Governing bodies write these guidelines that act like programs, and your local doctor is the interpreter.[1] When was the last time you found a bug that could be attributed to the interpreter rather than the programmer?
[0] https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate...
[1] It’s worth considering what medical schools, emergency rooms, and malpractice lawyers are analogous to in this metaphor.
My ER notes literally say “can’t be a heart attack but that’s what it looks like, so we’ll treat it as one for now”, which is a little unnerving.
Why so? You were lucky! You had a low probability for the diagnosis, but the doc made the right decision. That's to be celebrated.
> did not qualify for a study on heart attack risk because she was only 39.
Criteria for studies are designed to test a specific hypothesis. There are many possible reasons why your sister was not eligible, and not all of them bad.
This is absolutely not true. Only someone knowing nothing about healthcare could come to such a conclusion.
> guidelines that act like programs, and your local doctor is the interpreter.
Such reframing is irrational. You are reframing scientific facts into an almost completely empirical context. It doesn't work like that at all.
The relatability of OP’s shared experience has us wanting to replace most medical professionals with genAI language models as soon as the regulations allow
I think you misunderstand how the risk calculator is used.
Physicians are still expected to use their clinical judgement and information from patient conversation to determine the appropriate intervention.
If a 30 year old patient comes in with high blood pressure, but no existing cardiovascular disease (so the calculator could be used except for the age), it would clearly be malpractice for the doctor to say "sorry! you're too young to use the calculator so I'm going to give you a stamp of approval for health!"
By the time you're put on a statin, for example, you've already had decades of exposure due to your lifestyle.
Also, I don't believe the claim that physicians don't care about CVD risk in patients <40yo including high blood pressure and high cholesterol.
1) You go in after feeling confused and have a headache after falling from a skateboard with no helmet. The ER sends you home not having checked anything or any notes to watch out for because they think you're too young to have problems from a fall (despite many young people having problems after a fall each year). At home you die because of a brain bleed.
vs.
2) You go in after feeling confused and have a headache after falling from a skateboard with no helmet. The ER runs some tests, sees the problem, and prescribes the best course of treatment given this information. Despite this you still die or have lasting effects on your brain.
Despite the doctors not fully remedying your problem in both situations only situation 1 involves negligence for a malpractice claim because the problem isn't the outcome, it's the quality of treatment not meeting the minimum levels. Flip the scenario specifics back and what GP is saying is that it isn't considered negligence to say "you're under 40, you're fine, go home" instead of "you could seriously be having a problem. We should put you on a statin and talk over the risks/symptoms of a heart attack" because the standard of care (sort of one measurement for what's a negligent treatment action) says the calculator defines the appropriate treatment and the calculator doesn't even work for those <40. What GP is not implying is doctors are negligent just because you still had a heart attack anyways.
I agree with you heavily here: "Also, I don't believe the claim that physicians don't care about CVD risk in patients <40yo including high blood pressure and high cholesterol."
Seems odd over all. My physician, unprompted, wanted to put me on a statin when I was very healthy and in my early 30s just to lower my risk as my cholesterol numbers were trending up at the time. Whether or not this calculator actually works for those under 40, physicians certainly still prescribe statins, evaluate heart health risks, and communicate on the dangers of poor heart health to individuals all the time anyways.
On the other hand, when was the last time you used a custom one-off interpreter?
> The choice of a 5-year period seems to be because of data availability
> An algorithmic absurdity: cancer improves survival
> [...]
> algorithmic absurdity, something that would
> seem obviously wrong to a person based on common sense.
> optimize “quality-adjusted” life years
https://repaer.earth/ was posted on HN recently as an extreme example of this hehe
There are so many ways to get it wrong - bad data, bad algo design/requirements, mistakes in implementation, people understanding the system too well being able to game it, etc.
Human systems have biases, but at least there are diverse biases when there are many decision makers. If you put something important behind a single algorithm, you are locking in a fixed bias inadvertently.
It's also likely that a cross-regional system existed, that may have been ad-hoc. If you had a patient with an exceptional need, you might ask the other regions to be on the look out for an exceptional liver that works just right for your patient. That sort of thing is harder to do in a national system where livers are allocated based on scores.
Another thing that's helpful with multiple systems is it encourages reviewing and comparing results.
For a single system, reviewing results is even more important, but comparing is harder. But you might look at things like demographics of patients who died from liver disease while on the list including how long they were on the list; how long the current people have been waiting; demographics of people who recieve a transplant and how long they waited.
If there's a bias against young people, you would likely see more young people with long wait times, etc.
US has its problems, but sometimes the "laboratory of ideas" that is federated system of 50 states prevents bad outcomes like this.
I wonder how exactly this would work. As the article identifies, health care in particular is continuously barraged with questions of how to allocate limited resources. I think the article is right to say that the public was probably in the dark to the specifics of this algorithm, and that the transition to utilitarian based decision making frameworks (ie algorithms) was probably -not- arrived by at by a democratic process.
But I think had you run a democratic process on the principle of using utilitarian logic in health care decision making, you would end up with consensus to go ahead. And then this returns us to this specific algorithmic failure. What is the scaleable process to retaining democratic oversight to these algorithms? How far down do we push? ER rooms have triage procedures. Are these in scope? If so, what do the authors imagine the oversight and control process to look like.
So what is the governance and oversight framework for ensuring democratic consent from ideation to implementation to monitoring, and how does it differ from what the UK did? The article points out that there were multiple reviews of the algorithm that identified this bias all the way back in 2019. What is the process that connects that feedback with the democratic process to ensure that flawed implementations never deploy, or are adjusted quickly.
The article doesn’t make this clear, and the name of the blog doesn’t help.
For kidney transplants, for example the EPTS score, compatibility, time on the list, geographic distance and antibody levels are used to generate the wait list ranking. For scale, you accrue 1/365 points for each day waiting on the list. Kids under 10 get 2 extra points. Kids under 20 get 1 extra point. Those with high antibody levels can get up to 20 extra points to increase their chance of getting a match.
The KDPI score is an estimate of how risk of graft failure of the donor organ. The lower the number the better the odds. Those with low EPTS (<20%) will get those with KDPI <20%. Age and diabetes heavily factor in an EPTS score. The donor KDPI is something they will tell you when you get a call. You can always pass on any donor organ.
https://news.ycombinator.com/item?id=38202885 (22 comments)
And then we get articles saying that AIs are biased, racist and don’t work as expected and that AI in general as a technology has no future.
I can even predict what will be their solution lmao, to pay atrocious lump of money to big consulting agencies with no expertise to develop it for them and fail again.
It also creates a weird scenario where all of the worst cases past some level will have no hope of getting a transplant. I.e. if the wait time is uniformly 3 years, then anyone with <3 years of expectancy has little hope despite being the ones who need it most, meanwhile everyone with >3 years expectancy can happily hang out on the list waiting for their transplant.
Simplified a little, but you get the idea. It’s arguably fairly obvious that livers should be assigned based on urgency in some form. I absolutely agree that this should be open and explainable though.
That’s an outrageous and obscene utility calculation to propose and it should be obviously so to just about anyone.
Ultimately a sacrifice must be chosen, but I am not sure a discussion about how that should be made is necessarily fit for HN (though I'd be interested in how you'd resolve your proposed scenario).
No. Because it's mild and could reduce your life expectancy. Once it becomes worse and a will, yes--you should.
Welcome to the reality of triage .. all decisions are bad from some PoV or another, some are arguably less bad.
Oh, to live in a world of infinite matching organs and unlimited theatre slots on demand.