6 ms·

A lot of people, including myself, don’t believe that central health authorities have the right to make that call. Moreover, I personally don’t have confidence

by laingc 4y ago

A lot of people, including myself, don’t believe that central health authorities have the right to make that call. Moreover, I personally don’t have confidence in their ability to make those kinds of decisions, and I believe the abysmal performance of the NHS supports my view.

ramraj07 4y ago
I share your disdain for a central authority in making these judgement calls, but I have even less confidence in the majority of people who think they can solve everything with AI. Signed, a data scientist with a PhD in biomedical engineering.
Gatsky 4y ago
The NHS has finite resources. They have to decide if implementing a screening program is worthwhile or not, versus spending the money elsewhere. You can still go to your doctor and get a mammogram (or even a more useful test) if you have other reasons why this might be justified in your situation. They aren’t ‘banning’ mammograms for young women.
- KennyBlanken 4y ago
  It's not just a matter of finite resources. Any sort of treatment is invasive. Almost all form of medical treatment has side effects and risks. Finding out you have "cancer" is traumatic and extremely emotional, though breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...) Putting these tools in the hands of medical professionals is one thing. Putting them in the hands of the general public is beyond irresponsible. People physically assaulted doctors and nurses for not being given ivermectin; imagine how insufferable people will get when some website examined their mammogram and said they have cancer.
  - johnday 4y ago
    > ...breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...) Extremely weird take. Not least because the survival rates for breast cancer and prostate cancer are very similar.
Waterluvian 4y ago
I think central authorities absolutely must make that call. Who else is going to decide how to dole out a scarce social resource? Americanizing healthcare is obviously not a good choice given how much worse it does overall by basically every measure (unless you're rich and don't give a toss about other people). I certainly agree that central authorities can be better. But that's kind of a truism. What alternative options do you have in mind? Admittedly I'm short on alternative ideas.
- civilized 4y ago
  I understand why people don't want money to completely decide who gets health care. But I don't think it should be a complete non-factor either. If I've worked hard and saved diligently for an emergency, and an emergency arrives, I feel I should be able to tell a doctor "will you treat me? I have money". But if you insist upon perfect equality of health care access, I guess it can't be. Some central authority has to decide if anyone is allowed to treat you, regardless of what you've saved for the eventuality.
  - Waterluvian 4y ago
    Medical tourism will always be a thing for the rich. But I personally do not see an argument for driving a social service, even if only slightly, with capitalism. Perhaps that’s part of my developing thought on the matter: the public system paid by tax dollars should be equitable to all. But by all means, take your credit card to Pepsi Presents: For Profit Medical Centre and get a full work up.
    - civilized 4y ago
      What makes the cut of a "social service"? Wouldn't it be anything people really need? Basic food staples, for example? China tried socializing food production, and it worked terribly. Production tripled when they re-privatized it and let farmers grow for themselves. People do a better job when they get to keep the rewards. US health care isn't capitalist in this sense of rewarding a good job. It's the worst of both worlds: a system whose regulations are superbly adapted to optimize profit for the administrative class at the expense of both doctors and patients.
nivenkos 4y ago
Yeah, just look at their disastrous handling of Covid for example.
- pas 4y ago
  the real problem is that we still don't have combined vaccines for all the new variants (+ influenza) and it's completely ridiculous why there isn't a public/government project to do this.
barry-cotter 4y ago
> A lot of people, including myself, don’t believe that central health authorities have the right to make that call. That’s absolutely fine. You’re free to spend your money on preventative healthcare that’s been determined to fail a cost benefit test. Organizations that have to save as many lives as possible or prolong healthspan as long as possible within a limited budget must make decisions somehow.
poirot2 4y ago
Misunderstanding here. The question is at what age is the base rate in the population sufficiently high that a test with a certain sensitivity and specificity useful net risks. Multiple studies have shown that these screening programmes don’t have a huge impact on mortality - excluding lead time bias etc. and noting the c. 10 in 100k extra cases of cancer caused by the screening. Here’s a review for prostate screening that’s even more damning about its usefulness - https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-screening.pdf https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-...
- pas 4y ago
  would it be possible to use MRI for screening?
  - manarth 4y ago
    MRI scans take longer, are often more uncomfortable for the patient (being in an enclosed, noisy machine), require much larger capital investment than an X-ray (and therefore supply is more limited), and have a higher cost per exam than an X-ray. It almost certainly would be possible to use MRI for screening, but the impact would be a reduction in availability and a higher cost.
deleted 4y ago
[deleted]

by laingc 4y ago

ramraj07 4y ago

I share your disdain for a central authority in making these judgement calls, but I have even less confidence in the majority of people who think they can solve everything with AI. Signed, a data scientist with a PhD in biomedical engineering.

Gatsky 4y ago

The NHS has finite resources. They have to decide if implementing a screening program is worthwhile or not, versus spending the money elsewhere. You can still go to your doctor and get a mammogram (or even a more useful test) if you have other reasons why this might be justified in your situation. They aren’t ‘banning’ mammograms for young women.

KennyBlanken 4y ago
It's not just a matter of finite resources. Any sort of treatment is invasive. Almost all form of medical treatment has side effects and risks. Finding out you have "cancer" is traumatic and extremely emotional, though breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...) Putting these tools in the hands of medical professionals is one thing. Putting them in the hands of the general public is beyond irresponsible. People physically assaulted doctors and nurses for not being given ivermectin; imagine how insufferable people will get when some website examined their mammogram and said they have cancer.
- johnday 4y ago
  > ...breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...) Extremely weird take. Not least because the survival rates for breast cancer and prostate cancer are very similar.

Waterluvian 4y ago

I think central authorities absolutely must make that call. Who else is going to decide how to dole out a scarce social resource? Americanizing healthcare is obviously not a good choice given how much worse it does overall by basically every measure (unless you're rich and don't give a toss about other people). I certainly agree that central authorities can be better. But that's kind of a truism. What alternative options do you have in mind? Admittedly I'm short on alternative ideas.

civilized 4y ago
I understand why people don't want money to completely decide who gets health care. But I don't think it should be a complete non-factor either. If I've worked hard and saved diligently for an emergency, and an emergency arrives, I feel I should be able to tell a doctor "will you treat me? I have money". But if you insist upon perfect equality of health care access, I guess it can't be. Some central authority has to decide if anyone is allowed to treat you, regardless of what you've saved for the eventuality.
- Waterluvian 4y ago
  Medical tourism will always be a thing for the rich. But I personally do not see an argument for driving a social service, even if only slightly, with capitalism. Perhaps that’s part of my developing thought on the matter: the public system paid by tax dollars should be equitable to all. But by all means, take your credit card to Pepsi Presents: For Profit Medical Centre and get a full work up.
  - civilized 4y ago
    What makes the cut of a "social service"? Wouldn't it be anything people really need? Basic food staples, for example? China tried socializing food production, and it worked terribly. Production tripled when they re-privatized it and let farmers grow for themselves. People do a better job when they get to keep the rewards. US health care isn't capitalist in this sense of rewarding a good job. It's the worst of both worlds: a system whose regulations are superbly adapted to optimize profit for the administrative class at the expense of both doctors and patients.

nivenkos 4y ago

Yeah, just look at their disastrous handling of Covid for example.

pas 4y ago
the real problem is that we still don't have combined vaccines for all the new variants (+ influenza) and it's completely ridiculous why there isn't a public/government project to do this.

barry-cotter 4y ago

> A lot of people, including myself, don’t believe that central health authorities have the right to make that call. That’s absolutely fine. You’re free to spend your money on preventative healthcare that’s been determined to fail a cost benefit test. Organizations that have to save as many lives as possible or prolong healthspan as long as possible within a limited budget must make decisions somehow.

poirot2 4y ago

Misunderstanding here. The question is at what age is the base rate in the population sufficiently high that a test with a certain sensitivity and specificity useful net risks. Multiple studies have shown that these screening programmes don’t have a huge impact on mortality - excluding lead time bias etc. and noting the c. 10 in 100k extra cases of cancer caused by the screening. Here’s a review for prostate screening that’s even more damning about its usefulness - https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-screening.pdf https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-...

pas 4y ago
would it be possible to use MRI for screening?
- manarth 4y ago
  MRI scans take longer, are often more uncomfortable for the patient (being in an enclosed, noisy machine), require much larger capital investment than an X-ray (and therefore supply is more limited), and have a higher cost per exam than an X-ray. It almost certainly would be possible to use MRI for screening, but the impact would be a reduction in availability and a higher cost.

deleted 4y ago

[deleted]