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Comment by hibikir | Hacker News Reader

The treatment you don't need might be zero risk, but it might also have quite a bit of it. And some tests carry risks too: See how different countries have very different protocols. The US system, which is colonoscopy first, and where polypectomies will be done at the same time, can end up with bowel perforations when the polyp was not even cancer. So the diferente treatment protocol is not just about costs, but about balancing different risks.

The unnecessary test, leading to an unnecessary intervention, which gets you unnecessary long term issues is a real risk in many cases. It's not just a matter of doing a bonus blood test here or there.

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To take it to the extreme:

If there were a risk free button that you could click to see a full breakdown of all illnesses no more how early stage, would you click the button?

It would include a report of cells that may eventually turn into cancer (or may not).

It would include things like polyps, and every other diagnosable condition.

Do you avoid pressing the button? Why?

Unnecessary medical treatments can have serious consequences. Even if you are absolutely certain you have a given condition, some treatments are very not worth it. More importantly, any given scan misses tons of important potential health issues. Not just the fact that CT scans don't show signs of MS vs MRIs, but neither of them will tell you about many cardiovascular conditions. So time spent treating made up issues from CT scans you don't need may be better spent doing other regular exams instead. Meanwhile, many aggressive cancers will be far too fast for any reasonable scan interval to catch in time. (And CT scans, to my understanding, can miss tumors early on, since it can't see as fine of detail as MRIs.)

But surely the mistake is doing the unnecessary treatment, not getting the information in the first place. In the above hypothetical where I could get an impossibly detailed full body scan result for free, I would absolutely do it.

I understand that in practice getting more information often leads to unnecessary treatment, so that in some cases the real world results are better if less investigation is done. But that's not inevitable; it depends on the choices made as a result of that information.

You don't seem to get it. There is no free lunch in medicine, because the human body and mind would have just discovered the free lunch during evolution and made it part of the bodies' natural healing process and daily routines.

This means all treatments have tradeoffs where you accept some damage to treat other damage and in the end you are mostly converting problems the human body can't deal with into problems the human body can fix on its own.

If you do an unnecessary treatment, you end up with a tradeoff with no benefits.

In the end everything has to follow a cost and benefit model

I think I disagree with your base premise. Evolution isn't magic, and its existence doesn't mean that the human organism is perfect. Even if the process of evolution itself were perfect, for one thing it has nothing to say about the health of the organism after child-rearing is complete, whereas we probably care quite a bit what happens to us at that point.

There's also no reason to believe that every treatment has trade-offs. Many do, but the claim that every treatment necessarily causes some damage in order to treat other damage is provably false. The most straightforward example I can think of is treating something like a vitamin deficiency. But there are plenty of more significant treatments that don't do any appreciable harm while providing significant benefit. Removing a precancerous skin legion, for example.

All that said, my previous comment was not advocating for unnecessary treatments. It was advocating for taking all available information into account when deciding on a treatment plan (or lack thereof). The fact that many treatments involve trade-offs does not seem to me to be a counter-argument.

But how do you know the unnecessary treatment isn’t necessary? There is likely always something happening in your body that would suggest an unnecessary treatment. So if you start doing scans when you have no outward reason to, you’ll always find something that looks like it needs treatment.

There’s no perfect information in medicine.

The more scans you do, the more times you’ll make the wrong choice and unnecessarily treat something.

Well, first of all, if it were possible to do these scans on everyone, we would be able to better study what things that show up actually do benefit from treatment, and which are better to ignore.

Absent that, it would be a matter of judgment. Some people do get fairly extensive annual physical exams, so there is data out there. For each issue the scan found, it would be a matter of researching and making a judgment call on whether the risk/benefit weighs toward action. I would prefer to make those decisions with as much information as possible vs just remaining ignorant and hoping the things I don't know about are best left alone.

Can I repeatedly press the button? Because then I'm pressing it, seeing what's up. Trying whatever low evidence/low risk method there is to "fix" it and then pressing it again.

Assuming there's no side effects to pressing the button of course.

I forget what this is called in medicine but someone linked about this on HN before. What I remember is this idea that there are so many things _that are wrong with all of us_, at any given time, that calling attention to and treating all of them would be more harmful than helpful. I think bodies being perfectly healthy is probably not how it works, it's more so that all the "bad" happening never rises to an emergent level.

I might avoid it because in reality the odds of it finding "something" are high, and the odds of that "something" being benign are high.

And then it's likely the options are 1) get a non-risk-free test, or 2) have constant anxiety about it (at least in my case)

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