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Comment by david_shi | Hacker News Reader

I've heard this argument before and it's always seemed downstream of capacity constraints and the current incentives of the healthcare industry.

There's a reason why billionaires like David Rockefeller, Larry Ellison, and Rupert Murdoch are able to live much longer lives than average, and having an oncall health team (that I'm sure does frequent testing and monitoring) is a big contributor to that.

More testing and data collection doesn't mean that every single anomaly would need to be investigated or communicated with the patient, but would provide a better longitudinal view that can help with disease prevention and health optimization.

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It's obviously a lie to get us to accept no tests due to limited machines. The same as when COVID started masks "didn't help" because they didn't yet secure enough supply for everyone, then when they did, suddenly the masks helped.

Every system that exists as a black box is more understandable with more sensing, not less. Our bodies are not special.

It's also ridiculous that the proposition goes like:

1. Doctor knows some tests will flag tumors or variations that look weird and that we shouldn't then go investigate all of them

2. Doctor shuts off their brain and will then investigate all of them by doing invasive procedures

Just knowing how many such variations there are and if they grow or not is useful information. But the doctors pretend like they are super smart before the test and super dumb right after.

It's not the same doctors saying they themselves are simultaneously smart and stupid. It's "smart" doctors saying that as a point of policy, it is not a good idea for biomedical companies to try to make a buck off of popularizing unnecessary diagnostics, because anxious patients will by chance or by intention find a "dumb" doctor who will agree to perform invasive procedures. (Have you ever heard a tech person say that the tech world has a lot of stupid ideas? It's the same thing.) Look up what happened with South Korea diagnosis vs. mortality rates when they instituted national thyroid screenings in the 90s.

> Every system that exists as a black box is more understandable with more sensing, not less.

With perfect humans in a perfect society, maybe. But such is ignoring the elephants in the room here, from the actual experts on the topic.

This kind of thinking (that it’s an obvious lie, perpetrated by a cabal) is the sort of superstitious bullshit that is going to jet us all killed. Look up Bayes theorem. As yourself how good a test would have to be if the base rate is low. Wonder what the probability of harm might be if the next advised test was invasive and the patients was anxious because a lump had been detected.

You should read til the end! No cabal, just stupidity and believing other people are stupid instead of telling them the truth and expecting them to act smart based on the information.

Ask yourself, do you think billionnaires have yearly MRIs or that they wait for later because the doctor and themselves will be anxious? It's an argument that treats regular people as stupid.

First, many regular people are “stupid” in the sense that they do get anxious about things that ar slow probability and are not anxious about things that are high probability.

If you are a billionaire you also have a doctor with the time and expertise to properly evaluate the evidence in a Bayesian framework, and you have time to talk to them and understand and implications. That isn’t scalable.

Also, it’s quite likely that billionaires are having lots of unnecessary procedures and that harm is being caused. The mri scans are not the reason they live longer!

Ok but now the argument shifted from "More MRI = bad" to "More MRI = okay as long as doctors do a good job and have enough time". I agree with that. My point was just that it's possible to get to a point where everyone having yearly MRIs is doable because the issue isn't with more information in itself, it's with doctors not having enough time for the patient.

But now your argument also depends on no opportunity costs for doing unneeded mri, or infinite medical resources.

As I said … we really don’t known how much harm billionaires are suffering (sob) and there are much simpler explanations for their longevity.

So do you think the doctors should hide the data from you so you don’t know anything looks weird, or tell you it looks weird but they don’t think it’s worth investigating it? And do you think the average patient will say “ok that’s fine, I’m not getting a second opinion and if I die my family will sue you into the grave too”?

I believe doctors should tell you the truth and not assume you will do things later that are detrimental with the information as that has a lot of bad consequences.

Case in point, doing that during COVID I think amplified the wave of antivaxxers and medical denialists. Which itself had in my opinion a way worse effect on global health than almost anything else recently because now you have to convince a number of people to trust the medical system again.

A sample size of 3 is hardly statistically significant.

From what I could found, billionaires die on average at ~83 years old. ( https://strygin.substack.com/p/how-billionaires-die )

It's not far off what a decent health care system is able to provide in most wealthy countries. It's even somewhat lower actually.

It's difficult to assess the risk factors, but in the end, I have the feeling their additional medical staff and their ability to "cut the queue" (S. Jobs-style) just barely offsets the additional common risk factors (stress, long hours, segregated life), specially if we compare to the upper-middle class.

In the end, there is no magic $100M pill giving you 10 more years. And in truth, access to food, drinking water, a non-toxic environment and really basic healthcare & medicine (vaccines, antibiotics) probably already brings you at a fairly high life expectancy.

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