Recent quotes:

A Montana Hospital Let Dr. Thomas Weiner Continue Practicing Despite Concerns — ProPublica

The hospital fired Weiner on Nov. 17, 2020. Johnson, the CEO, convened a meeting with the cancer staff, telling them Warwick’s death was “the tip of the iceberg.” He barred attendees from recording the meeting, court documents show, and the hospital’s chief nurse paced the room, instructing employees to put their phones away. All of Weiner’s patients should seek second opinions, Johnson said. Johnson also told the staff, “Don’t be surprised if black suits show up.” Weiner’s nurses understood this to mean that federal law enforcement or the Department of Health and Human Services would be investigating. “He explained it to be suits — there were going to be suits coming into the office and asking for things,” according to the testimony of nurse Andrea Thies, who, despite Johnson’s orders, took notes during the meeting.
#medicalindustrialcomplex #doctors #diagnostics #overdiagnosis - propublica.org

Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial | Clinical Decision Support | JAMA Network Open | JAMA Network

The clinical case vignettes were curated and summarized by human clinicians, a pragmatic and common approach to isolate the diagnostic reasoning process, but this does not capture competence in many other areas important to clinical reasoning, including patient interviewing and data collection.
#medicalindustrialcomplex #doctors #LLM - jamanetwork.com

Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial | Clinical Decision Support | JAMA Network Open | JAMA Network

An unexpected secondary result was that the LLM alone performed significantly better than both groups of humans, similar to a recent study with different LLM technology.31 This may be explained by the sensitivity of LLM output to prompt formulation.32 There are numerous frameworks for prompting LLMs and an emerging consensus on prompting strategies, many of which focus on providing details on the task, context, and instructions; our prompt was iteratively developed using these frameworks. Training clinicians in best prompting practices may improve physician performance with LLMs. Alternatively, organizations could invest in predefined prompting for diagnostic decision support integrated into clinical workflows and documentation, enabling synergy between the tools and clinicians. Prior studies on AI systems show disparate effects depending on the component of the diagnostic process they are used in.33,34 Given the conversational nature of chatbots, changes in how the LLM interacts with humans, for example by specifically pointing out features that do not fit the differential diagnosis, might improve diagnostic and reflective performance.35,36 More generally, we see opportunity with deliberate consideration and redesign of medical education and practice frameworks that adapt to disruptive emerging technologies and enable the best use of computer and human resources to deliver optimal medical care.
#medicalindustrialcomplex #prediction #doctors #LLM #ChatGPT - jamanetwork.com

Large Language Model Influence on Diagnostic Reasoning: A Randomized Clinical Trial | Clinical Decision Support | JAMA Network Open | JAMA Network

In the 3 runs of the LLM alone, the median score per case was 92% (IQR, 82%-97%). Comparing LLM alone with the control group found an absolute score difference of 16 percentage points (95% CI, 2-30 percentage points; P = .03) favoring the LLM alone.
#medicalindustrialcomplex #doctors #LLM - jamanetwork.com

ChatGPT Defeated Doctors at Diagnosing Illness - The New York Times

The chatbot, from the company OpenAI, scored an average of 90 percent when diagnosing a medical condition from a case report and explaining its reasoning. Doctors randomly assigned to use the chatbot got an average score of 76 percent. Those randomly assigned not to use it had an average score of 74 percent. The study showed more than just the chatbot’s superior performance. It unveiled doctors’ sometimes unwavering belief in a diagnosis they made, even when a chatbot potentially suggests a better one.
#prediction #AI #doctors #docbots - nytimes.com

An overdose of second opinions

To me we live in a bizarre world. Doctors take hundreds of thousands of dollars from pharmaceutical companies and then recommend those costly, toxic drugs to patients for uses that lack good randomized data. The same doctors help the companies design the trials that repeatedly fail to run the right comparisons— which help ensure that their unproven recommendations remain unfalsifiable (you can’t say they are wrong, just that there is no proof they are right). The hospitals make money from autotransplant, and refuse to heed evidence saying it has no survival benefit (DETERMINATION). The doctors make money from second opinions, and don’t care if they confuse the patient while indulging their fantasy of being the best doctor. The system is fundamentally broken. It won’t be reformed from within. Only external pressure can crack it. The first step you can do: is search your oncologist for drug company payments on open-payments and be skeptical when they take money from Abbvie and recommend venetoclax maintainence.
#medicalindustrialcomplex #doctors #cancer #corruption - drvinayprasad.com

Kaiser Permanente brings new AI tool to help doctors focus on patients

“By reducing administrative tasks, we’re making it easier for our physicians to focus on patients and foster an environment where they can provide effective communication and transparency while meeting the individual needs of each patient who comes to them for care,” he said. “Creating space for the patient and the physician connection is what inspired us to implement this technology. And we hope that those connections and improved efficiencies will help with the sustainability of the practice of medicine for many doctors.”
#medicalindustrialcomplex #AI #doctors - desertsun.com

Helpful, Harmful, or Illegal: Can Your Patients Really Record You? | MedPage Today

My overall takeaway from these phone calls is that it's complicated and really situation-dependent, but actions that hospitals might take range from taking away a patient's cell phone temporarily, all the way to terminating a relationship with the patient. But, obviously, you can't terminate a relationship for a patient who is critically ill in the ICU, so again, that's really situation-dependent.
#doctors #disclosure - medpagetoday.com

Primary care providers’ physical activity counseling and referral practices and barriers for cardiovascular disease prevention - PMC

Our analyses used data from DocStyles 2015, a Web-based panel survey of 1251 PCPs. Overall, 58.6% of PCPs discussed physical activity with most of their at-risk patients. Among these PCPs, the prevalence of components offered ranged from 98.5% encouraging increased physical activity to 13.9% referring to intensive behavioral counseling. Overall, only 8.1% both discussed physical activity with most at-risk patients and referred to intensive behavioral counseling. Barriers related to PCPs’ attitudes and beliefs about counseling (e.g., counseling is not effective) were significantly associated with both discussing physical activity with most at-risk patients and referring them to intensive behavioral counseling (adjusted odds ratio, 1.92; 95% confidence interval, 1.15–3.20). System-level barriers (e.g., referral services not available) were not. Just over half of PCPs discussed physical activity with most of their at-risk patients, and few both discussed physical activity and referred patients to intensive behavioral counseling. Overcoming barriers related to attitudes and beliefs about physical activity counseling could help improve low levels of counseling and referrals to intensive behavioral counseling for CVD prevention.
#exercise #paleotherapy #doctors #heart - ncbi.nlm.nih.gov

Hospital Bills Inflated by Surgeons Double Booking - Bloomberg

The University of Southern California’s hospital system is accused of billing for thousands of cases - costing taxpayers “hundreds of millions of dollars” - where the teaching physician left residents unattended to perform even spine and brain surgeries. When one doctor confronted a department head about an “embarrassingly high” rate of surgical injuries at one of its facilities, the administrator responded, according to the lawsuit: “Well, that’s where the residents go to practice on the poor folks.”
#medicalindustrialcomplex #doctors #corruption - bloomberg.com

Doctors watching pharma TV ads in ‘blue jeans moments’ often search to find out more, Roku survey says – Endpoints News

More than two-thirds (67%) of physi­cians said they re­searched a prod­uct af­ter see­ing a phar­ma ad while watch­ing TV.
#medicalindustrialcomplex #doctors #busted-medicine - endpts.com

Day-to-day variability in sleep parameters and depression risk: a prospective cohort study of training physicians | npj Digital Medicine

Within individuals, increased TST (b = 0.06, p < 0.001), later wake time (b = 0.09, p < 0.001), earlier bedtime (b = − 0.07, p < 0.001), as well as lower day-to-day shifts in TST (b = −0.011, p < 0.001) and in wake time (b = −0.004, p < 0.001) were associated with improved next-day mood.
#depression #paleotherapy #sleep #doctors - nature.com

Why Doctors Are Bad At Stats — And How That Could Affect Your Health

Gerd and his team have explored whether medical professionals understand the statistics measures actually needed to prove that a cancer screening programme saves lives. This is a classic problem in health statistics. What clinicians need to compare is mortality rates, not 5-year survival rates. The mortality rate tells the number of deaths in a period of time. In contrast, the 5-year survival rate only tells how many people live 5 years after the day they have been diagnosed with cancer. Some screening programmes can diagnose people earlier — which can increase those ‘5-year survival rates’ — without making them live any longer.
#medicalindustrialcomplex #prediction #doctors #statistics #probability - medium.com

The role of social media in cardiology - ScienceDirect

Social media may offer a way to distinguish and disseminate medical information much more rapidly. A few examples show the speed with which digital media can influence patient care.
#doctors #mediumismedicine - sciencedirect.com

Health-care costs soar so high, it’s like a tax, economists say - The Washington Post

“We have half as many physicians per head as most European countries, yet they get paid two times as much, on average,” Deaton said in an interview on the sidelines of the AEA conference. “Physicians are a giant rent-seeking conspiracy that’s taking money away from the rest of us, and yet everybody loves physicians. You can’t touch them.”
#USAUSA #doctors - washingtonpost.com

Fake doctor saved thousands of infants and changed medical history

But for all his showbiz, Couney was in the lifesaving business, and he took it seriously. The exhibit was immaculate. When new children arrived, dropped off by panicked parents who knew Couney could help them where hospitals could not, they were immediately bathed, rubbed with alcohol and swaddled tight, then “placed in an incubator kept at 96 or so degrees, depending on the patient. Every two hours, those who could suckle were carried upstairs on a tiny elevator and fed by breast by wet nurses who lived in the building. The rest [were fed by] a funneled spoon.”
#medicalindustrialcomplex #history #doctors - nypost.com

First systematic review and meta-analysis suggests artificial intelligence may be as effective as health professionals at diagnosing disease -- ScienceDaily

"We reviewed over 20,500 articles, but less than 1% of these were sufficiently robust in their design and reporting that independent reviewers had high confidence in their claims. What's more, only 25 studies validated the AI models externally (using medical images from a different population), and just 14 studies actually compared the performance of AI and health professionals using the same test sample," explains Professor Alastair Denniston from University Hospitals Birmingham NHS Foundation Trust, UK, who led the research.  "Within those handful of high-quality studies, we found that deep learning could indeed detect diseases ranging from cancers to eye diseases as accurately as health professionals. But it's important to note that AI did not substantially out-perform human diagnosis."
#AI #doctors #wwb #diagnostics - sciencedaily.com

Medicine as a turtle

In medicine, good ideas still take an appallingly long time to trickle down. Recently, the American Academy of Neurology and the American Headache Society released new guidelines for migraine-headache-treatment. They recommended treating severe migraine sufferers—who have more than six attacks a month—with preventive medications and listed several drugs that markedly reduce the occurrence of attacks. The authors noted, however, that previous guidelines going back more than a decade had recommended such remedies, and doctors were still not providing them to more than two-thirds of patients. One study examined how long it took several major discoveries, such as the finding that the use of beta-blockers after a heart attack improves survival, to reach even half of Americans. The answer was, on average, more than fifteen years.
#medicalindustrialcomplex #doctors - newyorker.com

The Heroism of Incremental Care | The New Yorker

Instead of once-a-year checkups, in which people are like bridges undergoing annual inspection, we will increasingly be able to use smartphones and wearables to continuously monitor our heart rhythm, breathing, sleep, and activity, registering signs of illness as well as the effectiveness and the side effects of treatments. Engineers have proposed bathtub scanners that could track your internal organs for minute changes over time. We can decode our entire genome for less than the cost of an iPad and, increasingly, tune our care to the exact makeup we were born with. Our health-care system is not designed for this future—or, indeed, for this present. We built it at a time when such capabilities were virtually nonexistent. When illness was experienced as a random catastrophe, and medical discoveries focussed on rescue, insurance for unanticipated, episodic needs was what we needed. Hospitals and heroic interventions got the large investments; incrementalists were scanted. After all, in the nineteen-fifties and sixties, they had little to offer that made a major difference in people’s lives. But the more capacity we develop to monitor the body and the brain for signs of future breakdown and to correct course along the way—to deliver “precision medicine,” as the lingo goes—the greater the difference health care can make in people’s lives, as well as in reducing future costs. This potential for incremental medicine to improve and save lives, however, is dramatically at odds with our system’s allocation of rewards. According to a 2016 compensation survey, the five highest-paid specialties in American medicine are orthopedics, cardiology, dermatology, gastroenterology, and radiology. Practitioners in these fields have an average income of four hundred thousand dollars a year. All are interventionists: they make most of their income on defined, minutes- to hours-long procedures—replacing hips, excising basal-cell carcinomas, doing endoscopies, conducting and reading MRIs—and then move on. (One clear indicator: the starting income for cardiologists who perform invasive procedures is twice that of cardiologists who mainly provide preventive, longitudinal care.)
#digiceuticals #doctors - newyorker.com

The Heroism of Incremental Care | The New Yorker

In the United Kingdom, where family physicians are paid to practice in deprived areas, a ten-per-cent increase in the primary-care supply was shown to improve people’s health so much that you could add ten years to everyone’s life and still not match the benefit.
#medicalindustrialcomplex #doctors - newyorker.com

The Heroism of Incremental Care | The New Yorker

We have a certain heroic expectation of how medicine works. Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters. Doctors became saviors. “Let me preface my remarks by saying that the chain is a lot longer than it looks.” But the model wasn’t quite right. If an illness is a fire, many of them require months or years to extinguish, or can be reduced only to a low-level smolder. The treatments may have side effects and complications that require yet more attention. Chronic illness has become commonplace, and we have been poorly prepared to deal with it. Much of what ails us requires a more patient kind of skill.
#medicalindustrialcomplex #doctors #chronic - newyorker.com

Survey shows many primary care doctors are unprepared to help patients avoid diabetes -- ScienceDaily

The researchers received 298 completed surveys, or 34% of the 888 ultimately found eligible for inclusion in the study. "Our results revealed that there are substantial gaps in the knowledge that PCPs have in all three categories we tested," Tseng says. For instance: - On average, respondents selected just 10 out of 15 correct risk factors for prediabetes, most often missing that African Americans and Native Americans are two groups at high risk. - Only 42% of respondents chose the correct values of the fasting glucose and Hb1Ac tests that would identify prediabetes. - Only 8% knew that a 7% weight loss is the minimum recommended by the American Diabetes Association as part of a diabetes prevention lifestyle change program. "Our results also suggests that 25% of PCPs may be identifying people as having prediabetes when they actually have diabetes, which could lead to delays in getting those patients proper diabetes care and management," Maruthur says.
#medicalindustrialcomplex #diabetes #doctors #malpractice - sciencedaily.com

Educate Your Patients…or They Will Take Medical Advice From Their Hairdresser |

“One of the bigger distractions in sports medicine practices is that patients often focus on what we do with professional athletes…everyone wants to try what worked for Kobe Bryant. But I tell them that is an n of 1, and what they should truly be basing their decision on is the result of a large prospective study where you are looking at efficacy of a specific dosage and formulary, for their particular type of orthopaedic problem. And this is our job to present that data in a fair fashion, particularly because of the appearance of conflict involved in these cash-based procedures that are rarely covered by insurance.  “Because medicine has become a consumer field we must focus on public education. If we were to poll the physicians who are performing most of these treatments, they will likely agree that the evidence is still pending but looking promising, and furthermore that the patients are asking for it.” I spend a good amount of time in my clinic talking to these patients about the current evidence (and lack of such) behind these treatments, and some still do choose to move forward with this option.
#medicalindustrialcomplex #doctors #n-of-1 #conflict-of-interest - orthospinenews.com

Book Review: ‘Ending Medical Reversal’ Laments Flip-Flopping - The New York Times

“Often the study of the study of how therapies should work is much more extensive and comes before the study of whether therapies do work,” the authors write. Thus a medical culture based on “should work” rather than “does work” is condemned to constantly correct itself when the science is finally evaluated for outcomes that matter. To fix this constant backtracking would require nothing less than a revolution in how doctors are trained, with an emphasis on the proven and practical rather than the theoretical. (It would also require a second revolution in how doctors practice, with less prestige and remuneration for coming up with new ideas and more for validating old ones.)
#medicalindustrialcomplex #doctors #education #theory #experiments - nytimes.com

Saving the Endangered Physician-Scientist — A Plan for Accelerating Medical Breakthroughs | NEJM

In the past four decades, however, the proportion of U.S. physicians engaged in research has dwindled from a peak of 4.7% of the overall physician workforce in the 1980s to approximately 1.5% today.
#medicalindustrialcomplex #doctors - nejm.org

Use of evidence-based therapies for youth psychiatric treatment is slow to catch on: Intensive training and practices with 'proficient culture' are critical to evidence-based therapy use -- ScienceDaily

"Evidenced-based therapies are effective for treating a wide range of psychiatric conditions, but there is still a gap in widespread use," said the study's lead author Rinad S. Beidas, PhD, an associate professor of Psychiatry and Medical Ethics and Health Policy in the Perelman School of Medicine at the University of Pennsylvania, and founding director of the Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI). "While findings showed a modest increase in use, the data point to a clear need for finding better ways to support clinicians and organizations in using EBP therapies. This research-to-practice gap is a historically intractable problem, which exists not only in behavioral health but all across health care specialties."
#medicalindustrialcomplex #doctors #CBT #wwb - sciencedaily.com