It was great fun to talk about the health care system with Dr Zeyad “Z” Baker on his podcast, so I thought I would share it here–Matthew Holt
The Penn State College of Medicine Oath vs. “Doomscrolling.”
By MIKE MAGEE
Two years ago, prior to the 2022 election, mental health experts alerted the medical world to their version of an assessment scale for yet another new condition – “doomscrolling.”
As defined in the article, “Constant exposure to negative news on social media and news feeds could take the form of ‘doomscrolling’ which is commonly defined as a habit of scrolling through social media and news feeds where users obsessively seek for depressing and negative information.”
As the distressing recent MSG Rally well broadcast, there apparently are no guard rails remaining in Trump-led “doom making.” But that does not mean that the majorities that oppose him have to fall victim as well.
Optimism is a choice and an effective political message. No one can deny a range of legitimate concerns. Faced with continued background noise from residual effects of the pandemic, we’ve been forced to absorb global warming induced weather disasters, renegade AI, sectional warfare around the globe, and the fact that (inexplicably) most elected Republican leaders have chosen to compromise all values and decency to preserve their jobs.
With real challenges like these, our troubled world needs to stay focused on values and resilience. This means aligning our humanity with our approach to self-governance. John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.”
We live under a constitutional and representative democracy, as do two-thirds of our fellow citizens in over 100 nations around the world. The health of these democracies varies widely. The case for democracy emphasizes its capacity to enhance dignity and self-worth, promote well-being, advance equal opportunity, protect equal rights, advance economic productivity, promote peace and order, resolve conflicts peacefully, hold rulers accountable, and achieve legitimacy through community based action.
One of the challenges of democracy is to find the right balance in pursuing “the common good” which has dual (and often competing) arms. One arm is communitarian well-being and the other, individual well-being. Blending personal and public interests is complex.
Both nursing and medicine have worked to bridge this gap through “professionalism,” and launched new graduates by voicing “oaths” or promises to themselves, their colleagues, and our society as a whole.
Continue reading…Will Medical Facial Recognition Technology (mFRT) Reawaken Eugenics?
By MIKE MAGEE
How comfortable is the FDA and Medical Ethics community with a new super-charged medical Facial Recognition Technology (mFRT) that claims it can “identify the early stages of autism in infants as young as 12 months?” That test already has a name -the RightEye GeoPref Autism Test. Its’ UC San Diego designer says it was 86% accurate in testing 400 infants and toddlers.
Or how about Face2Gene which claims its’ mFRT tool already has linked half of the known human genetic syndromes to “facial patterns?”
Or how about employers using mFRT facial and speech patterns to identify employees likely to contract early dementia in the future, and adjusting career trajectories for those individuals. Are we OK with that?
What about your doctor requiring AiCure’s video mFRT to confirm that you really are taking your medications that you say you are, are maybe in the future monitoring any abuse of alcohol?
And might it be possible, even from a distance, to identify you from just a fragment of a facial image, even with most of your face covered by a mask?
The answer to that final question is what DARPA, the Defense Advanced Research Projects Agency, was attempting to answer in the Spring of 2020 when they funded researchers at Wuhan University. If that all sounds familiar, it is because the very same DARPA, a few years earlier, had quietly funded controversial “Gain of Function” viral re-engineering research by U.S. trained Chinese researchers at the very same university.
The pandemic explosion a few months later converted the entire local population to 100% mask-wearing, which made it an ideal laboratory to test whether FRT at the time could identify a specific human through partial periorbital images only. They couldn’t – at least not well enough. The studies revealed positive results only 39.55% of the time compared to full face success 99.77% of the time.
Facial Recognition Technology (FRT) dates back to the work of American mathematician and computer scientist Woodrow Wilson Bledsoe in 1960. His now primitive algorithms measured the distance between coordinates on the face, enriched by adjustments for light exposure, tilts of the head, and three-dimensional adjustments. That triggered an unexpectedly intense commercial interest in potential applications primarily by law enforcement, security, and military clients.
The world of FRT has always been big business, but the emergence of large language models and sophisticated neural networks (like ChatGPT-4 and Genesis) have widened its audience well beyond security, with health care involvement competing for human and financial resources.
Whether you are aware of it or not, you have been a target of FRT. The US has the largest number of closed circuit cameras at 15.28 per capita, in the world. On average, every American is caught on a closed circuit camera 238 times a week, but experts say that’s nothing compared to where our “surveillance” society will be in a few years.
Continue reading…Engage with Grace
Alex Drane started this movement in 2008 & named it Engage with Grace. What are your loved one’s wishes at the end of life? Are you with them this Thanksgiving weekend? This one slide can help you start the conversation
The Heat is On
BY KIM BELLARD
Attention must be paid: the world is now hotter than it has been in 125,000 years.
A week ago, we broke the record for average global temperature. That record was broken the next day. Later in the week it was broken yet again. Yeah, I know; weather records are broken all the time, so what’s the big deal?
Well, it is a big deal, and we should all be worried. “It’s not a record to celebrate and it won’t be a record for long,” Friederike Otto, senior lecturer in climate science at the Grantham Institute for Climate Change and the Environment, told CNN.
Bill Maguire, a professor at University College London, tweeted: “The global temperature record smashed again yesterday. The first four days of the week were the hottest recorded for Planet Earth. I would say welcome to the future – except the future will be much hotter.”
“Expect many more hottest days in the future,” agrees Saleemul Huq, director of Bangladesh’s International Centre for Climate Change and Development.
Continue reading…Asking Bard And ChatGPT To Find The Best Medical Care, I Got Truth And Truthiness
BY MICHAEL MILLENSON
If you ask ChatGPT how many procedures a certain surgeon does or a specific hospital’s infection rate, the OpenAI and Microsoft chatbot inevitably replies with some version of, “I don’t do that.”
But depending upon how you ask, Google’s Bard provides a very different response, even recommending a “consultation” with particular clinicians.
Bard told me how many knee replacement surgeries were performed by major Chicago hospitals in 2021, their infection rates and the national average. It even told me which Chicago surgeon does the most knee surgeries and his infection rate. When I asked about heart bypass surgery, Bard provided both the mortality rate for some local hospitals and the national average for comparison. While sometimes Bard cited itself as the information source, beginning its response with, “According to my knowledge,” other times it referenced well-known and respected organizations.
There was just one problem. As Google itself warns, “Bard is experimental…so double-check information in Bard’s responses.” When I followed that advice, truth began to blend indistinguishably with “truthiness” – comedian Stephen Colbert’s memorable term to describe information that’s seen as true not because of supporting facts, but because it “feels” true.
Continue reading…Return to McAllen: A Father-Son Interview
By IAN ROBERTSON KIBBE
You are going to hear a little more about McAllen, TX on THCB Shortly. And before we dive into what’s happened there lately, I thought those of you who weren’t here back in the day might want to read an article on THCB from July 2009. Where then THCB editor Ian Kibbe interviewed his dad David Kibbe about what he was doing as a primary care doc in McAllen–Matthew Holt
By now, Dr. Atul Gawande’s article on McAllen’s high cost of health care has been widely read. The article spawned a number of responses and catalyzed a national discussion on cost controls and the business of medicine. It even made it’s way into the President’s address to the AMA.
Almost overnight, McAllen and the Rio Grande Valley were thrust into the national health care spotlight – the once sleepy border town became, not a beacon on a hill, but a balefire in the valley, representing much of what is wrong with the current medical culture.
But, McAllen wasn’t always like something from an old Western, where doctors run wild and hospital CEO’s compete like town bosses. I remember McAllen quite differently. I remember it, because as it turns out, it was where I was born.
It’s also where my father, Dr. David Kibbe, practiced medicine from 1980 to 1990. In order to find out how McAllen earned the dubious reputation it now has, I sat down with my Dad, and asked him what he remembers about that little border town on the Rio Grande.
Ian Kibbe: So Dad, what was your first reaction to reading Atul Gawande’s article?
David Kibbe: Well, Ian, it was sort of “oh-my-gosh, he nailed it.” And, of course, a flood of memories, good and bad, came back to me about our time there. My medical career began there, you and your sisters were born there, small town 4th of July parades, etc. But I left after great disappointment and frustration.
IK: What were you doing in McAllen practicing medicine anyway?
DK: The National Health Service Corps sent me there to work in a clinic for migrant farm workers. The NHSC had provided me three years of medical school scholarship, and so I owed three years of service in an under-doctored area of the country. I speak Spanish, and so working as a family doctor in the Rio Grande Valley of Texas, which is the home of many of the country’s Hispanic migrant farm workers, was a good fit. Hidalgo County, where McAllen is located, was the poorest county in the country, and there was a real physician shortage there in 1980.
Continue reading…Barcodes Are Us
BY KIM BELLARD
Usually I write about things where I see some unexpected parallel to healthcare, or something just amazed me, or outraged me (there are lots of things about healthcare like the latter). But sometimes I run across something that just delights me.
So when I inexplicably stumbled across DNA Barcoding Technology for High Throughput Cell-Nanoparticle Study, by Andy Tay, PhD, my first thought was, oh, nanoparticles, that’s always interesting, then it hit me: wait, DNA has barcodes?
How delightful.
Continue reading…Adventures in health care — Hinge Health
At the HLTH conference in Vegas the week before Thanksgiving, I decided to embark on another adventure in health care. Somehow I badly hurt my back and was barely able to walk when I found myself at the Hinge Health booth. Could they give me any help? As it turned out they could. I met physical therapist Lori Wolter who showed me (and used me as a guinea pig for) their Enso device and got a quick update on Hinge Health’s progress from its President Jim Pursley.
America, the intolerant
BY ANISH KOKA
Historically, the great tension between liberty and authority was between government as embodied by the ruling class and its subjects. Marauding barbarians and warring city-states meant that society endowed a particular class within society with great powers to protect the weaker members of society. It was quickly recognized that the ruling class could use these powers for its own benefit on the very people it was meant to protect, and so society moved to preserve individual liberties first by recognizing certain rights that rulers dare not breach lest they risk rebellion. The natural next step was the establishment of a body of some sort that was meant to represent the interests of the ruled, which rulers sought agreement and counsel from, and became the precursor to the modern day English parliament and the American Congress. Of course, progress in governance did not end with rulers imbued with a divine right to rule being held in check by third parties. The right to rule eventually ceased to be a divine right, and instead came courtesy of a periodical choice of the ruled in the form of elections. The power the ruled now wielded over those who would seek to rule lead some to wonder whether there was any reason left to limit the power of a government that was now an embodiment of the will of the people.
Continue reading…
