Health Care AI, Intended To Save Money, Turns Out To Require a Lot of Expensive Humans
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Preparing cancer patients for difficult decisions is an oncologist’s job. They don’t always remember to do it, however. At the University of Pennsylvania Health System, doctors are nudged to talk about a patient’s treatment and end-of-life preferences by an artificially intelligent algorithm that predicts the chances of death.
But it’s far from being a set-it-and-forget-it tool. A routine tech checkup revealed the algorithm decayed during the covid-19 pandemic, getting 7 percentage points worse at predicting who would die, according to a 2022 study.
There were likely real-life impacts. Ravi Parikh, an Emory University oncologist who was the study’s lead author, told KFF Health News the tool failed hundreds of times to prompt doctors to initiate that important discussion — possibly heading off unnecessary chemotherapy — with patients who needed it.
He believes several algorithms designed to enhance medical care weakened during the pandemic, not just the one at Penn Medicine. “Many institutions are not routinely monitoring the performance” of their products, Parikh said.
Algorithm glitches are one facet of a dilemma that computer scientists and doctors have long acknowledged but that is starting to puzzle hospital executives and researchers: Artificial intelligence systems require consistent monitoring and staffing to put in place and to keep them working well.
In essence: You need people, and more machines, to make sure the new tools don’t mess up.
“Everybody thinks that AI will help us with our access and capacity and improve care and so on,” said Nigam Shah, chief data scientist at Stanford Health Care. “All of that is nice and good, but if it increases the cost of care by 20%, is that viable?”
Government officials worry hospitals lack the resources to put these technologies through their paces. “I have looked far and wide,” FDA Commissioner Robert Califf said at a recent agency panel on AI. “I do not believe there’s a single health system, in the United States, that’s capable of validating an AI algorithm that’s put into place in a clinical care system.”
AI is already widespread in health care. Algorithms are used to predict patients’ risk of death or deterioration, to suggest diagnoses or triage patients, to record and summarize visits to save doctors work, and to approve insurance claims.
If tech evangelists are right, the technology will become ubiquitous — and profitable. The investment firm Bessemer Venture Partners has identified some 20 health-focused AI startups on track to make $10 million in revenue each in a year. The FDA has approved nearly a thousand artificially intelligent products.
Evaluating whether these products work is challenging. Evaluating whether they continue to work — or have developed the software equivalent of a blown gasket or leaky engine — is even trickier.
Take a recent study at Yale Medicine evaluating six “early warning systems,” which alert clinicians when patients are likely to deteriorate rapidly. A supercomputer ran the data for several days, said Dana Edelson, a doctor at the University of Chicago and co-founder of a company that provided one algorithm for the study. The process was fruitful, showing huge differences in performance among the six products.
It’s not easy for hospitals and providers to select the best algorithms for their needs. The average doctor doesn’t have a supercomputer sitting around, and there is no Consumer Reports for AI.
“We have no standards,” said Jesse Ehrenfeld, immediate past president of the American Medical Association. “There is nothing I can point you to today that is a standard around how you evaluate, monitor, look at the performance of a model of an algorithm, AI-enabled or not, when it’s deployed.”
Perhaps the most common AI product in doctors’ offices is called ambient documentation, a tech-enabled assistant that listens to and summarizes patient visits. Last year, investors at Rock Health tracked $353 million flowing into these documentation companies. But, Ehrenfeld said, “There is no standard right now for comparing the output of these tools.”
And that’s a problem, when even small errors can be devastating. A team at Stanford University tried using large language models — the technology underlying popular AI tools like ChatGPT — to summarize patients’ medical history. They compared the results with what a physician would write.
“Even in the best case, the models had a 35% error rate,” said Stanford’s Shah. In medicine, “when you’re writing a summary and you forget one word, like ‘fever’ — I mean, that’s a problem, right?”
Sometimes the reasons algorithms fail are fairly logical. For example, changes to underlying data can erode their effectiveness, like when hospitals switch lab providers.
Sometimes, however, the pitfalls yawn open for no apparent reason.
Sandy Aronson, a tech executive at Mass General Brigham’s personalized medicine program in Boston, said that when his team tested one application meant to help genetic counselors locate relevant literature about DNA variants, the product suffered “nondeterminism” — that is, when asked the same question multiple times in a short period, it gave different results.
Aronson is excited about the potential for large language models to summarize knowledge for overburdened genetic counselors, but “the technology needs to improve.”
If metrics and standards are sparse and errors can crop up for strange reasons, what are institutions to do? Invest lots of resources. At Stanford, Shah said, it took eight to 10 months and 115 man-hours just to audit two models for fairness and reliability.
Experts interviewed by KFF Health News floated the idea of artificial intelligence monitoring artificial intelligence, with some (human) data whiz monitoring both. All acknowledged that would require organizations to spend even more money — a tough ask given the realities of hospital budgets and the limited supply of AI tech specialists.
“It’s great to have a vision where we’re melting icebergs in order to have a model monitoring their model,” Shah said. “But is that really what I wanted? How many more people are we going to need?”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Self-Compassion – by Dr. Kristin Neff
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
A lot of people struggle with self-esteem, and depending on one’s surrounding culture, it can even seem socially obligatory to be constantly valuing oneself highly (or else, who else will if we do not?). But, as Dr. Neff points out, there’s an inherent problem with reinforcing for oneself even a positive message like “I am smart, strong, and capable!” because sometimes all of us have moments of being stupid, weak, and incapable (occasionally all three at once!), which places us in a position of having to choose between self-deceit and self-deprecation, neither of which are good.
Instead, Dr. Neff advocates for self-compassion, for treating oneself as one (hopefully) would a loved one—seeing their/our mistakes, weaknesses, failures, and loving them/ourself anyway.
She does not, however, argue that we should accept just anything from ourselves uncritically, but rather, we identify our mistakes, learn, grow, and progress. So not “I should have known better!”, nor even “How was I supposed to know?!”, but rather, “Now I have learned a thing”.
The style of the book is quite personal, as though having a heart-to-heart over a hot drink perhaps, but the format is organized and progresses naturally from one idea to the next, taking the reader to where we need to be.
Bottom line: if you have trouble with self-esteem (as most people do), then that’s a trap that there is a way out of, and it doesn’t require being perfect or lowering one’s standards, just being kinder to oneself along the way—and this book can help inculcate that.
Click here to check out Self-Compassion, and indeed be kind to yourself!
Share This Post
-
Cherries vs Cranberries – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing cherries to cranberries, we picked the cherries.
Why?
In terms of macros, cherries have a little more protein (but it’s not much) while cranberries have a little more fiber. Despite this, cherries have the lower glycemic index—about half that of cranberries.
In the category of vitamins, cherries have a lot more of vitamins A, B1, B2, B3, B9, and a little more choline, while cranberries have more of vitamins B5, B6, C, E, and K. A modest win for cherries here.
When it comes to minerals, things are more divided: cherries have more calcium, copper, iron, magnesium, phosphorus, potassium, and zinc, while cranberries have more manganese. An easy win for cherries here.
This all adds up to a total win for cherries, but both of these fruits are great and both have their own beneficial properties (see our main features below!)
Want to learn more?
You might like to read:
- Cherries’ Very Healthy Wealth Of Benefits!
- Health Benefits Of Cranberries (But: You’d Better Watch Out)
Take care!
Share This Post
-
Lucid Dreaming: How To Do It, & Why
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Lucid Dreaming: Methods & Uses
We’ve written about dreaming more generally before:
Today we’re going to be talking more about a subject we’ve only touched on previously: lucid dreaming
What it is: lucid dreaming is the practice of being mentally awake while dreaming, with awareness that it is a dream, and control over the dream.
Why is it useful? Beyond simply being fun, it can banish nightmares, it can improve one’s relationship with sleep (always something to look forward to, and sleep doesn’t feel like a waste of time at all!), and it can allow for exploring a lot of things that can’t easily be explored otherwise—which can be quite therapeutic.
How to do it
There are various ways to induce lucid dreaming, but the most common and “entry-level” method is called Mnemonic-Induced Lucid Dreaming (MILD).
MILD involves having some means of remembering what one has forgotten, i.e., that one is dreaming. To break it down further, first we’ll need to learn how to perform a reality check. Again, there are many of these, but one of the simplest is to ask yourself:
How did I get here?
- If you can retrace your steps with relative ease and the story of how you got here does not sound too much like a dream sequence, you are probably not dreaming.
- If you are dreaming, however, chances are that nothing actually led to where you are now; you just appeared here.
Other reality checks include checking whether books, clocks, and/or lightswitches work as they should—all are notorious for often being broken in dreams; books have gibberish or missing or repeated text; clocks do not tell the correct time and often do not even tell a time that could be real (e.g: 07:72), and lightswitches may turn a light on/off without actually changing the level of illumination in the room.
Now, a reality check is only useful if you actually perform it, so this is where MILD comes in.
You need to make a habit of doing a reality check frequently. Whenever you remember, it’s a good time to do a reality check, but you should also try tying it to something. Many people use a red light, because then they can also use a timed red light during the night to subconsciously cue them that they are dreaming. But it could be as simple as “whenever I go to the bathroom, I do a reality check”.
With this in mind, a fun method that has extra benefits is to try to use a magical power, such as psychokinesis. If (while fully awake) whenever you go to pick up some object you imagine it just wooshing magically to meet your hand halfway, then at some point you’ll instinctively do that while dreaming, and it’ll stand a good chance of working—and thus cluing you in that you are dreaming.
How to stay lucid
When you awaken within a dream (i.e. become lucid), there’s a good chance of one of two things happening quickly:
- you forget again
- you wake up
So when you realize you are dreaming, do two things at once:
- verbally repeat to yourself “I am dreaming now”. This will help stretch your awareness from one second to the next.
- look at your hands, and touch things, especially the floor and/or walls. This will help to ground you within the dream.
Things to do while lucid
Flying is a good fun entry-level activity; it’s very common to initially find it difficult though, and only be able to lift up very slightly before gently falling down, or things like that. A good tip is: instead of trying to move yourself, you stay still and move the dream around you, as though you are rotating a 3D model (because guess what: you are).
Confronting your nightmares and/or general fears is a good thing for many. Think, while you’re still awake during the day, about what you would do about the source/trigger of your fear if you had magical powers. Whatever you choose, keep it consistent for now, because this is about habit-forming.
Example: let’s say there’s a person from your past who appears in your nightmares. Let’s say your chosen magic would be “I would cause the ground to open up, swallow them, and close again behind them”. Vividly imagine that whenever they come to mind while you are awake, and when you encounter them next in a nightmare, you’ll remember to do exactly that, and it’ll work.
Learning about your own subconscious is a more advanced activity, but once you’re used to lucid dreaming, you can remember that everything in there is an internal projection of your own mind, so you can literally talk to parts of your subconscious, including past versions of yourself, or singular parts of your greater-whole personality, as per IFS:
Take Care Of Your “Unwanted” Parts Too!
Want to know more?
You might like to read:
Enjoy!
Share This Post
-
How to keep your teeth young
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
How to keep your teeth young
The association between aging and teeth is so well-established that it’s entered popular idiom, “too long in the tooth”, and when it comes to visual representations, false teeth are well-associated with old age.
And yet, avoiding such outcomes does not get anywhere near so much attention as, say, avoiding wrinkles or hair loss.
At 10almonds, we’ve covered general dental health before, in a three-part series:
- Toothpastes & Mouthwashes: Which Help And Which Harm?
- Flossing, Better (And Easier!)
- Less Common Oral Hygiene Options
Today, we’re going to be looking specifically at keeping our teeth young. What if you have lost your teeth already? Well, gum health remains important, and it’s foundational for everyone, so…
Look after your gums first and last
Hollywood’s most “perfect” whites would be nothing without the gums holding them in place. So, set aside the cosmetic whitening products that often harm gums (anything containing bleach / hydrogen peroxide, is generally a bad idea), andinstead focus on your gums.
As for avoiding gum disease (periodontitis)?
❝In conclusion, periodontitis might enhance the association of biological aging with all-cause mortality in middle-aged and older adults.
Hence, maintaining and enhancing periodontal health is expected to become an intervention to slow aging and extend life span.❞
Source: Does Periodontitis Affect the Association of Biological Aging with Mortality?
Ways to look after gum health include the obvious “floss” and “brush often” and “use fluoride toothpaste”, along with other options we covered in our “Less Common Oral Hygiene Options” article above.
Also important: don’t smoke. It is bad for everything, and this is no exception.
We expect we probably don’t have many subscribers who smoke, but if you do, please consider making quitting a priority.
See also: Smoking, Gum Disease, and Tooth Loss
Consider supplementing with collagen
Everyone’s all about the calcium and vitamin D for bones (and teeth), but a large part of the mass of both is actually collagen. And unlike calcium, which most people not living in a food desert get plenty of, or vitamin D, which is one of the most popular supplements around, collagen is something that gets depleted as we get older. We’ve written about its importance for bones:
We Are Such Stuff As Fish Are Made Of—Collagen’s benefits are more than skin deep
And as for its role in combatting gum disease and tooth loss:
Nanoscale Dynamics of Streptococcal Adhesion to AGE-Modified Collagen
By the way, that “AGE” there isn’t about chronological age; it’s about advanced glycation end-products. Those are also something you can and should avoid:
A different kind of “spit and polish”
We imagine you have the “polishing” part in hand; that’s tooth-brushing, of course. But spit?
Saliva is hugely important for our oral health, but it’s not something most of us think about a lot. For example, you might not have known (or might have known but not thought much about) that many common medications affect our saliva, including many blood pressure medications and antidepressants:
Impact of ageing and drug consumption on oral health
Because there are so many possibilities, this is the kind of thing to check with your pharmacist or doctor about. But as a rule, if you take a medication whose side-effects include “dry mouth”, this might be you.
Here’s a really useful (academic) article that covers what drugs cause this, how to diagnose it, and what can be done about it:
Hyposalivation in Elderly Patients
If something’s difficult, find a way to make it easier
Sometimes, as we get older, some things that used to be easy, aren’t. We can lose strength, coordination, manual dexterity, memory, attention, and more. Obviously, we try not to, and do what we can to keep ourselves in good health.
But, if you do have some disability that makes for example brushing and/or flossing difficult to do consistently and/or well, consider talking to your doctor to see if there are assistive devices that can help, or some other kind of support that could allow you to do what you need to.
There’s never any shame in getting help if we need it.
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Qigong: A Breath Of Fresh Air?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Qigong: Breathing Is Good (Magic Remains Unverified)
In Tuesday’s newsletter, we asked you for your opinions of qigong, and got the above-depicted, below-described, set of responses:
- About 55% said “Qigong is just breathing, but breathing exercises are good for the health”
- About 41% said “Qigong helps regulate our qi and thus imbue us with healthy vitality”
- One (1) person said “Qigong is a mystical waste of time and any benefits are just placebo”
The sample size was a little low for this one, but the results were quite clearly favorable, one way or another.
So what does the science say?
Qigong is just breathing: True or False?
True or False, depending on how we want to define it—because qigong ranges in its presentation from indeed “just breathing exercises”, to “breathing exercises with visualization” to “special breathing exercises with visualization that have to be exactly this way, with these hand and sometimes body movements also, which also must be just right”, to far more complex definitions that involve qi by various mystical definitions, and/or an appeal to a scientific analog of qi; often some kind of bioelectrical field or such.
There is, it must be said, no good quality evidence for the existence of qi.
Writer’s note, lest 41% of you want my head now: I’ve been practicing qigong and related arts for about 30 years and find such to be of great merit. This personal experience and understanding does not, however, change the state of affairs when it comes to the availability (or rather, the lack) of high quality clinical evidence to point to.
Which is not to say there is no clinical evidence, for example:
Acute Physiological and Psychological Effects of Qigong Exercise in Older Practitioners
…found that qigong indeed increased meridian electrical conductance!
Except… Electrical conductance is measured with galvanic skin responses, which increase with sweat. But don’t worry, to control for that, they asked participants to dry themselves with a towel. Unfortunately, this overlooks the fact that a) more sweat can come where that came from, because the body will continue until it is satisfied of adequate homeostasis, and b) drying oneself with a towel will remove the moisture better than it’ll remove the salts from the skin—bearing in mind that it’s mostly the salts, rather than the moisture itself, that improve the conductivity (pure distilled water does conduct electricity, but not very well).
In other words, this was shoddy methodology. How did it pass peer review? Well, here’s an insight into that journal’s peer review process…
❝The peer-review system of EBCAM is farcical: potential authors who send their submissions to EBCAM are invited to suggest their preferred reviewers who subsequently are almost invariably appointed to do the job. It goes without saying that such a system is prone to all sorts of serious failures; in fact, this is not peer-review at all, in my opinion, it is an unethical sham.❞
~ Dr. Edzard Ernst, a founding editor of EBCAM (he since left, and decries what has happened to it since)
One of the other key problems is: how does one test qigong against placebo?
Scientists have looked into this question, and their answers have thus far been unsatisfying, and generally to the tune of the true-but-unhelpful statement that “future research needs to be better”:
Problems of scientific methodology related to placebo control in Qigong studies: A systematic review
Most studies into qigong are interventional studies, that is to say, they measure people’s metrics (for example, blood pressure, heart rate, maybe immune function biomarkers, sleep quality metrics of various kinds, subjective reports of stress levels, physical biomarkers of stress levels, things like that), then do a course of qigong (perhaps 6 weeks, for example), then measure them again, and see if the course of qigong improved things.
This almost always results in an improvement when looking at the before-and-after, but it says nothing for whether the benefits were purely placebo.
We did find one study that claimed to be placebo-controlled:
…but upon reading the paper itself carefully, it turned out that while the experimental group did qigong, the control group did a reading exercise. Which is… Saying how well qigong performs vs reading (qigong did outperform reading, for the record), but nothing for how well it performs vs placebo, because reading isn’t a remotely credible placebo.
See also: Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago ← this one explains a lot about how placebo effect does work
Qigong is a mystical waste of time: True or False?
False! This one we can answer easily. Interventional studies invariably find it does help, and the fact remains that even if placebo is its primary mechanism of action, it is of benefit and therefore not a waste of time.
Which is not to say that placebo is its only, or even necessarily primary, mechanism of action.
Even from a purely empirical evidence-based medicine point of view, qigong is at the very least breathing exercises plus (usually) some low-impact body movement. Those are already two things that can be looked at, mechanistic processes pointed to, and declarations confidently made of “this is an activity that’s beneficial for health”.
See for example:
- Effects of Qigong practice in office workers with chronic non-specific low back pain: A randomized control trial
- Qigong for the Prevention, Treatment, and Rehabilitation of COVID-19 Infection in Older Adults
- Impact of Medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial
…and those are all from respectable journals with meaningful peer review processes.
None of them are placebo-controlled, because there is no real option of “and group B will only be tricked into believing they are doing deep breathing exercises with low-impact movements”; that’s impossible.
But! They each show how doing qigong reliably outperforms not doing qigong for various measurable metrics of health.
And, we chose examples with physical symptoms and where possible empirically measurable outcomes (such as COVID-19 infection levels, or inflammatory responses); there are reams of studies showings qigong improves purely subjective wellbeing—but the latter could probably be claimed for any enjoyable activity, whereas changes in inflammatory biomarkers, not such much.
In short: for most people, it indeed reliably helps with many things. And importantly, it has no particular risks associated with it, and it’s almost universally framed as a complementary therapy rather than an alternative therapy.
This is critical, because it means that whereas someone may hold off on taking evidence-based medicines while trying out (for example) homeopathy, few people are likely to hold off on other treatments while trying out qigong—since it’s being viewed as a helper rather than a Hail-Mary.
Want to read more about qigong?
Here’s the NIH’s National Center for Complementary and Integrative Health has to say. It cites a lot of poor quality science, but it does mention when the science it’s citing is of poor quality, and over all gives quite a rounded view:
Enjoy!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Younger You – by Kara Fitzgerald
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
First, a note about the author: she is a naturopathic doctor, a qualification not recognized in most places. Nevertheless, she clearly knows a lot of stuff, and indeed has been the lead research scientist on a couple of studies, one of which was testing the protocol that would later go into this book.
Arguably, there’s a conflict of interest there, but it’s been peer reviewed and the science seems perfectly respectable. After an 8-week interventional trial, subjects enjoyed a reversal of DNA methylation (one of various possible markers of biological aging) comparable to being 3 years younger.
Where the value of this book lies is in optimizing one’s diet in positive fashion. In other words, what to include rather than what to exclude, but the “include” list is quite extensive so you’re probably not going to be reaching for a donut by the time you’ve eaten all that. In particular, she’s optimized the shopping list for ingredients that contain her DNA methylation superstars most abundantly; those nutrients being: betaine choline, curcumin, epigallocatechin gallate, quercetin, rosmarinic acid, and vitamins B9 and B12.
To make this possible, she sets out not just shopping list but also meal plans, and challenges the reader to do an 8-week intervention of our own.
Downside: it is quite exacting if you want to follow it 100%.
Bottom line: this is a very informative, science-based book. It can make you biologically younger at least by DNA methylation standards, if the rather specific diet isn’t too onerous for you.
Click here to check out Younger You, and enjoy a younger you!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
