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Manipulability of comparative tests.

ABSTRACT: Multiple self-proclaimed experts claim that they know the probabilities of future events. A tester does not know the odds of future events and she also does not know whether, among the multiple experts, there are some who do know the relevant probabilities. So the tester requires each expert to announce, before any data are observed, the probabilities of all future events. A test either rejects or does not reject each expert based on the observed data and the profile of the probabilities announced by the experts. We assume that the test controls for the type I error of rejecting the true probabilities. However, consider the case in which all experts are uninformed (i.e., they do not know anything about true probabilities). We show that they can still independently produce false forecasts that are likely to both pass the test, no matter how the data evolve in the future. Hence, the data may not suffice to effectively discredit uninformed, but strategic, experts.

SUBMITTER: Olszewski W

PROVIDER: S-EPMC2656560 | biostudies-literature | 2009 Mar

REPOSITORIES: biostudies-literature

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Manipulability of comparative tests.

Olszewski Wojciech W Sandroni Alvaro A

Proceedings of the National Academy of Sciences of the United States of America 20090316 13

Multiple self-proclaimed experts claim that they know the probabilities of future events. A tester does not know the odds of future events and she also does not know whether, among the multiple experts, there are some who do know the relevant probabilities. So the tester requires each expert to announce, before any data are observed, the probabilities of all future events. A test either rejects or does not reject each expert based on the observed data and the profile of the probabilities announc ...[more]

PMID: 19289847

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Project description:BackgroundHealthcare is a major contributor to global greenhouse gas emissions. Colorectal cancer (CRC) screening is one of the most widely used healthcare services in the US, indicated for approximately 134 million adults. Recommended screening options include fecal immunochemical tests (FITs) every year, CT colonographies (CTCs) every 5 years, or colonoscopies every 10 years. We compared the environmental impacts of these tests and identified opportunities for impact reduction.MethodsWe conducted a comparative life cycle assessment of three CRC screening strategies at the University of California, San Francisco. We performed on site audits to document the materials and energy used for each screening test. We used the ReCiPe 2016 method to estimate the environmental impacts of these procedures, measured by global warming potential (GWP) and damage to human health. We estimated the 10-year cumulative impacts of each screening strategy using a Markov reward model. We accounted for model uncertainty using hierarchical Monte Carlo simulations.FindingsFIT-based screening had the lowest environmental impacts, with a roughly 20% margin of superiority over colonoscopies, and this finding was robust in sensitivity analyses. Across tests, the biggest cause of environmental harm was car-based transportation of patients and staff. Prioritizing FITs over screening colonoscopies in the US could enhance population health by roughly 5.2 million disability adjusted life years per decade. Transitioning to electric vehicles could reduce the GWP of all screening tests by 15-20%.InterpretationGiven the similar efficacy and safety of these tests, payors should prioritize FITs for low-risk patients. Government initiatives to decarbonize transportation, incentivize telehealth, and mandate environmental product declarations will help reduce the environmental impacts of healthcare more generally. Our results call for a closer look at resource-intensive preventative health strategies, which could result in more harm than good if applied to a low-risk population.FundingNIH, UCSF.

Dataset Information

Manipulability of comparative tests.

Publications

Manipulability of comparative tests.

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