Occasional reflections on Life, the World, and Mathematics

Posts tagged ‘healthcare’

Fraud detection and statistics

Elizabeth Holmes, founder of Theranos, has now been formally indicted for criminal fraud. I’ve commented on the company before, and on the journalistic conventions around intellectuals that fostered her rise. But now that the Theranos story is coming to an end, I feel a need to comment on how utterly unnecessary this all was.

At its peak, Theranos was valued at $9 billion and employed 800 people. Yet according to John Carreyrou, the Wall Street Journal reporter whose investigations exposed Theranos’s fraud, the company is down to just 20 employees who are trying to close up shop.

All credit to Carreyrou, who by all accounts has done an excellent job investigating and reporting on this fiasco, but literally any statistician — anyone who has been through and understood a first-year statistics course — could have said from the start that this was sheer nonsense. That’s presumably why the board was made up mainly of politicians and generals.

The promise of Theranos was that they were going to revolutionise medicine by performing a hundred random medical tests on a drop of blood, and give patients a complete readout of their state of health, independent of medical recommendation of specific tests. But any statistician knows — and every medical practitioner should know — that the reason we don’t do lots of random tests without any specific indication isn’t that they’re too expensive — many aren’t — or that they require too much blood, but that the more tests you do, the more false positives you’re going to accumulate.

If you do a hundred tests on an average person, you’re going to find at least a few questionable results — either from measurement error, or because most tests aren’t all that specific — requiring followups and expensive investigations, and possibly unnecessary treatments.

Of course, if I had to evaluate the proposal for such a company I would keep an open mind about the possibility of a conceptual breakthrough that would allow them to control the false positives. But I would have demanded very clear evidence and explanations. The fact that the fawning news reports back in 2013-15 raved about the genius new biomedical technology, and failed to even claim to have produced (or found) any innovative statistical methodology, made me pretty sure that they had no idea what they were doing. In the end, it turned out that the biomedical innovations were also fake, which I probably should have guessed. But if the greedhead generals — among them the current secretary of defense, who definitely should be questioned about this, and probably ought to resign — had asked a statistician, they could have saved a lot of people a lot of unpleasantness, and maybe helped save Elizabeth Holmes from herself.

The people let down the NHS

I saw this headline in the Daily Mail yesterday:

Pity the poor NHS. Doing its job perfectly, but being cruelly let down by the shiftless population. To paraphrase Bertolt Brecht, perhaps it would be better were the NHS to carry out a root-and-branch reform of the British public. Eliminate waste. Get rid of the dead wood.

Up from disaster

US Senate majority leader Mitch McConnell had this to say about the Senate’s attempts at a “healthcare” bill:

“Obamacare is a disaster,” said McConnell, according to video captured by the Louisville Courier-Journal. “No action is not an option. But what to replace it with is very challenging.”

It makes you wonder: If current policy is unquestionably a “disaster”, why is it such a challenge to find an alternative that is superior? It’s like, “Living in a hole in the ground covered by a board really sucks, but it’s challenging to find good housing…”

Emphasis!

This graphic from the US Department of Health and Human Services has been getting a lot of attention.

Mainly, people have commented on the egregious deceptiveness of the content. The government’s plan is to increase the number of uninsured by 22 million. It’s like Hitler fulminating against Soviet barbarity (which he did — and was probably sincere). But I am fascinated instead by the Trumpification of official US government communications. Leaving aside the sheer novelty of government agencies putting out propaganda against current laws, the first “informational” slogan ends with an exclamation point! Is that normal? And am I merely fantasising the phallic-impotence imagery of the second one? (I mean, it’s hard to imagine why that image is there. Who thinks of mercury thermometers as a symbol for medical care these days? How many people have even seen one? And if that is a thermometer, did Obamacare fail by not getting the fever high enough?)

Contorting with reality

People misspeak all the time, and there’s usually no point to mocking them for it.

But in this quote from an article about dissatisfaction among Congressional Republicans with the way the Congressional Budget Office is likely to evaluate their healthcare proposal, Senator Roger Wicker reveals too much about the true basis of their disagreement

Sen. Roger Wicker (R-Miss.) said he has “never been one who worried too much about scores because there are constraints that the bean counters have to operate under that don’t necessarily contort with reality.”

At least we don’t get ID cards

… because that would be fascism! Instead, we’re likely to get the NHS checking people’s passports and utility bills (for proof of address) before they can get medical treatment.

As I’ve commented before, the British seem obsessed with not having national ID cards — when they came into power one of the first things the Conservatives did was to cancel a Labour programme that had been in the works for about five years to provide ID cards — because carrying an ID card is inimical to Anglo-Saxon freedom. They don’t object to round-the-clock video surveillance, police stopping foreign-looking people on the Tube to ask for proof of right to be in the country, or now checking nationality documents at the hospital.

They just object to providing people with the documents they need to meet the authorities’ demand (given that one in six Britons has no passport, and they cost about £80). Instead, they leave it up to easily falsifiable electric bills to attest their address.

Nationalist health service

I’ve been appalled at the leaflets delivered to our home by the Leave campaign. 16-06-2016, 11 44 37

They prominently use the blue and white NHS logo, as though this were official health-service literature, rather than being a political message from people who have never been friends of the NHS before, and are unlikely to be so in the future. It amazes me that they would be permitted to use the logo, or more likely are simply so brazen as to use it without permission.

Their argument, if we can call it that is that without spending on the EU, the UK could build a new hospital every week. Of course, they don’t have enough nurses to adequately staff even the hospitals they have, much less the 200+ new hospitals they promise to build by 2020, and without the East Europeans the staffing crisis will only get worse.

16-06-2016, 11 43 18

Change of venue

In the most recent Republican debate this exchange occurred:

TRUMP: If people — my plan is very simple. I will not — we’re going to have private — we are going to have health care, but I will not allow people to die on the sidewalks and the streets of our country if I’m president. You may let it and you may be fine with it…

CRUZ: So does the government pay for everyone’s health care?

TRUMP: … I’m not fine with it. We are going to take those people…

CRUZ: Yes or no. Just answer the question.

TRUMP: Excuse me. We are going to take those people and those people are going to be serviced by doctors and hospitals. We’re going to make great deals on it, but we’re not going to let them die in the streets.

Obviously, Trump recognized the trap of promising the great expense of keeping people from dying on the streets and sidewalks, so he quickly fell back to this compromise position: During the Trump presidency, poor people will be permitted to die on the sidewalks, but not in the streets. This leaves open the question of whether they will receive medical attention or merely cited by medical personnel to the sidewalk. It’s a win-win, since the dying would no longer impede the free flow of traffic.

It’s quite a bit like UK asylum policy: it would be unconscionable to send civilians back into a war zone, and we can’t just let them fend for themselves on the streets of London. So we need to make sure that as many as possible drown at sea, pour décourager les autres.

Of course, this may increase pressure to build barriers between the streets and sidewalks, at least in the vicinity of hospitals. Jobs!

How to do it: Medical testing edition

I was commenting just recently on the cult of big ideas, where people whose life experiences have given them hierarchical power are suckers for “ideas” that are mostly blather, lots of words about the irrelevant bits of the problem, distracting attention from the real difficulties. And now Theranos is in the news. I read about this company, started by the obviously charismatic Elizabeth Holmes, in The New Yorker about a year ago. My immediate reaction was, this must be a joke. It was very much in the spirit of Monty Python’s How to do it.

Theranos, a Silicon Valley company[…], is working to upend the lucrative business of blood testing. Blood analysis is integral to medicine. When your physician wants to check some aspect of your health, such as your cholesterol or glucose levels, or look for indications of kidney or liver problems, a blood test is often required. This typically involves a long needle and several blood-filled vials, which are sent to a lab for analysis… [Theranos] has developed blood tests that can help detect dozens of medical conditions, from high cholesterol to cancer, based on a drop or two of blood drawn with a pinprick from your finger. Holmes told the audience that blood testing can be done more quickly, conveniently, and inexpensively, and that lives can be saved as a consequence.

Sounds wonderful. Quick. Convenient. Inexpensive. Saving lives. How is she going to do all that? Well, she wears “a black suit and a black cotton turtleneck, reminiscent of Steve Jobs”. She dropped out of Stanford. She has a board of directors full of highly influential aged former politicians, but no scientists, so far as I can tell. She “is in advanced discussions with the Cleveland Clinic. It has also opened centers in forty-one Walgreens pharmacies, with plans to open thousands more. If you show the pharmacist your I.D., your insurance card, and a doctor’s note, you can have your blood drawn right there…. A typical lab test for cholesterol can cost fifty dollars or more; the Theranos test at Walgreens costs two dollars and ninety-nine cents.” (more…)

Up is down

I mentioned in an earlier post George Lakoff’s work on metaphorical language. One fascinating issue is the way same metaphorical target can be mapped onto by multiple conceptual domains, and sometimes these can come into conflict — or a metaphor can come into conflict with the literal meaning of the target. When the figurative-literal target conflict is particularly succinct, this tends to be called “oxymoron”. One of my favourites is the 1970s novel and subsequent film about a burning skyscraper, called The Towering Inferno.

This particular one depends on the conflict between the “UP is GOOD, DOWN is BAD” metaphor (an indirect  form of it, since it goes by way of DOWN is BAD is HELL is BURNING), conflicting with the literally towering skyscraper. Anyway, the UP-DOWN dichotomy gets used a lot, creating lots of potential confusion. For example, UP is DIFFICULT and DOWN is EASY, inspiring the famous allegory of Hesiod that inspired so many devotional images:

Vice is easy to have; you can take it by handfuls without effort. The road that way is smooth and starts here beside you, but between us and virtue, the immortals have put what will make us sweat. The road to virtue is long and steep uphill hard climbing at first.

Hence the uncertainty of the phrase “Everything’s going downhill.” Is it getting worse, or getting easier?

There is a triple ambiguity when numbers get involved. LARGE NUMBERS are UP (“higher numbers”, “low number”) when we are counting the floors of a building, but SMALL NUMBERS are UP when ranking (#1 is the winner and comes at the top of the list).

This brings us to the example that inspired this post. The BBC news web site this morning told us that “A&E waiting times in England have fallen to their worst level for a decade.” It’s hard to feel much sense of urgency about the fact that waiting times have “fallen”.

BBC website A&E morning

 

 

Presumably that’s why the text had changed in the afternoon:

bbc website afternoon

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