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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.”

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."

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.

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.)

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.

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.

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.

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.

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.)

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.

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."

New doctors' DNA ages six times faster than normal in first year: Long work hours of intern year associated with accelerated shortening of telomere regions of chromosomes -- ScienceDaily

Published online in the journal Biological Psychiatry, the new study is the first to measure telomere length before and after individuals faced a common prolonged intense experience. It involved 250 interns from around the country who volunteered for the Intern Health Study, based at the University of Michigan, and a comparison group of college students from U-M. "Research has implicated telomeres as an indicator of aging and disease risk, but these longitudinal findings advance the possibility that telomere length can serve as a biomarker that tracks effects of stress, and helps us understand how stress gets 'under the skin' and increases our risk for disease," says Srijan Sen, M.D., Ph.D., the U-M neuroscientist and psychiatrist who is the study's senior author and heads the Intern Health Study. He adds, "It will be important to study how telomere changes play out in larger groups of medical trainees, and in other groups of people subjected to specific prolonged stresses such as military training, graduate studies in the sciences and law, working for startup companies, or pregnancy and the first months of parenting."

The Lab Coat Is on the Hook in the Fight Against Germs - The New York Times

This change took place in part because doctors wanted to spruce up their dubious reputation. Until the advent of such medical reformers as Abraham Flexner and Sir William Osler about 100 years ago, medical training in the United States was notoriously lax. Lectures, not clinical experience, were the norm. It was the age of horse sense and the quack. So to more closely associate themselves in the public mind with sound science, physicians began donning the lab coats that were being worn by chemists and other laboratory types. These coats were generally beige. But white soon became the standard. “Our notion since the 1880s, when the germ theory of disease began to take hold, is that microbes hide in dark, dirty places, and that white stands for purity, both material and moral,” said Guenter Risse, a physician and author of “Mending Bodies, Saving Souls: A History of Hospitals” (Oxford, 1999). “Wearing white coats was a symbol that you were clean.”

Comparative Accuracy of Diagnosis by Collective Intelligence of Multiple Physicians vs Individual Physicians. | Medical Education and Training | JAMA Network Open | JAMA Network

Using the top 3 diagnoses given by each user to adjudicate solutions, the diagnostic accuracy of all users was 62.5% (95% CI, 60.1%-64.9%). The accuracy of individual residents and fellows was 65.5% (95% CI, 63.1%-67.8%) compared with 55.8% for medical students (95% CI, 53.4%-58.3%; P < .001 for difference vs residents and fellows by z test for proportions) and 63.9% for attending physicians (95% CI, 61.6%-66.3%; P = .10 for difference vs residents and fellows).

Feces transplantation: Effective treatment facing an uncertain future -- ScienceDaily

The study showed a large and significant difference between the faeces transplantation and the antibiotics, which are today considered to be state of the art: A total of 22 out of the 24 patients were cured after just a single faeces transplantation, while only ten out of 24 patients were cured using the antibiotic fidaxomicin. Results were even worse for the 16 patients who tested the most well-proven type of antibiotic which is called vancomycin. In this case, only three out of 16 trail participants were cured. Additionally, more than half of the participants in the trial from the group who were given antibiotics suffered from a Clostridium infection again after completing the course of antibiotics. This group therefore received what is known as a 'rescue' faeces transplantation -- and ninety per cent of them were cured by this. Out of the 120 referred patients, 56 were not included in the randomised trial, either because they were too ill or because they could not cope with participating. So a total of 49 patients subsequently received a faeces transplantation because there were no other options left, and of these 39 were literally brought back to life.

Ping An Good Doctor blazes trail in developing unstaffed, AI-assisted clinics in China | South China Morning Post

Each clinic, which is about the size of a traditional telephone booth, enables users to consult a virtual “AI doctor” that collects health-related data through text and voice interactions. After the AI consultation, the information gathered is reviewed by a human doctor who then provides the relevant diagnosis and prescription online. Customers can buy their medicine from the smart drug-vending machine inside the clinic.

Everything You Know About Obesity Is Wrong - The Huffington Post

The problem starts in medical school, where, according to a 2015 survey, students receive an average of just 19 hours of nutrition education over four years of instruction—five hours fewer than they got in 2006. Then the trouble compounds once doctors get into daily practice. Primary care physicians only get 15 minutes for each appointment, barely enough time to ask patients what they ate today, much less during all the years leading up to it. And a more empathic approach to treatment simply doesn’t pay: While procedures like blood tests and CT scans command reimbursement rates from hundreds to thousands of dollars, doctors receive as little as $24 to provide a session of diet and nutrition counseling.

Everything You Know About Obesity Is Wrong - The Huffington Post

Doctors have shorter appointments with fat patients and show less emotional rapport in the minutes they do have. Negative words—“noncompliant,” “overindulgent,” “weak willed”—pop up in their medical histories with higher frequency. In one study, researchers presented doctors with case histories of patients suffering from migraines. With everything else being equal, the doctors reported that the patients who were also classified as fat had a worse attitude and were less likely to follow their advice. And that’s when they see fat patients at all: In 2011, the Sun-Sentinel polled OB-GYNs in South Florida and discovered that 14 percent had barred all new patients weighing more than 200 pounds.

Take a vacation -- it could prolong your life -- ScienceDaily

Participants were randomised into a control group (610 men) or an intervention group (612 men) for five years. The intervention group received oral and written advice every four months to do aerobic physical activity, eat a healthy diet, achieve a healthy weight, and stop smoking. When health advice alone was not effective, men in the intervention group also received drugs recommended at that time to lower blood pressure (beta-blockers and diuretics) and lipids (clofibrate and probucol). Men in the control group received usual healthcare and were not seen by the investigators. As previously reported, the risk of cardiovascular disease was reduced by 46% in the intervention group compared to the control group by the end of the trial. However, at the 15-year follow-up in 1989 there had been more deaths in the intervention group than in the control group. The analysis presented today extended the mortality follow-up to 40 years (2014) using national death registers and examined previously unreported baseline data on amounts of work, sleep, and vacation. The researchers found that the death rate was consistently higher in the intervention group compared to the control group until 2004. Death rates were the same in both groups between 2004 and 2014.

Wait, just a second, is your doctor listening? -- ScienceDaily

On average, patients get about 11 seconds to explain the reasons for their visit before they are interrupted by their doctors. Also, only one in three doctors provides their patients with adequate opportunity to describe their situation. The pressure to rush consultations affects specialists more than primary care doctors says Naykky Singh Ospina of the University of Florida, Gainesville and the Mayo Clinic in the US. She led research that investigated the clinical encounters between doctors and their patients, how the conversation between them starts, and whether patients are able to set the agenda.

What doctors wear really does matter, study finds: Survey of more than 4,000 patients isn't just about fashion -- patient satisfaction may be affected -- ScienceDaily

When asked directly what they thought their own doctors should wear, 44 percent said the formal attire with white coat, and 26 percent said scrubs with a white coat. When asked what they would prefer surgeons and emergency physicians wear, scrubs alone got 34 percent of the vote, followed by scrubs with a white coat with 23 percent.

Pharmaceutical Advertising Down But Not Out - News - News Releases - 2013

The pharmaceutical industry has pulled back on marketing to physicians and consumers, yet some enduring patterns persist. According to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, advertising peaked in 2004, with industry promotion to physicians declining nearly 25 percent by 2010, to $27.7 billion or 9 percent of sales.  Similar declines were seen in direct-to-consumer advertising, which remains concentrated among a small number of products. The number of products promoted to providers peaked at over 3,000 in 2004, and declined by approximately 20 percent by 2010. Despite these changes, there was little change in the split of marketing between primary care physicians and specialists, and the proportion of all promotion taking place in physicians’ offices also remains unchanged. Free samples and physician detailing accounted for over 70 percent of promotional expenditures in 2010, with the remainder comprised by consumer advertising as well as physician marketing through journal ads, e-promotion and sponsored conferences and meetings. The results are featured in the February 2013 issue of the open-access journal PLOS ONE.

Research Center Tied to Drug Company - The New York Times

tors. In a November 1999 e-mail message, John Bruins, a Johnson & Johnson marketing executive, begs his supervisors to approve a $3,000 check to Dr. Biederman as payment for a lecture he gave at the University of Connecticut. “Dr. Biederman is not someone to jerk around,” Mr. Bruins wrote. “He is a very proud national figure in child psych and has a very short fuse.” Mr. Bruins wrote that Dr. Biederman was furious after Johnson & Johnson rejected a request that Dr. Biederman had made for a $280,000 research grant. “I have never seen someone so angry,” Mr. Bruins wrote. “Since that time, our business became non-existant (sic) within his area of control.” Mr. Bruins concluded that unless Dr. Biederman received a check soon, “I am truly afraid of the consequences.”

Drug Maker Told Studies Would Aid It, Papers Say - The New York Times

In a contentious Feb. 26 deposition between Dr. Biederman and lawyers for the states, he was asked what rank he held at Harvard. “Full professor,” he answered. “What’s after that?” asked a lawyer, Fletch Trammell. “God,” Dr. Biederman responded. “Did you say God?” Mr. Trammell asked. “Yeah,” Dr. Biederman said.

The model is not the reality

Doctors loved Kübler-Ross’s five stages. The stages gave doctors the capacity to diagnose their dying patients, to target their questions and categorize the evidence: if the patient wasn’t depressed, then maybe she was in denial. The stages provided guidance on what to say in impossible circumstances. She had, unwittingly, provided doctors with a system for discussing death like a medical process. Her collaborator, Kessler, told me that on more than one occasion, a medical colleague would stop by while he and Kübler-Ross were writing to seek help with a diagnosis. “They’d be like, ‘Elisabeth, what stage are they in?’ And she would say, ‘It’s not about the stages! It’s about meeting them where they are!’” She found it laughable how some doctors had the gall to hold an essential organ in their hand but had no capacity for ambiguity.

Doctors in denial about death, their own powerlessness

Medical students were invited to attend the seminars, but for a long time, none did. “The physicians have been the most reluctant in joining us in this work,” Kübler-Ross noted in On Death and Dying. “It may take both courage and humility to sit in a seminar which is attended not only by the nurses, students, and social workers with whom they usually work, but in which they are also exposed to the possibility of hearing a frank opinion about the role they play in the reality or fantasy of their patients.” American doctors were so preoccupied with avoiding death that they avoided any discussion of it. “I observed the desperate need of the hospital staff to deny the existence of terminally ill patients on their ward.” This was typical for the medical profession at the time. In the early 1970s, years after Kübler-Ross began her research, only about 10 percent of doctors told their patients when they had a terminal condition; until 1980, the American Medical Association considered it a doctor’s right not to tell their patients if they had an incurable disease. At Kübler-Ross’s hospital, most doctors would inform the patient’s family of a fatal diagnosis and allow them to decide what to share with the patient.