My Medical Nightmare: When Doctors Can't Tell You If You're Going to Live or Die

[xchrom]

http://www.alternet.org/belief/living-medical-uncertainty



"If we don't know the answer to a question, it's better to just say, 'We don't know.' And then, of course, investigate and try to find an answer. We shouldn't jump in with an uninformed answer based on our cognitive biases. And we definitely shouldn't assume that, because we don't know the answer to a question, the answer is therefore God, or something else supernatural."

Skeptics and atheists say this stuff a lot. It's all very well and good: I totally agree. But what do you do if the question on the table is one you really need an answer to? What if the question isn't something fairly abstract or distant, like, "Why is there something instead of nothing"? What if the question is one with an immediate, practical, non-trivial impact on your everyday life? Something like... oh, say, just for a random example, "What are my chances of getting cancer, and what should I do to prevent it and detect it early?"

Here's what I mean. I'll start with my own story, and get it out of the way.

I recently got a presumptive diagnosis of Lynch Syndrome. This is a genetic syndrome that gives you about an 80% chance of getting colon cancer (a cancer I've sort of had -- my last two colonoscopies found pre-cancerous adenomas which would have turned to cancer if they hadn't been removed); a 20% - 60% risk of endometrial cancer (a cancer I definitely had, it's the cancer I had surgery for last fall); and a somewhat increased chance of some other cancers, including an as-yet-unknown-but-possibly-as-high-as-10-or-20-percent chance of stomach cancer.

[bemildred]

1. False certainty is much more dangerous than alert doubt.

But you don't get paid the big bucks for saying "I don't know."

[Warpy]

2. One of the first things you learn in medicine is that there's no certainty

Some vigorous people who ran miles every day and lived on health foods could come in for a minor problem, have it turn into a major problem and cascade from one problem to the next and end up dead in a month. Then you'd get a frail old person from a nursing home with a devastating illness and he'd perk up with treatment and go back to the nursing home in a few days. It's just not predictable on an individual basis.

Of course, the first guy has the best chances and the second guy has few, but the problem with statistical norms is that they break down when you get to the individual level because there are always outliers.

[bemildred]

3. Yes, that's a fact.

Even in physics one gets down to probability this and probability that in the end. Even math is not what it used to be.

And as you say, something as complex as we, are, it is to laugh.

But uncertainty makes people anxious, so there is a big market for second-hand certainty. Mass religions of all stripes are built on that.

[mopinko]

4. as are snake oil fortunes.

[bemildred]

5. Indeed, many fortunes of all sorts. Confidence men are always with us.

Edit: and "health care" has always been littered with them, just like religion, because one can exploit the confirmation bias scared people have when told their problem will be OK.

The problem is telling the genuine article from the self-serving racket, and it's far from black and white even in the best of situations.