AI: The Doctor That Never Tires?
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AI: The Doctor That Never Tires?
We asked you for your opinion on the use of Artificial Intelligence (AI) in healthcare, and got the above-depicted, below-described set of results:
- A little over half of respondents to the poll voted for “It speeds up research, and is more methodical about diagnosis, so it’s at least a good extra tool”
- A quarter of respondents voted for “I’m on the fence—it seems to make no more nor less mistakes than human doctors do”
- A little under a fifth of respondents voted for “AI is less prone to fatigue/bias than human doctors, making it an essential new tech”
- Three respondents voted for “AI is a step too far in medical technology, and we’re not ready for it”
Writer’s note: I’m a professional writer (you’d never have guessed, right?) and, apparently, I really did write “no more nor less mistakes”, despite the correct grammar being “no more nor fewer mistakes”. Now, I know this, and in fact, people getting less/fewer wrong is a pet hate of mine. Nevertheless, I erred.
Yet, now that I’m writing this out in my usual software, and not directly into the poll-generation software, my (AI!) grammar/style-checker is highlighting the error for me.
Now, an AI could not do my job. ChatGPT would try, and fail miserably. But can technology help me do mine better? Absolutely!
And still, I dismiss a lot of the AI’s suggestions, because I know my field and can make informed choices. I don’t follow it blindly, and I think that’s key.
AI is less prone to fatigue/bias than human doctors, making it an essential new tech: True or False?
True—with one caveat.
First, a quick anecdote from a subscriber who selected this option in the poll:
❝As long as it receives the same data inputs as my doctor (ie my entire medical history), I can see it providing a much more personalised service than my human doctor who is always forgetting what I have told him. I’m also concerned that my doctor may be depressed – not an ailment that ought to affect AI! I recently asked my newly qualified doctor goddaughter whether she would prefer to be treated by a human or AI doctor. No contest, she said – she’d go with AI. Her argument was that human doctors leap to conclusions, rather than properly weighing all the evidence – meaning AI, as long as it receives the same inputs, will be much more reliable❞
Now, an anecdote is not data, so what does the science say?
Well… It says the same:
❝Of 6695 responding physicians in active practice, 6586 provided information on the areas of interest: 3574 (54.3%) reported symptoms of burnout, 2163 (32.8%) reported excessive fatigue, and 427 (6.5%) reported recent suicidal ideation, with 255 of 6563 (3.9%) reporting a poor or failing patient safety grade in their primary work area and 691 of 6586 (10.5%) reporting a major medical error in the prior 3 months. Physicians reporting errors were more likely to have symptoms of burnout (77.6% vs 51.5%; P<.001), fatigue (46.6% vs 31.2%; P<.001), and recent suicidal ideation (12.7% vs 5.8%; P<.001).❞
See the damning report for yourself: Physician Burnout, Well-being, and Work Unit Safety Grades in Relationship to Reported Medical Errors
AI, of course, does not suffer from burnout, fatigue, or suicidal ideation.
So, what was the caveat?
The caveat is about bias. Humans are biased, and that goes for medical practitioners just the same. AI’s machine learning is based on source data, and the source data comes from humans, who are biased.
See: Bias and Discrimination in AI: A Cross-Disciplinary Perspective
So, AI can perpetuate human biases and doesn’t have a special extra strength in this regard.
The lack of burnout, fatigue, and suicidal ideation, however, make a big difference.
AI speeds up research, and is more methodical about diagnosis: True or False?
True! AI is getting more and more efficient at this, and as has been pointed out, doesn’t make errors due to fatigue, and often comes to accurate conclusions near-instantaneously. To give just one example:
❝Deep learning algorithms achieved better diagnostic performance than a panel of 11 pathologists participating in a simulation exercise designed to mimic routine pathology workflow; algorithm performance was comparable with an expert pathologist interpreting whole-slide images without time constraints. The area under the curve was 0.994 (best algorithm) vs 0.884 (best pathologist).❞
About that “getting more and more efficient at this”; it’s in the nature of machine learning that every new piece of data improves the neural net being used. So long as it is getting fed new data, which it can process at rate far exceeding humans’ abilities, it will always be constantly improving.
AI makes no more nor less fewer mistakes than humans do: True or False?
False! AI makes fewer, now. This study is from 2021, and it’s only improved since then:
❝Professionals only came to the same conclusions [as each other] approximately 75 per cent of the time. More importantly, machine learning produced fewer decision-making errors than did all the professionals❞
See: AI can make better clinical decisions than humans: study
All that said, we’re not quite at Star Trek levels of “AI can do a human’s job entirely” just yet:
BMJ | Artificial intelligence versus clinicians: pros and cons
To summarize: medical AI is a powerful tool that:
- Makes healthcare more accessible
- Speeds up diagnosis
- Reduces human error
…and yet, for now at least, still requires human oversights, checks and balances.
Essentially: it’s not really about humans vs machines at all. It’s about humans and machines giving each other information, and catching any mistakes made by the other. That way, humans can make more informed decisions, and still keep a “hand on the wheel”.
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‘It’s okay to poo at work’: new health campaign highlights a common source of anxiety
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For most people, the daily or near-daily ritual of having a bowel motion is not something we give a great deal of thought to. But for some people, the need to do a “number two” in a public toilet or at work can be beset with significant stress and anxiety.
In recognition of the discomfort people may feel around passing a bowel motion at work, the Queensland Department of Health recently launched a social media campaign with the message “It’s okay to poo at work”.
The campaign has gained significant traction on Instagram and Facebook. It has been praised by health and marketing experts for its humorous handling of a taboo topic.
A colourful Instagram post is accompanied by a caption warning of the health risks of “holding it in”, including haemorrhoids and other gastrointestinal problems. The caption also notes:
If you find it extremely difficult to poo around other people, you might have parcopresis.
Queensland Health/Instagram What is parcopresis?
Parcopresis, sometimes called “shy bowel”, occurs when people experience a difficulty or inability to poo in public toilets due to fear of perceived scrutiny by others.
People with parcopresis may find it difficult to go to the toilet in public places such as shopping centres, restaurants, at work or at school, or even at home when friends or family are around.
They may fear being judged by others about unpleasant smells or sounds when they have a bowel motion, or how long they take to go, for example.
Living with a gastrointestinal condition (at least four in ten Australians do) may contribute to parcopresis due to anxiety about the need to use a toilet frequently, and perceived judgment from others when doing so. Other factors, such as past negative experiences or accessibility challenges, may also play a role.
Some people may feel uncomfortable about using the toilet at work. Motortion Films/Shutterstock For sufferers, anxiety can present in the form of a faster heart rate, rapid breathing, sweating, muscle tension, blushing, nausea, trembling, or a combination of these symptoms. They may experience ongoing worry about situations where they may need to use a public toilet.
Living with parcopresis can affect multiple domains of life and quality of life overall. For example, sufferers may have difficulties relating to employment, relationships and social life. They might avoid travelling or attending certain events because of their symptoms.
How common is parcopresis?
We don’t really know how common parcopresis is, partly due to the difficulty of evaluating this behaviour. It’s not necessarily easy or appropriate to follow people around to track whether they use or avoid public toilets (and their reasons if they do). Also, observing individual bathroom activities may alter the person’s behaviour.
I conducted a study to try to better understand how common parcopresis is. The study involved 714 university students. I asked participants to respond to a series of vignettes, or scenarios.
In each vignette participants were advised they were at a local shopping centre and they needed to have a bowel motion. In the vignettes, the bathrooms (which had been recently cleaned) had configurations of either two or three toilet stalls. Each vignette differed by the configuration of stalls available.
The rate of avoidance was just over 14% overall. But participants were more likely to avoid using the toilet when the other stalls were occupied.
Around 10% avoided going when all toilets were available. This rose to around 25% when only the middle of three toilets was available. Men were significantly less likely to avoid going than women across all vignettes.
For those who avoided the toilet, many either said they would go home to poo, use an available disabled toilet, or come back when the bathroom was empty.
Parcopresis at work
In occupational settings, the rates of anxiety about using shared bathrooms may well be higher for a few reasons.
For example, people may feel more self-conscious about their bodily functions being heard or noticed by colleagues, compared to strangers in a public toilet.
People may also experience guilt, shame and fear about being judged by colleagues or supervisors if they need to make extended or frequent visits to the bathroom. This may particularly apply to people with a gastrointestinal condition.
Reducing restroom anxiety
Using a public toilet can understandably cause some anxiety or be unpleasant. But for a small minority of people it can be a real problem, causing severe distress and affecting their ability to engage in activities of daily living.
If doing a poo in a toilet at work or another public setting causes you anxiety, be kind to yourself. A number of strategies might help:
- identify and challenge negative thoughts about using public toilets and remind yourself that using the bathroom is normal, and that most people are not paying attention to others in the toilets
- try to manage stress through relaxation techniques such as deep breathing and progressive muscle relaxation, which involves tensing and relaxing different muscles around the body
- engaging in gradual exposure can be helpful, which means visiting public toilets at different times and locations, so you can develop greater confidence in using them
- use grounding or distraction techniques while going to the toilet. These might include listening to music, watching something on your phone, or focusing on your breathing.
If you feel parcopresis is having a significant impact on your life, talk to your GP or a psychologist who can help identify appropriate approaches to treatment. This might include cognitive behavioural therapy.
Simon Robert Knowles, Associate Professor and Clinical Psychologist, Swinburne University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How to Prevent Dementia – by Dr. Richard Restak
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We’ve written about this topic here, we know. But there’s a lot more we can do to be on guard against, and pre-emptively strengthen ourselves against, dementia.
The author, a neurologist, takes us on a detailed exploration of dementia in general, with a strong focus on Alzheimer’s in particular, as that accounts for more than half of all dementia cases.
But what if you can’t avoid it? It could be that with the wrong genes and some other factor(s) outside of your control, it will get you if something else doesn’t get you first.
Rather than scaremongering, Dr. Restak tackles this head-on too, and discusses how symptoms can be managed, to make the illness less anxiety-inducing, and look to maintain quality of life as much as possible.
The style of the book is… it reads a lot like an essay compilation. Good essays, then organized and arranged in a sensible order for reading, but distinct self-contained pieces. There are ten or eleven chapters (depending on how we count them), each divided into few or many sections. All this makes for:
- A very “read a bit now and a bit later and a bit the next day” book, if you like
- A feeling of a very quick pace, if you prefer to sit down and read it in one go
Either way, it’s a very informative read.
Bottom line: if you’d like to better understand the many-headed beast that is dementia, this book gives a far more comprehensive overview than we could here, and also explains the prophylactic interventions available.
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Insomnia? High blood pressure? Try these!
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Your Questions, Our Answers!
Q: Recipes for insomnia and high blood pressure and good foods to eat for these conditions?
A: Insomnia can be caused by many things, and consequently can often require a very multi-vector approach to fixing it. But, we’ll start by answering the question you asked (and probably address the rest of dealing with insomnia in another day’s edition!):
- First, you want food that’s easy to digest. Broadly speaking, this means plant-based. If not plant-based, fish (unless you have an allergy, obviously) is generally good and certainly better than white meat, which is better than red meat. In the category of dairy, it depends so much on what it is, that we’re not going to try to break it down here. If in doubt, skip it.
- You also don’t want blood sugar spikes, so it’s good to lay off the added sugar and white flour (or white flour derivatives, like white pasta), especially in your last meal of the day.
- Magnesium supports healthy sleep. A fine option would be our shchi recipe, but using collard greens rather than cabbage. Cabbage is a wonderful food, but collard greens are much higher in magnesium. Remember to add plenty of mushrooms (unless you don’t like them), as they’re typically high in magnesium too.
As for blood pressure, last month we gave tips (and a book recommendation) for heart health. The book, Dr. Monique Tello’s “Healthy Habits for Your Heart: 100 Simple, Effective Ways to Lower Your Blood Pressure and Maintain Your Heart’s Health”, also has recipes!
Here’s one from the “mains” section:
Secret Ingredient Baltimore-Style Salmon Patties with Not-Oily Aioli
❝This is a family favorite, and no one knows that it features puréed pumpkin! Most salmon cake recipes all for eggs and bread crumbs as binders, but puréed pumpkin and grated carrot work just as well, lend a beautiful color, and add plenty of fiber and plant nutrients. Canned salmon is way cheaper than fresh and has just as much omega-3 PUFAs and calcium. Serve this alongside a salad (the Summer Corn, Tomato, Spinach, and Basil Salad would go perfectly) for a well-rounded meal.❞
Serves 4 (1 large patty each)
Secret Ingredient Baltimore-Style Salmon Patties:
- 1 (15-oz) can pink salmon, no salt added
- ½ cup puréed pumpkin
- ½ cup grated carrot (I use a handheld box grater)
- 2 tablespoons minced chives (Don’t have chives? Minced green onions or any onions will do)
- 2 teaspoons Old Bay Seasoning
- 1 tablespoon olive oil
- ½ large lemon, sliced, for serving
Not-Oily Aioli:
- ½ cup plain low-fat Greek yogurt
- Juice and zest from ½ large lemon
- 1 clove garlic, crushed and minced fine
- 2 tablespoons chopped fresh dill
- For the patties: mix all the ingredients for the salmon patties together in a medium bowl
- Form patties with your hands and set on a plate or tray (you should have 4 burger-sized patties)
- Heat oil in a large skillet over medium heat.
- Set patties in a skillet and brown for 4 minutes, then carefully flip.
- Brown the other side, then serve hot.
- For the Aioli: mix all the ingredients for the aioli together in a small bowl.
- Plop a dollop alongside or on top of each salmon patty and serve with a spice of lemon.
Per serving: Calories: 367 | Fat: 13.6g | Saturated Fat: 4.4g | Protein: 46g | Sodium: 519mg | Carbohydrates: 13.2g | Fiber: 1.3g | Sugars: 9g | Calcium: 505mg | Iron: 1mg | Potassium 696mg
Notes from the 10almond team:
- If you want to make it plant-based, substitute cooked red lentils (no salt added) for the tinned salmon, and plant-based yogurt for the Greek yogurt
- We recommend adding more garlic. Seriously, who uses 1 clove of garlic for anything, let alone divided between four portions?
- The salads mentioned are given as recipes elsewhere in the same book. We strongly recommend getting her book, if you’re interested in heart health!
Do you have a question you’d like to see answered here? Hit reply or use the feedback widget at the bottom; we’d love to hear from you!
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Lifespan – by Dr. David Sinclair
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Some books on longevity are science-heavy and heavy-going; others are glorified manifestos with much philosophy but little practical.
This one’s a sciencey-book written for a lay reader. It’s heavily referenced, but not a challenging read.
This book is divided into three parts:
- What we know (the past)
- What we’re learning (the present)
- Where we’re going (the future)
Let us quickly mention: the last part is principally sociology and economics, which are not the author’s wheelhouse. Some readers may enjoy his thoughts regardless, but we’re going to concentrate on where we found the real value of the book to be: in the first and second parts, where he brings his expertise to bear.
The first part lays the foundational knowledge that’s critical for understanding why the second part is so important.
Basically: aging is a genetic disease, and diseases can be cured. No disease has magical properties, even if sometimes it can seem for a while like they do, until we understand them better.
The second part covers a lot of recent and contemporary research into aging. We learn about such things as NAD-agonists that make elderly mice biologically young again, and the Greenland shark that easily lives for 500 years or so (currently the record-holder for vertebrates). And of course, biologically immortal jellyfish.
It’s not all animal studies though…
We learn of how NAD-agonists such as NMN have been promising in human studies too, along with resveratrol and the humble diabetes drug, metformin. These things alone may have the power to extend healthy life by 20%
Other recommendations pertain to lifestyle; the usual five things (diet, exercise, sleep, no alcohol, no smoking), as well as intermittent fasting and cryotherapy (cold showers/baths).
Bottom line: this book is informative and inspiring, and if you’ve been looking for an “in” to understanding the world of biogerontology and/or anti-aging research, this is it.
Get your copy of “Lifespan: Why We Age—And Why We Don’t Have To” from Amazon today!
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Considering taking Wegovy to lose weight? Here are the risks and benefits – and how it differs from Ozempic
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The weight-loss drug Wegovy is now available in Australia.
Wegovy is administered as a once-weekly injection and is approved specifically for weight management. It’s intended to be used in combination with a reduced-energy diet and increased physical activity.
So how does Wegovy work and how much weight can you expect to lose while taking it? And what are the potential risks – and costs – for those who use it?
Let’s look at what the science says.
Halfpoint/Shutterstock What is Wegovy?
Wegovy is a brand name for the medication semaglutide. Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA). This means it makes your body’s own glucagon-like peptide-1 hormone, called GLP-1 for short, work better.
Normally when you eat, the body releases the GLP-1 hormone which helps signal to your brain that you are full. Semaglutides enhance this effect, leading to a feeling of fullness, even when you haven’t eaten.
Another role of GLP-1 is to stimulate the body to produce more insulin, a hormone which helps lower the level of glucose (sugar) in the blood. That’s why semaglutides have been used for several years to treat type 2 diabetes.
Wegovy is self-injected once a week. S Becker/Shutterstock How does Wegovy differ from Ozempic?
Like Wegovy, Ozempic is a semaglutide. The way Wegovy and Ozempic work in the body are essentially the same. They’re made by the same pharmaceutical company, Novo Nordisk.
But there are two differences:
1) They are approved for two different (but related) reasons.
In Australia (and the United States), Ozempic is approved for use to improve blood glucose levels in adults with type 2 diabetes. By managing blood glucose levels effectively, the medication aims to reduce the risk of major complications, such as heart disease.
Wegovy is approved for use alongside diet and exercise for people with a body mass index (BMI) of 30 or greater, or 27 or greater but with other conditions such as high blood pressure.
Wegovy can also be used in people aged 12 years and older. Like Ozempic, Wegovy aims to reduce the risk of future health complications, including heart disease.
2) They are both injected but come in different strengths.
Ozempic is available in pre-loaded single-dose pens with varying dosages of 0.25 mg, 0.5 mg, 1 mg, or 2 mg per injection. The dose can be slowly increased, up to a maximum of 2 mg per week, if needed.
Wegovy is available in prefilled single-dose pens with doses of 0.25 mg, 0.5 mg, 1 mg, 1.7 mg, or 2.4 mg. The treatment starts with a dose of 0.25 mg once weekly for four weeks, after which the dose is gradually increased until reaching a maintenance dose of 2.4 mg weekly.
While it’s unknown what the impact of Wegovy’s introduction will be on Ozempic’s availability, Ozempic is still anticipated to be in low supply for the remainder of 2024.
Is Wegovy effective for weight loss?
Given Wegovy is a semaglutide, there is very strong evidence it can help people lose weight and maintain this weight loss.
A recent study found that over four years, participants taking Wevovy as indicated experienced an average weight loss of 10.2% body weight and a reduction in waist circumference of 7.7cm.
For those who stop taking the medication, analyses have shown that about two-thirds of weight lost is regained.
Wegovy can help people lose weight and maintain their weight loss – while they take the drug. Mladen Mitrinovic/Shutterstock What are the side effects of Wegovy?
The most common side effects are nausea and vomiting.
However, other serious side effects are also possible because of the whole-of-body impact of the medication. Thyroid tumours and cancer have been detected as a risk in animal studies, yet are rarely seen in human scientific literature.
In the four-year Wegovy trial, 16.6% of participants who received Wegovy (1,461 people) experienced an adverse event that led to them permanently discontinuing their use of the medication. This was higher than the 8.2% of participants (718 people) who received the placebo (with no active ingredient).
Side effects included gastrointestinal disorders (including nausea and vomiting), which affected 10% of people who used Wegovy compared to 2% of people who used the placebo.
Gallbladder-related disorders occurred in 2.8% of people who used Wegovy, and 2.3% of people who received the placebo.
Recently, concerns about suicidal thoughts and behaviours have been raised, after a global analysis reviewed more than 36 million reports of adverse events from semaglutide (Ozempic or Wegovy) since 2000.
There were 107 reports of suicidal thoughts and self-harm among people taking semaglutide, sadly including six actual deaths. When people stopped the medication, 62.5% found the thoughts went away. What we don’t know is whether dose, weight loss, or previous mental health status or use of antidepressants had a role to play.
Finally, concerns are growing about the negative effect of semaglutides on our social and emotional connection with food. Anecdotal and scientific evidence suggests people who use semaglutides significantly reduce their daily dietary intake (as anticipated) by skipping meals and avoiding social occasions – not very enjoyable for people and their loved ones.
How can people access Wegovy?
Wegovy is available for purchase at pharmacists with a prescription from a doctor.
But there is a hefty price tag. Wegovy is not currently subsidised through the Pharmaceutical Benefits Scheme, leaving patients to cover the cost. The current cost is estimated at around A$460 per month dose.
If you’re considering Wegovy, make an appointment with your doctor for individual advice.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Nicotine Benefits (That We Don’t Recommend)!
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Does nicotine have any benefits at all? I know it’s incredibly addictive but if you exclude the addiction, does it do anything?❞
Good news: yes, nicotine is a stimulant and can be considered a performance enhancer, for example:
❝Compared with the placebo group, the nicotine group exhibited enhanced motor reaction times, grooved pegboard test (GPT) results on cognitive function, and baseball-hitting performance, and small effect sizes were noted (d = 0.47, 0.46 and 0.41, respectively).❞
Read in full: Acute Effects of Nicotine on Physiological Responses and Sport Performance in Healthy Baseball Players
However, another study found that its use as a cognitive enhancer was only of benefit when there was already a cognitive impairment:
❝Studies of the effects of nicotinic systems and/or nicotinic receptor stimulation in pathological disease states such as Alzheimer’s disease, Parkinson’s disease, attention deficit/hyperactivity disorder and schizophrenia show the potential for therapeutic utility of nicotinic drugs.
In contrast to studies in pathological states, studies of nicotine in normal-non-smokers tend to show deleterious effects.
This contradiction can be resolved by consideration of cognitive and biological baseline dependency differences between study populations in terms of the relationship of optimal cognitive performance to nicotinic receptor activity.
Although normal individuals are unlikely to show cognitive benefits after nicotinic stimulation except under extreme task conditions, individuals with a variety of disease states can benefit from nicotinic drugs❞
Read in full: Effects of nicotinic stimulation on cognitive performance
Bad news: its addictive qualities wipe out those benefits due to tolerance and thus normalization in short order. So you may get those benefits briefly, but then you’re addicted and also lose the benefits, as well as also ruining your health—making it a lose/lose/lose situation quite quickly.
As an aside, while nicotine is poisonous per se, in the quantities taken by most users, the nicotine itself is not usually what kills. It’s mostly the other stuff that comes with it (smoking is by far and away the worst of all; vaping is relatively less bad, but that’s not a strong statement in this case) that causes problems.
See also: Vaping: A Lot Of Hot Air?
However, this is still not an argument for, say, getting nicotine gum and thinking “no harmful effects” because then you’ll be get a brief performance boost yes before it runs out and being addicted to it and now being in a position whereby if you stop, your performance will be lower than before you started (since you now got used to it, and it became your new normal), before eventually recovering:
In summary
We recommend against using nicotine in the first place, and for those who are addicted, we recommend quitting immediately if not contraindicated (check with your doctor if unsure; there are some situations where it is inadvisable to take away something your body is dependent on, until you correct some other thing first).
For more on quitting in general, see:
Addiction Myths That Are Hard To Quit
Take care!
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