Ben Genovese, MD

Married to @jessicacole22, Father of three Anesthesiology Fellow @TexasChildrens🫀 hic sunt leones

[Sensible Medicine @Sensible__Med]

It's not slop because it doesn't change practice: it's slop because:
Has no control arm
Has inappropriate control arm
Has inappropriate time zero
Does not properly address confounding
Does not properly discuss residual confounding
Is unable to be replicated
1/3

[Crémieux @cremieuxrecueil]

I win again!

Newly-released Swedish data shows that the rise in autism between 2001 and 2020 was...

ENTIRELY attributable to an increase in cases WITHOUT intellectual disability—less severe cases than used to be the norm!

The autism epidemic is not real: we just diagnose more.

[Crémieux @cremieuxrecueil]

10 points if you see the identification problem.

[Joseph Younis, MD @YounisJoseph]

Let me make a few important qualifications:
1. First and foremost, the COIs: One of the authors is the CEO of Curai Health, which unsurprisingly is a AI physician startup. Another author is the investor in Curai Health.

2. "Published" is actually an overestimation of the qualitative threshold of this "review": This is, in fact and contrary to the paper's claim, NOT a "review" or "of all published articles on AI in medicine since Jan 1 2024." There is no review methodology, databases searched, search queries/strings, inclusion/exclusion criteria, PRISMA structure, risk-of-bias assessments, preregistered protocol, or really anything scientific.

3. Cherry-picked epistemology: When a paper showed physicians or physicians + AI > AI, they rationalize it as "old LLM model" or "sub-optimal prompting." Vice versa is, of course, evidence AI > physician. Its a unidirectional epistemic criteria.

4. Endpoints are proxies rather than real clinical outcomes: Correct diagnosis/appropriate test/guide-line concordant treatment/simulated cost/top-1 diagnosis vs. mortality rate/re-hospitalization rate/adverse drug events/morbidity/healthcare utilization rate

5. The review is misleading: they cite an RCT with their claim that "AI is better at chronic management for conditions including diabetes" but in that RCT before the AI was activated, each patient's diabetes clinician selected the protocol... So in other words, it was a human-based AI management

6. The review is again misleading, and possibly confused: They cite a meta-analysis with their claim that "When AI is better than humans, adding a human can actually make AI performance worse." This paper covered 106 experiments, of which only about 20 were medicine related. And here's the kicker... a human always signed off on the AI-generated medical plans.

tl;dr: Dad funds son's health startup and write an opinion piece. Embarrassingly low scientific comprehension by the authors but they're the equivalent of 'non-technical' in this domain, as they like to say in Silicon Valley, so we'll give them a pass. But, @JAMA_current do better? I get it's a perspective but like... at least make sure the studies cited say what the perspective cites them for?

@CuraiHQ if need some consulting before waging war against physicians, I am open for a curbside peer-review next time

[Matthew Zirwas, MD @MattZirwas]

5% of patients account for 50% of messages sent to patient portals.

Some doctors have lots of that 5%, others have none.

And, by the way, doctors don't get compensated for the time involved in responding to those messages.

The takeaway?

'Good' doctors, the ones patients feel comfortable messaging, get paid less and burn out more.

'Bad" doctors, the ones who don't respond to messages or connect with patients get paid more and burn out less.

Explains a lot about the medical system.

[Crémieux @cremieuxrecueil]

Why do Americans, despite being rich, live shorter lives than the people of peer countries?

The answer has little to do with healthcare. It has to do with being fat, violent, and risk-seeking!

Americans shoot more guns, crash more cars, and eat more garbage. Simple as that!

[Vincent Geloso @VincentGeloso]

Crémieux is not original here. I have been screaming this for years.

1: Americans spend far more resources trying to save infants who are low-weight and thus they enter the infant mortality stats. Other countries (notably Canada and France) simply give up when the infant is really small (below 500 or 600g). This accounts for a big share of the IMR gap between USA and rest of the world. But this is actually awesome because it says America is so wealthy and medically-well-endowed that there is a shot worth taking in saving insanely low-weight babies. Its not a problem, its a blessing that America can try and save so much babies (see Oster's AEJ article on this).

2: Americans drive alot. And I mean alot. Driving, however, more often kills than walking. And who drives a lot? The young. And that depresses life expectancy alot. That explains a big share of the rest.

3: America has more violence than other countries and the violence kills mostly young people. And that depresses life expectancy alot. Explains a big share of the rest of the gap. It sucks but it doesnt speak to healthcare!

4: Americans have bad eating habits and poor lifestyle choices (notably on drug consumption). That accounts pretty much for all the rest. It sucks but it doesnt speak to healthcare

https://t.co/HIvAxfTZQm

[Crémieux @cremieuxrecueil]

This study found a clever way to make people think this incredibly small correlation vindicates their poor sleeping habits.

Can you even eyeball an effect this small?

[John Mandrola, MD @drjohnm]

@DrRyanPDaly Can you point me to the best supportive evidence? A trial, perhaps.

[Crémieux @cremieuxrecueil]

The gender wage gap is mostly about married men doing an incredible job earning more than everybody else.

[Rob Henderson @robkhenderson]

On a college campus, you’re surrounded by people of the same age with similar abilities and interests. That’ll never happen again. The hidden marriage market: https://t.co/lEAyuEJS2K

[Anil Makam @AnilMakam]

I wouldn't bother with his news. Parrots narratives rather than independent critical analysis. I recall him gleefully calling me out when I celebrated a tide in the pandemic that I hadn't seen any severe COVID hospitalizations in 2022 months after Omicron (which was implied as my experience). He thought it was still a global problem. I still haven't seen a patient in 3+ years. Epidemiology supports severe COVID became rare with immunity after Omicron. People should get their news from people with a good track record. Doubtful he has one

[John Mandrola, MD @drjohnm]

A) We don’t know how he died. It could have been PE after a long flight

B) There’s a 90% chance that Mr Graham had coronary calcium based on age

C) There’s exactly zero evidence that intervention on coronary disease absent acute symptoms prevents MI or death.

D) Mr Gerstner understands business and I laud him for invest America, but he and many of his colleagues fundamentally misunderstand heart disease

[Melissa S. Kearney @kearney_melissa]

It’s not that hard — Learning to use AI to enhance your productivity and having AI give you the answers to exam and homework questions so you don’t have to learn are not the same thing. 1 should be encouraged. 2 should not.

[Joshua Reed Eakle 🗽 @JoshEakle]

Chris Cuomo (of all people) just effortlessly unmasked Tucker Carlson as a Russian propagandist.

Cuomo: “I'm a journalist. I'm not allowed into Russia. Why are you allowed in?”

Just watch how Tucker squirms.

[Venk Murthy MD PhD @venkmurthy]

Another silly fallacy. Because some docs may not understand math does not mean all don't.

See my bio and tell me I am in numeratate and don't understand how medical imaging works

(hint I have a PhD in biophysics from Johns Hopkins and graduated from MIT with a BS and MS in 3 years)

[Mark Cuban @mcuban]

The reason anyone gets insanely rich is almost always because of the stock market. It certainly how @elonmusk did.

And the reason they get rich from the stock market, is because 150m Americans decided they wanted to own shares of stocks directly, or through their retirement plans, or through other approaches as a way of building their net worth and trying to create a better life for themselves.

One Hundred Fifty Million Americans. About 60% of adults.

Effectively believing that @elonmusk and many billionaires could make them wealthier and help them achieve a better life.

If you want @elonmusk , and most billionaires to no longer be that rich, convince those 150m to sell their stocks, funds, ETFs whatever.

Of course you would wipe out the net-worth of most of those people, and everyone else’s savings, as the markets crashed and brought down the economy and created the worst depression we have ever seen.

Alternatively

There are ways to improve healthcare access and eventually make it available to all.

To start -
If you want @elonmusk and all billionaires to improve healthcare for everyone , ask them to stop doing business with the enormous healthcare conglomerates and to work directly with transparently priced care providers.

It’s the behemoth HC conglomerates that make HC so bad for so many. (Check my timeline for more detail)

Removing them would push the cost of healthcare down for everyone. Their corporate decisions impact our healthcare cost and availability.

Of course if they do that, not only would our HC costs go down , and the quality of care for their employees and the entire country go up

But

They would see their corporate cash flow increase dramatically and we would have more millionaires, billionaires and maybe even another trillionaire when that cash flow moved from the big health care conglomerates to their bottom line, so would the net worth of the 150 million American adults that own public stocks

Capitalism is better than socialism because 150m Americans can influence exactly what happens in this country.

[Kristin M. Collier, MD @HSRdirector]

I was once asked by a female academic leader why there was a 10 yr gap in academic output on my CV

I said that the “gap” was where the most important work of my life happened—having 4 boys in 5 years and then helping to keep them alive

my only regret is not having more children

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

Everyone is suddenly an expert in brain death.

Dr. Klessig is confusing the ischemic penumbra with brain death.

Yes, there is a range of reduced blood flow in which brain tissue may stop functioning without yet being irreparably damaged. We rescue patients in that state all the time with thrombectomy procedures, where blood clots are literally removed from arteries in the brain before permanent damage occurs.

But at a certain point, irreversible damage does occur. The cells die, and they do not recover.

A patient can recover from coma, drug intoxication, hypothermia, hypoxic-ischemic injury, or an ischemic penumbra if the underlying injury is reversible or treatment restores perfusion in time. That does not mean a correctly diagnosed brain-dead person recovered. Diagnostic standards require excluding reversible mimics such as severe metabolic derangements, intoxication, sedatives/paralytics, and hypothermia before brain death testing proceeds. We are also required to have an underlying catastrophic brain injury consistent with brain death.

The tweet makes reference to EEG. To be crystal clear: EEG is not accepted as a standalone way to determine brain death.

We can use blood-flow tests. But those tests do not show a 20–50% reduction in blood flow. When used to support a brain-death diagnosis, they show an absence of intracranial cerebral blood flow. None. Zero. That is not a power outage in the home. That is a power outage after the wires have been torn out all the way back to the street.

No amount of work can restore brain function once the brain has reached that point. Those neurons are dead, and they are not coming back.

When we test for brain death, we are not just looking for a lack of response. We must rule out other causes, identify a legitimate catastrophic brain injury, ensure adequate temperature, blood pressure, oxygenation, and lab conditions, and then test the most basic functions of the brainstem: pupil response to light, corneal reflexes, gag and cough reflexes, spontaneous breathing, and others.

So, no: a brain-dead person cannot spontaneously recover.

[Crémieux @cremieuxrecueil]

BEAUTIFUL!

This anti-vax study that I showed was fatally flawed has now been retracted.

It was garbage and never should've been published. It's been used to dissuade parents from getting their kids vaccinated for a potentially deadly disease.

Glad it's gone.