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> The medical world weighs these things against each other and determines when the data shows that the risk of mortality from testing is smaller than the risk o

> The medical world weighs these things against each other and determines when the data shows that the risk of mortality from testing is smaller than the risk of cancer. Let the patient weigh the odds. Especially when they can afford retesting or may be otherwise in good health or whatever. Plus the test’s algorithms can be tuned to provide more or less false positives.

smt88 2y ago
> Let the patient weigh the odds. Patients are uninformed and emotional. Part of a doctor's job is to make the best decision for the patient using the information they have. For example, if you tell people that daily aspirin reduces the risk of heart disease, you might get a 25yo with no heart issues starting to take it. But if you look at actual data, all-cause mortality increases for people who have no risk of heart disease if they take daily aspirin, because aspirin can cause fatal internal bleeding. That's the kind of thing doctors know and need to be firm about.
- blackeyeblitzar 2y ago
  I disagree. Doctors are frequently incompetent, don’t spend enough time with patients to understand them deeply, and are not aware of the latest research or these nuances. But leaving that aside, this is about patient control. Doctors should not be gatekeepers for diagnostics. I don’t even want them to be a gatekeeper for many relatively safe prescriptions, which is clearly a way to increase medical costs.
  - smt88 2y ago
    > Doctors should not be gatekeepers for diagnostics. Doctors mostly aren't gatekeepers for risk-free diagnostics, like a blood test for a vitamin deficiency. Insurance companies are. But for risky tests, doctors have a duty to "do no harm" and can't/shouldn't order something that they know causes an increase in all-cause mortality for their patients. The concept is the same with antibiotics or anything else a patient might ask for without knowing the risks.
    - ethbr1 2y ago
      > Doctors mostly aren't gatekeepers for risk-free diagnostics That's not entirely true. There are more than a few diagnostics in the US that the FDA explicitly discouraged companies from offering without physician referral. E.g. whole genome sequencing several years ago
      - smt88 2y ago
        Whole-genome sequencing leads to unnecessary treatment, like mastectomies. It’s not risk-free.
        ethbr1 2y ago
        Whole-genome sequencing gives me more information about my health than I had before. Being ignorant is not risk free.

smt88 2y ago

> Let the patient weigh the odds. Patients are uninformed and emotional. Part of a doctor's job is to make the best decision for the patient using the information they have. For example, if you tell people that daily aspirin reduces the risk of heart disease, you might get a 25yo with no heart issues starting to take it. But if you look at actual data, all-cause mortality increases for people who have no risk of heart disease if they take daily aspirin, because aspirin can cause fatal internal bleeding. That's the kind of thing doctors know and need to be firm about.

blackeyeblitzar 2y ago
I disagree. Doctors are frequently incompetent, don’t spend enough time with patients to understand them deeply, and are not aware of the latest research or these nuances. But leaving that aside, this is about patient control. Doctors should not be gatekeepers for diagnostics. I don’t even want them to be a gatekeeper for many relatively safe prescriptions, which is clearly a way to increase medical costs.
- smt88 2y ago
  > Doctors should not be gatekeepers for diagnostics. Doctors mostly aren't gatekeepers for risk-free diagnostics, like a blood test for a vitamin deficiency. Insurance companies are. But for risky tests, doctors have a duty to "do no harm" and can't/shouldn't order something that they know causes an increase in all-cause mortality for their patients. The concept is the same with antibiotics or anything else a patient might ask for without knowing the risks.
  - ethbr1 2y ago
    > Doctors mostly aren't gatekeepers for risk-free diagnostics That's not entirely true. There are more than a few diagnostics in the US that the FDA explicitly discouraged companies from offering without physician referral. E.g. whole genome sequencing several years ago
    - smt88 2y ago
      Whole-genome sequencing leads to unnecessary treatment, like mastectomies. It’s not risk-free.
      - ethbr1 2y ago
        Whole-genome sequencing gives me more information about my health than I had before. Being ignorant is not risk free.