I don’t see any particular evidence of bias in the factors they say they made their decision on in the linked report. The shortcoming I see in the report is that many of the factors mentioned are not quantified and it is not clear to me whether the recommendation given is based on a calculation that is not laid out in the report or whether the calculation was never done. There is simply not enough information in the report to determine whether the recommendation is justified.
Your criticism of the recommendation suffers from exactly the same shortcoming. You state your conclusion without quantifying the factors involved or showing the calculation you used to reach the conclusion. It also seems to me that you neglect to mention some relevant factors which the original report at least suggests were considered. Your implication is that the original report places a much lower value on human life than is used when making other decisions, or that it places an unduly high weight on the negative utility of ‘anxiety’, but neither the report or your criticism provide any concrete quantification of those factors.
You state your conclusion without quantifying the factors involved or showing the calculation you used to reach the conclusion. … neither the report or your criticism provide any concrete quantification of those factors.
I wrote:
So, if we assume biannual mammograms, the conclusion is that the worry and inconvenience to 286 women who have false positives, and 71 women who receive biopsies, is worth more than one woman’s life. If we suppose that a false positive causes one week of anxiety, that’s a little over 5 years of anxiety, plus less than one year of soreness.
You pluck some numbers out the air without any justification (‘suppose that a false positive causes one week of anxiety’), you don’t attempt to quantify the possible complications from surgical biopsy, you compare against ‘one woman’s life’ when you should compare the expected number of extra years of life from early treatment, you don’t account for the overdiagnosis problem mentioned in the report and as mentioned elsewhere you ignore the costs of screening women who get a negative result.
You didn’t introduce any new factors not mentioned in the original report and you don’t give a neutral reader any reason to suppose that your hidden assumptions and calculations are any more valid than those underlying the report’s recommendation. Indeed, an unbiased observer has every reason to place a great deal more faith in the report than in your estimates.
You may have a worthwhile point about a bias for action/inaction under different circumstances. You may be right that routine mammograms for 40-49 year olds are worthwhile. I don’t think you make a strong case for your position vs. that of the report though and your apparent high level of confidence in your position suggests that you may be labouring under some biases of your own.
Sure, I could have been a lot more thorough, if I had several hours to devote to this post. I didn’t need to. I pointed out the gap between the values the USPSTF used in their recommendation, and the values the FDA uses when regulating drugs. I think the gap is large enough that none of the factors you mention will come close to closing it. I suggest you take it on yourself to supply the figures if you think otherwise.
But you didn’t accuse me of just being sloppy, or failing to account for some factors. You wrote (my emphasis):
You state your conclusion without quantifying the factors involved or showing the calculation you used to reach the conclusion. … neither the report or your criticism provide any concrete quantification of those factors.
And that is a blatantly false accusation.
You further wrote:
you don’t give a neutral reader any reason to suppose that your hidden assumptions and calculations
As I already showed you my calculations twice, I can’t imagine what you are referring to. There are no hidden calculations. Missing calculations, maybe. Hidden, no.
You didn’t introduce any new factors not mentioned in the original report
Why would I do that? I think you’re missing the point. This is not an post arguing in favor of mammograms.
I think you’re missing the point. I’m not arguing against mammograms. From what I’ve seen here I’m still agnostic. The point of my original post was primarily to note the discrepancy between the apparent confidence you have in the wrongness of the report’s conclusion and my impression that you failed to make your case at all convincingly.
I’m not aware of having any particular prior opinion on this issue. I was aware that it had come up in the back and forth debate over health care but I had not consciously formed a strong opinion on it. My (probably biased) belief was that I was relatively impartial on this issue. To me there are numerous obvious logical flaws in your argument that rather undermine it’s use as an example on which to build a general theory of an action/inaction bias. The argument for such a bias appears to be premised on there being a watertight and unarguable case for mammograms, a case which it seems to me you failed to make. I don’t appear to be the only one who wasn’t convinced based on the other comments.
I don’t see any particular evidence of bias in the factors they say they made their decision on in the linked report. The shortcoming I see in the report is that many of the factors mentioned are not quantified and it is not clear to me whether the recommendation given is based on a calculation that is not laid out in the report or whether the calculation was never done. There is simply not enough information in the report to determine whether the recommendation is justified.
Your criticism of the recommendation suffers from exactly the same shortcoming. You state your conclusion without quantifying the factors involved or showing the calculation you used to reach the conclusion. It also seems to me that you neglect to mention some relevant factors which the original report at least suggests were considered. Your implication is that the original report places a much lower value on human life than is used when making other decisions, or that it places an unduly high weight on the negative utility of ‘anxiety’, but neither the report or your criticism provide any concrete quantification of those factors.
I wrote:
You pluck some numbers out the air without any justification (‘suppose that a false positive causes one week of anxiety’), you don’t attempt to quantify the possible complications from surgical biopsy, you compare against ‘one woman’s life’ when you should compare the expected number of extra years of life from early treatment, you don’t account for the overdiagnosis problem mentioned in the report and as mentioned elsewhere you ignore the costs of screening women who get a negative result.
You didn’t introduce any new factors not mentioned in the original report and you don’t give a neutral reader any reason to suppose that your hidden assumptions and calculations are any more valid than those underlying the report’s recommendation. Indeed, an unbiased observer has every reason to place a great deal more faith in the report than in your estimates.
You may have a worthwhile point about a bias for action/inaction under different circumstances. You may be right that routine mammograms for 40-49 year olds are worthwhile. I don’t think you make a strong case for your position vs. that of the report though and your apparent high level of confidence in your position suggests that you may be labouring under some biases of your own.
Sure, I could have been a lot more thorough, if I had several hours to devote to this post. I didn’t need to. I pointed out the gap between the values the USPSTF used in their recommendation, and the values the FDA uses when regulating drugs. I think the gap is large enough that none of the factors you mention will come close to closing it. I suggest you take it on yourself to supply the figures if you think otherwise.
But you didn’t accuse me of just being sloppy, or failing to account for some factors. You wrote (my emphasis):
And that is a blatantly false accusation.
You further wrote:
As I already showed you my calculations twice, I can’t imagine what you are referring to. There are no hidden calculations. Missing calculations, maybe. Hidden, no.
Why would I do that? I think you’re missing the point. This is not an post arguing in favor of mammograms.
I think you’re missing the point. I’m not arguing against mammograms. From what I’ve seen here I’m still agnostic. The point of my original post was primarily to note the discrepancy between the apparent confidence you have in the wrongness of the report’s conclusion and my impression that you failed to make your case at all convincingly.
I’m not aware of having any particular prior opinion on this issue. I was aware that it had come up in the back and forth debate over health care but I had not consciously formed a strong opinion on it. My (probably biased) belief was that I was relatively impartial on this issue. To me there are numerous obvious logical flaws in your argument that rather undermine it’s use as an example on which to build a general theory of an action/inaction bias. The argument for such a bias appears to be premised on there being a watertight and unarguable case for mammograms, a case which it seems to me you failed to make. I don’t appear to be the only one who wasn’t convinced based on the other comments.