I enjoyed this interview with Steven Pinker on ChatGPT in the Harvard Gazette. From the piece:

“It’s impressive how ChatGPT can generate plausible prose, relevant and well-structured, without any understanding of the world — without overt goals, explicitly represented facts, or the other things we might have thought were necessary to generate intelligent-sounding prose.

And this appearance of competence makes its blunders all the more striking.”

Some data on excess death rates among physicians before and after the availability of Covid vaccines.  From JAMA Internal Medicine: Kiang MV, Carlasare LE, Thadaney Israni S, Norcini JJ, Zaman JAB, Bibbins-Domingo K. Excess Mortality Among US Physicians During the COVID-19 Pandemic. JAMA Intern Med. Published online February 06, 2023.

The always-wonderful Eric Foner writes in the NYT about using the 14th amendment’s Section 4 to avert a Republican-induced debt ceiling crisis:

“The validity of the public debt of the United States,” it declares, “shall not be questioned.”

No, medical error is NOT the third leading cause of death, and no, Emergency Department misdiagnoses are NOT killing 250,000 people a year in the U.S. As an emergency physician, the widely publicized AHRQ report is particularly painful because it has numerous flaws, and like the Institute of Medicine /BMJ  study, is guilty of completely unwarranted extrapolations.  The authors, for instance, looked at a Canadian study on 503 patients discharged from EDs, one of who died within 14 days of the ED visit (it’s not clear whether this actually represented a diagnostic error; the study was looking at outcomes after the visit, not misdiagnoses).  The AHRQ study then took this single death from a single study to establish a 0.2% (1/503) death rate due to ED diagnosis and multiplied it by the 130 million total annual ED visits to get the purported death numbers.  They went on to concoct arbitrary confidence intervals for this extrapolation:

“The rate of misdiagnosis-related deaths in the one high-quality, prospective study (0.2 percent, n=1 of 503) is 217-fold higher than the weighted mean from the three retrospective studies (0.0009 percent). Although the rate of 0.2 percent is based on just a single death (so is imprecise, with a wide 95% CI 0.005 to 1.1), the value is the best estimate from this study and matches data from other sources. However, the confidence interval from the Calder study alone is implausibly wide. Based on data from other sources, we have assigned a +/- 2-fold plausible range to the 0.2 percent estimate (0.1% to 0.4%).”

This is not good science.  For more, see:

• https://youcanknowthings.com/2022/12/18/no-er-misdiagnoses-are-not-killing-250000-per-year/
• https://www.emergencyphysicians.org/press-releases/2022/12-14-22-multi-organizational-letter-regarding-ahrq-report-on-diagnostic-errors-in-the-emergency-department
• https://www.acep.org/globalassets/sites/acep/media/medical-legal/multi-organizational-letter-regarding-ahrq-report-on-diagnostic-errors-in-the-emergency-department—december-14-2022.pdf
• https://www.acep.org/acep-media-hub/media-hub-articles/december-2022/talking-points–ahrq-report/
• https://insidemedicine.substack.com/p/breaking-government-report-on-er
• https://soundcloud.com/acep-frontline/when-a-report-on-errors-is-all-in-error-review-of-the-ahrq-report-on-em-diagnostic-errors
• https://www.emrap.org/episode/emrap202220/theahrqreporton

Yet another sadly undistinguished rip off by Twitter as used office inventory goes out for auction…

I thought this was a very interesting (and revealing) excerpt from Matt Yglesias’ excellent Slow Boring, Jan 9 edition:

Zeke Emanuel and Matthew Guido write in the NYT about declining childhood vaccination rates in the US, leading to inadequate levels of population “herd immunity” and therefore increasing the risks of outbreaks.  They advocate eliminating nonmedical exemptions for vaccinations and allowing children 14 or over to get immunized without parental permission.   I agree.

German Lopez, writing in the NYT’s “The Morning” newsletter, writes on the toll of firearms on child mortality in the U.S.; an excerpt:

“Guns are now the No. 1 cause of deaths among American children and teens, ahead of car crashes, other injuries and congenital disease.

In other rich countries, gun deaths are not even among the top four causes of death, a recent Kaiser Family Foundation report found. The U.S. accounts for 97 percent of gun-related child deaths among similarly large and wealthy countries, despite making up just 46 percent of this group’s overall population.”

The NY Times Magazine has a story on the lives some of the children killed by gun violence lived.

Very cool stuff; about a megajoule’s worth of net positive energy output from a lab fusion experiment at the Lawrence Livermore National Laboratory.  We have ignition!  Not ready for steady state energy production (likely not for several decades), since it took 300 megajoules of electricity from the grid to power the relatively inefficient lasers’ delivery of 2.05 MJ to the target —  but a promising demonstration.  Read about it in the NYT here.