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Comment by blakesterz | Hacker News Reader

That's exactly what I was thinking. Sure, if we look at a population then maybe we don't see a remarkable result. But surely we've helped SOMEONE here.

From the article: "which means that only 27% of positive test results are right"

Yes, 27% is not great, but that's still more than 1/4 of the people that had a good result and will live longer or better or whatever. 1/4 of the people got some kind of benefit. Sure, we'd rather see 75% but 27% is SOMETHING and that's worth, well, something I guess. Does the cost mean it's worth it?

For those in the 27% they are sure as heck going to say yes, right?

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Maybe, maybe not. For example the treatments for prostate cancer can be worse than not treating early state elevated PSAs.

Being told you have AIDs, then 24h later being told "just kidding false positive"... do you think that has no consequences on your life?

> For example the treatments for prostate cancer can be worse than not treating early state elevated PSAs.

I suppose that positive test results need not be followed directly by treatment, but can also be used to trigger further testing.

In the specific case of prostate testing, all they can do is repeat the test. And it likely comes back with the same results.

Many men in their 40s and 50s have high test results. Those same men can live 30, 40 more years with the condition. Or they can die of prostate cancer in 3 years. Or they could get treatment, and lose all use of their prostate for the rest of their life.

It seems like prostate cancer testing is the poster child for "the test tells you something, but often you statistically don't want to act on the test...".

I have no plans of ever having the test done.

what do you say to the 73% whose lives got negatively impacted? Prostate screening is a great example. Elevated PSAs are indicative of cancer, which people want to get rid of. So they have a procedure done, which often leaves them incontinent. But the reality is that, the majority of the time, prostate cancer remains effectively dormant. The end result is a lot of old men who would have been healthy but are now walking around in diapers because they got a test.

You've missed the other side of the equation, which is: what if there is no cure for the 27% with the supposed condition? What help has been provided then?

What if there are some recommended follow-up treatments, but they are all expensive and risky, with the possibility of terrible complications?

This is how over-diagnosis actually leads to worse outcomes on a population scale. Medicine is often viewed as this big near-perfect algorithm where information is always enabling. In fact, too much information can be counterproductive for a patient and doctor.

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