Ultra-Processed People – by Dr. Chris van Tulleken

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It probably won’t come as a great surprise to any of our readers that ultra-processed food is—to make a sweeping generalization—not fabulous for the health. So, what does this book offer beyond that?

Perhaps this book’s greatest strength is in showing not just what ultra-processed foods are, but why they are. In principle, food being highly processed should be neither good nor bad by default. Much like GMOs, if a food is modified to be more nutritious, that should be good, right?

Only, that’s mostly not what happens. What happens instead is that food is modified (be it genetically or by ultra-processing) to be cheaper to produce, and thus maximise the profit margin.

The addition of a compound that increases shelf-life but harms the health, increases sales and is a net positive for the manufacturer, for instance. Dr. van Tulleken offers us many, many, examples and explanations of such cost-cutting strategies at our expense.

In terms of qualifications, the author has an MD from Oxford, and also a PhD, but the latter is in molecular virology; not so relevant here. Yet, we are not expected to take an “argument from authority”, and instead, Dr. van Tulleken takes great pains to go through a lot of studies with us—the good, the bad, and the misleading.

If the book has a downside, then this reviewer would say it’s in the format; it’s less a reference book, and more a 384-page polemic. But, that’s a subjective criticism, and for those who like that sort of thing, that is the sort of thing that they like.

Click here to check out Ultra-Processed People, and understand better what you are putting in your body!

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Recommended

  • The Autoimmune Cure – by Dr. Sara Gottfried
  • Indistractable – by Nir Eyal
    Conquer distractions with psychological tactics that outperform typical app solutions, promising focus on tasks and time for loved ones—’Indistractable’ offers next-level focus strategies.

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  • What Teas To Drink Before Bed (By Science!)

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    Which Sleepy Tea?

    Herbal “tea” preparations (henceforth we will write it without the quotation marks, although these are not true teas) are popular for winding down at the end of a long day ready for a relaxing sleep.

    Today we’ll look at the science for them! We’ll be brief for each, because we’ve selected five and have only so much room, but here goes:

    Camomile

    Simply put, it works and has plenty of good science for it. Here’s just one example:

    ❝Noteworthy, our meta-analysis showed a significant improvement in sleep quality after chamomile administration❞

    ~ Dr. Hieu et al.

    Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials

    Also this writer’s favourite relaxation drink!

    (example on Amazon if you want some)

    Lavender

    We didn’t find robust science for its popularly-claimed sedative properties, but it does appear to be anxiolytic, and anxiety gets in the way of sleep, so while lavender may not be a sedative, it may calm a racing mind all the same, thus facilitating better sleep:

    The effect of lavender herbal tea on the anxiety and depression of the elderly: A randomized clinical trial

    (example on Amazon if you want some)

    Magnolia

    Animal study for the mechanism:

    Magnolol, a major bioactive constituent of the bark of Magnolia officinalis, induces sleep via the benzodiazepine site of GABA(A) receptor in mice

    Human study for “it is observed to help humans sleep better”:

    A randomized controlled pilot study of the effectiveness of magnolia tea on alleviating depression in postnatal women

    As you can see from the title, its sedative properties weren’t the point of the study, but if you click through to read it, you can see that they found (and recorded) this benefit anyway

    (example on Amazon if you want some)

    Passionflower

    There’s not a lot of evidence for this one, but there is some. Here’s a small study (n=41) that found:

    ❝Of six sleep-diary measures analysed, sleep quality showed a significantly better rating for passionflower compared with placebo (t(40) = 2.70, p < 0.01). These initial findings suggest that the consumption of a low dose of Passiflora incarnata, in the form of tea, yields short-term subjective sleep benefits for healthy adults with mild fluctuations in sleep quality.❞

    ~ Dr. Ngan & Dr. Conduit

    A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata (passionflower) herbal tea on subjective sleep quality

    So, that’s not exactly a huge body of evidence, but it is promising.

    (example on Amazon if you want some)

    Valerian

    We’ll be honest, the science for this one is sloppy. It’s very rare to find Valerian tested by itself (or sold by itself; we had to dig a bit to find one for the Amazon link below), and that skews the results of science and renders any conclusions questionable.

    And the studies that were done? Dubious methods, and inconclusive results:

    Valerian Root in Treating Sleep Problems and Associated Disorders-A Systematic Review and Meta-Analysis

    Nevertheless, if you want to try it for yourself, you can do a case study (i.e., n=1 sample) if not a randomized controlled trial, and let us know how it goes 🙂

    (example on Amazon if you want some)

    Summary

    • Valerian we really don’t have the science to say anything about it
    • Passionflower has some nascent science for it, but not much
    • Lavender is probably not soporific, but it is anxiolytic
    • Magnolia almost certainly helps, but isn’t nearly so well-backed as…
    • Camomile comes out on top, easily—by both sheer weight of evidence, and by clear conclusive uncontroversial results.

    Enjoy!

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  • Almonds vs Walnuts – Which is Healthier?

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    Our Verdict

    When comparing almonds to walnuts, we picked the almonds.

    Why?

    It wasn’t just our almond bias, but it was close!

    In terms of macros, the main important differences are:

    • Almonds are higher in protein
    • Walnuts are higher in fats (they are healthy fats)

    So far, so even.

    In terms of vitamins, both are rich in many vitamins; mostly the same ones. However, walnuts have more of most of the B vitamins (except for B2 and B3, where almonds win easily), and almonds have more vitamin E by several orders of magnitude.

    So far, so balanced.

    Almonds have slightly more choline.

    Almonds have a better mineral profile, with more of most minerals that they both contain, and especially, a lot more calcium.

    Both nuts have [sometimes slightly different, but] comparable benefits against diabetes, cancer, neurodegeneration, and other diseases.

    In summary

    This one’s close. After balancing out the various “almonds have this but walnuts have that” equal-but-different benefits, we’re going to say almonds take first place by virtue of the better mineral profile, and more choline.

    But: enjoy both!

    Learn more

    You might like this previous article of ours:

    Why You Should Diversify Your Nuts

    Take care!

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  • Sleep wrinkles are real. Here’s how they leave their mark

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    You wake up, stagger to the bathroom and gaze into the mirror. No, you’re not imagining it. You’ve developed face wrinkles overnight. They’re sleep wrinkles.

    Sleep wrinkles are temporary. But as your skin loses its elasticity as you age, they can set in.

    Here’s what you can do to minimise the chance of them forming in the first place.

    How side-sleeping affects your face

    Your skin wrinkles for a number of reasons, including ageing, sun damage, smoking, poor hydration, habitual facial expressions (such as grinning, pouting, frowning, squinting) and sleeping positions.

    When you sleep on your side or stomach, your face skin is squeezed and crushed a lot more than if you sleep on your back. When you sleep on your side or stomach, gravity presses your face against the pillow. Your face skin is distorted as your skin is stretched, compressed and pulled in all directions as you move about in your sleep.

    You can reduce these external forces acting on the face by sleeping on your back or changing positions frequently.

    Doctors can tell which side you sleep on by looking at your face

    In a young face, sleep wrinkles are transient and disappear after waking.

    Temporary sleep wrinkles can become persistent with time and repetition. As we age, our skin loses elasticity (recoil) and extensibility (stretch), creating ideal conditions for sleep wrinkles or lines to set in and last longer.

    The time spent in each sleeping position, the magnitude of external forces applied to each area of the face, as well as the surface area of contact with the pillow surface, also affects the pattern and rate of sleep wrinkle formation.

    Skin specialists can often recognise this. People who favour sleeping on one side of their body tend to have a flatter face on their sleeping side and more visible sleep lines.

    Can a night skincare routine avoid sleep wrinkles?

    Collagen and elastin are two primary components of the dermis (inner layer) of skin. They form the skin structure and maintain the elasticity of skin.

    Skin structure
    The dermis is the inner layer of skin. mermaid3/Shutterstock

    Supplementing collagen through skincare routines to enhance skin elasticity can help reduce wrinkle formation.

    Hyaluronic acid is a naturally occurring molecule in human bodies. It holds our skin’s collagen and elastin in a proper configuration, stimulates the production of collagen and adds hydration, which can help slow down wrinkle formation. Hyaluronic acid is one of the most common active ingredients in skincare creams, gels and lotions.

    Moisturisers can hydrate the skin in different ways. “Occlusive” substances produce a thin layer of oil on the skin that prevents water loss due to evaporation. “Humectants” attract and hold water in the skin, and they can differ in their capacity to bind with water, which influences the degree of skin hydration.

    Do silk pillowcases actually make a difference?

    Bed with silk sheets and pillowcases
    Can they help? New Africa/Shutterstock

    Silk pillowcases can make a difference in wrinkle formation, if they let your skin glide and move, rather than adding friction and pressure on a single spot. If you can, use silk sheets and silk pillows.

    Studies have also shown pillows designed to reduce mechanical stress during sleep can prevent skin deformations. Such a pillow could be useful in slowing down and preventing the formation of certain facial wrinkles.

    Sleeping on your back can reduce the risk of sleep lines, as can a nighttime routine of moisturising before sleep.

    Otherwise, lifestyle choices and habits, such quitting smoking, drinking plenty of water, a healthy diet (eating enough vegetables, fruits, nuts, seeds, healthy fats, yogurt and other fermented foods) and regular use of sunscreens can help improve the appearance of the skin on our face.

    Yousuf Mohammed, Dermatology researcher, The University of Queensland; Khanh Phan, Postdoctoral Research Fellow, Frazer Institute, The University of Queensland, and Vania Rodrigues Leite E. Silva, Honorary Associate Professor, Frazer Institute, The University of Queensland

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • The Autoimmune Cure – by Dr. Sara Gottfried
  • The Case of the Armadillo: Is It Spreading Leprosy in Florida?

    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.

    GAINESVILLE, Fla. — In an open-air barn at the edge of the University of Florida, veterinarian Juan Campos Krauer examines a dead armadillo’s footpads and ears for signs of infection.

    Its claws are curled tight and covered in blood. Campos Krauer thinks it was struck in the head while crossing a nearby road.

    He then runs a scalpel down its underside. He removes all the important organs: heart, liver, kidneys. Once the specimens are bottled up, they’re destined for an ultra-cold freezer in his lab at the college.

    Campos Krauer plans to test the armadillo for leprosy, an ancient illness also known as Hansen’s disease that can lead to nerve damage and disfigurement in humans. He and other scientists are trying to solve a medical mystery: why Central Florida has become a hot spot for the age-old bacteria that cause it.

    Leprosy remains rare in the United States. But Florida, which often reports the most cases of any state, has seen an uptick in patients. The epicenter is east of Orlando. Brevard County reported a staggering 13% of the nation’s 159 leprosy cases in 2020, according to a Tampa Bay Times analysis of state and federal data.

    Many questions about the phenomenon remain unanswered. But leprosy experts believe armadillos play a role in spreading the illness to people. To better understand who’s at risk and to prevent infections, about 10 scientists teamed up last year to investigate. The group includes researchers from the University of Florida, Colorado State University, and Emory University in Atlanta.

    “How this transmission is happening, we really don’t know,” said Ramanuj Lahiri, chief of the laboratory research branch for the National Hansen’s Disease Program, which studies the bacteria involved and cares for leprosy patients across the country.

    ‘Nothing Was Adding Up’

    Leprosy is believed to be the oldest human infection in history. It probably has been sickening people for at least 100,000 years. The disease is highly stigmatized — in the Bible, it was described as a punishment for sin. In more modern times, patients were isolated in “colonies” around the world, including in Hawaii and Louisiana.

    In mild cases, the slow-growing bacteria cause a few lesions. If left untreated, they can paralyze the hands and feet.

    But it’s actually difficult to fall ill with leprosy, as the infection isn’t very contagious. Antibiotics can cure the ailment in a year or two. They’re available for free through the federal government and the World Health Organization, which launched a campaign in the 1990s to eliminate leprosy as a public health problem.

    In 2000, reported U.S. cases dropped to their lowest point in decades with 77 infections. But they later increased, averaging about 180 per year from 2011 to 2020, according to data from the National Hansen’s Disease Program.

    During that time, a curious trend emerged in Florida.

    In the first decade of the 21st century, the state logged 67 cases. Miami-Dade County noted 20 infections — the most of any Florida county. The vast majority of its cases were acquired outside the U.S., according to a Times analysis of Florida Department of Health data.

    But over the next 10 years, recorded cases in the state more than doubled to 176 as Brevard County took center stage.

    The county, whose population is about a fifth the size of Miami-Dade’s, logged 85 infections during that time — by far the most of any county in the state and nearly half of all Florida cases. In the previous decade, Brevard noted just five cases.

    Remarkably, at least a quarter of Brevard’s infections were acquired within the state, not while the individuals were abroad. India, Brazil, and Indonesia diagnose more leprosy cases than anywhere, reporting over 135,000 infections combined in 2022 alone. People were getting sick even though they hadn’t traveled to such areas or been in close contact with existing leprosy patients, said Barry Inman, a former epidemiologist at the Brevard health department who investigated the cases and retired in 2021.

    “Nothing was adding up,” Inman said.

    A few patients recalled touching armadillos, which are known to carry the bacteria. But most didn’t, he said. Many spent a lot of time outdoors, including lawn workers and avid gardeners. The cases were usually mild.

    It was difficult to nail down where people got the illness, he added. Because the bacteria grow so slowly, it can take anywhere from nine months to 20 years for symptoms to begin.

    Amoeba or Insect Culprits?

    Heightened awareness of leprosy could play a role in Brevard’s groundswell of cases.

    Doctors must report leprosy to the health department. Yet Inman said many in the county didn’t know that, so he tried to educate them after noticing cases in the late 2000s.

    But that’s not the sole factor at play, Inman said.

    “I don’t think there’s any doubt in my mind that something new is going on,” he said.

    Other parts of Central Florida have also recorded more infections. From 2011 to 2020, Polk County logged 12 cases, tripling its numbers compared with the previous 10 years. Volusia County noted 10 cases. It reported none the prior decade.

    Scientists are honing in on armadillos. They suspect the burrowing critters may indirectly cause infections through soil contamination.

    Armadillos, which are protected by hard shells, serve as good hosts for the bacteria, which don’t like heat and can thrive in the animals whose body temperatures range from a cool 86-95 degrees.

    Colonists probably brought the disease to the New World hundreds of years ago, and somehow armadillos became infected, said Lahiri, the National Hansen’s Disease Program scientist. The nocturnal mammals can develop lesions from the illness just as humans can. More than 1 million armadillos occupy Florida, estimated Campos Krauer, an assistant professor in the University of Florida’s Department of Large Animal Clinical Sciences.

    How many carry leprosy is unclear. A study published in 2015 of more than 600 armadillos in Alabama, Florida, Georgia, and Mississippi found that about 16% showed evidence of infection. Public health experts believe leprosy was previously confined to armadillos west of the Mississippi River, then spread east.

    Handling the critters is a known hazard. Lab research shows that single-cell amoebas, which live in soil, can also carry the bacteria.

    Armadillos love to dig up and eat earthworms, frustrating homeowners whose yards they damage. The animals may shed the bacteria while hunting for food, passing it to amoebas, which could later infect people.

    Leprosy experts also wonder if insects help spread the disease. Blood-sucking ticks might be a culprit, lab research shows.

    “Some people who are infected have little to no exposure to the armadillo,” said Norman Beatty, an assistant professor of medicine at the University of Florida. “There is likely another source of transmission in the environment.”

    Campos Krauer, who’s been searching Gainesville streets for armadillo roadkill, wants to gather infected animals and let them decompose in a fenced-off area, allowing the remains to soak into a tray of soil while flies lay eggs. He hopes to test the dirt and larvae to see if they pick up the bacteria.

    Adding to the intrigue is a leprosy strain found only in Florida, according to scientists.

    In the 2015 study, researchers discovered that seven armadillos from the Merritt Island National Wildlife Refuge, which is mostly in Brevard but crosses into Volusia, carried a previously unseen version of the pathogen.

    Ten patients in the region were stricken with it, too. At the genetic level, the strain is similar to another type found in U.S. armadillos, said Charlotte Avanzi, a Colorado State University researcher who specializes in leprosy.

    It’s unknown if the strain causes more severe disease, Lahiri said.

    Reducing Risk

    The public should not panic about leprosy, nor should people race to euthanize armadillos, researchers warn.

    Scientists estimate that over 95% of the global human population has a natural ability to ward off the disease. They believe months of exposure to respiratory droplets is needed for person-to-person transmission to occur.

    But when infections do happen, they can be devastating.

    “If we better understand it,” Campos Krauer said, “the better we can learn to live with it and reduce the risk.”

    The new research may also provide insight for other Southern states. Armadillos, which don’t hibernate, have been moving north, Campos Krauer said, reaching areas like Indiana and Virginia. They could go farther due to climate change.

    People concerned about leprosy can take simple precautions, medical experts say. Those working in dirt should wear gloves and wash their hands afterward. Raising garden beds or surrounding them with a fence may limit the chances of soil contamination. If digging up an armadillo burrow, consider wearing a face mask, Campos Krauer said.

    Don’t play with or eat the animals, added John Spencer, a scientist at Colorado State University who studies leprosy transmission in Brazil. They’re legal to hunt year-round in Florida without a license.

    Campos Krauer’s team has so far examined 16 dead armadillos found on Gainesville area roads, more than 100 miles from the state’s leprosy epicenter, trying to get a preliminary idea of how many carry the bacteria.

    None has tested positive yet.

    This article was produced through a partnership between KFF Health News and the Tampa Bay Times.

    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.

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  • Inverse Vaccines for Autoimmune Diseases

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    Inverse Vaccines for Autoimmune Diseases

    This is Dr. Jeffrey Hubbell. He’s a molecular engineer, with a focus on immunotherapy, immune response, autoimmune diseases, and growth factor variants.

    He’s held 88 patents, and was the recipient of the Society for Biomaterials’ Founders Award for his “long-term, landmark contributions to the discipline of biomaterials”, amongst other awards and honours that would make our article too long if we included them all.

    And, his latest research has been about developing…

    Inverse Vaccines

    You may be thinking: “you mean diseases; he’s engineering diseases?”

    And no, it’s not that. Here’s how it works:

    Normally in the case of vaccine, it’s something to tell the body “hey, if you see something that looks like this, you should kill it on sight” and the body goes “ok, preparing countermeasures according to these specifications; thanks for the heads-up”

    In the case of an inverse vaccine, it’s the inverse. It’s something to tell the body “hey, this thing you seem to think is a threat, it’s actually not, and you should leave it alone”.

    Why this matters for people with autoimmune diseases

    Normally, autoimmune diseases are treated in one or more of the following ways:

    • Dampen the entire immune system (bad for immunity against actual diseases, obviously, and is part of why many immunocompromised people have suffered and died disproportionately from COVID, for example)
    • Give up and find a workaround (a good example of this is Type 1 Diabetes, and just giving up on the pancreas not being constantly at war with itself, and living on exogenous insulin instead)

    Neither of those are great.

    What inverse vaccines do is offer a way to flag the attacked-in-error items as acceptable things to have in the body. Those might be things that are in our body by default, as in the case of many autoimmune diseases, or they may even be external items that should be allowed but aren’t, as in the case of gluten, in the context of Celiac disease.

    The latest research is not yet accessible for free, alas, but you can read the abstract here:

    Synthetically glycosylated antigens for the antigen-specific suppression of established immune responses

    Or if you prefer a more accessible pop-science approach, here’s a great explanatory article:

    “Inverse vaccine” shows potential to treat multiple sclerosis and other autoimmune diseases

    Where can we get such inverse vaccines?

    ❝There are no clinically approved inverse vaccines yet, but we’re incredibly excited about moving this technology forward❞

    ~ Dr. Jeffrey Hubbell

    But! Lest you be disappointed, you can get in line already, in the case of the Celiac disease inverse vaccine, if you’d like to be part of their clinical trial:

    Click here to see if you are eligible to be part of their clinical trial

    If you’re not up for that, or if your autoimmune disease is something else (most of the rest of their research is presently focusing on Multiple Sclerosis and Type 1 Diabetes), then:

    • The phase 1 MS trial is currently active, estimated completion in summer 2024.
    • They are in the process of submitting an investigational new drug (IND) application for Type 1 Diabetes
      • This is the first step to starting clinical safety and efficacy trials

    …so, watch this space!

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  • Mammography AI Can Cost Patients Extra. Is It Worth It?

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    As I checked in at a Manhattan radiology clinic for my annual mammogram in November, the front desk staffer reviewing my paperwork asked an unexpected question: Would I like to spend $40 for an artificial intelligence analysis of my mammogram? It’s not covered by insurance, she added.

    I had no idea how to evaluate that offer. Feeling upsold, I said no. But it got me thinking: Is this something I should add to my regular screening routine? Is my regular mammogram not accurate enough? If this AI analysis is so great, why doesn’t insurance cover it?

    I’m not the only person posing such questions. The mother of a colleague had a similar experience when she went for a mammogram recently at a suburban Baltimore clinic. She was given a pink pamphlet that said: “You Deserve More. More Accuracy. More Confidence. More power with artificial intelligence behind your mammogram.” The price tag was the same: $40. She also declined.

    In recent years, AI software that helps radiologists detect problems or diagnose cancer using mammography has been moving into clinical use. The software can store and evaluate large datasets of images and identify patterns and abnormalities that human radiologists might miss. It typically highlights potential problem areas in an image and assesses any likely malignancies. This extra review has enormous potential to improve the detection of suspicious breast masses and lead to earlier diagnoses of breast cancer.

    While studies showing better detection rates are extremely encouraging, some radiologists say, more research and evaluation are needed before drawing conclusions about the value of the routine use of these tools in regular clinical practice.

    “I see the promise and I hope it will help us,” said Etta Pisano, a radiologist who is chief research officer at the American College of Radiology, a professional group for radiologists. However, “it really is ambiguous at this point whether it will benefit an individual woman,” she said. “We do need more information.”

    The radiology clinics that my colleague’s mother and I visited are both part of RadNet, a company with a network of more than 350 imaging centers around the country. RadNet introduced its AI product for mammography in New York and New Jersey last February and has since rolled it out in several other states, according to Gregory Sorensen, the company’s chief science officer.

    Sorensen pointed to research the company conducted with 18 radiologists, some of whom were specialists in breast mammography and some of whom were generalists who spent less than 75% of their time reading mammograms. The doctors were asked to find the cancers in 240 images, with and without AI. Every doctor’s performance improved using AI, Sorensen said.

    Among all radiologists, “not every doctor is equally good,” Sorensen said. With RadNet’s AI tool, “it’s as if all patients get the benefit of our very top performer.”

    But is the tech analysis worth the extra cost to patients? There’s no easy answer.

    “Some people are always going to be more anxious about their mammograms, and using AI may give them more reassurance,” said Laura Heacock, a breast imaging specialist at NYU Langone Health’s Perlmutter Cancer Center in New York. The health system has developed AI models and is testing the technology with mammograms but doesn’t yet offer it to patients, she said.

    Still, Heacock said, women shouldn’t worry that they need to get an additional AI analysis if it’s offered.

    “At the end of the day, you still have an expert breast imager interpreting your mammogram, and that is the standard of care,” she said.

    About 1 in 8 women will be diagnosed with breast cancer during their lifetime, and regular screening mammograms are recommended to help identify cancerous tumors early. But mammograms are hardly foolproof: They miss about 20% of breast cancers, according to the National Cancer Institute.

    The FDA has authorized roughly two dozen AI products to help detect and diagnose cancer from mammograms. However, there are currently no billing codes radiologists can use to charge health plans for the use of AI to interpret mammograms. Typically, the federal Centers for Medicare & Medicaid Services would introduce new billing codes and private health plans would follow their lead for payment. But that hasn’t happened in this field yet and it’s unclear when or if it will.

    CMS didn’t respond to requests for comment.

    Thirty-five percent of women who visit a RadNet facility for mammograms pay for the additional AI review, Sorensen said.

    Radiology practices don’t handle payment for AI mammography all in the same way.

    The practices affiliated with Boston-based Massachusetts General Hospital don’t charge patients for the AI analysis, said Constance Lehman, a professor of radiology at Harvard Medical School who is co-director of the Breast Imaging Research Center at Mass General.

    Asking patients to pay “isn’t a model that will support equity,” Lehman said, since only patients who can afford the extra charge will get the enhanced analysis. She said she believes many radiologists would never agree to post a sign listing a charge for AI analysis because it would be off-putting to low-income patients.

    Sorensen said RadNet’s goal is to stop charging patients once health plans realize the value of the screening and start paying for it.

    Some large trials are underway in the United States, though much of the published research on AI and mammography to date has been done in Europe. There, the standard practice is for two radiologists to read a mammogram, whereas in the States only one radiologist typically evaluates a screening test.

    Interim results from the highly regarded MASAI randomized controlled trial of 80,000 women in Sweden found that cancer detection rates were 20% higher in women whose mammograms were read by a radiologist using AI compared with women whose mammograms were read by two radiologists without any AI intervention, which is the standard of care there.

    “The MASAI trial was great, but will that generalize to the U.S.? We can’t say,” Lehman said.

    In addition, there is a need for “more diverse training and testing sets for AI algorithm development and refinement” across different races and ethnicities, said Christoph Lee, director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington School of Medicine. 

    The long shadow of an earlier and largely unsuccessful type of computer-assisted mammography hangs over the adoption of newer AI tools. In the late 1980s and early 1990s, “computer-assisted detection” software promised to improve breast cancer detection. Then the studies started coming in, and the results were often far from encouraging. Using CAD at best provided no benefit, and at worst reduced the accuracy of radiologists’ interpretations, resulting in higher rates of recalls and biopsies.

    “CAD was not that sophisticated,” said Robert Smith, senior vice president of early cancer detection science at the American Cancer Society. Artificial intelligence tools today are a whole different ballgame, he said. “You can train the algorithm to pick up things, or it learns on its own.”

    Smith said he found it “troubling” that radiologists would charge for the AI analysis.

    “There are too many women who can’t afford any out-of-pocket cost” for a mammogram, Smith said. “If we’re not going to increase the number of radiologists we use for mammograms, then these new AI tools are going to be very useful, and I don’t think we can defend charging women extra for them.”

    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.

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