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Tag: Saurabh Jha

THCB Gang Episode 15

Episode 15 of “The THCB Gang” was live-streamed on Thursday, June 25th!

Joining Matthew Holt were our regulars: health futurist Ian Morrison (@seccurve), writer Kim Bellard (@kimbbellard), WTF Health Host Jessica DaMassa (@jessdamassa), radiologist Saurabh Jha (@RougeRad), policy expert Vince Kuraitis (@VinceKuraitis), and THCB’s Editor-in-Chief, Me (@zoyak1594)! We got into increasing COVID-19 rates, updates in health policy, what is the future of hospitals, and how the new generation is dealing with the health care industry. All while keeping an eye on the politics of the US.

If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels — Zoya Khan

THCB Gang: Episode 8 LIVE 1PM PT/4PM ET, 5/7

Episode 8 of “The THCB Gang” was live-streamed on Thursday, May 7th at 1pm PT- 4pm ET! You can see it below.

Joining me were our regulars: patient advocate Grace Cordovano (@GraceCordovano), data privacy lawyer Deven McGraw (@HealthPrivacy), policy expert Vince Kuraitis (@VinceKuraitis), radiologist Saurabh Jha (@RogueRad) (who snuck in late), and writer Kim Bellard (@Kimbbellard). We had a great conversation including a lot of detail around access to patient records, and some fun about infectious disease epidemiologists behaving badly! If you’d rather listen, the “audio only” version is preserved as a weekly podcast available on our iTunes & Spotify channels from Friday— Matthew Holt

THCB Gang: Episode 6, LIVE 1PM PT/4PM ET, 4/23

Episode 6 of “The THCB Gang” was live-streamed on Thursday, April 23 at 1pm PT- 4pm ET! 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the sh*t about health care business, politics, practice, and tech. It’s available below and is preserved as a weekly podcast available on our iTunes & Spotify channels.

Our lineup included: Saurabh Jha (@roguerad), Ian Morrison (@seccurve), Kim Bellard (@kimbbellard), Grace Cordovano (@GraceCordovano),Vince Kuraitis (@VinceKuraitis), Brian Klepper (@bklepper1), and a special guest – Alexandra Drane (@adrane, founder of Eliza, Queen of the Unmentionables, CEO of ArchAngels and sometimes Walmart cashier). Lots of great conversation especially around palliative care, patient experience, the real prevalence of COVID-19 and much more.

And if you want to contact Alex about caregiving, here is her Youtube Channel or please email her. — Matthew Holt

The THCB Gang Episode 4

Episode 4 of “The THCB Gang” was live-streamed Thursday April 9. You can see it below and it’s also preserved as a weekly podcast available on our iTunes & Spotify channels. Every Thursday at 1pm PT-4pm ET, 4-6 semi-regular guests drawn from THCB authors and other assorted old friends of mine will shoot the shit about health care business, politics, practice, and tech. It tries to be fun but serious and informative!

This week, joining me were Jane Sarasohn Kahn (@healthythinker), Anish Koka (@anish_koka), Saurabh Jha (@roguerad), Elizabeth Clayborne (@DrElizPC), and Ian Morrison (@seccurve). A fun and very informative discussion about where the COVID-19 crisis is right now and what it’s going to mean both now and in the near future — Matthew Holt

False Negative: Testing’s Catch-22

By SAURABH JHA, MD

In a physician WhatsApp group, a doctor posted he had fever of 101° F and muscle ache, gently confessing that it felt like his typical “man flu” which heals with rest and scotch. Nevertheless, he worried that he had coronavirus. When the reverse transcription polymerase chain reaction (RT-PCR) for the virus on his nasal swab came back negative, he jubilantly announced his relief. 

Like Twitter, in WhatsApp emotions quickly outstrip facts. After he received a flurry of cheerful emojis, I ruined the party, advising that despite the negative test he assume he’s infected and quarantine for two weeks, with a bottle of scotch. 

It’s conventional wisdom that the secret sauce to fighting the pandemic is testing for the virus. To gauge the breadth of the response against the pandemic we must know who and how many are infected. The depth of the response will be different if 25% of the population is infected than 1%. Testing is the third way, rejecting the false choice between death and economic depression. Without testing, strategy is faith-based. 

Our reliance on testing has clinical precedence – scarcely any decision in medicine is made without laboratory tests or imaging. Testing is as ingrained in medicine as the GPS is in driving. We use it even when we know our way home. But tests impose a question – what’ll you do differently if the test is negative? 

That depends on the test’s performance and the consequences of being wrong. Though coronavirus damages the lungs with reckless abandon, it’s oddly a shy virus. In many patients, it takes three to four swabs to get a positive RT-PCR. The Chinese ophthalmologist, Li Wenliang, who originally sounded the alarm about coronavirus, had several negative tests. He died from the infection.

Continue reading…

Artificial Intelligence vs. Tuberculosis – Part 2

By SAURABH JHA, MD

This is the part two of a three-part series. Catch up on Part One here.

Clever Hans

Preetham Srinivas, the head of the chest radiograph project in Qure.ai, summoned Bhargava Reddy, Manoj Tadepalli, and Tarun Raj to the meeting room.

“Get ready for an all-nighter, boys,” said Preetham.

Qure’s scientists began investigating the algorithm’s mysteriously high performance on chest radiographs from a new hospital. To recap, the algorithm had an area under the receiver operating characteristic curve (AUC) of 1 – that’s 100 % on multiple-choice question test.

“Someone leaked the paper to AI,” laughed Manoj.

“It’s an engineering college joke,” explained Bhargava. “It means that you saw the questions before the exam. It happens sometimes in India when rich people buy the exam papers.”

Just because you know the questions doesn’t mean you know the answers. And AI wasn’t rich enough to buy the AUC.

The four lads were school friends from Andhra Pradesh. They had all studied computer science at the Indian Institute of Technology (IIT), a freaky improbability given that only hundred out of a million aspiring youths are selected to this most coveted discipline in India’s most coveted institute. They had revised for exams together, pulling all-nighters – in working together, they worked harder and made work more fun.

Continue reading…

Artificial Intelligence vs. Tuberculosis, Part 1

By SAURABH JHA, MD

Slumdog TB

No one knows who gave Rahul Roy tuberculosis. Roy’s charmed life as a successful trader involved traveling in his Mercedes C class between his apartment on the plush Nepean Sea Road in South Mumbai and offices in Bombay Stock Exchange. He cared little for Mumbai’s weather. He seldom rolled down his car windows – his ambient atmosphere, optimized for his comfort, rarely changed.

Historically TB, or “consumption” as it was known, was a Bohemian malady; the chronic suffering produced a rhapsody which produced fine art. TB was fashionable in Victorian Britain, in part, because consumption, like aristocracy, was thought to be hereditary. Even after Robert Koch discovered that the cause of TB was a rod-shaped bacterium – Mycobacterium Tuberculosis (MTB), TB had a special status denied to its immoral peer, Syphilis, and unaesthetic cousin, leprosy.

TB became egalitarian in the early twentieth century but retained an aristocratic noblesse oblige. George Orwell may have contracted TB when he voluntarily lived with miners in crowded squalor to understand poverty. Unlike Orwell, Roy had no pretentions of solidarity with poor people. For Roy, there was nothing heroic about getting TB. He was embarrassed not because of TB’s infectivity; TB sanitariums are a thing of the past. TB signaled social class decline. He believed rickshawallahs, not traders, got TB.

Continue reading…

The Rise and Rise of Quantitative Cassandras

By SAURABH JHA, MD

Despite an area under the ROC curve of 1, Cassandra’s prophesies were never believed. She neither hedged nor relied on retrospective data – her predictions, such as the Trojan war, were prospectively validated. In medicine, a new type of Cassandra has emerged –  one who speaks in probabilistic tongue, forked unevenly between the probability of being right and the possibility of being wrong. One who, by conceding that she may be categorically wrong, is technically never wrong. We call these new Minervas “predictions.” The Owl of Minerva flies above its denominator.

Deep learning (DL) promises to transform the prediction industry from a stepping stone for academic promotion and tenure to something vaguely useful for clinicians at the patient’s bedside. Economists studying AI believe that AI is revolutionary, revolutionary like the steam engine and the internet, because it better predicts.

Recently published in Nature, a sophisticated DL algorithm was able to predict acute kidney injury (AKI), continuously, in hospitalized patients by extracting data from their electronic health records (EHRs). The algorithm interrogated nearly million EHRS of patients in Veteran Affairs hospitals. As intriguing as their methodology is, it’s less interesting than their results. For every correct prediction of AKI, there were two false positives. The false alarms would have made Cassandra blush, but they’re not bad for prognostic medicine. The DL- generated ROC curve stands head and shoulders above the diagonal representing randomness.

The researchers used a technique called “ablation analysis.” I have no idea how that works but it sounds clever. Let me make a humble prophesy of my own – if unleashed at the bedside the AKI-specific, DL-augmented Cassandra could unleash havoc of a scale one struggles to comprehend.

Leaving aside that the accuracy of algorithms trained retrospectively falls in the real world – as doctors know, there’s a difference between book knowledge and practical knowledge – the major problem is the effect availability of information has on decision making. Prediction is fundamentally information. Information changes us.

Continue reading…

Radiology Firing Line | Choosing Wisely, Wisely

By SAURABH JHA, MD

How easy is it for physicians to choose wisely and reject low value care? Who decides what’s wise and what’s unwise? In this episode Saurabh Jha (aka @RogueRad) speaks with William Sullivan MD JD. Dr. Sullivan is an emergency physician and an attorney specializing in healthcare issues. Dr. Sullivan represents physicians and has published many articles on legal aspects of medicine. He is a past president of the Illinois College of Emergency Physicians and a past chair and current member of the American College of Emergency Physicians’ Medical Legal Committee.

Listen to our conversation here.

Saurabh Jha is a contributing editor to THCB and host of Radiology Firing Line Podcast of the Journal of American College of Radiology, sponsored by Healthcare Administrative Partner

HardCore Health Podcast| Episode 3, IPOs, Privacy, & more!

On Episode 3 of HardCore Health, Jess & I start off by discussing all of the health tech companies IPOing (Livongo, Phreesia, Health Catalyst) and talk about what that means for the industry as a whole. Zoya Khan discusses the newest series on THCB called, “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?”, which follows & discuss the legislation being passed on data privacy and protection in Congress today. We also have a great interview with Paul Johnson, CEO of Lemonaid Health, an up-and-coming telehealth platform that works as a one-stop-shop for a virtual doctor’s office, a virtual pharmacy, and lab testing for patients accessing their platform. In her WTF Health segment, Jess speaks to Jen Horonjeff, Founder & CEO of Savvy Cooperative, the first patient-owned public benefit co-op that provides an online marketplace for patient insights. And last but not least, Dr. Saurabh Jha directly address AI vendors in health care, stating that their predictive tools are useless and they will not replace doctors just yet- Matthew Holt

Matthew Holt is the founder and publisher of The Health Care Blog and still writes regularly for the site.

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