seq_to_en... From here: https://www.pathwaycommons.org/guide/workflows/rna_seq_to_enrichment_map/identify_pathways/ https://www.pathwaycommons.org/guide/workflows/rna_seq_to_en... This is what people think the activation of genes is. What they THINK the activation of genes is. Note the following: - They don't know all the genes. They are constantly identifying new ones. The number of gene pathways people are pretty sure are complete is small. I don't know if this one is one of the "pretty sure" ones. - Gene pathways are not just complex in terms of size, they are also non-linear. This is not a computer program, this is a horrible biological mess where biological components constantly and probabilistically emit chemicals. I don't even think that the pathway I gave you is super representative - it doesn't feature the ridiculous non-linearity and uncertainty that many pathways at the bleeding edge have. They can get much worse. People are not burying their heads in the sand. They are trying their almighty to dig up from bedrock and reach the sky.

skybrian 5y ago

I have no expertise here but I worry that these trials are studying the decision-making processes around how people decide to use the information from these tests, rather than the tests themselves. How people use information varies, so the data might not have external validity - it’s culture specific, and cultures differ. Cultures can also change through accumulated experience. So do the people studying these things try again with different and possibly better decision-making, or do they conclude that the test itself is no good?

TaupeRanger 5y ago
That is a very important point. This is why multiple studies are needed that across time, location, culture, etc. The more data a doctor has the better decisions they can make for their specific patients.

fierro 5y ago

you're conflating "pushing for further tests" with "pushing for further treatment.' IMO, everyone should be entitled to as much data accumulation as they want. Insurance companies can set reasonable thresholds, but if I want to pay out of pocket to get bloodwork done, that should be easy to get. Whether or not a doctor prescribes/advises a certain treatment is still firmly in their domain. The amount of biomarkers/biological evidence a patient has shouldn't sway a doctor's decision to alter a treatment plan. As a reasonably smart non-medical professional, I would rather have more data than less data, and it's paternalistic and a little condescending to say "no, you shouldn't actually take diagnostic tests because 'having that information might freak you out'"

bick_nyers 5y ago

I wonder if the psychological stress you describe is a result of societal expectations, which itself is a result of what has been done historically. I would think that to most people you are either healthy, or you have a problem, because that is often how it is viewed when it comes to healthcare. In the same way your doctor could say "you are a little overweight, and let's keep an eye on it to make sure it doesn't cause problems down the road", a similar perspective could be had for what people commonly associate with more serious issues. You can look at what the correlations say for health policy, or you can consider the actual reasoning as to why people view healthcare as such in the first place. It's normalized for people to not go to a doctor unless they have a problem, it's normalized to not take regular preventative measures and screenings. In addition, there are financial barriers. While insurance companies may benefit in the long run from more regular, personalized, preventative care, they are likely very resistant to paying for it. With the costs of healthcare, only well off people would consider this approach, as most of their costs may be out of pocket because they don't have a problem to point to for these kinds of screenings. Like getting blood work done maybe every 6 months just to make sure everything is doing ok, hormones, etc. If it was normalized, and people less afraid of the doctor, needles, and of the costs attached to being unhealthy, their sources of psychological stress would likely be non-existent.