The Epidemic of Fake Disease
Medlife Crisis7 HN recommenders · recommended in 7 months, 2020–2026
explainer · general · evergreen · 2020–2026 on HN
A Medlife Crisis video by cardiologist Rohin Francis on overdiagnosis and over-screening. It explains how detecting more disease does not necessarily mean saving more lives, and covers harms such as unnecessary treatment.
Pointed to in threads about cancer screening, PSA tests, full-body MRIs and consumer diagnostics as an explanation of why more testing can hurt.
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9 comments from Hacker News
It does, doesn't it! This is basically the reason scepticism in screening has risen (amongst scientists and medics, not the general population) - research seems to show that screening catches much more cancer but doesn't save many more people. Rohin Francis does a good video on it, which you don't have to watch because it has references underneath you can click straight through to (the video is good though): ▶ this video I am frustrated by this because it seems obvious to me that "more data == better" but I guess it makes sense if you think of the scans as having high amounts of noise, and us having a poor understanding of the system we're monitoring (this never happens in tech, of course :)).
I'd encourage you to think about the consequences of over testing. Although it is somewhat counter intuitive, there are many negative consequences to patient outcomes from overtesting. A deeper overview: ▶ this video
Compare and contrast this video from 'Medlife Crisis': ▶ this video > Trying to detect disease early seems like an obviously good thing to do. But reality isn't always quite so straightforward, especially in medicine. If It Ducks Like A Quack is a series where I try to go beyond the hype and explore how complicated the apparently simple phenomena in medicine are. One point from the video: five year survival rates of prostate cancer in the US are massively better than in the UK. However, roughly the same proportion of people die of prostate cancer in both countries. The US just screens a lot more.
This video does a good job also of covering the topic of over-testing/over-treating potential cancer (or creating "Fake Disease" as it terms it): ▶ this video
This one is even more relevant as he talks about dangers of over screening for beast cancer, and side effects of mastectomy+chemo: ▶ this video
The opposite can be just as dangerous * . "Medlife Crisis" has an [informative video][1] that explains some of what can happen. * Edit: I shouldn't have equated the dangers here. This was a bad take. I still believe there are good bits of info provided in the video, but the relevance to this thread is less than I considered and I should have thought more about what I was sharing. Edit 2: I didn't mean to link to a specific timestamp of the video in the original link. That has been removed. [1]: ▶ this video
>Are there legitimate safety reasons these mundane diagnostics are so locked down? Healthcare is not my area of expertise either, but my understanding is that the short answer to your question is yes. For a longer introduction to the issues surrounding letting anyone get whatever diagnostics they want to pay for, this Medlife Crisis video that came out today seems appropriate: ▶ this video
I think the consensus on cancer screening is stil not fully there? Came across this video by a cardiologist a long time ago ▶ this video I guess the main gist is that screening is not completely benign and a positive screen might lead to more interventions for what in the end could just be a benign tumor. Then there's the other point of detecting it late in life. Like treatment for cancer might not make much sense if you are already 89 years old
Are you implying that more active screening would cause more good than harm, and that the scientific evidence that shows otherwise is mistaken? What makes you think the evidence is wrong? Screening is a very complicated topic and being overly aggressive with screening can really hurt patients. ▶ this video Or do you simply not support using scientific evidence and/or harm reduction to guide medical policy? What do you propose should be used instead in that case?