5 ms·

Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I l

by throwway120385 3y ago

Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. What if some people in the group that didn't get screening had fewer high-quality years? It might simply be that the last 5 years of life for people who are screened positive early on and who subsequently receive treatment is a better 5 years than the last 5 years of life for people who aren't screened positive early on and who subsequently have to undergo brutal hail mary treatments at the last minute.

pessimizer 3y ago
> Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. Claiming that there are missing elements that could possibly turn the equation in favor of screening is cause for further research and analysis. You can't just claim that they fall in your favor; some diagnostic and exploratory processes due to false positives are painful and/or dangerous in and of themselves. > What if "What if" is right. You can't just conjure these people into existence to justify current policies, you have to find them and do the statistics.
- throwway120385 3y ago
  Given that screening is arguably benign for most people, you could argue that we continue screening while we gather more information. But you do whatever you want to do. I'm just pointing out that it's really premature to cancel all of your screenings based on the idea that it doesn't add any years to your life. That may be true, but there's more to a life than how long you live.
  - idopmstuff 3y ago
    > Given that screening is arguably benign for most people You're 100% wrong here, this is not a given. Prostate cancer screenings, which are very common, can have both false positives as well as findings of cancer that is and would remain completely benign. These can both lead to unnecessary treatments that cause serious negative health effects, including incontinence and erectile dysfunction. https://www.cdc.gov/cancer/prostate/basic_info/benefits-harms.htm https://www.cdc.gov/cancer/prostate/basic_info/benefits-harm...
    - Gibbon1 3y ago
      Also read that death rates from thyroid cancer hasn't changed in 50 years. Despite huge numbers of thyroid screenings and treatment. An ultrasound of the thyroid often leads to finding a nodule. Which leads to a biopsy. Which comes out indeterminate. Which leads to a thyroidectomy and life long dependence on thyroid hormones. Another one is ductal carcinoma in situ. Read somewhere there is a 1% chance that will evolve into cancer. And yet you have women having double mastectomies and chemo for it.
      - haldujai 3y ago
        Absolutely no one is getting a bilateral mastectomy or chemotherapy for DCIS. This is by far the most inaccurate medical claim I've ever seen on HN. Where on earth did you get this from? The whole point of diagnosing DCIS on screening mammography is that it avoids systemic therapy and mastectomy. It also wouldn't be bilateral.
        vc8f6vVV 3y ago
        Yes, they do. I have a friend who did just that. Was it justified? I don't know, but it's very real.
    - DennisP 3y ago
      So work the numbers. Put together the chance of false positives, false negatives, rate of negative effects from treatment, and rate of death with and without treatment. Tell the patient the risk of each outcome. The math is easy. If we don't have the numbers for it, then get them. Plenty of people get prostate cancer and some of them choose to just monitor. We should have plenty of information to make a rational decision. This seems preferable to blinding ourselves out of fear that we'll do something stupid with the information we might get.
dudeofea 3y ago
I'm going to start with one assumption that I believe is true: higher mental and physical stress will kill you faster. If two statistical people both get cancer, one gets screened and potentially treated, and the other doesn't and they both live to 80, I would rather be the person that doesn't get treated. A regular schedule of treatments is only better than a hail mary if you actually get more longevity from it, otherwise it's just more pain for the patient. At least with the hail mary, I only spend a short time feeling horrible before dying. This is most likely why doctors don't opt for treatment more than the average. https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...
kirkni 3y ago
There are attempts to address this, “The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions.” See: https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year
vc8f6vVV 3y ago
There is another consideration: 1. You have an aggressive (i.e. non-treatable) cancer, maybe you feel slightly off, but you go on with your life, until you finally got worse and die. Or you performed screening, focus on treatment, bankrupt your family and ... die anyway, 2. You have a slow growing cancer (e.g. prostate), live your life and die of some other causes. Or you performed screening, got surgery, got tons of problems and die of myocardial infarction (yes, that's one of complications after prostate surgery). If you read the original JAMA publication you would notice that there is a research on quality of life metric. That metric for breast cancer is higher among non-screened women.

pessimizer 3y ago

> Life expectancy is really only one dimension of "health," and it's probably the most shallow dimension. If I'm quadriplegic and confined to a ventilator but I live to 80, that's the same in this metric as if I'm not paralyzed and able to breathe on my own until I die. Claiming that there are missing elements that could possibly turn the equation in favor of screening is cause for further research and analysis. You can't just claim that they fall in your favor; some diagnostic and exploratory processes due to false positives are painful and/or dangerous in and of themselves. > What if "What if" is right. You can't just conjure these people into existence to justify current policies, you have to find them and do the statistics.

throwway120385 3y ago
Given that screening is arguably benign for most people, you could argue that we continue screening while we gather more information. But you do whatever you want to do. I'm just pointing out that it's really premature to cancel all of your screenings based on the idea that it doesn't add any years to your life. That may be true, but there's more to a life than how long you live.
- idopmstuff 3y ago
  > Given that screening is arguably benign for most people You're 100% wrong here, this is not a given. Prostate cancer screenings, which are very common, can have both false positives as well as findings of cancer that is and would remain completely benign. These can both lead to unnecessary treatments that cause serious negative health effects, including incontinence and erectile dysfunction. https://www.cdc.gov/cancer/prostate/basic_info/benefits-harms.htm https://www.cdc.gov/cancer/prostate/basic_info/benefits-harm...
  - Gibbon1 3y ago
    Also read that death rates from thyroid cancer hasn't changed in 50 years. Despite huge numbers of thyroid screenings and treatment. An ultrasound of the thyroid often leads to finding a nodule. Which leads to a biopsy. Which comes out indeterminate. Which leads to a thyroidectomy and life long dependence on thyroid hormones. Another one is ductal carcinoma in situ. Read somewhere there is a 1% chance that will evolve into cancer. And yet you have women having double mastectomies and chemo for it.
    - haldujai 3y ago
      Absolutely no one is getting a bilateral mastectomy or chemotherapy for DCIS. This is by far the most inaccurate medical claim I've ever seen on HN. Where on earth did you get this from? The whole point of diagnosing DCIS on screening mammography is that it avoids systemic therapy and mastectomy. It also wouldn't be bilateral.
      - vc8f6vVV 3y ago
        Yes, they do. I have a friend who did just that. Was it justified? I don't know, but it's very real.
  - DennisP 3y ago
    So work the numbers. Put together the chance of false positives, false negatives, rate of negative effects from treatment, and rate of death with and without treatment. Tell the patient the risk of each outcome. The math is easy. If we don't have the numbers for it, then get them. Plenty of people get prostate cancer and some of them choose to just monitor. We should have plenty of information to make a rational decision. This seems preferable to blinding ourselves out of fear that we'll do something stupid with the information we might get.

dudeofea 3y ago

I'm going to start with one assumption that I believe is true: higher mental and physical stress will kill you faster. If two statistical people both get cancer, one gets screened and potentially treated, and the other doesn't and they both live to 80, I would rather be the person that doesn't get treated. A regular schedule of treatments is only better than a hail mary if you actually get more longevity from it, otherwise it's just more pain for the patient. At least with the hail mary, I only spend a short time feeling horrible before dying. This is most likely why doctors don't opt for treatment more than the average. https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/ https://slatestarcodex.com/2013/07/17/who-by-very-slow-decay...

kirkni 3y ago

There are attempts to address this, “The quality-adjusted life year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived. It is used in economic evaluation to assess the value of medical interventions.” See: https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year https://en.m.wikipedia.org/wiki/Quality-adjusted_life_year

vc8f6vVV 3y ago

There is another consideration: 1. You have an aggressive (i.e. non-treatable) cancer, maybe you feel slightly off, but you go on with your life, until you finally got worse and die. Or you performed screening, focus on treatment, bankrupt your family and ... die anyway, 2. You have a slow growing cancer (e.g. prostate), live your life and die of some other causes. Or you performed screening, got surgery, got tons of problems and die of myocardial infarction (yes, that's one of complications after prostate surgery). If you read the original JAMA publication you would notice that there is a research on quality of life metric. That metric for breast cancer is higher among non-screened women.