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> whether it is ethical or worthwhile to expose patients to the risk of harming their health through the follow up So you seem to be saying that, in certain ca
by waterhouse 4y ago
> whether it is ethical or worthwhile to expose patients to the risk of harming their health through the follow up
So you seem to be saying that, in certain cases, if you have a positive test result, then the expected value of taking certain follow-up actions is negative. It follows that a rational actor, knowing this, would not take those actions in that situation. Then isn't the solution for doctors to update their procedures so that they don't take those follow-up actions in those situations (and explain the odds to patients who care)?
The phrasing "expose patients to the risk of harming their health through the follow up" makes it sound like the follow-up is something that automatically and unavoidably just happens, as if no one has any agency in the matter. If that's true, due to some kind of regulations or rules or liability rulings, then that sounds like a problem.
To some extent this is resolved by backpropagating: if the test is just a two-value "positive"/"negative" thing, and you plan to take the same action (i.e. nothing) regardless of the result, then there's no point in taking the test. However, I expect there are also other tests where, say, the test has a "super positive" value (or value range) where you should take action, and a "technically positive" value where you shouldn't act (plus a "negative" value); and the test is worth taking because of the likelihood of "super positive", but that means you do sometimes end up with the "technically positive" result, and must solve the problem of knowing when not to act.
- deleted 4y ago[deleted]
- albertgoeswoof 4y agoOn an individual case you’re right. But in aggregate is where the nuance lies. E.g. If 99 out of 100 cases are false positives, and those 99 people are harmed by taking action, but the one true positive was helped, which is the better policy to pursue? Blanket screening or none at all? This gets more complicated when there are limited resources available, eg treating the 100 people means someone else misses out. And then there are diseases like cancer, which pretty much every human will get, if they live long enough. So screening for some types of cancer can have negative health implications on some target populations.
- btilly 4y agoIf it is not worth taking the follow-up action, then it is not worth doing the screening either. Concrete example. Younger women have firmer breasts. A chunk of relatively firm breast looks a lot like cancer. Therefore the younger a woman is, the higher the odds are of a false positive from a mammogram. As a result a woman who is 30-40 SHOULD NOT get a mammogram UNLESS she has a variety of specific risk factors that increase the odds that a positive on the test is a true positive, and not a false positive. You may verify that guideline description against https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html https://www.cancer.org/cancer/breast-cancer/screening-tests-....