Comment by jungletime | Hacker News Reader

Comment by jungletime | Hacker News Reader

Doctors in California went on strike and mortality dropped.

One reason for the drop may be due to elective surgeries not being performed. And since more people at staying at home in a safe environment, due to COVID there will be fewer accidents. And far fewer medical mistakes too, not COVID related.

"The third-leading cause of death in US most doctors don’t want you to know about"

https://www.cnbc.com/2018/02/22/medical-errors-third-leading...

"Why Do Patients Stop Dying When Doctors Go on Strike?"

https://www.psychologytoday.com/ca/blog/slightly-blighty/201...

My personal take on this based on statistics and observation is that many medical procedures are not very effective.

Or trade short term risk, for long term benefit. Eg. Those that survive a bypass surgery may live longer. But it will shorten the life of those that it kills. Chemo therapy can kill you immediately, but if you survive the procedure, it may have also killed the cancer that then will increase your life expectancy.

I also think many medical procedures are not really changing the course of the disease. And being in a hospital is inherently risky. You are exposing yourself to other very sick people, and possible human errors in treatment.

ITs easy to fool yourself into thinking that what you are doing is having an effect. Consider the thousands of football fans in stadiums thinking they are changing the course of the game with cheering or booing.

IMO, there is a lot of hocus pocus going on in the "medical error is the 3rd leading cause of death" statistic, and the case they chose to highlight is extremely atypical. The vast majority of health care spending and the vast majority of medical resources are spent on old people in their last 18 months of life. Most deaths due to medical error are very old people undergoing risky and invasive surgeries they demand to have and are unlikely to have a great outcome in, not children. How much of the blame should be placed on the doctor when the patient is 80+ years old, has comorbidities, has been counseled on the risks, and wants to proceed with treatment? Bypass surgery is quite effective on someone younger than 60 who is also put on a diet and exercise regimen, and doesn't have diabetes. Bypass surgery is not effective for someone over 60 who is obese and has diabetes and will not change their diet habits.

If you have an accident in a hospital they don't send you to the ER department.

Most interventions are for something that's not going to kill you right away, so I would guess that seeking intervention for a medical problem I'm having would increase my odds of dying right now (due to a mistake, or exposure to other wick people) while increasing my long term odds. I would not expect an increase in mortality when non-emergency doctors go on strike.

And I hope to someday live in a world where medical error is the #1 cause of death. I hope we also focus on quality of life and not just quantity -- but if medicine seeks to continue extending life then the success case is that error is essentially the only cause of death. Those articles, and especially their headlines, are sensational and misleading.

There is also another possibility. If you kill of the weak, the remaining strong will show better health outcomes. And if you are a drug company, you can tout that as proof of the success of the treatment.

And I suspect that is exactly what is happening with some of these medical treatments. They take out the weakest patients (with for example chemo therapy) and the remaining stronger ones will do better. But really its a statistical effect.

Same way you can improve test scores in a class, by getting rid of students with low IQ and work ethic. All of sudden, the average test taking ability will go up.

Survivor effects like you're describing are controlled for in clinical trials for chemo and other drugs by comparing outcomes for the entire control and treatment groups.

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