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Is the UK's liver transplant matching algorithm biased against younger patients?

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Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#21

Post by rscho »

yieldcrv wrote: post #17
rscho wrote: post #15

Earlier quoted context omitted.

> if you are under 40 you will never encounter a physician who believes you are at risk of heart attack or stroke 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'…

Then the entire medical industry is failing at communicating that 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

> replace most medical professionals with genAI language models as soon as the regulations allow

Understandable, I guess. But not feasible now, nor in the foreseeable future. The problem is not even "AI" performance. The real problem is that the useful data isn't available to machines, because it's mostly acquired through meeting patients in person. It's gonna take lots of money to make machines that can compensate for that.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#22

Post by yieldcrv »

rscho wrote: post #21
yieldcrv wrote: post #17

Earlier quoted context omitted.

Then the entire medical industry is failing at communicating that 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

> replace most medical professionals with genAI language models as soon as the regulations allow Understandable, I guess. But not feasible now, nor in the foreseeable future. The problem is not even "AI" performance. The real problem is that the useful data isn't available to machines, because it's mostly acquired through meeting patients in person. It's gonna take lots of money to make machines that can compensate f…

Multimodal language models have already been good at accepting imaging input and noticing things that professionals overlook

I don't see how a meeting patient in person requirement is an issue. They can listen to the patient, have a context window large enough to analyze their medical history and environmental factors, look at charts, and diagnostics of tissues

and still have a much greater EQ, ability to affirm, and have empathy more than the dismissive high IQ doctor ever will

humans are going to chose that because smart humans don't have those attributes

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#23

Post by hgomersall »

hombre_fatal wrote: post #9
ipnon wrote: post #5

Similarly the main calculator used in the US to calculate 10-year risk of cardiovascular incident literally cannot compute scores for people under 40.[0] There are two consequences to this. The first is that if you are under 40 you will never encounter a physician who believes you are at risk of heart attack or stroke, even though over 100,000 Americans under 40 will experience such an incident each year. The second…

Out of curiosity, how is a physician negligent if decades of exposure to hypertension/LDL/smoking/diabetes (the variables on that calculator) give you a heart attack or stroke? 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 c…

Almost all ailments can be mitigated to some extent by lifestyle choices. Is anyone that doesn't make the best possible choices for the particular ailment responsible for their situation?

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#24

Post by rscho »

yieldcrv wrote: post #22
rscho wrote: post #21

Earlier quoted context omitted.

> replace most medical professionals with genAI language models as soon as the regulations allow Understandable, I guess. But not feasible now, nor in the foreseeable future. The problem is not even "AI" performance. The real problem is that the useful data isn't available to machines, because it's mostly acquired through meeting patients in person. It's gonna take lots of money to make machines that can compensate f…

Multimodal language models have already been good at accepting imaging input and noticing things that professionals overlook I don't see how a meeting patient in person requirement is an issue. They can listen to the patient, have a context window large enough to analyze their medical history and environmental factors, look at charts, and diagnostics of tissues and still have a much greater EQ, ability to affirm, and…

It is said that "90% of diagnosis is made on patient history". That's the whole problem for machines. We'll need machines able to converse and integrate patient appearance, behaviour etc. as well as humans, and reliably derive the appropriate conclusions from that before we get efficient medical AI. We'll see how fast progress can be made, but from what I see from chatGPT and the like, I seriously doubt the current AI wave will achieve acceptable results in real, everyday medicine. IMO, procedural medicine where lots of multimodal info is always available and the environment relatively fixed, such as (simple) surgery, is a better candidate for (reliable) automation in the near term. Something like prosthetic orthopedics, maybe ?

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#25

Post by hombre_fatal »

hgomersall wrote: post #23
hombre_fatal wrote: post #9

Earlier quoted context omitted.

Out of curiosity, how is a physician negligent if decades of exposure to hypertension/LDL/smoking/diabetes (the variables on that calculator) give you a heart attack or stroke? 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 c…

Almost all ailments can be mitigated to some extent by lifestyle choices. Is anyone that doesn't make the best possible choices for the particular ailment responsible for their situation?

The question in this context is whether they are less responsible for their lifestyle choices than their physician.

We're talking about the variables in the calculator: blood pressure, cholesterol, smoking, and diabetes.

Which one of those is the physician more responsible for than the patient?

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#26

Post by gyudin »

What can go wrong when you let government agencies with no expertise to develop and maintain AI models and algorithms, right?

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.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#27

Post by binary132 »

So, if I as a 38-year-old had a mild liver impairment which could reduce my life expectancy to 60 (22 years from now) I should get priority over a 60-year-old with a debilitating, excruciating condition which will end his life in six months, merely because his life expectancy with the transplant may only be 70?

That’s an outrageous and obscene utility calculation to propose and it should be obviously so to just about anyone.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#28

Post by mquander »

rscho wrote: post #24
yieldcrv wrote: post #22

Earlier quoted context omitted.

Multimodal language models have already been good at accepting imaging input and noticing things that professionals overlook I don't see how a meeting patient in person requirement is an issue. They can listen to the patient, have a context window large enough to analyze their medical history and environmental factors, look at charts, and diagnostics of tissues and still have a much greater EQ, ability to affirm, and…

It is said that "90% of diagnosis is made on patient history". That's the whole problem for machines. We'll need machines able to converse and integrate patient appearance, behaviour etc. as well as humans, and reliably derive the appropriate conclusions from that before we get efficient medical AI. We'll see how fast progress can be made, but from what I see from chatGPT and the like, I seriously doubt the current A…

Isn't it dramatically easier to provide more useful history to machines?

If I'm providing history to a doctor I am pretty much trying to jam the history into a two minute explanation, and they are trying to remember our previous interactions based on short summarized notes that they made without my help.

If I'm providing history to a machine I can take my time to tell the machine as much as I want every time. I can send it whole spreadsheets of symptom logging and tell it my whole life story.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#29

Post by rscho »

hansvm wrote: post #10
ipnon wrote: post #5

Similarly the main calculator used in the US to calculate 10-year risk of cardiovascular incident literally cannot compute scores for people under 40.[0] There are two consequences to this. The first is that if you are under 40 you will never encounter a physician who believes you are at risk of heart attack or stroke, even though over 100,000 Americans under 40 will experience such an incident each year. The second…

What happens if the doctor says the tool is likely wrong and gives a reasonable (according to their peers) reason why? Does the court blindly accept some algorithm over hard-earned experience?

No, typically a court would summon an expert on the topic for testimony. Such an expert, as most any doc, would understand the limits of guidelines/calculators/etc. and judge accordingly. A typical clinical presentation resulting in a missed diagnosis would not fly at all under this process. But an atypical presentation in a very low probability context (young patient, no risk factors) might get through. Also, contrary to popular belief docs absolutely do not cover for each other in court.

Re: Is the UK's liver transplant matching algorithm biased against younger patients?

#30

Post by cedws »

gyudin wrote: post #26

What can go wrong when you let government agencies with no expertise to develop and maintain AI models and algorithms, right? 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 a…

The fairest way to do it I feel is a FIFO. Yeah you might give an organ to a 70 year old on their last legs, but they don’t have any less of a right to live than anyone else. After the Horizon scandal, public trust in complicated computer systems are at an all time low. It shouldn’t be an opaque system making such important decisions. Everything should be in the open and explainable.
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