Hacker News Reader

Comment by louden | Hacker News Reader

More data is not always better. The collection process itself can be dangerous or unpleasant for the patient.

Several years ago I worked on a study looking at the spread of bacterial lung infections in long term hospital patient. In order to get the data, we would have to intubate patients that did not need it. In this case, the people who approve these studies rightfully ruled that getting that data would be too painful for the patients to allow.

Biopsies caused by benign findings from a full body scan are not without pain, emotional distress, risk or cost to the patient. Period. It must be weighed against the benefit that the patient would recieve (all in the aggregate, or course).

View on HN

> The collection process itself can be dangerous or unpleasant for the patient.

That’s asinine, obviously he doesn’t mean more data is always better even if the test is invasive or dangerous.

> Biopsies caused by benign findings from a full body scan are not without pain, emotional distress, risk or cost to the patient. Period. It must be weighed against the benefit that the patient would recieve (all in the aggregate, or course).

Both need to be judged on time and cost, but only the biopsy needs to be weighed against risk, not the scan. If people see a scan with anomalies and want dangerous procedures even if the risk is not demonstrated that is a cultural, education, and legal problem. Both for doctors wanting to avoid malpractice ordering unjustified tests, and for patients “wanting it out”.

But if the scan can demonstrate some marginal elevated risk, not the need for immediate intervention but for increased screening, that data could potentially save many lives, and it should be used, not hidden away because of the possibility of overreaction. Researchers need to find how best to use the data and patients and doctors need to be educated in our current best understanding, not pandered to.

> but only the biopsy needs to be weighed against risk, not the scan.

You're setting an arbitrary boundary because you don't want to consider the downsides. If you set the same boundary on the benefits of the MRI, then you wouldn't be able to include treatment of cancer as part of the upside to doing an MRI scan.

Doctors are far wiser about these things than HN commenters that have never dealt with the complex tradeoffs of dealing not only with populations of people, but also with dealing with the psychology of humans beyond people that prioritize rationality over everything else.

Doctors are responsible for treating all of humanity, not just the subset that behave the way we want them to.

People can (and did) make the same case against the thermometer.

In medicine, there are physically harmless tests that can still cause harm. Full body scans are one of them. If something is found, it will likely have an emotional impact on the patient. Not all people are equally rational. Not all people have a good grasp of the statistical nature of the findings. That applies to educated people and medical professionals who deal with this stuff everyday.

My point was not that either side was correct but rather that a simple statement like "more data is always better" is not as simple as they seem to think it is. Those of us who work in this field deal with balancing the risks as best we can so that we can detect the marginal elevated risk of something in a way so that the benefit outweighs the costs (financial, physical and emotional).

It’s perfectly reasonable not to use such a test if medical science doesn’t have strong evidence what the data means. Likely that sort of statistical evidence would require institutions with teams of researchers managing and adjusting screening campaigns rather than the judgement of an individual doctor anyway. I really can’t accept the idea though that any test which is safe, cost and time effective, and produces actionable data shouldn’t be undertaken on the basis of some other judgment of emotional state. Doctors are in no way competent to make such judgements about individuals, and even accepting the premise on the scale of population, it means pandering to ignorance and in so doing damaging people’s health. You might as well limit vaccination programmes because of anti-vaccination PR campaigns.

You are comparing a program where the benefits vastly outweigh the cost to a program where the benefit is mostly speculative and the cost known.

The cost of full body imaging is not just in the scan itself but in the procedures that follow it that require anasthesia (non-zero chance of killing the patient), cause pain and may cause secondary infection. In fact, just being in the hospital or doctors office to get the procedure has a non-zero risk to due to the concentration of sick people there.

I agree in the sense that this appears to be the reality of the situation at the moment, that the benefit is speculative because of a lack of evidence for the effectiveness of either the data or our ability to interpret it. I highly doubt that will be the case in the long run, as costs come down, resolution goes up, and analysis software improves.

> That’s asinine, obviously he doesn’t mean more data is always better even if the test is invasive or dangerous.

With him classifying all MDs as idiots, no it is not asinine.

I’ve known few academic physicians that would turn down data if it can be ethically obtained.

The difference between the medical profession and, say Google, is that we as a general rule do not consider the populace one big lab to experiment on as we please. The consequences are more than a little different.

It’s not like things were always this way in medicine either.

I think the key distinction is that clinical science rather than medicine needs as much data as possible, and then medicine needs to follow clinical science.

And then, that medicine needs to become much more sophisticated in dealing with risk and uncertainty, given the absurd complexity of the problem domain. Doctors are not idiots but they are no more than human while trying to do an impossibly difficult job, and are far too cocksure given that context. They should be asking for as much help as they can get, which is not the reality of the situation. See something as simple as the resistance to checklists in surgery for example, despite the evidence.

I see your point about ethical breaches which have taken place. I would tend to think of those as abuses of power rather than coming from an ideological position, but that may not be correct. You’re certainly right about the dangers of a beta test mentality.

>In order to get the data, we would have to intubate patients that did not need it. In this case, the people who approve these studies rightfully ruled that getting that data would be too painful for the patients to allow.

I wonder what the patients who died because they had especially fast-spreading infections whose pace was not detected quickly enough would think of these altruists' wise decision to weigh the median level of "emotional distress" more highly than their lives.

People have commited suicide because of medical test results that turned out to be wrong. A decision has to be made about how many tests are performed and under what conditions. Unfortunately, that will cause harm to people no matter where we, as a society, draw that line.

Reply on news.ycombinator.com