Radiologists vs. Mark Cuban on Don’t Ask / Don’t Tell

Radiologists vs. Mark Cuban on Don’t Ask / Don’t Tell

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https://twitter.com/mcuban/status/583468799145349120

To his credit, Mark Cuban, engaged on Twitter in response to my post.

Mark, I’m sorry I had to leave Twitter abruptly. My wife threatened to kill me and then divorce me – in that order – if I didn’t get off Twitter instantly and get the groceries.

However, I caught the tail end of the Tweets. I’ll do my best to respond.

1. “Why is this contingency all radiologists?”

Mark wondered why everyone on a thread about overtesting were radiologists. It would be a great question if radiologists, who deal with testing, overtesting, limitations of testing, harms of testing, benefits of testing, appropriateness of testing, in other words the science of testing, would be offering advice on financial planning or offering the White House advice on their ISIS policy.

I can do no better than quote @jeffware.

“Exactly Mark – why are the Drs. who specialize in testing trying to explain the dangers of overtesting?”

That was a rhetorical question. But there are some entrepreneurial radiologists who are licking their lips at the epidemic of overtesting. I can hear them say “Mark and acolytes, bring it on.”

To wit, overtesting is better business for us. So our objection is not financially motivated. Let me make this even clearer. The more blood tests and genomic tests the “must prove that I’m healthy” brigade have, more $$$ for radiologists.

2. “Why if doctors fail so often do you want to limit patient interaction?”

Mark asks, given that doctors fail, why should we limit patient interaction? Given the context of the discussion, I’ll take patient interaction includes quarterly blood tests for everything.

If doctors promised 100 % certainty, immortality and never missing any diagnosis ever than we certainly have failed. We’ve failed to be honest. Medicine is not perfect. Information is imperfect.

When the healthy, remember we’re talking about the healthy, fish for disease that they could have but may well not have, they’re more likely to encounter a false than a true positive. That’s because many more people have that warning sign for early disease than actually have the disease the sign warns about.

Let’s say ten thousand Marks have quarterly blood tests to spot the earliest sign of a disease such as cancer. One sign of cancer is a low hemoglobin – this is one of many. Then one Mark, let’s call him Lucky Mark, will live longer because of vigilance. That Mark was destined to have cancer and the lower than baseline hemoglobin tipped him off that there could be cancer brewing. He then had a whole body scan which found a pancreatic cancer, which was nipped in the bud, and he lived happily ever after.

But there are many more Marks who have a slight fall in hemoglobin who don’t have pancreatic cancer or any cancer. The problem is we don’t know who the Lucky Mark is amongst them. They, too, will have whole body scans to look for a cancer because of the fall in hemoglobin.

There are some Marks, let’s call them Unlucky Marks, who have the whole body scan, which finds a lung nodule. This could be cancer but most probably is not. We don’t know. To confirm we biopsy. The biopsy is negative – that is no cancer. Unlucky Mark dies from a complication of the biopsy. Remember, biopsies are dangerous.

Think of Unlucky Mark. He was healthy. He would have lived happily ever after. But he wanted the medical system to prove that he was healthy. He wanted to make sure he was not Lucky Mark. Curiosity killed Unlucky Mark. Unlucky Mark died to save Lucky Mark. It’s like hanging an innocent man. Is this a fair trade?

Information is messy. This concept is hard even for doctors to grasp, so I don’t blame non-physicians for not getting it. Doctors have done a lousy job of explaining imperfect information. False positives are dangerous because we don’t know they’re false positives before a whole lot of intervening. We don’t know who the Lucky Mark is and who is the Unlucky Mark. If I knew I would be God, or at least a very rich man.

3. “So you believe don’t Ask/don’t Tell is a valid healthcare strategy to avoid overdiagnosis?

You’ve nailed it, Mark. For completeness let’s explore other strategies.

  1. Ask but not tell. Why ask in the first place?

  1. Ask and tell.

Once found, we don’t know it is overdiagnosis or not for sure. That’s the nature of information. Even if biopsied and biopsy says cancer it could very well be overdiagnosis. Cancer is not a single entity – there is mild badness and very bad badness.

The question is what do you want to do with that information? Let’s say it’s a tumor of the kidney that’s most likely overdiagnosis but you don’t know for sure. What next? May be surgery. Surgery has complications. Sooner or later someone will be harmed for a condition that never was destined to cause the person any problems. Is that a victory?

4. “The question for elective testing is how much data is the right amount.”

That’s an excellent question, Mark. Permit me to rephrase. How much data is necessary to prove that I’m healthy and not diseased?

This question has more philosophical than scientific implications, but it implies something. It implies that we must prove that we’re healthy not diseased, that the burden of proof is on those who say we don’t have disease. This has problems. Imagine if our legal system operated the same way and the burden of proof was on the defense to prove the innocence of the accused, rather than on the prosecution to prove the guilt of the accused. In fact it’s worse. Because we are talking about the healthy – they don’t have symptoms – they are not even the accused.

There’s no way to prove one doesn’t have disease with certainty. But it can get messy. The deadliest cancers are also the fastest growing. The only way to catch the fastest growing cancer is to scan the whole body regularly, at least faster than the cancer multiplies and invades. That means scans every two weeks or so. Since we don’t know which possible growth is the fast growing cancer we’ll be taking out tissue unnecessarily, although we’ll catch some fast growing cancers, sometimes. Soon Homo sapiens will be without any organs.

So on the scanner every 2 weeks and a biopsy every other month. Is that how you envisage the human race to spend their time, Mark?

Do you test the water for arsenic before drinking it? How do you know it has no arsenic for sure?

5. “There are no facts in an absence of data. Only educated guesses.”

Excellent point, Mark. I think every data-driven dullard should have this line tattooed on his forehead.

I’ll make a few points. Not all educated guesses are the same. I suspect the educated guess of the flying conditions made by an airline pilot is more valid than mine (that’s an educated guess). You get the drift here. I don’t call the pilot or air traffic controller paternalistic, even though once I was stranded in DFW because of a storm.

There never has been a controlled scientific study on the benefits of parachutes, or anti-venom for rattlesnake poisoning. Only an idiot would deny the use of either because of “lack of data.”

But testing in the healthy is not the same as jumping off a plane. If you don’t use a parachute you’ll die. If you don’t get tested you’ll likely live.

6. We need perfect information.

During the discussion futurists chimed in. Futurists are a combination of entrepreneurs and physicians who are distinguishable by certain traits. First, they use the term “disruptive innovation.” The term has created such a paradigm shift in me so that when I hear it I’m paralyzed with catatonic boredom. Second, they’re “solving” problems. It’s unclear exactly what is being solved and why. Third, they oppose status quo. But what’s on offer instead of status quo is never mentioned.

It’s like saying to car drivers “in the future we’ll have automatic flying cars fuelled by cow dung. Release your grip on status quo.”

Release my grip on status quo? Come again? Until the future car comes I’m going to have to do with my Honda Civic, which smells like cow dung.

Future promises that are not here yet can’t be a prescription for the present.

Like toddlers who haven’t controlled their sphincters, futurists wet themselves with excitement over what is patently embryonic.

May be in 2125 the human race will have perfect information. When one urinates, a computerized screen called Watson will detect subtle DNA changes in the urine which will alert a team of robotic surgeons called Da Vinci that there is an 8 mm cancer brewing in the sigmoid colon. Then a spaceship will hover over the lavatory, and internalize me and take me to hyperspace, and then, using minimally invasive cryogenic robotic surgery, the robots will take the cancer out in five minutes. Then a robot will give me a Press Gainey satisfaction survey to complete. Within an hour, I’ll be released and be able to visit the “Museum of Paternalistic Physicians” and read all about the crusade in medicine which brought about utopia.

Until then I have to make decisions with partial information.

About the Author

<em>Saurabh Jha is a radiologist and an armchair pontificator. The pontifications do not represent the views of his employer, spouse, fourth grade teacher, personal trainer or anyone remotely associated him. Follow him on Twitter @RogueRad</em>

 

 

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72 Comments on "Radiologists vs. Mark Cuban on Don’t Ask / Don’t Tell"


Guest
beulah
Apr 13, 2015

Over the years I have had many patients that were symptomatic from hypothyroidism and didn’t know it until after they started on Synthroid. It was only then that they realized that they were better off with it than without it. I would say that is a positive outcome.
We have to remember that TSH is not a of form of thyroxin rather a hormone that stimulates the thyroid gland when the body lacks thyroid. That makes it a very sensitive and useful test that is responding to the bodies own natural call for more thyroxin.
thanku for sharing
beulah (healthcareadmin.org)

Guest
mark cuban
Apr 8, 2015

There is no question that there will be Drs that offer data analytics support and get paid a premium for the service

Which may be how you get less testing. Charge for analytics

Guest
Apr 8, 2015

There’s sure seems to be a consistent trend toward anti-paternalism among our Direct Primary Care (DPC) physicians. It would be great to do a survey of attitudes between physicians in different models.

Many, like Sunil, will support Mark’s side of this, including, I’d wager, Garrison Bliss, co-founder of Qliance, one of the real innovators in the field, highlighted in Time in December: See “Medicine Gets Personal” http://time.com/3643841/medicine-gets-personal/

Isn’t it odd that those that are on the hook for seeing patients get better and lower costs are the ones that are more open-minded and less paternalistic about what works and what doesn’t, and even additional testing?

Not really.

As he says, “There are no insurance codes for ‘cure,’ In that world, more information does not automatically mean more treatment and more cost, it means better decisions.

Mark, you may find part of an answer to your question in the 2nd to last paragraph of the TIME article,

“When people say this is going to worsen the physician shortage (because docs can see fewer patients), Umbehr says, “No. The current system is worsening the physician shortage. The ship is already sinking. We probably talk to 10 doctors per week who are burned out, going bankrupt, ready to retire years before they ought to. And when they see they can take better care of their patients and never deal with insurance companies again, and earn $210,000, $220,000, $250,000 per year, you’re going to see physicians flocking.””

Guest
Apr 8, 2015

I am an Internal Medicine Physician, a long time lurker and have a Direct Primary care practice. Wow !! a very lively discussion.

@Saurabh: I am a big fan of your posts and have been meaning to contact you. I have to take an opposing stance here.
@Mark : Mark , I am one of the few physicians that completely support your position and actually let my patients get tested as they need.

Here is why:
1. It is great that patients care about their health: Too often it is the opposite problem Diabetic patients that that don’t ever come back for testing or take their medications.
2. It’s natural that people want to do something to improve their health: Whether it makes a difference or not , trying is quintessentially human and the essence of American dream. Restless, not happy with status quo, striving for something better.
3. Cost of testing is trivial: Labs tests cost nothing to run. If they are expensive, the question should be why in this day that the entire genome can be sequence for a 100 bucks does it cost more to run a simple thyroid test.
The cost of a thyroid test is the same as a cup of coffee. Even if it adds no medical value, why not? I want it, I pay for it, end of story.

The problem lies not in the testing per se, but in what we do with the data. If the doctor recommends additional testing then that is not the fault of testing (which will inherently show false positives) but in the doctor’s risk tolerance. If the patient demands additional testing, then the doctor needs to explain the risks to the patient, including the risks of invasive procedures for testing. If the doctor cannot adequately explain that to the patient maybe there is an inadequate doctor patient relationship.

If doctors do not take a lead in understanding this phenomenon and channelizing the patient desire for health information they will go a far worse source.

Do you know how many patients, I get that talk about bio-identical hormone testing, salivary hormone levels etc.

Paternalistic attitudes by physicians is what is bring about this quackery of complete micro-nutrient testing, whole body cleansing etc.

Guest
mark cuban
Apr 8, 2015

The tech sector will leave people better off at a lower cost. Moores law will have its day. But we are 5 years off from minimal impact. 10 years off from Marginal Impact.

In 20 years we will all look back and think 2015 was a barbaric year of discovery

to give perspective. We pioneered the Streaming Industry TWENTY YEARS AGO. And now we are finally seeing streaming becoming mainstream as a technology but it still cant scale to handle mega live events

HealthTech will continue to move forward quickly with lots of small wins. It will slow down when there is an inevitable recession in the next 20 years, then jump again afterwards.

in 30 years our kids/grandkids will ask if its true that there were drugstores where we all bought the same medications , no personalization at all, and there were warnings that the buyer may be the one unlucky schmuck that dies from what used to be called over the counter medication.

We will have to admit that while unfortunate it was true. Which is why “one dose fits all ” medications were outlawed in 2040 🙂

By then hopefully we will have a far better grasp on this math equation we call our bodies.

Of course it will be long before then that we make decisions based on optimizing health rather than trying to reduce risk

The biggest challenge will be training health care professionals.

Medicine today seems to be in that 1980s phase that tech went through where no one got fired for hiring IBM. So IBM got lots of business because it was the safe choice rather than the best choice.

As best i can tell from my involvement in funding a single study on HGH for injury recovery (just getting started), becoming well versed on performance enhancing drugs and from the feedback on the blood capture and testing discussions, doctors are rightfully fearful of messing with people’s lives , so they make the IBM type decisions that “no one got fired for” or they dont get sued for. (again, just my observations).

This may not be the best process for those who can invest in what they hope are the best minds. But its an understandable process when the funnel of people healthcare professionals have to see stays full continuously .

Which is why I think part of the market and government response will be to increase the number of healthcare professionals

We need 3x (or some multiple, this is a guess ) as many doctors as we have today so that the amount of time spent per patient can increase to better understand and use the dramatic increase in data we will see.

Anyone have any good ideas on how to train 3x more doctors annually, with better quality at a lower cost ?

IMHO, thats the holy grail

Guest
Allan
Apr 8, 2015

Thanks for your insight Mark. I’ve been a physician for over 40 years. I have watched dramatic technological changes in medicine but the social change of delivering care remains almost at a standstill or moving backwards. It is my opinion that but for technology medicine would be moving in the reverse direction.

There is an undo amount of government intervention in the practice of medicine due to entitlements and the fact that tax deductions for health insurance revolve around an employer/ employee relationship and the employer not the patient is in control of those dollars. Thus the patient cannot fire the doctor/ insurer. He is not in control as no one cares about the patient because everyone is answering to someone other than the patient while placing additional burdens on the professionals to solve their own problems (not the problems of the patient).

Among the many interesting comments you made your belief that we needed 3X the number of physicians than we have is central to the problems I see. When I first started practice overhead was about ¼ – ⅓ of receipts. At the end of my years of practice my overhead was about ⅔. The percentage of time spent with the patient was probably >er 4/5. The administrative time to meet insurer, Medicare and legal requirements dramatically increased over the years and today with government promoted EHR’s might have well exceeded two thirds of the time which strangely could account for your calculated need of 3X the number of doctors. (I am talking about things from the Internist’s vantage point, the primary care provider. I am also including unnecessary time spent with the patient that is done only to meet administrative requirements.)

Formerly we were forced to spend enormous quantities of time evaluating physical symptoms and signs to make a tentative diagnosis. Today with the MRI etc. we are very frequently told what the disease is or is not. Yet, we seem to need even more time. Government’s intervention has been against doing tests, yet those are the things that speed up diagnosis and frequently make better diagnosis. The only reason government cares is because of cost, but the only reason they cost so much is that these tests are not in the free market place and have become political as so many people are feeding off the healthcare system. In a free system prices of MRI’s and the like would rapidly fall.

Your view into the future went further than I was actually looking for. You were talking mostly about advances in medical technology which appear unlimited. I am looking at the divide between the scientific advances in medicine and the lack of development in changing the way care is delivered and who delivers that care (we need technology of a different source than is being forced down our throats). Hospitals are nothing more than brick and mortal malls with a lot of specialty stores inside. Physician offices are just mini malls. Technology if permitted to innovate (something government is intimidated by) in the present should have the ability to completely change the delivery system today. I can almost envision that in my head now just like you envision personalized medications, but yours is something for the future when my vision should have started to be realized years ago.

Your point about the fears of doctors messing with people’s lives is justified on all sides, but frequently medicine is dictated by consensus while rapid forward movement is created by outliers. Rather than creating 3X the number of physicians which is costly I would rather create a better process reducing the need of physicians and create 3X as many scientists. Every physician is a potentially lost scientist and that might not be the best deal.

Guest
Apr 8, 2015

I am an Internal Medicine Physician, a long time lurker and have a Direct Primary care practice. Wow !! a very lively discussion.

@Saurabh: I am a big fan of your posts and have been meaning to contact you. I have to take an opposing stance here.
@Mark : Mark , I am one of the few physicians that completely support your position and actually let my patients get tested as they need.

Here is why:
1. It is great that patients care about their health: Too often it is the opposite problem Diabetic patients that that don’t ever come back for testing or take their medications.
2. It’s natural that people want to do something to improve their health: Whether it makes a difference or not , trying is quintessentially human and the essence of American dream. Restless, not happy with status quo, striving for something better.
3. Cost of testing is trivial: Labs tests cost nothing to run. If they are expensive, the question should be why in this day that the entire genome can be sequence for a 100 bucks does it cost more to run a simple thyroid test.
The cost of a thyroid test is the same as a cup of coffee. Even if it adds no medical value, why not? I want it, I pay for it, end of story.

The problem lies not in the testing per se, but in what we do with the data. If the doctor recommends additional testing then that is not the fault of testing (which will inherently show false positives) but in the doctor’s risk tolerance. If the patient demands additional testing, then the doctor needs to explain the risks to the patient, including the risks of invasive procedures for testing. If the doctor cannot adequately explain that to the patient maybe there is an inadequate doctor patient relationship.

If doctors do not take a lead in understanding this phenomenon and channelizing the patient desire for health information they will go a far worse source.

Do you know how many patients, I get that talk about bio-identical hormone testing, salivary hormone levels etc.

Paternalistic attitudes by physicians is what is bring about this quackery of complete micro-nutrient testing, whole body cleansing etc.

Guest
Allan
Apr 8, 2015

I have one question to ask Mark Cuban. If the government weren’t so heavy handed, collectivist and controlling and litigation wasn’t such a dire threat does he believe our large technology sector could rapidly revise the healthcare sector in a market fashion that would leave all people better off at a lower cost? The bloat caused by excessive government intervention in the healthcare sector is astounding.

Guest
Apr 7, 2015

Am I actually in a comment thread with Mark Cuban? OMG! But seriously, I think that yesterday’s signing of the Arizona law allowing tests without physician order tilts the playing field significantly towards Mr. Cuban. It was backed by Theranos.

Guest
Allan
Apr 7, 2015

John, I suppose a lot of people will state how horrible that is, but I see it as a way to lower prices and permit the individual to gain control over their own lives. Imagine real prices! It will also stop some of the other labs from jacking up prices when insurance doesn’t cover the bill. (In the somewhat distant past I saw bills jacked up 10-20 times what the insurer would have paid if filed with a different diagnosis.)

What would happen if MRI’s (along with a lot of other things) were done in the same fashion, read in India with the results returned to the patient? Imagine all those patients that had back pains but were refused the MRI by their insurers. They could probably end up paying in the $200 range to find out that the MRI was normal and only go to the physician if needed. There would still be a big profit and the government and taxpayer could save billions.

I know Mark Cuban’s technological know how could dramatically change the way healthcare is delivered permitting the patient to be the boss and moving government to the sidelines.

Guest
Apr 7, 2015

I am with you.

Guest
mark cuban
Apr 7, 2015

A benchmark of Paternalism- arguing about definitions in order to prove your position is correct

Guest
Saurabh Jha
Apr 7, 2015

We can all choose a word to mean what we want it to mean when we want to mean as we want to mean. Vanilla can mean raspberry.

So now I have a new meaning for paternalism.

Paternalism: I don’t like that you don’t like what I like.

Feel free to change the meaning.

More a more scholarly discussion see Through the Looking Glass by Lewis Carroll.

“When I use a word,’ Humpty Dumpty said in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

’The question is,’ said Alice, ‘whether you can make words mean so many different things.’

’The question is,’ said Humpty Dumpty, ‘which is to be master — that’s all.”

Guest
Bill Springer
Apr 6, 2015

As I read through the various statements from Mark Cuban, Saurabh Jha and the various commenters, one place where testing data is quite useful is for self-management of chronic disease. Who criticizes the insulin-dependent diabetic patient for regular or even continuous blood glucose monitoring, to help manage insulin intake safely? Granted, we have some distance to go before similar low-cost, reasonably accurate testing is available for all of the various chronic diseases where the magnitude and frequency of medical intervention is dictated by data. But there is a sizable potential population of chronic disease patients who would be helped by better and more frequent data about how well controlled their condtion is.

Guest
Saurabh Jha
Apr 7, 2015

“testing data is quite useful is for self-management of chronic disease.”

Agree.

Guest
Apr 6, 2015

That’s the whole crux. Individuals don’t need a hypotheses to collect data about themselves, but a physician needs a hypothesis to order a test.

A patient can be curious. A physician can’t make a recommendation because of curiosity.

Physicians are further down a decision tree, but that doesn’t mean satisfying curiosity is “useless”.

Reminds me of all the big data vs. little data arguments about whether you need a hypothesis to gain insight. It turns out that sometimes you don’t need a structured experiment to see a pattern, you just need to open your eyes.

Consider: perhaps we’d be able to see just how poor some tests are with more hypothesis-free testing.

Guest
civisisus
Apr 6, 2015

“First, they use the term “disruptive innovation.” The term has created such a paradigm shift in me so that when I hear it I’m paralyzed with catatonic boredom.”

I came, I read, I laughed. Dr. Jha’s distinctive rhetorical style has at last intersected with the ideal complementary correspondent.

Mr. Cuban, lay down your pen – you’ve met your match….

Guest
Saurabh Jha
Apr 6, 2015

“That is not what you have done”

That is EXACTLY what I have done.

I have asked how might the outcome have been different without the testing. Only a hypothesis-driven trial can answer that, though not with certainty.

“I have said my situation is anectodal.”

Then we have come to an agreement.

The agreement is this:

– your situation is anecdotal

– you feel empowered by the collection of data (that no science can deny, and even a detractor like myself acknowledges)

– you have a right to advise others based on your anecdote

– to answer the value of quarterly testing we need science

– that quarterly blood tests (+/- downstream tests) for the healthy should be paid out of pocket, not covered by insurance

Where do we disagree?

” I think the risk of something bad happening from the process of extracting IA less than the reward of having the information available to me to use or not use with my doctor as we see fit”

It was a good discussion, Mark. I think it should be recorded for posterity. Thanks for engaging.

Best,

Saurabh

Guest
Allan
Apr 6, 2015

Saurabh writes: “I have asked how might the outcome have been different without the testing.”

Mark Cuban might have developed hypothyroidism and not known it. He might have blamed his fatigue on getting older or simply working too hard which a doctor might readily believe. The diagnosis may have been delayed for a considerable time period during which one of his many businesses may have suffered from the loss of his direction causing some people to lose their jobs.

Anecdote Alert: When I was still a medical student decades ago I worked one summer at Brooklyn State mental institution. I had to do a lot of physicals and found a number of people who were hospitalized for decades that had undiscovered thyroid disease. I can’t say that was the cause of their hospitalization, but it was a potential explanation.

Guest
Saurabh Jha
Apr 6, 2015

“Mark Cuban might have developed hypothyroidism and not known it.”

Correct.

That’s why it’s called an anecdote.

That’s why if we generalize it, we must run trials to account for those eventualities,

This is the essence of hypothesis testing. Crux of science and evidence-based medicine.

I think we, that is you, me and Mark, all agree with the definition of anecdote.

Guest
Saurabh Jha
Apr 6, 2015

Anecdote vs. Evidence vs Advice vs Paternalism…

Drinking single malt has stopped me from developing flu (anecdote)

Fewer episodes of flu in those randomized to drinking single malt (evidence).

Everyone should drink single malt. It stops flu (advice)

You are talking baloney (paternalism)

Government should pay for single malt (entitlement)

We need evidence before third parties can pay for single malt (value-based healthcare)

Everyone is entitled to opine what saves them from flu (freedom)

We need science to determine efficacy of single malt (elitism)

Burden of proof is on he who asserts the benefit of single malt (epistemology)

Guest
Allan
Apr 6, 2015

A better definition of collectivism might be:

Someone likes alcohol. A law is passed so that all taxpayers including those that do not drink have to pay for alcohol, but the collectivist specifies the alcohol has to be single malt.

Willing buyer? No.
Willing seller? No.

Collectivism.

Guest
Saurabh Jha
Apr 6, 2015

“collectivism”

If the tax payer is paying for your single malt regulatory agencies decide which brand you drink (collectivism)

Admin
Apr 6, 2015

Today me and my entire family has the flu including copious vomiting (in our bed by the 3 yr old and 7 month old–at least the parents made it to the bathroom!). None of us drank single malt yesterday.

On the other hand there has been the odd occasion when I drank way too much single malt and also vomited. I couldn’t find the bathroom, or for that matter the house.

But today (for obvious reasons) I discovered the location and the instructions for how to use the washing machine.

So there’s confounding and colinear impacts of single malt and flu–which makes me very confused

Guest
Allan
Apr 6, 2015

“ You are talking baloney (paternalism)”

You got anecdote right so now we have to work on paternalism. Just to let you know that non doctor, Mark Cuban, was the one that made the accusation of paternalism so take it up with him. I just agreed that a lot of your statements made in the past sounded as if they were in parallel with Mark Cuban’s thinking.

In a way I liked your short remarks followed by a word related to those remarks because they are so you and revealing, but you left out the remark having to do with collectivism.

Guest
Allan
Apr 6, 2015

“That’s why it’s called an anecdote.”

No one labelled or at least not I labelled the Mark Cuban’s example as anything but an anecdote. However, there is scientific proof that many develop hypothyroidism without recognizing any symptoms.

Mark Cuban, as a patient, was exactly correct in the way he personally assessed things though not necessarily correct in the medical aspects of the discussion. I like people who think out of the box and I like people that are independently minded. Frequently they are outliers, but they are the one’s that frequently can take big steps forward. As long as you do not advocate coercion with regard to my personal healthcare needs I have little problem with your desired goals in healthcare.

Note: Great scientific advances frequently start with a single anecdote.

Guest
mark cuban
Apr 6, 2015

I have no problem being questioned. Ask away.

That is not what you have done

I have said my situation is anectodal

I have not said having quarterly blood work accomplishes anything other than giving a personal baseline of information

I agree it would be nice to have a study to prove the impact one way or another .

Until then, I think the risk of something bad happening from the process of extracting IA less than the reward of having the onformation available to me to use or not use with my doctor as we see fit

Guest
mark cuban
Apr 6, 2015

Saurabh Jha

i have ever bit of faith in science. Just that my hope was that when people
“wonder” they then ask/inquire rather than suspect.

asking is science.
promoting your suspicions as science suggests paternalism

and Mike, we self insure, so i do pay for it and one of my companies does offer it. And it has not led to any surge in testing or stress

Guest
Saurabh Jha
Apr 6, 2015

“promoting your suspicions as science suggests paternalism”

What I asked you is precisely science. How do you know regular blood tests help.

Answering with an n of 1, “in my experience”, is an anecdote.

The burden of proof is on the person who states the benefit. That is it is on you that quarterly blood tests are helpful, not on me.

Anecdotes have a place in society. Literature is rich because of anecdotes.

But anecdotes are not science. And questioning anecdotes is not paternalism, it is the want of science.

Guest
mike
Apr 6, 2015

Mark,

If you feel so strongly about this issue, please pay for all of your employees that work for your various companies for which you have ownership of, to have quarterly blood tests and full body scans.

Then pay for all of the treatment of ancillary tests which inevitable come from all of these screenings.

And please do this all in Texas so the surge in demand doesn’t screw up my network of physicians.