flykespice
10 hours ago
Just for additional note:
* the owner of the lab that realized the tests (PCS Lab Saleme) is the cousin of the former secretary of health from Rio, Dr.Luizinho.
* Anvisa (brazil health regulatory agency) alleges the lab didn't have the kits to realize the blood exams and didn't present the receipts proving their purchases, leading to the suspicion they didn't do the tests at all and forged the results.
* Since many hospitals outsourced donor organ tests to the 3rd party lab, there is a precedent for more cases of infected organs, so the stored material of 286 donors will be retested by HemoRio, a state health unity.
rbanffy
5 hours ago
> Dr.Luizinho.
He was also short listed to take over the Ministry of Health under Bolsonaro’s government.
Qem
8 hours ago
> Since many hospitals outsourced donor organ tests to the 3rd party lab
It's the same sort of rampant outsourcing that doomed Boeing. This time instead of screwing passengers it screwed patients.
appendix-rock
8 hours ago
No. That is just naive pattern-matching against a hot-button issue that you read a lot about on HN. For both this story AND Boeing, the explanation is more complicated than “outsourcing bad!”
Teever
10 minutes ago
It's also an example of the really irksome thing that happens on American sites where people will quickly steer the conversation away from non-America stuff to America stuff because they feel more comfortable talking about something that they know about than just not participating in the conversation and watching other people talk about stuff that they are knowledgeable of.
Which is kinda silly because if they just sat back and listened they could learn more about the thing that other people are talking about so that the next time this topic comes up they won't feel uncomfortable and can jump in and add something to the conversation instead of just nervously pivoting to talking about Alatucky or Boeing or the number of street poops in SF.
I for one look forward to learning more about the medical system of Brazil from this post.
iancmceachern
8 hours ago
Yeah, it's more about the failure of the checks and balances in both cases. Old school corruption really.
zmgsabst
8 hours ago
Okay — what makes it more complicated?
lukan
7 hours ago
Because you can have solid outsourced work, as long as you bother to check and verify that work.
raziel2701
6 hours ago
In this particular case you're saying you need to test the organs once at the outsource place and then again at the hospital? Why not just get rid of outsourcing then?
Bouncingsoul1
6 hours ago
No, that is not what the parent said. "Check an verfiy" can come in diffrent forms and tastes eg. having some samples (not all) checked by another lab, asking for standards and inspection performed by 3rd parties, asking and checking for documentation...the hell how do you think anybody could work with suppliers?
krisoft
5 hours ago
> eg. having some samples (not all) checked by another lab,
I don't think that is useful at all in case of rare diseases. You would just get two reports saying that the random sample is free of HIV.
Much better would be to send some known control samples. Making sure that some of the samples is known HIV+, and then check if the supplier can tell which ones are those.
DoctorOetker
11 minutes ago
I agree with you, also the bogus argument of "since most people are HIV free..." assumes direct testing instead of pooled testing (using modern information theoretic optimized pooled testing).
A bit of data is most informative if the entropy is 1 bit as well. A signal that is true most of the time, or a different signal that is false most of the time is less informative. Use pooled testing such that the result is true or false half of the time.
Had information theoretically justified pooled testing been applied from the start, then:
* 1) control-testing the testing contractors would have been straightforward and passing 10 control samples by chance would have a likelihood of 1 over 1024.
* 2) it would have made obvious that saving money on control-testing the contractors would hardly save any money
* 3) even in the bad scenario that control testing was skipped, the issue of contractors cheating would have surfaced much faster, since combining the pooled tests to identify which patient tests positive would constantly result in mysteries, meaning control-testing needs to be enabled, not the mathematics of pooled testing brought in doubt.
* 4) testing pharma industry hates pooled testing, as it means technological competition instead of sales growth by abusing the naive but false "common sense" that you need as many tests as patients tested.
on a side note: assuming tests with different operating point on the RoC curves (having different false positive vs false negative ratios) have different prices, do we know if the operators blatantly provided fabricated results, or if they blatantly ignored basic mathematics and thought the more expensive tests could be substituted by the cheaper ones even if intended for a different purpose?
consider a test designed for telling a patient that we diagnosed HIV, and then consider a test designed for screening an organ to be inserted into a patient.
do you think they should both use the same test? or do you think it wiser to have the diagnosis test have lower false positive rates, and the organ screening test to have lower false negative rates?
JumpCrisscross
3 hours ago
> Why not just get rid of outsourcing then?
The problem is corruption. I don't see why you think that wouldn't plague internal operations.
Retric
41 minutes ago
Outsourced companies deal similar issues internally while also forcing you to trust their management. Internally this kind of corruption is more difficult because you have more control, and fewer people are going to cooperate. Similar to how companies can regularly use untrustworthy low level employees handle cash.
You can still get rogue employees in ether case, but an outsourcing company is like a ready made conspiracy where any corners cut automatically turns into money.
DoctorOetker
6 minutes ago
Outsource to 2+ contractors, use pooled testing, and use control tests to steer that percentage of tests towards those contractors that score better on the control tests. Obviously the contractor should not be allowed to know which samples are control tests.
A4ET8a8uTh0
33 minutes ago
I think the issue is that some people ( and this may be HN-specific ) think that medicine in general, and maybe even diagnostics in particular, is almost exactly like software testing. In a lot of ways, it really isn't. Some reasons get a little esoteric, but the more important one is rather simple: until more recently, software did not have a direct impact on life and as such was mostly given a pass on some otherwise heavy blunders. That is slowly changing, but missing something during quality control is not likely to have the same impact.
But this brings me to the other important reason, statistical check can only get you so far and that is assuming we can now trust it was even done. Some people do rely on being able to say, 'this was false positive once, you know what are the odds of it being false positive twice'? Now, we add variable of uncertainty into the system in the form of 'well, it was outsourced so there is a non-zero chance it is bs anyway'.
Not exactly a recipe for success.
zmgsabst
7 hours ago
I haven’t seen a company outsource a core competency and succeed, eg Boeing outsourcing airplane manufacturing.
krisoft
3 hours ago
How about Apple and Foxconn?
If your reaction is that Apple’s core competency is in marketing and design and not manufacturing then i will ask if the same pattern couldn’t be applied to Boeing.
braza
7 hours ago
Further context: In Brazil since we have universal health care provided by the government, generally speaking non outsourced or contractors becomes public servants.
The issue is: Public service in Brazil is expensive and is virtually impossible to fire anyone. On top of that the cost of public service has second order effects in the public balance sheet for the municipalities plus it has a huge burden in the public retirement system.
Not saying that is right or wrong, but this is very common in the Brazilian heath system.
JoshTko
8 hours ago
Outsourcing isn't a problem, people don't make their own clothes. It's inadequate checks relative to the risk of the component.
Terr_
36 minutes ago
> It's inadequate checks
I agree provided that "checks" isn't just the narrow sense of "verification upon receipt of the product", but also the supporting framework of "violators will get punished."
raziel2701
6 hours ago
How are you gonna check the organs? You can't see HIV on the organs by eye. Checking means re-testing, so might as well get rid of outsourcing.
krisoft
3 hours ago
> How are you gonna check the organs?
You don’t check the organs. You check the process by intermingling known HIV+ samples and check if they are being detected.
> Checking means re-testing, so might as well get rid of outsourcing.
Thing is you need to do QA on the testing system no matter what. Doesn’t matter if it is performed by contractors, in house staff or little grey aliens. If you are not doing QA you won’t know if the testing is done correctly or not.
photochemsyn
8 hours ago
Nothing wrong with outsourcing as long as it doesn't allow the user of the third-party operation to escape legal liability for failures and fraud committed by said third party that affect the user's clients.