4 ms·

Okay — what makes it more complicated?

by zmgsabst 2y ago

lukan 2y ago
Because you can have solid outsourced work, as long as you bother to check and verify that work.
- zmgsabst 2y ago
  I haven’t seen a company outsource a core competency and succeed, eg Boeing outsourcing airplane manufacturing.
  - krisoft 2y ago
    How about Apple and Foxconn? If your reaction is that Apple’s core competency is in marketing and design and not manufacturing then i will ask if the same pattern couldn’t be applied to Boeing.
    - zmgsabst 2y ago
      Apple is higher up the descent than Boeing — but I’d argue that their lackluster iPhone 16 is precisely that they’re on the same slope.
- raziel2701 2y ago
  In this particular case you're saying you need to test the organs once at the outsource place and then again at the hospital? Why not just get rid of outsourcing then?
  - Bouncingsoul1 2y ago
    No, that is not what the parent said. "Check an verfiy" can come in diffrent forms and tastes eg. having some samples (not all) checked by another lab, asking for standards and inspection performed by 3rd parties, asking and checking for documentation...the hell how do you think anybody could work with suppliers?
    - krisoft 2y ago
      > eg. having some samples (not all) checked by another lab, I don't think that is useful at all in case of rare diseases. You would just get two reports saying that the random sample is free of HIV. Much better would be to send some known control samples. Making sure that some of the samples is known HIV+, and then check if the supplier can tell which ones are those.
      - DoctorOetker 2y ago
        I agree with you, also the bogus argument of "since most people are HIV free..." assumes direct testing instead of pooled testing (using modern information theoretic optimized pooled testing). A bit of data is most informative if the entropy is 1 bit as well. A signal that is true most of the time, or a different signal that is false most of the time is less informative. Use pooled testing such that the result is true or false half of the time. Had information theoretically justified pooled testing been applied from the start, then: * 1) control-testing the testing contractors would have been straightforward and passing 10 control samples by chance would have a likelihood of 1 over 1024. * 2) it would have made obvious that saving money on control-testing the contractors would hardly save any money * 3) even in the bad scenario that control testing was skipped, the issue of contractors cheating would have surfaced much faster, since combining the pooled tests to identify which patient tests positive would constantly result in mysteries, meaning control-testing needs to be enabled, not the mathematics of pooled testing brought in doubt. * 4) testing pharma industry hates pooled testing, as it means technological competition instead of sales growth by abusing the naive but false "common sense" that you need as many tests as patients tested. on a side note: assuming tests with different operating point on the RoC curves (having different false positive vs false negative ratios) have different prices, do we know if the operators blatantly provided fabricated results, or if they blatantly ignored basic mathematics and thought the more expensive tests could be substituted by the cheaper ones even if intended for a different purpose? consider a test designed for telling a patient that we diagnosed HIV, and then consider a test designed for screening an organ to be inserted into a patient. do you think they should both use the same test? or do you think it wiser to have the diagnosis test have lower false positive rates, and the organ screening test to have lower false negative rates?
  - JumpCrisscross 2y ago
    > Why not just get rid of outsourcing then? The problem is corruption. I don't see why you think that wouldn't plague internal operations.
    - Retric 2y ago
      Outsourced companies deal similar issues internally while also forcing you to trust their management. Internally this kind of corruption is more difficult because you have more control, and fewer people are going to cooperate. Similar to how companies can regularly use untrustworthy low level employees handle cash. You can still get rogue employees in ether case, but an outsourcing company is like a ready made conspiracy where any corners cut automatically turns into money.
      - DoctorOetker 2y ago
        Outsource to 2+ contractors, use pooled testing, and use control tests to steer that percentage of tests towards those contractors that score better on the control tests. Obviously the contractor should not be allowed to know which samples are control tests.
      - JumpCrisscross 2y ago
        > Internally this kind of corruption is more difficult because you have more control If we anthropomorphise the regulatory body, sure. In reality, there isn’t evidence either way. Corrupt governments handing work to the private sector is a proven efficiency booster. Meanwhile, competent governments Severn Trenting everything is textbook (on the political left).
        Retric 2y ago
        Outsourcing and corruption isn’t limited to government agencies. Quite a lot of it is from companies to other companies or governments to company A and then from company A to company B where the subcontractors are at issue.
  - kelnos 2y ago
    Yes, why not? You don't re-test every single one, though: you spot-check a statistically significant percentage of them. Or maybe you do check all of them, but only for a one month period every year (a month that changes every year, and isn't known to the testing lab, so they can't game the system). Another option is to send "control samples" to the testing lab, something you know already is infected with something they should be testing for. Do this enough times, and you'll know if they're accurately reporting the bad samples. This type of thing is the only way for anyone in any kind of organization to verify that their outsourcing is effective and they're getting the result they want.
- A4ET8a8uTh0 2y ago
  I think the issue is that some people ( and this may be HN-specific ) think that medicine in general, and maybe even diagnostics in particular, is almost exactly like software testing. In a lot of ways, it really isn't. Some reasons get a little esoteric, but the more important one is rather simple: until more recently, software did not have a direct impact on life and as such was mostly given a pass on some otherwise heavy blunders. That is slowly changing, but missing something during quality control is not likely to have the same impact. But this brings me to the other important reason, statistical check can only get you so far and that is assuming we can now trust it was even done. Some people do rely on being able to say, 'this was false positive once, you know what are the odds of it being false positive twice'? Now, we add variable of uncertainty into the system in the form of 'well, it was outsourced so there is a non-zero chance it is bs anyway'. Not exactly a recipe for success.
braza 2y ago
Further context: In Brazil since we have universal health care provided by the government, generally speaking non outsourced or contractors becomes public servants. The issue is: Public service in Brazil is expensive and is virtually impossible to fire anyone. On top of that the cost of public service has second order effects in the public balance sheet for the municipalities plus it has a huge burden in the public retirement system. Not saying that is right or wrong, but this is very common in the Brazilian heath system.

Okay — what makes it more complicated?

lukan 2y ago

Because you can have solid outsourced work, as long as you bother to check and verify that work.

zmgsabst 2y ago
I haven’t seen a company outsource a core competency and succeed, eg Boeing outsourcing airplane manufacturing.
- krisoft 2y ago
  How about Apple and Foxconn? If your reaction is that Apple’s core competency is in marketing and design and not manufacturing then i will ask if the same pattern couldn’t be applied to Boeing.
  - zmgsabst 2y ago
    Apple is higher up the descent than Boeing — but I’d argue that their lackluster iPhone 16 is precisely that they’re on the same slope.
raziel2701 2y ago
In this particular case you're saying you need to test the organs once at the outsource place and then again at the hospital? Why not just get rid of outsourcing then?
- Bouncingsoul1 2y ago
  No, that is not what the parent said. "Check an verfiy" can come in diffrent forms and tastes eg. having some samples (not all) checked by another lab, asking for standards and inspection performed by 3rd parties, asking and checking for documentation...the hell how do you think anybody could work with suppliers?
  - krisoft 2y ago
    > eg. having some samples (not all) checked by another lab, I don't think that is useful at all in case of rare diseases. You would just get two reports saying that the random sample is free of HIV. Much better would be to send some known control samples. Making sure that some of the samples is known HIV+, and then check if the supplier can tell which ones are those.
    - DoctorOetker 2y ago
      I agree with you, also the bogus argument of "since most people are HIV free..." assumes direct testing instead of pooled testing (using modern information theoretic optimized pooled testing). A bit of data is most informative if the entropy is 1 bit as well. A signal that is true most of the time, or a different signal that is false most of the time is less informative. Use pooled testing such that the result is true or false half of the time. Had information theoretically justified pooled testing been applied from the start, then: * 1) control-testing the testing contractors would have been straightforward and passing 10 control samples by chance would have a likelihood of 1 over 1024. * 2) it would have made obvious that saving money on control-testing the contractors would hardly save any money * 3) even in the bad scenario that control testing was skipped, the issue of contractors cheating would have surfaced much faster, since combining the pooled tests to identify which patient tests positive would constantly result in mysteries, meaning control-testing needs to be enabled, not the mathematics of pooled testing brought in doubt. * 4) testing pharma industry hates pooled testing, as it means technological competition instead of sales growth by abusing the naive but false "common sense" that you need as many tests as patients tested. on a side note: assuming tests with different operating point on the RoC curves (having different false positive vs false negative ratios) have different prices, do we know if the operators blatantly provided fabricated results, or if they blatantly ignored basic mathematics and thought the more expensive tests could be substituted by the cheaper ones even if intended for a different purpose? consider a test designed for telling a patient that we diagnosed HIV, and then consider a test designed for screening an organ to be inserted into a patient. do you think they should both use the same test? or do you think it wiser to have the diagnosis test have lower false positive rates, and the organ screening test to have lower false negative rates?
- JumpCrisscross 2y ago
  > Why not just get rid of outsourcing then? The problem is corruption. I don't see why you think that wouldn't plague internal operations.
  - Retric 2y ago
    Outsourced companies deal similar issues internally while also forcing you to trust their management. Internally this kind of corruption is more difficult because you have more control, and fewer people are going to cooperate. Similar to how companies can regularly use untrustworthy low level employees handle cash. You can still get rogue employees in ether case, but an outsourcing company is like a ready made conspiracy where any corners cut automatically turns into money.
    - DoctorOetker 2y ago
      Outsource to 2+ contractors, use pooled testing, and use control tests to steer that percentage of tests towards those contractors that score better on the control tests. Obviously the contractor should not be allowed to know which samples are control tests.
    - JumpCrisscross 2y ago
      > Internally this kind of corruption is more difficult because you have more control If we anthropomorphise the regulatory body, sure. In reality, there isn’t evidence either way. Corrupt governments handing work to the private sector is a proven efficiency booster. Meanwhile, competent governments Severn Trenting everything is textbook (on the political left).
      - Retric 2y ago
        Outsourcing and corruption isn’t limited to government agencies. Quite a lot of it is from companies to other companies or governments to company A and then from company A to company B where the subcontractors are at issue.
- kelnos 2y ago
  Yes, why not? You don't re-test every single one, though: you spot-check a statistically significant percentage of them. Or maybe you do check all of them, but only for a one month period every year (a month that changes every year, and isn't known to the testing lab, so they can't game the system). Another option is to send "control samples" to the testing lab, something you know already is infected with something they should be testing for. Do this enough times, and you'll know if they're accurately reporting the bad samples. This type of thing is the only way for anyone in any kind of organization to verify that their outsourcing is effective and they're getting the result they want.
A4ET8a8uTh0 2y ago
I think the issue is that some people ( and this may be HN-specific ) think that medicine in general, and maybe even diagnostics in particular, is almost exactly like software testing. In a lot of ways, it really isn't. Some reasons get a little esoteric, but the more important one is rather simple: until more recently, software did not have a direct impact on life and as such was mostly given a pass on some otherwise heavy blunders. That is slowly changing, but missing something during quality control is not likely to have the same impact. But this brings me to the other important reason, statistical check can only get you so far and that is assuming we can now trust it was even done. Some people do rely on being able to say, 'this was false positive once, you know what are the odds of it being false positive twice'? Now, we add variable of uncertainty into the system in the form of 'well, it was outsourced so there is a non-zero chance it is bs anyway'. Not exactly a recipe for success.

braza 2y ago

Further context: In Brazil since we have universal health care provided by the government, generally speaking non outsourced or contractors becomes public servants. The issue is: Public service in Brazil is expensive and is virtually impossible to fire anyone. On top of that the cost of public service has second order effects in the public balance sheet for the municipalities plus it has a huge burden in the public retirement system. Not saying that is right or wrong, but this is very common in the Brazilian heath system.