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Google Is Training Machines to Predict When a Patient Will Die

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Re: Google Is Training Machines to Predict When a Patient Will Die

#81

Post by Eridrus »

Spivak wrote: post #80
Eridrus wrote: post #76

Earlier quoted context omitted.

Insurance works when you incur a lot of one time costs, it works much worse when you start incurring a lot of expenses over a long period of time. Ideally you could buy insurance that would cover all of your long term costs once you contracted some disease, but this doesn't exist in the US. And doubly doesn't exist when you realise that there are a bunch of forces incentivizing people to get their insurance from an e…

> you could buy insurance that would cover all of your long term costs once you contracted some disease Kind of defeats the point if you're using it to cover known future costs. Insurance can really only insulate you against risk, it's not free money.

But at the earlier point in time, when people are buying insurance, these are unknown future costs.

And this is the whole problem, insurers don't want to pay those costs because that would increase the premiums they need to charge, making them uncompetitive (and then you're into the realm of behavioural economics), but what people actually want is something that can insure against spending on chronic diseases, which accounts for 90% of the spending on healthcare in the US.

And IMO, to the extent that insurance doesn't cover chronic conditions, it is a bad model for healthcare.

Re: Google Is Training Machines to Predict When a Patient Will Die

#82

Post by knuththetruth »

Spivak wrote: post #78
knuththetruth wrote: post #75

Earlier quoted context omitted.

>A world where you didn't have to pay upfront would make care even more expensive because doctor's offices have to essentially become banks. Those are called nationalized healthcare systems and are almost all cheaper than the US’ privatized system?

Huh? The doctor is still getting guaranteed payment but by your government instead of you. I mean the world in which doctors had to accept patients regardless of their ability to pay and have to try and recover later.

Apologies, thought you were excluding this kind of arrangement in your argument.

Re: Google Is Training Machines to Predict When a Patient Will Die

#83

Post by Broken_Hippo »

Spivak wrote: post #73
Broken_Hippo wrote: post #39

Earlier quoted context omitted.

I wish that were the case. They'll treat you in the ER, but not make sure you can actually purchase antibiotics to cure the thing that brought you to the ER to begin with, nor make sure you can afford the bone specialist you need to see for your surgery. Anything short of an emergency and you can be denied care due to finances. Even if your problem is cancer or they know it will eventually be an emergency or life-thr…

What is the ER going to do about the fact that you can't afford a prescription or treatment/surgery from a specialist? Their job is pretty much to stop you from dying right now and direct you to another doctor when you're stable. You can also present insurance upfront but same difference I suppose. A world where you didn't have to pay upfront would make care even more expensive because doctor's offices have to essent…

Most hospitals have pharmacies in-house. Would it be too much to ask that the hospital provide you with the prescription or pain meds that will take care of the problem that brought you there and include that in the bill? As far as the specialist is concerned, they can easily refer people to places that help the folks that can't afford such things. All they'd need to do is give a piece of paper with information on it.

It would essentially be this: YOu break your leg and go to the hospital. When you leave, you have not only a cast, but pain meds and crutches if required (many hospitals do not offer them). If you can't breathe and you need medicine for infection, you leave with the medicine. If you can't afford a follow up with a doctor, they refer you to folks that can help you.

Insurance doesn't help if you are near-broke and two days away from payday. Lots of folks can't afford their deductible plus the yearly out-of-pocket.

Re: Google Is Training Machines to Predict When a Patient Will Die

#84

Post by Broken_Hippo »

Spivak wrote: post #78
knuththetruth wrote: post #75

Earlier quoted context omitted.

>A world where you didn't have to pay upfront would make care even more expensive because doctor's offices have to essentially become banks. Those are called nationalized healthcare systems and are almost all cheaper than the US’ privatized system?

Huh? The doctor is still getting guaranteed payment but by your government instead of you. I mean the world in which doctors had to accept patients regardless of their ability to pay and have to try and recover later.

Um. Nationalized health care. Sure, they get payment from the government, but this isn't much different than waiting on insurance to pay in the states.

My yearly out-of-pocket is about 300 a year for regular medical: Another 300 for physical therapy and a few other things. This includes maintenance prescriptions. The rest is out of taxes - the main difference is that I can plan for these things. Once people hit the out of pocket, they get a special card to pay with. Most doctors offices will bill folks without an issue and I think they are required to see people even if they can pay, though I'm not sure how late bills affect folks.

That world exists in some forms, and if folks would agree to it, surely could exist more places.

Re: Google Is Training Machines to Predict When a Patient Will Die

#85

Post by taneq »

class4behavior wrote: post #63
taneq wrote: post #46

Earlier quoted context omitted.

The simple fact that "evidence-based medicine" needs a special name to describe it, rather than all medicine being evidence-based, is still absolutely mindblowing to me.

Uh, you're confusing this with the distinction made between Western standard medicine and folk or alternative medicine practices.

No, this term was proposed as an "emerging new paradigm" in 1992 (!!) focusing on "the examination of evidence from clinical research" as our most reliable source of information.

"Western standard medicine" was still largely based on intuition and woo less than 30 years ago.

Source: https://jamanetwork.com/journals/jama/article-abstract/40095...

Re: Google Is Training Machines to Predict When a Patient Will Die

#86

Post by mcny »

neurobashing wrote: post #20

I'm sure it's an interesting technical challenge with huge amounts of complex, nuanced debate involved, and it could have a huge impact on health care. That said, my wife is an oncology nurse, and I will bet everything that no machine will ever get better at predicting than an experienced, skilled nurse. Humans are built to read humans.

» my wife is an oncology nurse

Have you ever asked her if she wants to do the job of predicting when a patient will die? How many hours would she need to spend reading the patient's history to come up with a prediction she feels satisfied to use to decide what service the patient will get? I'm not a medical professional but my gut reaction is I don't want to do anything with predicting or sentencing if some machine can do it almost as well as I can.

I remember this story of a radiologist who told me he thinks we spend too much money for too little during the last about six months of a patient's life. If we had better information on when the last six months starts, maybe we could reduce the cost of healthcare? Apparently, we spend cost to 18% of GDP on healthcare in the US? Iirc, most of Europe is closer to 12?

Re: Google Is Training Machines to Predict When a Patient Will Die

#87

Post by mcny »

tialaramex wrote: post #51
baxtr wrote: post #7

A very close relative of mine passed away 2 weeks ago. She had cancer for 2 years and when she was first diagnosed the doctors would give her 8-10 “good years”. Well... When she died, I was shocked to learn that very few data points of her sichkness and treatment history would be preserved for later analysis. Doctors work almost entirely on their gut feeling and probably some clinical studies with n being very small.…

Yup. Doctors interested in the philosophy of science have moaned about this sort of thing before. A more typical example goes like this: I'm a GP, and I see dozens of patients every year with cases of Foozle disease. I was taught in medical school to give them orange pills, but I follow developments in general medicine and I know the new purple pill has seen good results for Foozle too. Nobody has published even a sm…

» But, if I pick randomly AND record the results, thus doing science to find out which was best, that's an unauthorised medical experiment and I could lose my job or even go to jail.

Perhaps we can try to cut down the red tape a little but we can't eliminate the idea of informed consent. If you're doing a study on patients, they absolutely have a right to know and a right to refuse to be a part of your study without any repercussions.

I think informed consent is something we can't get rid of even if we do something drastic and eliminate medical licensing altogether.

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