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Comment by comrade_ogilvy | Hacker News Reader

I am the guilty party, and I think your counterargument is a good one.

It is not the actual screenings that I particularly care about -- that is just data. The elephant in the room is the implied massive amount of overtreatment that are justified on the basis of the screenings -- overtreatment that inflicts a tremendous physical, emotional, financial, and health toll on the patient.

What are the long term health costs of unnecessary chemotherapy? Is it ethically okay for a doctor to inflict torturous poisoning (chemotherapy) on a patient for fear of potential lawsuits, when it could easily be true that 75% of those patients gain zero medical benefit?

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>What are the long term health costs of unnecessary chemotherapy?

How could you possibly know it whether or not it's necessary?

There are other rich nations that treat breast cancers with chemo/radiation ~25% as often as American doctors, and get the same overall breast cancer mortality rate.

That is extremely strong evidence that American doctors are applying a painful & damaging treatment far more often than can be rationally justified.

Still, there's no way you can know in a particular case if the cancer will respond to chemotherapy or not.

And how are you measuring mortality?

In some cases, no; in some cases, yes.

By the number of women who actually die of breast cancer.

Suppose, normalized for population size, 1000 women of a certain age die of breast cancer in both country A and country B. In country A, 5000 women are treated with chemo. In country B, 20000 women are treated with chemo.

Which country has the more competent doctors? I think the answer is obvious.

Hint: The USA is not country A.

The answer isn't obvious at all. What if in country B the average woman with breast cancer lives an additional five years? What if breast cancer is simply more prevalent in country B?

You're trying to oversimplify something that isn't simple.

By the way, exactly what country are you talking about here?

Is it ethically okay

I'd think in the general case, yes. The patient is going to want it, even if it is only 25% effective. I'm not an expert on medical ethics, but in my mind if the patient has complete information and still wants the treatment, the doctor is not morally bankrupt in providing it. The doctor can certainly advise otherwise if they choose, of course.

You are assuming the patient has complete information. If actually true, I would agree. What is "complete information"? Do the doctors offer the statistics that the treatment is not 25% effective, that by American medical treatment norms chemo is 75% worse than useless and of the remaining 25% many will still die?

The patients are scared. Doctors are playing on those fears, acting on the assumption that fast and aggressive treatment is the wisest course all the time. The patients are reacting out of fear, not getting second opinions, and are hurried into the operating table to be cut open.

That is the norm. I have seen it happen.

It is my personal opinion that, no, most doctors are not offering complete information. So your argument, while reasonable, simply does not apply.

Even in the face of "complete information" from a doctor there is a log of "awareness" being raised elsewhere which is almost uniformly in the battle/fight/beat/win direction.

In such a case it is very easy to see how it would be possible for the patient to choose treatment which is in fact against their best interest.

Also, as mentioned elsewhere in the thread the current regulatory/legal climate leaves a vanishingly small upside and massive downside to the doctor who would advise against treatment.

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