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Comment by alextheparrot | Hacker News Reader

> He said the use of the larger test was appropriate because it could catch a wider range of diseases, particularly for those who were symptomatic. [0]

Cant’t believe this isn’t an ethics violation, it is like going into the car dealership to change my oil and them charging me to take apart the engine because “It could catch a wider range of issues”.

I know what service I want and would consent to, this “Technically correct but costs 50x as much” is harmful.

[0] This is the doctor’s response when asked why he is testing for ~20 other respiratory diseases in the drive-through coronavirus line.

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This also betrays a lack of understanding of testing by the doctor.

If each test has a 1% chance of returning a false positive (and false positives are possible in most tests), there's a significant chance that one of the 20 will return a false positive, which will then prompt unnecessary treatments, further tests, etc.

The general medical guidance is to only test when there's a legitimate suspicion that a patient has the illness. In this case, these patients wouldn't have been tested for a wide range of respiratory issues anyway, and given the pandemic it's much more likely that they've got coronavirus, so they really shouldn't be tested for the other things, especially if asymptomatic.

Yeah that's straight up malpractice. If there's a 99% chance it's Covid and not something else, you do the Covid test first and if that comes back negative, then you test for the "something else" (if symptoms are severe enough).

It's even worse than that, he was testing asymptomatic patients with a full panel. That part takes it from probably unethical to full-blown fraud for me.

> But in interviews, asymptomatic patients said they had also received the more expensive test.

For asymptomatic patients, doing those tests could easily cause net harm from follow-up to false positives. So, even if the tests had been free, it's probably unethical.

This is why organizations like the United States Preventative Services Task Force exist. They review studies and recommend best practices for medical screening. They do recommend against asymptomatic screening for a lot of tests.

>it is like going into the car dealership to change my oil and them charging me to take apart the engine because “It could catch a wider range of issues”.

This kind of stuff is pretty par for the course. They try and up-sell. If you agree then you're on the hook for the bill. That's just how the industry works. But businesses that make a habit of being sleazy don't survive long because the bill must be agreed upon beforehand and customer is free to go elsewhere with little friction and there isn't all sorts of gatekeeping and regulatory capture constraining supply.

There's a reason it's endemic and that's because people fall for it. Every few months there's an investigation by the government and some oil changer business gets fined for it. Dealers do it too but if your car is under warranty these days it tends to be less of an issue. Cars are more reliable now too. Out of warranty though, hold onto your hat!

> Cars are more reliable now too

This is hard to believe. If anything they are more disposable.

Average age has been ticking up for a while, at least in the US.

https://www.bts.gov/content/average-age-automobiles-and-truc...

I feel like the disposability angle comes from having relatively expensive parts/repair costs with low value older vehicles, which results in them being retired because of the economics of having someone else repair them.

That and the ever present complaint that they can't take a hit like they used too.

Never mind that makes them way safer and saves tons of lives. Some people want to crash up derby their car every weekend.

It's also not even remotely true. Check out the IIHS crashing a 60s bel air into a modern malibu.

"They don't make them like they used to" has always been a nostalgic crock of shit, like the people who think the NES was the golden age of video games, despite the vast majority of the 700 or so releases being utter trash for $60 that sometimes didn't even work!

https://www.youtube.com/watch?v=C_r5UJrxcck

I think they're talking about damage from low speed hits. Older cars can take those without as much apparent damage because they have big heavy bumpers and aren't designed for occupant/pedestrian safety, but like you said they'll fold up like a tin can in higher speed crashes.

That's a promotional video for showcasing how far safety has come. It's about as grounded in reality as that Top Gear episode with the Hilux that the online fanboys all beat it to but people who actually work in industry roll their eyes at.

Nobody's ever done an 80s Town Car vs a 2010 Town Car at 30mph because a crash test where the result is "both drivers would have walked away" is boring and doesn't make for the kinds of DARE-esque media that the people who do crash testing have found it worthwhile to put out.

I can give you an anecdote. A modern car crashed on our nissan from 1990's a while ago and while absolutely nothing happened to ours the other car looked like a wreck. Maybe the behind of the car is made to be more durable than the front? I do not know.

The body may not have warped much, but that just means the force was transferred directly to the occupants with zero reduction from crumple zones. This is terrible for safety but good for the pocket book if you are lucky enough to escape unscathed.

With significant and well engineered crumple zones and fairly expensive components, modern cars are significantly easier to total.

Having a crumple zone turn to mush in a 10mph parking lot mishap does pretty much nothing to make your car more survivable in a crash that might hurt you.

There's no real reason slow speed crashes have to be as damaging as they are. It's just a result of what our tests our and natural optimization toward them. If the NHTSA reintroduced a "is the vehicle drive-able after a minor hit" type crash things would get a lot better very quickly.

I'd imagine that there are companies that buy these vehicles from salvage or auction and rehab them for sale in other countries.

People used to consider it a major milestone for their car to hit 100,000 miles. It wouldn't be particularly surprising if you needed your engine or transmission rebuilt before that point. American cars didn't even have 6-digit odometers for a long time. These days, your average inexpensive sedan will hit 100,000 miles with nothing but oil changes (every 10,000 miles instead of every 3,000 like it used to be), a couple sets of tires, and some new brake pads.

Of course, if it breaks, it's full of all these complex little systems that let modern cars run for hundreds of thousands of miles at 40mpg, and you'll need to pull in a professional, but they break a LOT less frequently.

My experience is that the drivetrain is MUCH more reliable than it used to be, but the various electronic systems are subject to high failure rates - displays, buttons, computers, sensors, etc. Many of these failures don't impact your actual driving ability, but are just a nuisance, like if your AC button stops working or your cars information displays.

Going back to when my parents were growing up, a car with 60,000 miles was near the end of its life. They checked the oil every time they got gas out of necessity.

Now almost nobody needs to check the oil that frequently (though it'd be good practice) and even lower end cars routinely last to 100,000 miles.

I'm driving a 2010 Honda Civic with 100k miles and fully expect to replace it with a newer vehicle out of concern for safety, desire for an electric vehicle, and wanting some better creature comforts. The thing will probably run to 250k miles, which would take me another 13 years to achieve.

Cars today may be harder/more expensive to fix, but they do seem to last a lot longer before they need it, and as pointed out down thread they tend to last a lot longer in the absolute sense.

As a kid, we had a van that made it to 150k miles and my parents friends were amazed it was still on the road. I've personally owned 4 or 5 vehicles older than that, all in better shape than that van at 150k.

You must be a youngster. Cars are more reliable by several orders of magnitude compared to 50 years ago.

It wasn’t unusual to be stranded on the side of the road because your car stopped working. Maybe once per year? You rarely see that now.

And if your car hit 100k miles/160k km, that was pretty much it’s life span. Now hitting 300-400k km is not that unusual.

And good luck starting your car in the 80’s if it got cold out. Or too hot out. Fuel injection has made cars way more reliable.

Trustworthy mechanics are worth their weight in gold. Our local mechanic spent a lot of time diagnosing a problem and when he found out it was covered by the standard warranty (it was a part that has a longer than normal one, don't remember which exactly) sent us on our way to get it fixed by a dealership.

We brought them coffee and bagels the next day.

I mean, you should pay for the diagnostic time, which is usually $100 or so.

What exactly do they get fined for? I recognize this sort of upselling is sleazy, but I'm curious about the wording of laws that make it a fineable offense.

It usually starts with an investigation by the attorney general who responds to customer complaints alleging fraud and deceit etc... Sometimes things are kicked off by a local news channel sting.

I've had multiple dealers discover a laundry list of problems on my/wifes "out of warranty" vehicles. Frequently for thousands of dollars. Then its pointed out its actually under a factory extended warantty (certified preowned from another dealer). And the resulting scrambles have been entertaining, as they do a ton of work replacing stuff on a vehicle no one in their right mind would have "fixed". Although at least a few times the repairs have been denied ("worn out" engine mounts).

Yes, they do slimy stuff, but nothing like the parent was describing. I've never heard of a maintenance place taking apart your engine without asking you first.

That's exactly my point. Why aren't costs agreed upon first in healthcare? Sure the doctors, hospitals, insurance, etc will lose their ass on some jobs but it should more than balance out over time.

Oh sorry I misunderstood you, I thought you were referring to the car repair industry's upsells.

My own story is when I went to an ENT for something unrelated and he asked me if it was okay to pull out a hair he saw on my ear and I said yes, and then the bill had a $500 charge for it.

It is probably an ethics violation. I am sure he probably covered himself in the fine print but as you can see the customers are confused so that means they didn't expect the full respiratory panel testing. Insurance companies may have rules on it too so he could be in violation of contracts. I would expect negative flu test, negative covid test, then that justifies the remaining panel if symptoms worsen or what not.

This is though the same thing car dealers do. They always want to up sell services.

Was this a modern machine-based test where testing for one disease is just as easy as testing for 20 at a time? There's been a lot of false information and insurance screwups in the news about such tests. A single lab test that the machine vendor charges $200 for, and thus costs the hospital probably $50 or less if they own the machine, gets coded by insurance as 20 separate tests.

We 100% should be using these kinds of tests way more often. If this was such a rapid multi-test, the villain here is the billing department and insurance.

Sure, on a forum like this you can talk like that. Go anywhere else and you'll be instantly shut down with "Oh, so you're supposed to know better than a guy who went to school for 15 years?!"

It's a beautiful rhetorical technique. Very effective.

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