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You're missing a step. There are several responses saying basically the same thing (testing kills), and more or less randomly I'm going to answer yours. All hav

You're missing a step. There are several responses saying basically the same thing (testing kills), and more or less randomly I'm going to answer yours. All have the same step missing. Testing doesn't kills by itself, not in numbers worth mentioning. Treatments - sure, a whole different ball game, they're positively dangerous. But between testing and treatments there should be a specialist that crunches the numbers and comes to a decision. Which, like in the mammogram example above, is not always going to be more aggressive testing. What testing does is give you more information, which in a remotely sane system should lead to better decision making. Of course, I can imagine insane systems where, for example, the patient decides, the insurance pays and the doctor can be sued for discouraging treatments. In this particular combo you probably want to avoid doing mammograms to 20 yo, because the chance of a false positive is 1%, the chance of a true positive is 0.01%, and you end up with perverse chains leading to healthy people doing chemo. Like I said in the original comment, I GET the phenomenon. What I don't get however is how it can get even close to conventional wisdom that you want to avoid testing, as a rule. That's a particular fix to a particularly insane incentive combo, and common sense should make everybody rail against the insane incentive combo, and not act like the niche fix is actually a goal. I can't really explain how this came to be. Maybe people stumbled on an explanation of how extra testing _may_ be harmful, and the idea was so cool that it got stripped of context and became a meme in itself.

vidarh 5y ago
> Testing doesn't kills by itself, not in numbers worth mentioning. Mammography involves radiation and pressure. The radiation alone is a significant risk [1], and kills by causing cancer. It can also cause tumors to rupture and spread malignant cells. It's significant enough to significantly increase the hurdle where mammography is justified. It does not mean it never is - absolutely not. But it means screening programs need to be targeted. > What I don't get however is how it can get even close to conventional wisdom that you want to avoid testing, as a rule. It's not conventional wisdom that you want to avoid testing. That is for example what led to a lot of really aggressive campaigns for extensive breast cancer screening. What we saw was a small improvement in outcomes on a small number of positive test results, for a level of testing that suggested it was necessary to take into account other factors. Breast cancer screening was rolled back many places, or widening of the age bracket was halted as a result of looking at outcomes and realising that "conventional wisdom", which used to be that more testing was inherently good was flawed. There are clear, quantifiable harms from it, ranging from actual risks of causing cancer or causing spread of cancer with mammography. These risks are low enough to be worth it for certain patient groups, but high enough to add up to problems if screening is too widespread. People didn't start worrying about this because it was "conventional wisdom", but because the data shows people actually dying. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878445/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878445/
- radu_floricica 5y ago
  The study reads like a success story to me. They started from a hypotheses of testing reducing deaths overall, which was confirmed. Once they had more data they were able to find ways to optimize the process, like delaying testing for large breasted women who have a worse risk/benefit profile. What I'm advocating for btw, just to make clear, is regularly showing up to a doctor who will recommend all the cost effective non-intrusive tests (like blood work) plus the intrusive testing depending in your particular risk profile. This doesn't seem like a controversial opinion to me - more like a common sense default. As for conventional wisdom, look at this thread. Count the pro/contra comments if you want. Other then a tautological "some medical procedures can be dangeours if misused/overused", I still don't get how people can be against testing, in general.
  - vidarh 5y ago
    The way to optimise the process was to reduce the amount of screening. It points out exactly why broad, indiscriminate screening can not be assumed to be safe, and that "optimizing the process" means moving away from thinking that more screening is automatically better, and towards identifying which groups where the benefits outweigh the dangers. But the main reason for posting that link was to point out that the idea that testing does not kill is false for some types of testing, and as such you need to understand the risk vs. reward, or you may end up doing harm. > What I'm advocating for btw, just to make clear, is regularly showing up to a doctor who will recommend all the cost effective non-intrusive tests (like blood work) plus the intrusive testing depending in your particular risk profile. This doesn't seem like a controversial opinion to me - more like a common sense default. I haven't seen anyone here arguing against that. That's not what's been discussed by those of us here pointing out the dangers of mass-screening.

vidarh 5y ago

> Testing doesn't kills by itself, not in numbers worth mentioning. Mammography involves radiation and pressure. The radiation alone is a significant risk [1], and kills by causing cancer. It can also cause tumors to rupture and spread malignant cells. It's significant enough to significantly increase the hurdle where mammography is justified. It does not mean it never is - absolutely not. But it means screening programs need to be targeted. > What I don't get however is how it can get even close to conventional wisdom that you want to avoid testing, as a rule. It's not conventional wisdom that you want to avoid testing. That is for example what led to a lot of really aggressive campaigns for extensive breast cancer screening. What we saw was a small improvement in outcomes on a small number of positive test results, for a level of testing that suggested it was necessary to take into account other factors. Breast cancer screening was rolled back many places, or widening of the age bracket was halted as a result of looking at outcomes and realising that "conventional wisdom", which used to be that more testing was inherently good was flawed. There are clear, quantifiable harms from it, ranging from actual risks of causing cancer or causing spread of cancer with mammography. These risks are low enough to be worth it for certain patient groups, but high enough to add up to problems if screening is too widespread. People didn't start worrying about this because it was "conventional wisdom", but because the data shows people actually dying. [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878445/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4878445/

radu_floricica 5y ago
The study reads like a success story to me. They started from a hypotheses of testing reducing deaths overall, which was confirmed. Once they had more data they were able to find ways to optimize the process, like delaying testing for large breasted women who have a worse risk/benefit profile. What I'm advocating for btw, just to make clear, is regularly showing up to a doctor who will recommend all the cost effective non-intrusive tests (like blood work) plus the intrusive testing depending in your particular risk profile. This doesn't seem like a controversial opinion to me - more like a common sense default. As for conventional wisdom, look at this thread. Count the pro/contra comments if you want. Other then a tautological "some medical procedures can be dangeours if misused/overused", I still don't get how people can be against testing, in general.
- vidarh 5y ago
  The way to optimise the process was to reduce the amount of screening. It points out exactly why broad, indiscriminate screening can not be assumed to be safe, and that "optimizing the process" means moving away from thinking that more screening is automatically better, and towards identifying which groups where the benefits outweigh the dangers. But the main reason for posting that link was to point out that the idea that testing does not kill is false for some types of testing, and as such you need to understand the risk vs. reward, or you may end up doing harm. > What I'm advocating for btw, just to make clear, is regularly showing up to a doctor who will recommend all the cost effective non-intrusive tests (like blood work) plus the intrusive testing depending in your particular risk profile. This doesn't seem like a controversial opinion to me - more like a common sense default. I haven't seen anyone here arguing against that. That's not what's been discussed by those of us here pointing out the dangers of mass-screening.