Impressive of you to have such an excellent command of statistics. It all comes down to cost-benefit analysis which you referred to already in a previous post. In an older individual, possibly with comorbidities, is it worth taking the risk of undergoing a complicated procedure? Doctors are confronted with this type of risk-benefit analysis on a regular basis and some doctors make better decisions than others; having a good understanding of statistics will certainly give you a plus. As you correctly note it, the positive predictive value of a test is lower when the prevalence is low. So the merits of the GRAIL test (if indeed proven that it works, still too early to tell as it's in the clinical trial phase) will be not in the general population (such as the patient that asked you about it) but rather in the high-risk population such as that of cancer survivors who are at high risk of recurrence or developing another cancer. I completely agree with all the points you make about early screening, in fact it's for these exact reasons that I haven't had a mammogram yet at 46. But, the other day my son came to me after reading an article about the incidence of breast cancer and scolded me for not having one yet. So I gotta do what I gotta do, go have a mammogram -for his peace of mind at least- and hopefully make good decisions afterwards.
You’ve captured perfectly my concerns about “healthcare,” though I see it through the patient’s lens. My stepmother died in exactly the same story as your father in law. Surely we can learn to do better, even with all the lawyers around.
Love this newsletter, Bertie. Thanks for writing and sharing. See you at reunions one day?
Impressive of you to have such an excellent command of statistics. It all comes down to cost-benefit analysis which you referred to already in a previous post. In an older individual, possibly with comorbidities, is it worth taking the risk of undergoing a complicated procedure? Doctors are confronted with this type of risk-benefit analysis on a regular basis and some doctors make better decisions than others; having a good understanding of statistics will certainly give you a plus. As you correctly note it, the positive predictive value of a test is lower when the prevalence is low. So the merits of the GRAIL test (if indeed proven that it works, still too early to tell as it's in the clinical trial phase) will be not in the general population (such as the patient that asked you about it) but rather in the high-risk population such as that of cancer survivors who are at high risk of recurrence or developing another cancer. I completely agree with all the points you make about early screening, in fact it's for these exact reasons that I haven't had a mammogram yet at 46. But, the other day my son came to me after reading an article about the incidence of breast cancer and scolded me for not having one yet. So I gotta do what I gotta do, go have a mammogram -for his peace of mind at least- and hopefully make good decisions afterwards.
Excellent points all around!
Another gem. You are a wise person.
You’ve captured perfectly my concerns about “healthcare,” though I see it through the patient’s lens. My stepmother died in exactly the same story as your father in law. Surely we can learn to do better, even with all the lawyers around.
Love this newsletter, Bertie. Thanks for writing and sharing. See you at reunions one day?
Be well. (Jen Larkey)