[arpowers]

They suggest mortality is lower during meetings because:

"the intensity of care provided during meeting dates is lower and that for high-risk patients with cardiovascular disease, the harms of this care may unexpectedly outweigh the benefits."

Not sure if they accounted for delayed surgeries in the study.

[mankyd]

> Not sure if they accounted for delayed surgeries in the study.

That's sort of what I am wondering. Perhaps it just delays the inevitable - the patient is gravely ill is is going to die if they don't perform _potentially_ life-saving surgery. The surgery, is of course risky.

The conference delays the surgery, so the patient's surgery or other high risk procedures are delayed. This gives the patient a few more days of being ill, but doesn't probabilistically change the outcome of actually undergoing the procedure.

[Swizec]

> The conference delays the surgery, so the patient’s surgery or other high risk procedures are delayed.

My understanding from listening to the author’s podcast, is that this is the proposed mechanism. There is a percentage of patients who were going to get better on their own anyway. But if they receive urgent care, it may cause harm.

The conclusion seems to be that there is a measurable percentage of patients who got surgery but didn’t need it and thus suffered greater harm than if they had been left alone. Because heart attacks are so critical, medical staff errs on the side of action instead of waiting. This seems reasonable, but may in fact be bad.

it’s a good podcast: https://freakonomics.com/podcast/what-happens-to-patients-wh...

[MattRix]

They appear to be already accounting for that since they are measuring 30-day mortality for acute conditions. They’re saying it’s possible the reduced mortality is due to the high risk procedures actually being unnecessary.

[oaktrout]

As an argument to illustrate why 30 day mortality isnt a long enough period, imagine this scenario: you have a cancer that has a 90% chance of killing you in one year. You will be cured if you get the surgery tomorrow, but the surgery has a 30% mortality rate. In one month, 30% or those who got the surgery will die, where all those who didn't get the surgery will still be alive. In one year, 70% of those who got the surgery live, whereas only 10% who didn't get the surgery are alive.

[prepend]

But they don’t account for patients going to other hospitals and dying there instead.

[yellowapple]

Now I'm curious about mortality rates in the weeks following a conference. "Lemme try this neat trick I learned..."

[IG_Semmelweiss]

To understand why, i think you have to know 2 data points

1) The first date (and then-current surgery schedule) at the point when the conference dates where announced.

2) The date (and then-current surgery schedule) at the point, when the doctor booked his/her travel plans.

Both lists and dates will help you understand if changes in information also resulted in the changes of mortality (by rescheduling hard cases to a later date, for example).

[boringuser2]

Honestly, I've been trying with the idea that most medicine is actually just straight up actively harming people in complex ways.

Note: I said most, there are obvious exceptions.

[JHorse]

I like that framing. Personally, I've always thought of doctors as "professional educated guessers"

[Scoundreller]

A problem is that the inputs are so heterogenous. Hard to avoid "Garbage in, garbage out" in the input-process-output cycle.

[michaelmrose]

This is complete and utter nonsense. The "exceptions" are 99% of medicine. Almost all of medicine is applying strategies we know on average improve outcomes as well as we know how and as well as that clinician is able to within the scope of the time given. If you don't know this is likely that you haven't had much need of medicine. I you had you would know better.

This isn't to say outcomes are always good our knowledge is imperfect, people are imperfect, and not every situation has a good answer.

[robwwilliams]

Emphasis—“on average” and yet often applied deep into both tails of unknown distributions.

“Complete and utter nonsense” also ignores many inconvenient truths about medical care today and of course in the not-so-distant past. Medical history should temper the tone.

[michaelmrose]

> I've been trying with the idea that most medicine is actually just straight up actively harming people in complex ways.

This says that most medicine is harmful full stop. This is conspiracy theory thinking. It is not far off from I've been thinking maybe the earth really is flat.

Most medicine is setting broken legs, dispensing antibiotics for infections, prescribing insulin for diabetes. In other words interventions that are straightforwardly positive. It is only when the situation is already dire and outcomes are already poor that intervention is sometimes negative and even then we are often discussing whether an intervention at 72 resulted in the person dying then instead of 74 wherein the person would have died thrice over between 60 and 72 and been crippled between.

Yes I too read about both the era where we thought bad smells caused disease and disdained hand washing AND modern end of life care which is oft pointless this doesn't mean medicine is mostly harmful. Words have meanings and the posters are nonsense as you know.

[boringuser2]

1. You're pre-supposing that intervention in these cases is both common enough to affect things on a sociological level, and necessary enough to also contribute to the effect.

I suspect given that the rarity of many serious ailments until much later in life simply no intervention would suffice in any reasonable epidemiological sense.

2. Your hypothesis presupposes that serious medical care is commonly necessary enough to significantly improve public health.

I know of young people that have been harmed by medical science, and not many come to mind whom I would consider having been in absolute need of medical intervention.

Given that medicine often harms patients demonstrably, with mistakes and opiates contributing majorly to human fatalities, it occurs to me that I can more commonly produce anecdotes where medication or medicine harmed rather than helped where it would have been absolutely necessary.

[michaelmrose]

The majority of us if we live long enough will need medical help to live or live well. For the overwhelming majority of these interventions there is medial evidence as far as the beneficial nature of these interventions which you cannot simply refute by your badly considered incomplete anecdotal understanding of other people's experience.

Of course more things go wrong as people get older but accident or illness can happen at any age and without intervention in the overwhelming majority of cases in which we intervene the outlook isn't great and many people have 40 or more years left when they need help.

Just as a singular for instance people become diabetic. No intervention means they die soon.

People break their bones. No intervention means people experience weeks to months of screaming agony and are far more likely to experience ongoing pain and permanent decrease.

People get pre-cancerous growths or trivially treatable early cancers. No intervention means they die decades early.

People get a bad chest infection and their lungs start to fill up with fluid. Non-intervention means someone who could have lived to 80 dies at 40.

People break their hip in their 50s with decades of life back. What is the chance of walking by just lying abed and drinking tea. It's negligible because certain kinds of breaks don't actually get fixed without surgery.

Here is some data on hospital admissions and emergency department visits per 1000 by age. You will note that even among the relatively young visits are not particularly uncommon. Young people are less likely to have something go wrong with their body but more likely to have something go wrong with their judgement and have an accident.

These people aren't all morons marching in lockstep to get snake oil they are going to the emergency room because they did something stupid and broke their legs or 1000 different other legitimate interventions.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133481/

Here is the mayo clinic talking about what they do with a broken leg.

https://www.mayoclinic.org/diseases-conditions/broken-leg/di...

The truly strange thing is that the word epidemiological is in your vocabulary and not only do you know absolutely nothing about the world around you but you are aggressive in your ignorance. Defending the complete fantasy you have erected with vigor if not ability.

It's like talking with a true believer about the "theory" of evolution

[readthenotes1]

Medical care mistake is possibly the 3rd leading cause of death in the United States...

https://www.hopkinsmedicine.org/news/media/releases/study_su...

[contravariant]

Not sure if that's a useful definition of 'harm'. It's like pointing out that most substances are poisonous. Can't just ignore the dose or context when it comes to medicine.

[contravariant]

Alternatively people who suffered acute heart conditions while a cardiologist was not available were simply not hospitalized, they're dead.

[jprete]

What mechanism do you think might cause that connection?

[Detrytus]

Delayed surgeries are precisely what they mean by "lower intensity of care".