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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?

#31

Post by rscho »

mquander wrote: post #28
rscho wrote: post #24

Earlier quoted context omitted.

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 s…

Maybe for you, but not for most people. Because most people do not behave the way you are describing. Most people express themselves in vague, sometimes incomprehensible ways linked to their cultural and personal background. Their priorities might not be aligned with their best interests at all. Some will even think it clever to hide info from the doc, because they are prejudiced against docs or fear being reported, etc. That's why a skilled clinician is first of all a skilled interrogator, and second an accurate observer. The way you look, behave, walk and talk is very often of more value than lab tests. That's what a good GP is actually: someone good at extracting information from people. An unfortunate consequence of that is that every doc you'll meet will want to hear your story again, which gets old fast for patients.

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

#32

Post by adastra22 »

zamadatix wrote: post #19
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…

Flip the issue to something less polarizing and it should appear this is a very separate scenario from what GP is talking about (even if perhaps you still don't agree it should be malpractice for some reason): 1) You go in after feeling confused and have a headache after falling from a skateboard with no helmet. The ER sends you home not having checked anything or any notes to watch out for because they think you're…

Any ER would check for a concussion in that circumstance, as I can attest from experience.

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

#33

Post by JumpCrisscross »

binary132 wrote: post #27

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…

> 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

No. Because it's mild and could reduce your life expectancy. Once it becomes worse and a will, yes--you should.

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

#34

Post by JumpCrisscross »

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…

> 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

This presupposes the problem of medical records having been solved.

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

#36

Post by rscho »

lazyasciiart wrote: post #20
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…

I had a heart attack at 35, despite not really having other risks. A sibling who had a heart attack is the biggest risk factor, but later my sister did not qualify for a study on heart attack risk because she was only 39. My ER notes literally say “can’t be a heart attack but that’s what it looks like, so we’ll treat it as one for now”, which is a little unnerving.

> is a little unnerving

Why so? You were lucky! You had a low probability for the diagnosis, but the doc made the right decision. That's to be celebrated.

> did not qualify for a study on heart attack risk because she was only 39.

Criteria for studies are designed to test a specific hypothesis. There are many possible reasons why your sister was not eligible, and not all of them bad.

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

#37

Post by rscho »

JumpCrisscross wrote: post #34
rscho wrote: post #24

Earlier quoted context omitted.

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…

> 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 This presupposes the problem of medical records having been solved.

No, this presupposes that the machine won't interact solely with the medical record, but mostly directly with the patient. At least, that's my understanding. In this view, medical records won't be just text records anymore, but records of the whole system 'sensorium' for lack of a better term.

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

#38

Post by [deleted] »

binary132 wrote: post #27

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…

[deleted]

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

#39

Post by yieldcrv »

rscho wrote: post #31
mquander wrote: post #28

Earlier quoted context omitted.

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 s…

Maybe for you, but not for most people. Because most people do not behave the way you are describing. Most people express themselves in vague, sometimes incomprehensible ways linked to their cultural and personal background. Their priorities might not be aligned with their best interests at all. Some will even think it clever to hide info from the doc, because they are prejudiced against docs or fear being reported,…

but almost nobody has a skilled clinician or a good GP

or a skilled/good one at that point in time because their clinician is hungry, or has random bias against that person’s communication style, or insurer

or, in the US, you changed jobs and your insurer changed and you need a new doctor in an applicable network

I’m amused how all of your explanations and rebuttals reinforce the path to irrelevancy

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

#40

Post by yapyap »

rscho wrote: post #36
lazyasciiart wrote: post #20

Earlier quoted context omitted.

I had a heart attack at 35, despite not really having other risks. A sibling who had a heart attack is the biggest risk factor, but later my sister did not qualify for a study on heart attack risk because she was only 39. My ER notes literally say “can’t be a heart attack but that’s what it looks like, so we’ll treat it as one for now”, which is a little unnerving.

> is a little unnerving Why so? You were lucky! You had a low probability for the diagnosis, but the doc made the right decision. That's to be celebrated. > did not qualify for a study on heart attack risk because she was only 39. Criteria for studies are designed to test a specific hypothesis. There are many possible reasons why your sister was not eligible, and not all of them bad.

> Why so? You were lucky! You had a low probability for the diagnosis, but the doc made the right decision. That's to be celebrated

cause they still said “can’t”

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