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by bane
2922 days ago
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I get the impression that much of medicine is one of those strange practices that looks kinda like science, but really isn't. Medical practice appears to work more like a highly evolved guild system than any other kind of recognizable scientific activity. It's probably far beyond the point where its necessary to bring in actual scientific practices, so I can't say it's on the cusp of a sweeping change. One of the problems that really prevents the change is that analysis of patient data is so highly protected that it's virtually impossible to do proper studies. We assume that people with such access are performing them, but I know from second-hand experience that actual time spent on real treatment studies is very small and most of the time is spent dealing with policy and patient privacy issues. Large insurance and government-based (VA, CMS, etc.) providers have the most data, but either what they're looking for isn't exactly aligned with what patients need, or the organizations are so fubar (e.g. the VA) that real studies are unlikely to happen. There really needs to be some kind of research exception/feedback loop on massive scale data analytics that allows some group of objective researchers to mine patient data and put in place actionable recommendations that work their way into medicine rapidly -- perhaps with some penalizing stick insurance providers can leverage against practitioners to make sure they adopt newer better practices. |
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It is very hard to escape from the fact that there are patients who are so difficult to keep alive that the rational choice is probably to let them die. The exact circumstances will depend on your value structure, but once that is settled any scientific approach that optimises for greatest net good or quality of life will involve letting some patients go without really trying to save them.
There is a pretty substantial lobby (no particular affiliation) who just won't accept that attitude being out in public.
I watch the struggles of data science to take root in our medical system with great interest in light of this. Anyone using a statistical argument to justify inaction when confronted with a patient is running a risk of being pilloried. Pictures of ancient grandmas on the front page of a newspaper style stuff. And that is if they get the stats right - get something wrong and then you feel like a loser on top of running that risk.
Between that and the serious privacy concerns, I can believe that the medical world will be mysteriously disorganised and ad-hoc in their decision making no matter what statistics available. I don't see what the real incentive is to look at and use the numbers, without having a statesman like dedication to the greater good, come what may. Such persons combined with leadership and statistical knowhow are rare.