Health Care AI, Intended To Save Money, Turns Out To Require a Lot of Expensive Humans
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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.
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What is a ‘dopamine detox’? And do I need one?
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Advice about cutting down on dopamine is everywhere right now. From “dopamine fasting” to “anti-dopamine parenting” and even “raw-dogging” flights (going without any screens, books or music), TikTok influencers claim these practices have rewired their brains.
Modern life constantly bombards our brains with stimulation, through scrolling feeds, video games, email pings and sugary snacks. This keeps dopamine – the neurotransmitter linked to reward and motivation – in steady circulation.
Over time, this constant activation can leave us desensitised, chasing even more stimulation just to feel “normal”. Everyday life begins to seem bland by comparison.
So it’s no surprise people have tried to come up with ways to reset their dopamine and change their behaviour. But do these strategies actually work?
d3sign/Getty Images Can you actually detox from dopamine?
No, you can never actually “detox” from dopamine itself. A detox involves eliminating a chemical from your body. If you go through an alcohol detox, for example, you stop drinking and allow your body to rid itself of alcohol-related toxins.
In the context of dopamine, a detox is impossible. Dopamine is naturally occurring and plays a significant role in various aspects of human physiology. It’s involved in the pleasure and reward centre of the brain, as well as in motivation, movement, arousal and sleep.
If we were to completely detox from dopamine, we wouldn’t be able to function, let alone stay alive.
“Dopamine detoxes” have involved people intentionally avoiding behaviours or substances that trigger quick bursts of dopamine, such as gaming, social media, sugary foods or online shopping. These “pleasure detoxes” usually occur over a short, set period of time: around 24 hours.
A 24-hour dopamine detox might feel hard and like something significant is happening. People report uncomfortable urges, cravings and sometimes even feelings of fatigue, anxiety or irritability during the process. The discomfort can lead some to believe that they are successfully “resetting” their brains.
While a dopamine detox may feel intense, most people won’t experience any meaningful, lasting improvements by abstaining for a day or two. Dopamine regulation is a complex process influenced by many factors, and it doesn’t undergo a sudden reset in a short 24-hour period.
Research suggests that after the period of abstinence, old habits and urges often return, unless people actively build new routines and coping strategies that engage healthier reward pathways.
So what can you do instead?
If you want to change your relationship with dopamine-driven behaviours or substances, be prepared for this to take longer that 24 hours.
Substituting “fast dopamine” rewards with “slow dopamine” activities can gradually restore the brain’s sensitivity to pleasure and help life feel rich again.
This might involve returning to activities that naturally require more patience and effort, such as creative projects, exercising or learning something new.
But it can also include other pleasurable experiences, such as connecting with someone face-to-face, or listening to music you love.
These activities can activate dopamine pathways, as well as the release of other neurotransmitters, such as oxytocin and serotonin, which contribute to a positive mood.
The popularity of dopamine detoxes reflects a desire to feel better, regain motivation and reconnect with pleasures in a world overloaded by stimulation. But there’s no reset button for the brain’s dopamine system. Luckily, we can switch to longer-term rewards from movement, music, connection and stretching ourselves in other ways.
Anastasia Hronis, Clinical Psychologist, Lecturer and Research Supervisor, Graduate School of Health, University of Technology Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Feel-Good Productivity – by Dr. Ali Abdaal
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“Rise and grind” is not a sustainable way to live. Yet for most of us, there are things we do have to do every day that we don’t necessarily do for fun. So, how to be productive with those things, and not feel like we are constantly compromising and sacrificing our time on this earth for some intrinsically trivial but extrinsically required activity that’ll be forgotten tomorrow?
And most of us do also have dreams and ambitions (and if you don’t, then what were they before life snatched them away from you?), things to work towards. So there is “carrot” for us as well as “stick”. But how to break the cycle and get more carrot and less stick, while being more productive than before?
Dr. Abdaal frames this principally in terms of neurology first, psychology next.
That when we are bored, we simply do not have the neurochemicals required to work well anyway, so addressing that first needs to be a priority. He lays out many ways of doing this, gives lots of practical tips, and brings attention to the ways it’s easy to go wrong (and how to fix those too).
The writing style isdeceptively relaxed and casual, leading the reader smoothly into understanding of each topic before moving on.
Bottom line: if you want to get more done while feeling better about it (not a tired wreck), then this is the book for you!
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6 ways to talk to your teens about sex without the cringe
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Parents play an important role in teaching their children about sex and relationships. But our new report shows many parents – fathers in particular – find it mortifying.
Our national survey of 1,918 parents shows they are most likely to be very confident talking with children about body image (45%) and puberty (38%) and least confident talking about masturbation (12%) or sexual satisfaction (13%).
Mothers are more likely than fathers to start discussions about sex (32.3% vs 23.9%).
Our survey confirms the most common barriers to discussing sex with children are children feeling uncomfortable or refusing to engage. But parents are uncomfortable too, fearing they’ll say the wrong thing, and not knowing how to start the conversation.
But if a teenager knows their parents are up for non-judgemental discussions about sex, they’ll be more likely to share what is happening in their lives, ask questions and seek help when they need it.
Here’s how to start those discussions, even if you feel awkward.
Kamonwan Wankaew/Getty Our top tips for talking about sex
1. Start when children are young. “The sex talk” is not one single conversation. Parents should aim to open the door to ongoing, age-appropriate dialogue about issues related to bodies, reproduction and puberty when children are young. Even children under five should be learning about their bodies and the basics of reproduction.
Starting conversations when kids are young will make it easier to continue into the teenage years. But it’s never too late. Children will benefit from parents engaging with them on these issues at any age.
2. Find everyday opportunities to ask questions. Television, movies and radio mention sex and relationships all the time.
For instance, issues relating to young people viewing pornography or the impact of social media are regular features on the news. Use these opportunities to ask teenagers what they understand, know or think. Show interest in your teenager’s opinion and ask questions about how this portrayal fits with their experiences or that of their friends.
The conversation doesn’t need to lead to a specific message or outcome. The purpose is to talk and listen.
3. Try not to lead with what not to do. Telling a young person not to have sex or watch pornography is unlikely to stop them doing it and may shut down future conversation. Many young people become sexually active from around 15 to 17 years of age and a majority have viewed pornography at least once by this age.
The best we can do is support them to think carefully and critically about what they need to stay safe. Let them know you can help with things such as finding a good doctor if they need advice on contraception or sexual health care.
4. Tell your teenagers stories about yourself. Young people don’t always appreciate being reminded their parents were once teenagers, but they might be interested in a story about your first relationship, first kiss or an embarrassing date. Showing your own vulnerability may help open dialogue on these topics.
If you aren’t comfortable telling stories about yourself, perhaps tell stories you have read or heard about in the news.
5. Own your embarrassment. It is hard to talk about intimate or embarrassing topics. For some people even saying the word “masturbation” is uncomfortable, let alone speaking with children or teenagers about it.
Keeping it light and being prepared to laugh at your own awkwardness can help break the ice for both you and your teenager.
6. Do some reading and practise talking about it. Most of us don’t have a lot of experience talking intimately about sex or relationships. Do some research on topics you would like to speak with your teenagers about and then have a chat to your partner or a friend about it.
The aim is to get more comfortable talking about things we don’t often talk about. You don’t have to be an expert, you just have to give it a go.
Will talking about sex encourage my child to do it?
Parents are often told they need to be “sex positive” when talking to teenagers about sex. This doesn’t mean avoiding talking about risks and responsibilities. Rather, it means holding the perspective that, in the right circumstances, sex can be a safe, enjoyable and positive part of a young person’s life.
Talking about sex will not encourage a young person to have sex before they are ready.
Teaching young people about sexual consent relies on valuing pleasure. If someone can understand, and articulate, what they like and want, they will be in a stronger position to assert what they do not want. Young people should be encouraged to tune into what they, and their partner, enjoy and value when it comes to sex.
Sexual health messages for young people often focus on dangers and negative outcomes. It can be easy to forget that sex education should also be about supporting young people to have safe and enjoyable sex when they are ready. Parents play a key role in delivering this message.
Talk soon. Talk often: A guide for parents to talk to their kids about sex helps parents judge age-appropriate information and how to talk about it.
Jennifer Power, Principal Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe University; Alexandra James, Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe University, and Thomas Norman, Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Drug & Supplement Combo That Reverses Aging
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So far, its effects have been dramatic (in a good way) in mice; human trials are now underway.
How does it work?
It builds from previous work, in which a Japanese research team created an “anti-aging vaccine”, that responded to a problem more specific than aging as a whole, namely atherosclerosis.
They found that a certain* protein was upregulated (i.e., it was made at a greater rate resulting in greater quantities) in patients (mouse and human alike) with atherosclerosis. So, they immunized the mice against that protein, and long story short, everything improved for them, from their atherosclerosis to general markers of aging—including growing back fur that had been lost due to age-related balding (just like in humans). They also lived longer, as is to be expected of a mouse who is now biologically younger.
*To avoid being mysterious: it was glycoprotein nonmetastatic melanoma protein B, known to its friends as GPNMB.
You may be wondering: how can one be immunized against a protein? If so, do bear in mind, a virus is also a protein. In this case, they developed an RNA vaccine, that works in a similar way to the COVID vaccines we all know and love (albeit with a different target).
You can read about this in abundant detail here: Senolytic vaccination improves normal and pathological age-related phenotypes and increases lifespan in progeroid mice
Hot on the heels of that, new approaches were found, including…
The combination
We’ll not keep you waiting; the combination is dasatinib plus quercetin, or else fisetin alone.
It’s about killing senescent (aging) “zombie cells” while sparing healthy cells, which that drug (dasatinib) and those supplements (quercetin and fisetin) do.
The researchers noted:
❝Senescent cells are resistant to apoptosis, which is governed through the upregulation of senescent cell anti-apoptotic pathways (SCAPs). Compounds were subsequently identified that disrupted the SCAPs, inducing death of senescent cells while leaving healthy cells unaffected. Forty-six potential senolytic agents were discovered through this process. To advance translational efforts, the majority of research has focused on agents with known safety profiles and limited off-target effects (Kirkland and Tchkonia, 2020).
The best characterized senolytic agents are dasatinib, a tyrosine kinase inhibitor approved for use in humans for cancer treatment, and quercetin, a naturally occurring plant flavonoid. The agents have a synergistic effect, making their combination more potent for senescent cell clearance (Zhu et al., 2015). As senescent cells do not divide and accumulate over a period of weeks, they can be administered using an intermittent approach, which further serves to reduce the risk of side effects (Kirkland and Tchkonia, 2020).
In preclinical trials, the combination of dasatinib and quercetin (D + Q) have been found to alleviate numerous chronic medical conditions including vascular stiffness, osteoporosis, frailty, and hepatic stenosis❞
Source: A geroscience motivated approach to treat Alzheimer’s disease: Senolytics move to clinical trials
As to how they expanded on this research:
❝In our study, oral D + Q were intermittently administered to tau transgenic mice with late-stage pathology (approximated to a 70-year-old human with advanced AD) (Musi et al., 2018). The treatment effectively reduced cellular senescence and associated senescence-associated secretory phenotype incidence. The 35 % reduction in neurofibrillary tangles was accompanied by enhanced neuron density, decreased ventricular enlargement, diminished tau accumulation, and restoration of aberrant cerebral blood flow. A subsequent preclinical study validated the findings, reporting that intermittently administered D + Q cleared senescent cells in the central nervous system, reduced amyloid-β plaques, attenuated neuroinflammation, and enhanced cognition❞
Source: Ibid.
And now taking it to humans:
❝The first clinical trial of D + Q for early-stage Alzheimer’s Disease (AD) has completed enrollment (Gonzales et al., 2021). The primary aim of the open-label pilot study was to examine the central nervous system penetrance of D and Q in a small sample of older adults with early-stage AD (NCT04063124). In addition, two placebo-controlled trials of D + Q for neurodegenerative disease are underway (NCT04685590 and NCT04785300).
One of the trials in development is a multi-site, double-blind, randomized, placebo-controlled study of senolytic therapy in older adults with amnestic mild cognitive impairment (MCI) or early-stage dementia (Clinical Dementia Rating Scale (CDR) Global 0.5–1) due to AD (elevated CSF total tau/Aβ42 ratio).
The treatment regimen will consist of 12-weeks of intermittently administered oral D + Q.❞
Source: Ibid.
The study is actually completed now, but its results are not yet published (again, at time of writing). Which means: they have the data, and now they’re writing the paper.
We look forward to providing an update about that, when the paper is published!
In the meantime…
Dasatinib is a drug usually prescribed to people with certain kinds of leukemia, and suffice it to say, it’s prescription-only. And unlike drugs that are often prescribed off-label (such as metformin for weight loss), getting your doctor to prescribe you an anticancer drug is unlikely unless you have the cancer in question.
You may be wondering: how is an anticancer drug helpful against aging? And the answer is that cancer and aging are very interrelated, and both have to do with “these old cells just won’t die, and are using the resources needed for young healthy cells”. So in both cases, killing those “zombie cells” while sparing healthy ones, is what’s needed. However, your doctor will probably not buy that as a reason to prescribe you a drug that is technically chemotherapy.
Quercetin, on the other hand, is a readily-available supplement, as is fisetin, and both have glowing (in a good way) safety profiles.
Want to know more?
You can read more about each of quercetin and fisetin (including how to get them), here:
Enjoy!
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Do You Have Anosognosia?
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This is Dr. Ian McDonough. He’s a postdoctoral neuroscience research fellow and psychology professor, specializing in episodic memory, aging, and biomarkers of pre-clinical Alzheimer’s disease.
What does he want us to know?
As we get older, most of us tend to have fairly accurate perceptions of our financial abilities, and this awareness tends to improve with age and experience—until cognitive decline begins.
This was brought to light by a study he led, that analyzed 10 years of data from 2,802 older adults (age 65+). Participants rated their perceived ability in tasks like making change and paying bills, then performed actual financial tasks to test their competence.
Older adults in their 70s were better able to predict their financial performance than younger “older adults”, which the researchers noted was probably because…
❝It does seem people get better with time. So, by the time you get to your 70s, as long as you maintain your cognition decently well, you’re able to predict your financial ability slightly better. It’s almost like you do learn as you get more and more experience, especially as you retire, and you’re dealing with Social Security, Medicaid, Medicare and all those types of things that have to do with finances.❞
~ Dr. Ian McDonough
However! Cognitive decline disrupts this accuracy; people with cognitive decline (especially if progressing to dementia) often lose insight into their financial abilities, believing they’re more competent than they are—due to a condition called anosognosia, where one is unaware of one’s own cognitive impairment.
Which is reasonable, really. The very mental faculties that would normally clue us in to noticing our decline in a certain area, have been hit by the cognitive decline too.
This becomes a problem, because it then leaves people more vulnerable to suffering financial losses, either by maladministration of their affairs, or by falling prey to scams.
You can find the paper here: Relationship Between Perceived and Objective Financial Abilities Among Older Adults: Results From the Advanced Cognitive Training for Independent and Vital Elderly Cohort
What should we do about it?
According to Dr. McDonough,
❝Our research suggests that there is a critical window of time after people begin to experience cognitive decline during which they are still aware of their financial abilities. We believe that this is when people can take action to secure their finances and develop systems to protect themselves from fraud❞
We wrote about this a little before, in the context of planning around an Alzheimer’s diagnosis: Alzheimer’s: The Bad News And The Good
We also covered the topic of a “Living Will”, to enact if you are no longer considered able to advocate for yourself, here: Managing Your Mortality: When Planning Is a Matter of Life and Death ← while the title does not herald a cheerful prognosis, we promise we do also talk about living wills and such too!
This may particularly important in people with Parkinson’s disease, because of The Meds That Impair Decision-Making
Delegating to others is an obvious (and often reasonable) solution, but it can come with problems, because of such things as:
- Transitions in financial autonomy and risk for financial elder abuse, and
- Coping with Age-related Threats to Role Identity: Older Couples and the Management of Household Money
However, there are other options! For example:
Short version: it works! You can read a pop-science rendering of things, here:
Wondering how good your cognitive abilities are, and what that means in terms of dementia risk?
It’s actually quite identifiable, if one knows what things “count” and what things don’t:
Is It Dementia? Spot The Signs (Because None Of Us Are Immune)
Take care!
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Hold The Banana!
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Bananas are a healthy fruit for most people (there is such a thing as a banana allergy, so we can’t extend it to all people, but certainly most people).
Full of fiber, carbs for energy, vitamins and minerals, and a stack of nutritious phytochemicals.
One thing we will quickly say as a small counterpoint, which isn’t the main point of today’s article but is worth mentioning: the claim of bananas being “a good source of potassium” is true but greatly overstated; they’re not even in the top 10 of fruits for potassium; just, it was mentioned in a popular TV show, referenced in another popular TV show, and then the English-speaking world never let it go.
But that’s just a minor “not quite as good as people make it out to be” thing, rather than an actual negative.
So, what’s the problem with bananas?
It’s about polyphenol oxidase (PPO)
Researchers (Dr. Jodi Ensunsa et al.) found that adding bananas to berry smoothies drastically reduced flavanol absorption, with blood levels dropping by about 84% compared with a flavanol capsule or a low-PPO berry smoothie.
Quick recap on what flavanols are: flavanols are a kind of polyphenolic plant compounds linked to cardiovascular and cognitive health, that are found in foods like blueberries, blackberries, grapes, apples, pears, tea, and cocoa.
See for example: Are You Getting The Right Kinds Of Flavonoids? ← flavanols are a kind of flavonoid
Why bananas had this effect: bananas contain high amounts of polyphenol oxidase (PPO), which (as you might have guessed) mediates the oxidation of polyphenols; it’s the enzyme responsible for the browning of cut fruit, and the researchers believe PPO breaks down flavanols before your body can absorb them.
What the study tested: healthy participants consumed:
- a banana-based smoothie with high PPO activity
- a mixed berry smoothie with low PPO activity
- a flavanol capsule control
What they saw in the results: the berry smoothie produced flavanol absorption similar to the capsule control, while the banana smoothie produced much lower levels of flavanol metabolites in blood samples.
Also! A surprising follow-up finding: even when flavanols and banana were kept separate until consumption, absorption was still reduced, suggesting that PPO continues degrading flavanols in the stomach after ingestion.
You can read the paper in full, here: Impact of polyphenol oxidase on the bioavailability of flavan-3-ols in fruit smoothies: a controlled, single blinded, cross-over study
Quick note before we move on: no, the study doesn’t mean bananas are unhealthy; bananas still provide many wonderful nutrients; it’s just that they don’t pair well with flavanol-rich foods if maximizing flavanol intake is your goal 🙂
Want to learn more?
On a similar topic (it has many important bits of information like the one we discussed today), you might like to check out:
Make Your Vegetables Work Better Nutritionally
As for why you might want to favor getting it from food if you can, then while the title says “vitamins”, this book discusses an assortment of vitamins, minerals, and other nutrients; the “other nutrients” category including amino acids (branched chain and essential), prebiotics and probiotics, and triglycerides of various kinds:
Eat Your Vitamins – by Mascha Davis, RDN ← see our review, here
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