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[ENG] Nicolas had a diagnosis that, according to his doctor, needs urgent surgery.
In fact, he had an “overdiagnosis” and his futile treatment had a tragic outcome.
Nicolas is grateful and represents the proposed “Schrödinger’s cat bias”, which we just published at @CureusInc
![[ENG] Nicolas had a diagnosis that, according to his doctor, needs urgent surgery.In fact, he had an “overdiagnosis” and his futile treatment had a tragic outcome.Nicolas is grateful and represents the proposed “Schrödinger’s cat bias”, which we just published at @CureusInc](https://pbs.twimg.com/media/Er3yeNPW8AESkJR.jpg "[ENG] Nicolas had a diagnosis that, according to his doctor, needs urgent surgery.In fact, he had an “overdiagnosis” and his futile treatment had a tragic outcome.Nicolas is grateful and represents the proposed “Schrödinger’s cat bias”, which we just published at @CureusInc")
In fact, he had an “overdiagnosis” and his futile treatment had a tragic outcome.
Nicolas is grateful and represents the proposed “Schrödinger’s cat bias”, which we just published at @CureusInc
At 60, asymptomatic, Nicolas was impacted by this diagnosis in an innocent screening exam. His doctor explained the severity and mechanism of the condition and its surgical treatment.
In a parallel universe, Nicholas (with an h), did not take this exam.
In a parallel universe, Nicholas (with an h), did not take this exam.
As a convenient spectator of morning health TV shows, Nicolas (without and h) did not think about the probability of:
- False positive test - major issue with screening tests.
- Overdiagnosis - when a disorder that would not lead to symptoms or death is diagnosed
- False positive test - major issue with screening tests.
- Overdiagnosis - when a disorder that would not lead to symptoms or death is diagnosed
As a good mechanist doctor (ignorant and fragile), Nicolas’ physician did not consider these possibilities either.
For many years he has performed this surgery with good success rates - only 5% of people die from it.
“A good price to pay”, Nicolas thinks.
For many years he has performed this surgery with good success rates - only 5% of people die from it.
“A good price to pay”, Nicolas thinks.
Nicolas was one of those 5%. The mourning for the premature loss of the family provider is eased by the feeling of almost accidental tragedy.
Gratitude for the doctor and the therapy exists simply because they don’t know Nicholas (with an h), who lives in a parallel universe.
Gratitude for the doctor and the therapy exists simply because they don’t know Nicholas (with an h), who lives in a parallel universe.
Nicholas (with an h) has precisely the same body and, therefore, the same condition. But he did not have check-ups and never discovered that “condition”. He spent vacations every year in Italy and retired in Cascais, Portugal, where he died at 93.
Overdiagnosis is when a condition is diagnosed that, although it actually exists, would not lead to death, because it does not progress.
Patients and doctors are often unable to think in a probabilistic way and have a deterministic view of Medicine: a diagnosed disease is the tip of the iceberg compared to it nuances, the probabilities of false-positive and overdiagnosis, the efficacy of therapy, etc ...
Because of this overconfidence caused by predatory medicine (the doctor at the office next door offers futile exams), by the over-judicialization of medicine and by statistical illiteracy, is that we don’t think about “what if…?”. We don’t think about Nicholas (with an h).
Now imagining that Nicolas survived that 5% chance of death from surgery:
- Even greater gratitude by Nicolas’ family and by himself.
- Nobody convinces Nicolas and his family that going through this risk was unnecessary because he doesn’t know Nicholas.
- Even greater gratitude by Nicolas’ family and by himself.
- Nobody convinces Nicolas and his family that going through this risk was unnecessary because he doesn’t know Nicholas.
The absence of counterfactual thinking in medicine is what we call “Schrödinger’s Cat bias” - in honor of the illustration of an experiment in which a cat lives distinct realities while inside a box.
It favors ineffective treatments, medical reversals and quackery.
It favors ineffective treatments, medical reversals and quackery.
The bias we have proposed disfavors medical research and serious medicine, which goes “against public opinion” because it is simply seeking for solutions to improve this unfortunate spiral in which we are.
I thank @EduardoFarina10 and Maria Catarina Sampaio for supporting me write this manuscript and in the publication process. Congratulations to both! Your work was essential.
DOI: 10.7759/cureus.12697 https://www.cureus.com/articles/46463-schrdingers-cat-bias-a-new-cognitive-bias-proposed#
DOI: 10.7759/cureus.12697 https://www.cureus.com/articles/46463-schrdingers-cat-bias-a-new-cognitive-bias-proposed#
