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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?

#41

Post by [deleted] »

adastra22 wrote: post #32
zamadatix wrote: post #19

Earlier quoted context omitted.

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.

[deleted]

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

#42

Post by rscho »

yieldcrv wrote: post #39
rscho wrote: post #31

Earlier quoted context omitted.

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

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

As I said, one day certainly. But if you think current tech is up to par, then I'm sorry but you are being delusional. Also, you assume I'm trying to defend the statu quo. That's not the case. I'm all for progress.

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

#43

Post by zamadatix »

adastra22 wrote: post #32
zamadatix wrote: post #19

Earlier quoted context omitted.

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.

Almost certainly. That's why not doing so is used as a clear example of malpractice and negligence - the standard of care says to check for those kinds of issues given the situation and that's what nearly every doctor will therefore do.

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

#44

Post by zamadatix »

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…

(separating this out)

I agree with you heavily here: "Also, I don't believe the claim that physicians don't care about CVD risk in patients Seems odd over all. My physician, unprompted, wanted to put me on a statin when I was very healthy and in my early 30s just to lower my risk as my cholesterol numbers were trending up at the time. Whether or not this calculator actually works for those under 40, physicians certainly still prescribe statins, evaluate heart health risks, and communicate on the dangers of poor heart health to individuals all the time anyways.

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

#45

Post by rscho »

yapyap wrote: post #40
rscho wrote: post #36

Earlier quoted context omitted.

> 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”

If this doc meant it in the literal sense of 'can't', why go through with the workup, then? This is IMO evidence that the doc meant 'very unlikely, but let's check'. I agree words are important, but still the right decision was made and that's cool.

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

#46

Post by mannykannot »

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

> Then the entire medical industry is failing at communicating that.

Rebutting hypobolic extrapolations from literally one datum is still not something that the entire medical industry - or just my PCP and cardiologist, for that matter - should be prioritizing (unless they have a patient doing just that), even if the prevalence of such claims has increased over the last decade or so.

The afforementioned professionals had no reticence in taking my pre-40 symptoms of heart disease seriously, even though I did not present any of the correlates frequently associated with it.

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

#47

Post by jl6 »

It’s worth noting that the algorithm in question is not any kind of AI or ML as we might know it from the tech industry. Underneath, it is plain old statistical modelling.

The article doesn’t make this clear, and the name of the blog doesn’t help.

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

#48

Post by ClassyJacket »

jl6 wrote: post #47

It’s worth noting that the algorithm in question is not any kind of AI or ML as we might know it from the tech industry. Underneath, it is plain old statistical modelling. The article doesn’t make this clear, and the name of the blog doesn’t help.

I know we're on Hacker News, but still, that's how I interpreted it

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

#49

Post by rendaw »

rscho wrote: post #45
yapyap wrote: post #40

Earlier quoted context omitted.

> 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”

If this doc meant it in the literal sense of 'can't', why go through with the workup, then? This is IMO evidence that the doc meant 'very unlikely, but let's check'. I agree words are important, but still the right decision was made and that's cool.

I think the issue is "can't" is present tense, and the conclusion _after_ treating. In otherwords, they still think it isn't a heart attack.

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

#50

Post by danpalmer »

cedws wrote: post #30
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.

With FIFO the difficulty simply moves to whether you go on the list or not. What should the threshold be for being on the list. If you make it too high then people die without ever being given the opportunity for a liver, if you make it too low then too many people die waiting.

It also creates a weird scenario where all of the worst cases past some level will have no hope of getting a transplant. I.e. if the wait time is uniformly 3 years, then anyone with 3 years expectancy can happily hang out on the list waiting for their transplant.

Simplified a little, but you get the idea. It’s arguably fairly obvious that livers should be assigned based on urgency in some form. I absolutely agree that this should be open and explainable though.

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