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So far John P has created 282 blog entries.

Chat GPT vs Real Docs

• Interesting results from at attempt to rate physician generated versus Chat GPT generated responses to patient questions posed on Reddit’s r/AskDocs:

Ayers JW, Poliak A, Dredze M, et al. Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum. JAMA Intern Med. Published online April 28, 2023. doi:10.1001/jamainternmed.2023.1838

“Results  Of the 195 questions and responses, evaluators preferred chatbot responses to physician responses in 78.6% (95% CI, 75.0%-81.8%) of the 585 evaluations. Mean (IQR) physician responses were significantly shorter than chatbot responses (52 [17-62] words vs 211 [168-245] words; t = 25.4; P < .001). Chatbot responses were rated of significantly higher quality than physician responses (t = 13.3; P < .001). The proportion of responses rated as good or very good quality (≥ 4), for instance, was higher for chatbot than physicians (chatbot: 78.5%, 95% CI, 72.3%-84.1%; physicians: 22.1%, 95% CI, 16.4%-28.2%;). This amounted to 3.6 times higher prevalence of good or very goodquality responses for the chatbot. Chatbot responses were also rated significantly more empathetic than physician responses (t = 18.9; P < .001). The proportion of responses rated empathetic or very empathetic (≥4) was higher for chatbot than for physicians (physicians: 4.6%, 95% CI, 2.1%-7.7%; chatbot: 45.1%, 95% CI, 38.5%-51.8%; physicians: 4.6%, 95% CI, 2.1%-7.7%). This amounted to 9.8 times higher prevalence of empatheticor very empathetic responses for the chatbot.

Conclusions  In this cross-sectional study, a chatbot generated quality and empathetic responses to patient questions posed in an online forum. Further exploration of this technology is warranted in clinical settings, such as using chatbot to draft responses that physicians could then edit. Randomized trials could assess further if using AI assistants might improve responses, lower clinician burnout, and improve patient outcomes.”

The article itself has 5 sample questions with physician and Chatbot responses.  I’d agree that the Chatbot’s were better, both in content and tone.  Given the current possibility of hallucination, output should of course be reviewed before real clinical use, but boy, there will be pressure to use this…
2023-05-12T16:54:49-05:00May 12th, 2023|HomeRecommended|

A Supreme Problem

Jamelle Bouie, writing in the Times, once again discusses the significant problems with the Supreme Court, both at present and for the foreseeable future:

“The problem of the Supreme Court isn’t that its members are mired in ethics scandals (although they are). It isn’t that it’s been captured by a network of conservative apparatchiks and right-wing billionaires (although it has). No, the problem of the Supreme Court is that it is a powerful and unaccountable branch of government whose traditional role has been to protect the rights of property and the prerogatives of the privileged above all other concerns.”

I’m afraid he’s right.

2023-05-12T16:55:52-05:00May 12th, 2023|Home, Musings|

Ethics in the workplace

As a physician, the Physician Payments Sunshine Act meant that any pharmaceutical or durable medical goods company giving me more than $25 had to report the gift to the Centers for Medicare and Medicaid Services; this reporting is publicly available here.  Since 2009, Massachusetts has required such companies to report any gifts in excess of $50.  105 CMR 970.00 prohibits gifting of entertainment or recreational items of any value, such as tickets to a sporting event or concert, or vacation trip and payments of any kind, except as compensation for bona fide services, etc.  As part of my academic appointment at Harvard Medical School, I had to annually disclose outside institution positions and appointments, resources and funding, outside activities, etc.  As a physician administrator, I did not allow Pharmaceutical Representatives to provide samples due to the well documented undue influence on physician prescribing patterns. Yet the Supreme Court, with much greater power and influence, the ultimate arbiter of justice here in the U.S., can’t see fit to self regulate behaviors that undoubtedly influence their behavior?  What’s wrong with this picture?  Since the supremes can’t seem to regulate themselves, they should be regulated by law.  See this NYT editorial.

2023-04-14T14:58:00-05:00April 14th, 2023|Home, Musings|

Should crypto be a no-go?

Excellent article on the grid and environmental consequences of bitcoin mining in the U.S. by Gabriel Dance in the NYT here. Excerpts:

“34 of the largest mines identified by the Times together use more than 3,900 megawatts of electricity”
“The analysis found that the 34 mines’ power use was causing nearly 16.4 million tons of carbon pollution each year.”

To what end?

2023-04-10T13:20:11-05:00April 10th, 2023|Home, Musings|

The kids are not all right…

• David Wallace-Wells has another must-read piece in the NY Times: “It’s Not ‘Deaths of Despair.’ It’s Deaths of Children

Some excerpts:

“Americans are now dying younger on average than they used to, breaking from all global and historical patterns of predictable improvement. They are dying younger than in any peer countries, even accounting for the larger impact of the pandemic here. They are dying younger than in China, Cuba, the Czech Republic or Lebanon.

One in 25 American 5-year-olds now won’t live to see 40, a death rate about four times as high as in other wealthy nations.

Mortality is still increasing more quickly for those without a college degree, but as John Burn-Murdoch demonstrated vividly in The Financial Times, except for a few superrich Americans, individuals at every percentile of income are now dying sooner than their counterparts in Britain, for instance. For the poorer half of the country, simply being an American is equivalent to about four full years of life lost compared with the average Brit.

Black Americans, on average, can expect to live five fewer years than white Americans; Black American men have lower life expectancies than men in Rwanda, Laos and North Korea. White Americans, in turn, can expect to live seven fewer years than Asian Americans. Life expectancy in the Black Belt of the Deep South is as much as 20 years lower than it is north of the Mason-Dixon line and west of the Mississippi, according to the American Inequality Project.

The horror is that, as Burn-Murdoch memorably put it, in the average American kindergarten at least one child can expect to be buried by his or her parents.”

Wallace-Wells also refers to this viewpoint article published in JAMA Network by Woolf, Wolf, and Rivera.

2023-04-07T12:01:27-05:00April 7th, 2023|HomeRecommended|

ETOH? Nah, not really good for you…

As those of us who carefully read the literature suspected, the alcoholic beverage industry’s support for “research” was carefully crafted to demonstrate some benefit to alcohol consumption.  But when corrected for a number of factors (especially the so called “sick quitters”, people who stopped drinking because of underlying medical issues and ended up skewing the non-drinking population) a large meta-analysis by Zhao, Stockwell, Naomi at al in JAMA Network  shows that in fact, drinking turns out to have on average no real benefit at all. The fact that previous research tended to focus on cardiovascular health and ignored the increased risks of breast, esophageal, and head and neck cancers associated with alcohol consumption also contributed to the false sense of harmlessness or even”benefit.”  Thankfully, many health organizations now specifically state that one should NOT consume alcohol in an effort to improve health. The National Center for Drug Abuse Statistics estimates that there are over 95,000 alcohol-related deaths annually in the U.S., and the WHO estimates that worldwide, 3 million people die annually due to the harmful use of alcohol, representing some 5.3% of all deaths. Anyone who has worked in Emergency Medicine has seen firsthand ethanol’s heavy societal toll.

2023-04-07T11:36:24-05:00April 7th, 2023|Home, Musings|

The Republican War on America

Jamelle Bouie has it right on some conservatives blaming “wokeness” for the banking industry woes — that claim has no basis in reality, but is just another attempt to stoke the culture wars:

“It is unclear whether these conservatives are working from the same memo or just have the same narrow obsession. Regardless, there is no evidence that any diversity, equity and inclusion initiatives were responsible for the collapse of Silicon Valley Bank. It is nonsense. And while it shouldn’t be taken seriously on its own terms, this deflection is worth noting for what it represents: the relentless effort to mystify real questions of political economy in favor of endless culture war conflict.”

2023-03-18T11:15:14-05:00March 18th, 2023|Home, Musings|
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