Discover more from Overcoming Bias
In the US, new drugs are not allowed until a randomized clinical trial suggests they are safe and effective. New surgical techniques, however, require no such tests. This isn’t the only bias favoring surgery over other treatments:
In the JAMA study, … researchers found that some women with early stage breast cancer gained no survival benefit from removal of the lymph nodes even though cancer had been found in the lymphatic system. This finding sparked a wave of publicity, including an insightful Room for Debate feature in the New York Times that included 7 authors’ perspectives on whether American surgeons promote unnecessary surgery.
I have no doubt that many of the issues raised by the New York Times commentators are important. Surgeons do have financial incentives, established practices, and natural responses to clinical uncertainty that lead them to suggest surgery in some cases where there is no clinical evidence to support such an action.
Yet, I think we also need to acknowledge that we, the public, also contribute to overuse of surgical procedures. … A few years ago, my colleagues Angela Fagerlin, Peter Ubel, and I published a simple paper titled “Cure me even if it kills me: preferences for invasive cancer treatment.” In it, we showed that people who were presented with hypothetical cancer treatment scenarios tended to choose surgical interventions even when those interventions increased the total risk of death. The effect was much reduced for medication therapies versus surgeries. (more; HT Tony Barrett)
Beware Knives
I completely agree prostate cancer is over-treated, I just think its important to make sure people realize there is still is a decent subset of patients that NEED LOCAL treatment.
You quote studies in which participants are highly selected, but fail to consider how these patients came to be diagnosed. In order to find such asymptomatic patients, the general population has to be screened. When that is done, statistics tell us that the overall good achieved is matched by the harm done. In other words, to help the cohort you describe, you must harm an equal number of others. My statements addressed the general cohort of all men who might have prostate cancer.
It can be difficult to accept such statistical conclusions because they may seem counter-intuitive or even callous. But as Eliezer Yudkowsky once wrote to me: “I don’t think you understand what statistics mean. They are not a sort of weak extra argument that you weigh in addition to your much more reliable personal experience; statistics are a stronger, more reliable way of looking at the world that summarizes far more evidence than your personal experience, even though it just looks like a little number on paper while all that other experience weighs so heavy in your mind.”
I'm wondering how one could ethically perform randomized, double-blind surgeries. What would the placebo be?