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Comment by redeyedtreefrog | Hacker News Reader

In the UK the NHS don't do screening for breast cancer for under 50s because it's believed that it would do more harm than good by leading to unnecessary treatment for cancers that would never have actually caused any harm, and even where no treatment is carried out it causes great distress. Though there are arguments that the age cut off is too high, and should be set at 40.

The above is with regard to a well-funded and regulated screening program that presumably has much better precision/recall than this website. I wonder what the cut off age is for this website before the diagnoses cause more harm than good? 60? 70?

This is getting lots of upvotes because it's confirmation bias for the large segment of HN readers who believe that problems would easily be solved by a small number of brilliant technologists, if only it weren't for governments and big organisations with all their rules and regulations.

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A lot of people, including myself, don’t believe that central health authorities have the right to make that call.

Moreover, I personally don’t have confidence in their ability to make those kinds of decisions, and I believe the abysmal performance of the NHS supports my view.

I think central authorities absolutely must make that call. Who else is going to decide how to dole out a scarce social resource? Americanizing healthcare is obviously not a good choice given how much worse it does overall by basically every measure (unless you're rich and don't give a toss about other people).

I certainly agree that central authorities can be better. But that's kind of a truism.

What alternative options do you have in mind? Admittedly I'm short on alternative ideas.

I understand why people don't want money to completely decide who gets health care. But I don't think it should be a complete non-factor either. If I've worked hard and saved diligently for an emergency, and an emergency arrives, I feel I should be able to tell a doctor "will you treat me? I have money".

But if you insist upon perfect equality of health care access, I guess it can't be. Some central authority has to decide if anyone is allowed to treat you, regardless of what you've saved for the eventuality.

Medical tourism will always be a thing for the rich. But I personally do not see an argument for driving a social service, even if only slightly, with capitalism.

Perhaps that’s part of my developing thought on the matter: the public system paid by tax dollars should be equitable to all. But by all means, take your credit card to Pepsi Presents: For Profit Medical Centre and get a full work up.

What makes the cut of a "social service"? Wouldn't it be anything people really need? Basic food staples, for example?

China tried socializing food production, and it worked terribly. Production tripled when they re-privatized it and let farmers grow for themselves. People do a better job when they get to keep the rewards.

US health care isn't capitalist in this sense of rewarding a good job. It's the worst of both worlds: a system whose regulations are superbly adapted to optimize profit for the administrative class at the expense of both doctors and patients.

This is not an interesting conversation honestly.

Some Americans think that the US Healthcare way is “the right way but Slightly Off-Track(tm)” and will not be suaded.

You asked a direct question, though, to what extent do social services exist.

Social services exist to ensure that we all have a decent foundation on which to conduct our business of living.

For some that will be as you say, providing basic food and housing. In fact in Sweden food is given to children for free in school; however in the UK it is only poor students that get it.

In Sweden water is free, in the UK it’s charged but it’s a utility that cannot be turned off.

Everyone draws the line somewhere else, but the basis is meant to be that we have a solid foundation.

Unexpected medical expenses shouldn’t decimate a household economy for a decade, it doesn’t matter how unprepared the household is. But this is my personal feeling.

In addition: tying health insurance to employment and having at-will working conditions strikes me as ensuring compliance/docility in the work place, which I don’t believe in.

> This is not an interesting conversation honestly.

"Please don't post shallow dismissals" - HN Guidelines https://news.ycombinator.com/newsguidelines.html

> Some Americans think that the US Healthcare way is “the right way but Slightly Off-Track(tm)” and will not be suaded.

"Be kind. Don't be snarky... Please don't sneer, including at the rest of the community." - HN Guidelines

1) it's not a shallow dismissal if neither position is interested in having a conversation.

2) it's not unkind to point out the truth, it's not possible to persuade people that the American healthcare system has a fundamental architectural problem, they believe wholeheartedly that it would work if it wasn't for the <insert consequential factor here>

it's not an intellectually honest conversation, it's shallow, everyone has dug in. it's boring.

You've replied to my post, but I honestly cannot tell who you are talking to, or whether your assertions about whoever you're talking about are in any way connected to anything I've said.

It could be that this style of engagement is why you're bored. It does seem boring to talk to people without actually talking to them.

You're talking about "keeping the fruits of labour", in the context of socialised healthcare, however it seems the majority of the world is doing perfectly fine with socialised healthcare. In fact it seems that less tax money is spent on healthcare in countries that just nationalise it.

That's the relation, that's why it's boring, because you'll never truly argue the point or consider another perspective. You can't be persuaded, and neither can I, reasonably.

So, what's the point.

Go live in your squalid hole and I'll go live in mine and lets not pretend that either of us aren't brainwashed in some way, because there's no possible way that we're going to conclude this discussion that I keep seeing repeated on every public forum ad infinitum.

it's fucking exhausting.

Why bother intruding into a discussion to announce how exhausted you are by it? It means nothing to us, and it's more effort for you. You could just ignore it and be less exhausted.

I'm basically telling you both to shut the fuck up because we're rehashing the same shit as forever.

Unless either of you are willing to engage in intellectually honest, curious conversation then you should honestly just keep your gob shut.

Flame wars help nothing, rehashing this helps nothing. We're walking in circles, save your energy, I'm wasting mine in an effort to save yours in future.

You're welcome.

I made a couple points and it seems like you think that, based on those points, you know much more about what I believe than I even know myself, and hold a great deal of contempt for me and whatever it is I apparently believe.

I would love to have an open and inquisitive conversation. I am open-minded about how we structure our system. There are many considerations, and costs and benefits to any method. I do not think socialized or public structures are bad or inferior to private ones.

I do think it helps for people to be rewarded for their labor, but it isn't the only consideration, and it can be worked out in a range of systems.

Even though quite cheap in most places, water is not necessarily free in Sweden - at least not according to the bill I receive every month...

(I believe if you knock on someone's door and ask for water you can't say no to that person - if within reason - and there are usually lots of public/free places to get water to drink)

That sounds more like a red herring, food is not a service, it's a product.

Administration bloat is a problem everywhere, however I don't think that is the reason for or against national Healthcare.

there is private healthcare available in the uk for those who want to pay. it isnt nhs or nothing.

I'm not saying otherwise. I was replying to a specific comment that I did not interpret to be referring to a specific real health system.

I share your disdain for a central authority in making these judgement calls, but I have even less confidence in the majority of people who think they can solve everything with AI. Signed, a data scientist with a PhD in biomedical engineering.

Misunderstanding here. The question is at what age is the base rate in the population sufficiently high that a test with a certain sensitivity and specificity useful net risks. Multiple studies have shown that these screening programmes don’t have a huge impact on mortality - excluding lead time bias etc. and noting the c. 10 in 100k extra cases of cancer caused by the screening. Here’s a review for prostate screening that’s even more damning about its usefulness - https://med-fom-urlgsci.sites.olt.ubc.ca/files/2007/06/P-ca-...

would it be possible to use MRI for screening?

MRI scans take longer, are often more uncomfortable for the patient (being in an enclosed, noisy machine), require much larger capital investment than an X-ray (and therefore supply is more limited), and have a higher cost per exam than an X-ray.

It almost certainly would be possible to use MRI for screening, but the impact would be a reduction in availability and a higher cost.

> A lot of people, including myself, don’t believe that central health authorities have the right to make that call.

That’s absolutely fine. You’re free to spend your money on preventative healthcare that’s been determined to fail a cost benefit test. Organizations that have to save as many lives as possible or prolong healthspan as long as possible within a limited budget must make decisions somehow.

The NHS has finite resources. They have to decide if implementing a screening program is worthwhile or not, versus spending the money elsewhere. You can still go to your doctor and get a mammogram (or even a more useful test) if you have other reasons why this might be justified in your situation. They aren’t ‘banning’ mammograms for young women.

It's not just a matter of finite resources.

Any sort of treatment is invasive. Almost all form of medical treatment has side effects and risks.

Finding out you have "cancer" is traumatic and extremely emotional, though breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...)

Putting these tools in the hands of medical professionals is one thing. Putting them in the hands of the general public is beyond irresponsible.

People physically assaulted doctors and nurses for not being given ivermectin; imagine how insufferable people will get when some website examined their mammogram and said they have cancer.

> ...breast cancer is one of the most survivable (in part because, well, everyone loves boobs. Prostate cancer, on the other hand...)

Extremely weird take. Not least because the survival rates for breast cancer and prostate cancer are very similar.

Yeah, just look at their disastrous handling of Covid for example.

the real problem is that we still don't have combined vaccines for all the new variants (+ influenza)

and it's completely ridiculous why there isn't a public/government project to do this.

This is absurd logic. If the next step for a test like is a procedure with a lot of risk, change the next step.

We need to be able to work in a world with frequent, imperfect, low cost diagnostic tools. Cancer is almost completely survivable if caught early enough. So working to figure out early detection is effectively the "cure" for cancer we have been looking for.

As I recall the actual logic was after decades of early & frequent screening, allegedly the data showed a greatly increased rate of mass discovery and treatment, but no improvement in mortality at the population level. This suggested despite a lot of activity, we may not have accomplished anything.

but that means that instead of treatment the correct next step after discovery is monitoring of those masses, no?

also it's quite possible that (just as with COVID tests) we would benefit from more testing even if that test is not that reliable. (so there's an argument for developing fast non-ionizing radiation imaging machines, eg. a fast stand-in MRI)

I'm always surprised with the "just close your eyes" attitude of medical policies. I mean, this way we essentially choose when to get women misdiagnosed? Isn't the solution to get a better idea of how common it is for non-cancerous masses to appear and adjust the risk predictions? Or to actually improve the diagnostic methods?

NHS recommendations: https://www.cancerresearchuk.org/about-cancer/breast-cancer/...

Anecdotally, I know (directly and indirectly) many, many women who had breast cancer before 50 years of age.

The NHS is massive bureaucracy. What it does or doesn’t do is peering inside the belly of a Byzantine whale.

The article is a misnomer calling him an ‘amateur’. Its a click bait title. He’s shown himself to a world leading researcher in the application of AI to cancer screening.

Plenty of managers in the NHS can’t even do simple math.

Your solution to anxiety derived from lack of medical knowledge is more bureaucracy between a patient and their healthcare provider?

I think the suggestion was more along the lines of “screening programmes have their place, but their variables should be optimised”

Thanks for the different perspective. What did you mean by "unnecessary treatment" though? If you have cancer, doesn't it need to be treated? Doesn't cancer anywhere always cause harm to the body?

Breast cancer for example is diagnosed by increasing levels of invasiveness. First a mammogram, then possibly a 3D mammogram, then an ultrasound, then a biopsy. There are possibilities for false positives all along this path and increasing levels of possible complications when performing procedures. If a false positive gets to a biopsy and you get an infection from it, you would not have ever gotten that infection if they didn't start testing you so young. False positives are very common with breast cancer screening.

Wait, how is an ultrasound more invasive than a mammogram, an X-ray based technique?

I guess they are physically more invasive - you have to undress and the gel has to be applied on the body part to get the ultrasound scan.

Not to mention the fact that getting a biopsy can cause the cancer to spread all over the body where it might never have grown beyond its original position had it been left untouched.

Highly contested, and there is no evidence. Link to this published research: https://gut.bmj.com/content/64/7/1105.abstract

For many detectable tumors, the best answer is "wait and see", not "immediately remove". There are many reasons for this- surgery itself is risky, the tumor itself might not ever become harmful.

See for example https://jamanetwork.com/journals/jamaoncology/fullarticle/27... for some more context.

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