February 28th, 2011 by DrCharles in Opinion, Research
Tags: Artificial Intelligence and Healthcare, Biotechnology, Computers Replacing Doctors, DeepQA, Doctor Patient Relationship, Dr. Watson, General Medicine, Human Doctors, Human Qualities, IBM, Ideal Physician, Jeopardy!, Man Vs. Machine, Mayo Clinic, Medicine and New Technology, Robot Doctor, Robotics, Technology and Society, The Examining Room of Dr. Charles, Virtual Physician Assistants
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After the computer known as Watson easily dispatched of the best two human Jeopardy! contestants in history, IBM announced that one of the first applications of their artificial intelligence technology would be in the medical field. We should soon expect virtual physician assistants in the exam room. At least one of my friends even speculated that the days of human doctors are numbered.
Is it possible that machines will replace humans in the doctor-patient relationship? I doubt it. According to a study done by the Mayo Clinic in 2006, the most important characteristics patients feel a good doctor must possess are entirely human. According to the study, the ideal physician is confident, empathetic, humane, personal, forthright, respectful, and thorough. Watson may have proved his cognitive superiority, but can a computer ever be taught these human attributes needed to negotiate through patient fear, anxiety, and confusion? Could such a computer ever come across as sincere?
I’m afraid some major calibrations might be needed to substitute artificial intelligence for an “ideal” physician. What do you think? Here’s an artist’s conception (read: farce) of how such an application in the examining room might play out. Click HERE to watch the medical cartoon.
*This blog post was originally published at The Examining Room of Dr. Charles*
February 28th, 2011 by Elaine Schattner, M.D. in Opinion, Research
Tags: Breast Cancer Screening, Breast Imaging Studies, Diagnosis, Diagnostic Imaging, Diagnostic Radiology, Doctor Competence, Doctor Performance, Dr. Elaine Schattner, Experienced Radiologists, False Positives, Hands-On Medical Experience, Mammograms, Mammography, Medical Lessons, National Cancer Institute, NCI, Number of Mammograms Read, Radiology, Specialized Radiologists, Telemedicine, Women's Health
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There’s a new study out on mammography with important implications for breast cancer screening. The main result is that when radiologists review more mammograms per year, the rate of false positives declines.
The stated purpose of the research*, published in the journal Radiology, was to see how radiologists’ interpretive volume — essentially the number of mammograms read per year — affects their performance in breast cancer screening. The investigators collected data from six registries participating in the NCI’s Breast Cancer Surveillance Consortium, involving 120 radiologists who interpreted 783,965 screening mammograms from 2002 to 2006. So it was a big study, at least in terms of the number of images and outcomes assessed.
First — and before reaching any conclusions — the variance among seasoned radiologists’ everyday experience reading mammograms is striking. From the paper:
…We studied 120 radiologists with a median age of 54 years (range, 37–74 years); most worked full time (75%), had 20 or more years of experience (53%), and had no fellowship training in breast imaging (92%). Time spent in breast imaging varied, with 26% of radiologists working less than 20% and 33% working 80%–100% of their time in breast imaging. Most (61%) interpreted 1000–2999 mammograms annually, with 9% interpreting 5000 or more mammograms.
So they’re looking at a diverse bunch of radiologists reading mammograms, as young as 37 and as old as 74, most with no extra training in the subspecialty. The fraction of work effort spent on breast imaging –presumably mammography, sonos and MRIs — ranged from a quarter of the group (26 percent) who spend less than a fifth of their time on it and a third (33 percent) who spend almost all of their time on breast imaging studies. Read more »
*This blog post was originally published at Medical Lessons*
February 27th, 2011 by Glenn Laffel, M.D., Ph.D. in Better Health Network, Research
Tags: African Americans, American Fatness, BMI, Body Mass Index, Cultural Factors, Diet and Nutrition, Dr. Glenn Laffel, Ethnic Differences In Healthcare, Family Practice, Fitness and Exercise, Internal Medicine, Johns Hopkins School of Public Health, NAMCS, National Ambulatory Medical Care Survey, Obese Adults, Obesity Counseling, Obesity Epidemic, Overweight, Pizaazz, Primary Care, Racial Disparity, Sara Bleich, Socioeconomics, Weight Reduction, Weight-Loss Counseling, Weight-Related Counseling
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Most people know that the U.S. is struggling to contain a surging epidemic of obesity, and that the problem is most acute among African-Americans. Whereas about 27 percent of all adult Americans are obese (defined as having a body mass index of 30 or more), fully 37 percent of African-American adults are obese, and that number jumps to an appalling 42 percent among African-American women.
Over the years, public health officials have provided evidence that socioeconomic and cultural factors drive this racial disparity. Now, a new study suggests there is another reason as well: Obese African-Americans receive less obesity-related counseling than their white counterparts, and it matters not whether the physicians they see are African-American or white.
To reach these conclusions, Sara Bleich and colleagues from the Johns Hopkins School of Public Health used clinical encounter data from the 2005–2007 National Ambulatory Medical Care Surveys (NAMCS). The sample included 2,231 visits involving African-American and white obese people who were at least 20 years old and who visited family practitioners and internists that were either African-American or white. Asian and Hispanic patients and physicians were excluded from the study because their numbers were too small to permit hypothesis testing.
For each encounter in the study, the scientists determined whether the patient received guidance on weight reduction, diet and nutrition, or exercise from his or her physician. Read more »
*This blog post was originally published at Pizaazz*
February 27th, 2011 by RyanDuBosar in Better Health Network, Research
Tags: ACP Internist, Agency for Healthcare Research and Quality, American College Of Physicians, Household and Pharmacy Components, Medical Expenditure Panel Survey, MEPS, Most Expensive Medications, Outpatient Prescription Drug Purchases, Prescription Drugs, Ryan DuBosar, U.S. Healthcare Costs
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The top five therapeutic classes ranked by total expense are metabolic, central nervous system, cardiovascular, gastrointestinal, and psychotherapeutic, altogether totaling $155.7 billion, or two-thirds of prescription drug expenses by U.S. adults in 2008.
Two-thirds of American adults use a prescription drug, totaling the $232.6 billion in expenses. The Agency for Healthcare Research and Quality compiled a statistical brief showing that drug classes varied widely in how they made the top five list. While 46 percent of adults with a prescribed drug expense bought a central nervous system agent, they are relatively cheaper on average. Gastrointestinal agents had the highest average expense per prescription ($133), or more than three times the average expense of the cheapest class, which was cardiovascular agents ($39). But 46 percent of adults who take a prescription drug use a central nervous system agent, while 17.7 percent take a gastroenterological one.
Metabolic agents had the highest total expenses ($52.2 billion), or more than one-fifth of all prescription drug expenses. The rest of the list by total expenditures were central nervous system agents ($35.1 billion), cardiovascular agents ($28.6 billion), gastrointestinal agents ($20.2 billion), and psychotherapeutic agents ($19.6 billion).
The estimates presented are derived from the Household and Pharmacy Components of the 2008 Medical Expenditure Panel Survey (MEPS). Expenditures include payments from all sources including out of pocket, private and public insurance sources for outpatient prescription drug purchases during 2008. Over-the-counter medicines are excluded, as are prescription medicines administered in an inpatient setting, clinic, or physician’s office.
*This blog post was originally published at ACP Internist*
February 26th, 2011 by PJSkerrett in Opinion, Research
Tags: Blood Sugar Levels, Brain Activity, Brain Cancer, Brain Stimulation, Cell Phone Safety, Cell Phone Use, Dr. Nora Volkow, Energy Emission and Brain Health, Energy-Emitting Devices, General Medicine, Glucose Metabolism, Harvard Health Blog, Harvard Health Publications, Harvard Heart Letter, Harvard Medical School, Harvard University, How do I control my blood sugar better, JAMA, Journal of the American Medical Association, Memory, Mental Health, Oncology, Personal Technology and Health, PET scan, PJ Skerrett, Preventive Health, Preventive Medicine, Primary Care, Public Health
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We all know that using a cell phone can stimulate the brain to work a bit harder. “Mr. Skerrett? This is Dr. LeWine’s office. Do you have a minute to talk about your test results?” or “Dad, a bunch of kids are going to Casey’s house after the dance. Can I go?” But a new study published in JAMA is making me wonder what the energy emitted by the phone itself — not just the information it delivers — is doing to my brain.
Here’s the study in a nutshell. Dr. Nora Volkow and her colleagues recruited 47 volunteers to have their brain activity measured twice by a PET scanner. Both times the volunteer had a cell phone strapped to each ear. During one measurement, both phones were turned off. During the other, one phone was turned on but muted so the volunteer didn’t know it was on; the other was left off. Each session lasted about an hour. The scans showed a small increase in the brain’s use of glucose (blood sugar) when the phone was on, but only in parts of the brain close to the antenna.
It was an elegant study. The researchers took pains to anticipate sources of error. They used a control (both phones off) against which to compare the effect of a “live” cell phone. They used cell phones on each ear, one on and one off, to see if the effect was localized. They muted the phone that was on to eliminate the possibility that any brain activation was due to listening to the sound of a voice coming through the phone’s speaker. So the result is probably a real one, not an artifact or measurement error.
What does this brain activation mean? No one really knows. As Dr. Volkow told NPR, “I cannot say if it is bad that they [cell phones] are increasing glucose metabolism, or if it could be good.” Read more »
*This blog post was originally published at Harvard Health Blog*
