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?
#2 > The choice of a 5-year period seems to be because of data availability
> An algorithmic absurdity: cancer improves survival
> [...]
> algorithmic absurdity, something that would
> seem obviously wrong to a person based on common sense.
> optimize “quality-adjusted” life years
https://repaer.earth/ was posted on HN recently as an extreme example of this hehe
Re: Is the UK's liver transplant matching algorithm biased against younger patients?
#3I think the generalized take away from this article, and the position held by the authors is: "Overall, we are not necessarily against this shift to utilitarian logic, but we think it should only be adopted if it is the result of a democratic process, not just because it’s more convenient." and "Public input about specific systems, such as the one we’ve discussed, is not a replacement for broad societal consensus on the underlying moral frameworks.".
I wonder how exactly this would work. As the article identifies, health care in particular is continuously barraged with questions of how to allocate limited resources. I think the article is right to say that the public was probably in the dark to the specifics of this algorithm, and that the transition to utilitarian based decision making frameworks (ie algorithms) was probably -not- arrived by at by a democratic process.
But I think had you run a democratic process on the principle of using utilitarian logic in health care decision making, you would end up with consensus to go ahead. And then this returns us to this specific algorithmic failure. What is the scaleable process to retaining democratic oversight to these algorithms? How far down do we push? ER rooms have triage procedures. Are these in scope? If so, what do the authors imagine the oversight and control process to look like.
Re: Is the UK's liver transplant matching algorithm biased against younger patients?
#4I think I've worked in software/data long enough to be very very suspicious of a one-size-fits-all algorithm like this. I would be very hesitant to entrust something like organ matching to a singular matching system.
There are so many ways to get it wrong - bad data, bad algo design/requirements, mistakes in implementation, people understanding the system too well being able to game it, etc.
Human systems have biases, but at least there are diverse biases when there are many decision makers. If you put something important behind a single algorithm, you are locking in a fixed bias inadvertently.
Re: Is the UK's liver transplant matching algorithm biased against younger patients?
#5Similarly 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 is that even if you get a heart attack or stroke due to their negligence they will never be liable because that calculator is considered the standard of care in malpractice law!
Governing bodies write these guidelines that act like programs, and your local doctor is the interpreter.[1] When was the last time you found a bug that could be attributed to the interpreter rather than the programmer?
[0] https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate...
[1] It’s worth considering what medical schools, emergency rooms, and malpractice lawyers are analogous to in this metaphor.
Re: Is the UK's liver transplant matching algorithm biased against younger patients?
#6Similarly 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…
> When was the last time you found a bug that could be attributed to the interpreter rather than the programmer?
On the other hand, when was the last time you used a custom one-off interpreter?
Re: Is the UK's liver transplant matching algorithm biased against younger patients?
#7I think I've worked in software/data long enough to be very very suspicious of a one-size-fits-all algorithm like this. I would be very hesitant to entrust something like organ matching to a singular matching system. There are so many ways to get it wrong - bad data, bad algo design/requirements, mistakes in implementation, people understanding the system too well being able to game it, etc. Human systems have biases…
What does a non "one size fits all" approach for organ matching look like? What does a non-singular matching system work? Do you arbitrarily (randomly?) split up organs into different pools and let each pool match by a different algorithm?
Re: Is the UK's liver transplant matching algorithm biased against younger patients?
#8I think I've worked in software/data long enough to be very very suspicious of a one-size-fits-all algorithm like this. I would be very hesitant to entrust something like organ matching to a singular matching system. There are so many ways to get it wrong - bad data, bad algo design/requirements, mistakes in implementation, people understanding the system too well being able to game it, etc. Human systems have biases…
What does a non "one size fits all" approach for organ matching look like? What does a non-singular matching system work? Do you arbitrarily (randomly?) split up organs into different pools and let each pool match by a different algorithm?
Yes, in the US it might look like state level / hospital system level vs 1 singular national level matching system.
US has its problems, but sometimes the "laboratory of ideas" that is federated system of 50 states prevents bad outcomes like this.
Re: Is the UK's liver transplant matching algorithm biased against younger patients?
#9Similarly 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 cholesterol.
Re: Is the UK's liver transplant matching algorithm biased against younger patients?
#10Similarly 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?