Experts warn yearly checkups carry risks and do not reduce mortality • Hacker News Board

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#61

Post by trgn » Mon, Apr 03, 2023, 3:35 PM UTC

nlh wrote: post #19

im3w1l wrote: post #11

I find this sentiment almost offensive. Like it goes against everything I believe to say that less data is better. But the root of it is pretty clear "even basic blood tests can lead to unnecessary interventions or treatments". It's the belief that a test leads to interventions. But it doesn't have to of course. An intervention is a decision, and if an intervention is likely to be unnecessary, then they shouldn't int…

Agreed 100%. It's absurd. The results get distilled as "more data leads to worse outcomes" and that's ridiculous -- it should be: "more data leads to bad decisions which lead to worse outcomes". We should ALWAYS strive to have more and better data. What needs to change is how we (and our doctors) respond to that data.

That's just saying the same thing as the article. But instead of reconsidering the premise, this is just doubling down on it.

> We should ALWAYS strive to have more and better data.

If you value data in and of itself, in other words if data is an a priori good, then this is a fetish.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#62

Post by bombcar » Mon, Apr 03, 2023, 3:36 PM UTC

imwithstoopid wrote: post #23

95% of yearly US medical exams: doctor tells patient to lose weight. patient does not comply, and is even heavier next year

This is becoming more and more true world-wide; it's getting so bad that we've passed 21% of the entire healthcare budget on it.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#63

Post by HPsquared » Mon, Apr 03, 2023, 3:36 PM UTC

ghostpepper wrote: post #9

There's a similar phenomenon when you look at fetal heart monitoring for otherwise healthy pregnant women going into labour. The two options are continuous monitoring, where the monitor is left in place for the entire hospital stay, and periodic monitoring, where a nurse installs it, takes a reading, and removes it about once an hour. Common sense would dictate that negative outcomes are reduced with continuous monit…

Is everything else really equal here? I'd think "higher-risk" situations would be more likely to have a higher level of monitoring. In other words, was this randomised?

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#64

Post by kevinmchugh » Mon, Apr 03, 2023, 3:36 PM UTC

armitron wrote: post #22

masfuerte wrote: post #14

Earlier quoted context omitted.

There's no contradiction. Ignoring symptoms is foolish. Yearly checkups may do more harm than good. Both of these things can be true.

A lot of cancers have no symptoms at the beginning, but they can be flagged in blood tests performed as part of general health checkups.

I think the optimal move might be regular (possibly more than annual) blood work and only talking to a doctor when there's symptoms.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#65

Post by smileysteve » Mon, Apr 03, 2023, 3:37 PM UTC

imwithstoopid wrote: post #23

95% of yearly US medical exams: doctor tells patient to lose weight. patient does not comply, and is even heavier next year

The future with the ozempic type drugs is interesting; now a doctor will tell you to lose weight and can give you a pill that makes it more difficult for your body to absorb extra sugar and carbs and you can lose weight, even if you are diabetic already

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#66

Post by mhaberl » Mon, Apr 03, 2023, 3:37 PM UTC

This is just clickbait and people comment the title without reading the article. It doesn't say "don't do checkups"

> “The conclusions do not imply that physicians should stop clinically motivated testing and preventive activities,”

The article is saying that some tests give false positives, some tests even if positive don't point to illness without symptoms, but people get treated for illness.

I believe you should do checkups, but ask for second opinion before treatment in case that you feel ok and your family history doesn't point to risk factors. And that is also mentioned:

> However, Krogsbøll warned about the importance of distinguishing between people who do not feel sick and those with symptoms or a personal or family history of risk factors

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#67

Post by im3w1l » Mon, Apr 03, 2023, 3:38 PM UTC

jwestbury wrote: post #42

nlh wrote: post #19

Earlier quoted context omitted.

Agreed 100%. It's absurd. The results get distilled as "more data leads to worse outcomes" and that's ridiculous -- it should be: "more data leads to bad decisions which lead to worse outcomes". We should ALWAYS strive to have more and better data. What needs to change is how we (and our doctors) respond to that data.

Whilst I agree in theory -- in practice, humans are prone to misreading data. We have to build our systems to accommodate human flaws, as engineering away human flaws is much, much harder, and potentially impossible.

Human culture is constantly evolving, it's a mistake to assume that the flaws of today must remain so tomorrow. There is also AI to consider.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#68

Post by electric_mayhem » Mon, Apr 03, 2023, 3:40 PM UTC

wyldberry wrote: post #53

sklargh wrote: post #18

I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…

I was listening to Peter Attia on some podcast and he says to essentially throw out any BP reading that didn't occur after sitting down for five minutes. In his practice they have patients measure many times a day for multiple weeks just to get a baseline point to work from. More and more i find that, at least in America, if you're talking to a GP you're just talking to a human interface of insurance approved treatme…

That’s a great way to articulate the problem.

Imho, a brilliant solution is direct primary care. For $80/mo, I have access to a dr that works for me, and not my insurance company. Absolute game changer in that he has a bias toward understanding and optimizing rather than gaming insurance metrics to be rated as a double-plus preferred provider or whatever.

Also gets my lab work done at a fraction of what my insurance deductible would be.

Combine it with a high deductible insurance plan to hedge against the truly catastrophic/expensive possibilities.

There are direct primary care providers all over. Google it. I can’t recommend direct primary care highly enough.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#69

Post by jdeibele » Mon, Apr 03, 2023, 3:44 PM UTC

boringg wrote: post #12

belter wrote: post #8

Earlier quoted context omitted.

Interestingly, the scenario is somewhat discussed in the article: "...Rivero used as an example a request he receives frequently: to check the cholesterol of young people with no risk factors. “Checking a 32-year-old man with no history of sudden death or hypercholesterolemia in the family is pointless,” and can result in prescriptions for medication of questionable usefulness and that is not without risk in the even…

Cholesterol numbers are but guides/risk factors on your health risk. They do not necessarily mean that you will suffer from atherosclerosis the precursor to heart disease.

That was my argument to my primary care doctor. He then arranged for a CT scan of my arteries that showed there was significant blockage. I'm now on statins for the rest of my life to keep cholesterol in the blood down and hopefully keep the arteries from getting completely blocked.

Re: Experts warn yearly checkups carry risks and do not reduce mortality

#70

Post by nradov » Mon, Apr 03, 2023, 3:48 PM UTC

sklargh wrote: post #18

I have a personal example of this. My father died largely because of his annual physical. He hated doctors, became nervous around them and thus expressed hypertension in-office. He did not have material hypertension but did defer to his physician. Over the long term, despite my best efforts, this killed him. His blood pressure medication regime was poorly managed and severely impacted his quality of life. He eventual…

This is commonly known as "white coat syndrome". Some patients get nervous in medical offices, and some healthcare providers don't follow the recommended measurement protocol of allowing the patient to sit quietly for 5 minutes first. So this leads to some false positive hypertension diagnoses and iatrogenic harm.

Hypertension is common, dangerous, and generally under diagnosed. So primary care doctors have been trained to look for it and treat it aggressively. Overall the healthcare system is probably doing too little about hypertension rather than too much.