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mikenuman

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Bias in the ER 9 years ago

Lyme is the new fibromyalgia, which replaced ME, which replaced the "Victorian lady took to her bed for a number of years" trope. Be very careful of jumping down this rabbit hole. The tests you'll have had are not validated.

It's just another rhythm method, and this is covered by graph 2. The study you quote represents a "perfect use" because of the additional surveillance and support leading to better outcomes, associated with a study. BTW the study also compares with a low efficacy IUD; modern IUDs are much more effective.

Shame the "expert system" was wrong!

With that history you should have been seen urgently. There are a number of serious things that are possible with those symptoms.

Plus, the nurse was relying on your accurate reporting of symptoms. Things are often very different face to face than over a telephone. People very often under/overplay their symptoms.

Most up-to-date fertility clinics use ultrasound and hormonal tracking to check the cycle; temperature & mucus are unreliable.

And, even if someone's ovulating or not-ovulating... it's often moot when it comes to whether to opt for fertility treatment. It's much more about time spent trying already, and finances.

This app is a "me-too" app

Thank you.

The HRT study mentioned in the article (WHI study) looked at the effects of starting HRT, often years after menopause, often in women with existing morbidity.

Those women who started it at the correct time ie healthy women aged around 50, lowered their all-cause mortality by 25%+.

Thus, the original analysis of HRT WAS correct. Many women have died young since the WHI published with its erroneous conclusions, who would not had they taken HRT.

In the case of ovarian cancer, as described in the article, it's likely that "early" ovarian cancer is a separate disease from disseminated ovarian cancer.

Assuming that one leads to the other has lead to a large research effort that has failed to help. Screening is ineffective at best, and probably harmful as it:

picks up the earlies that would have been detected and cured in an ad hoc fashion; picks up a host of benign pathology, removal of which leads to iatrogenic harm; fails to pick up aggressive cancer which spreads almost immediately and may even arise in multiple locations at the same time.

The current best methods for prevention are using the contraceptive pill, removing the Fallopian tubes (50% of "ovarian cancers" are probably tubal), and removing the tubes and ovaries of people in high-risk families after childbearing.

Screening does not work.

This is a very difficult area.

Firstly, these consults are never as easy or logical in real life. If you think doctors don't understand Bayesian probabilities then how well do you think patients do?

Decision making when screen positive results occur, with appropriate perspective, is virtually impossible for patients. I've lost count of the procedures I've done for incidental findings found with screening, which we KNOW are benign and will remain benign. Unfortunately, despite very strong reassurance, patients generally want these incidentalomas removed.

Secondly, unless your positive screening test can be dealt with.... a) by a procedure that has zero risk of complications and b) in a way where no stress is engendered while waiting for definitive results and) the costs of (screening + treatment) could not be more effectively spent elsewhere ...then there will ALWAYS be negative sequelae with screening. Therefore these negatives need to be assessed in a real world RCT of sufficient size and with maximal control of bias, to make sure they don't outweigh the positives.

Your perfect world of logical patients balancing pre- and post-test probabilities, and acting accordingly doesn't exist.