“the number of people who reject all vaccines is quite small — so small that they are unlikely to compromise public health. The greater issue, the one we don’t discuss often enough, is the many parents who don’t identify as being opposed to vaccines but don’t always consent to them. Even before the Covid-19 pandemic, one-quarter to one-third of American parents were delaying vaccines or picking and choosing them cafeteria-style, deciding certain vaccines weren’t relevant to their family because they believed the risk for the disease was low. Some parents design their own vaccine schedules, often customizing for each child based on their perceptions … Read More
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“First, numbers (even if approximate) should be used to describe risk probabilities. The meaning of verbal probability terms (eg, rare, common, or unlikely) varies among people and situations. A systematic review of 24 studies found that people interpreted “rare” to mean probabilities ranging from 0% to 80%, while interpretations of “common” ranged from 10% to 100%. Using numbers helps patients understand whether a rare risk is 4% or 0.004%. [..] One caveat to this recommendation is that nonnumeric communication may be appropriate when it is more important that a patient understands a category (eg, that their risk is “high”) than the exact … Read More
Large language models are transforming medicine—but the technology comes with side effects. “Surveys have suggested that many people are more confident in A.I. diagnoses than in those rendered by professionals. Meanwhile, in the United States alone, misdiagnosis disables hundreds of thousands of people each year; autopsy studies suggest that it contributes to perhaps one in every ten deaths. [..] One recent study found that OpenAI’s GPT-4 answered open-ended medical questions incorrectly about two-thirds of the time. In another, GPT-3.5 misdiagnosed more than eighty per cent of complex pediatric cases. Meanwhile, leading large language models have become much less likely to … Read More
“A report on childhood health from the federal Make America Healthy Again (MAHA) commission released in May 2025 mentions the concept of harm associated with UPF dozens of times, signaling the possible inclusion of this category in the forthcoming Dietary Guidelines for Americans, 2025–2030. The available evidence, however, suggests that a focus in national nutrition policy on reducing UPF consumption won’t make Americans any healthier. The term “ultraprocessed food” [UPF] was adopted as part of a food-classification system that was introduced in a 2009 commentary by Carlos Monteiro and subsequently named “Nova.” Initially including three groups of food, Nova was … Read More
“A French team of investigators studied the question of whether a protocol-driven strategy of progressive reduction of blood pressure lowering drugs would alter a primary outcome of death rates in elderly frail patients who were residing in a nursing home. The authors also measured many relevant secondary endpoints. Just over 1000 patients underwent randomization to either the so-called step-down approach or usual care. The hypothesis was that reducing BP meds, and allowing BP to rise a bit would improve mortality. Inclusion in the trial required patients to be older than 80 years, be on more than one BP-lowering drug and … Read More
“A year before the beaver incident [a patient portal message stating “diffuse metastasis to the lungs” while staring at a giant beaver statue in a Buc-ee’s parking lot], I had undergone magnetic resonance imaging (MRI) of my cervical spine. My doctor read the impression and assured me everything was fine. Yet buried deep in the radiology report, not in the impression, but in the dense paragraph nobody reads, was “multiple thyroid nodules, likely nonmalignant.” This incidental finding was never mentioned in the impression or by my doctor. In fairness, I likely would have glossed over it with a patient too. … Read More
“Patients arriving with researched information is not new. They have long brought newspaper clippings, internet search results, or notes from conversations with family. Potential solutions passed along in WhatsApp threads have at times been an integral part of my clinical conversations. Information seeking outside the health care setting has always been part of the landscape of care. But something about this moment feels different. Generative artificial intelligence (AI), with tools like ChatGPT, offers information in ways that feel uniquely conversational and tailored. Their tone invites dialogue. Their confidence implies competence. Increasingly, patients are bringing AI-generated insights into my clinic and … Read More
David Wallace-Wells and Emily Oster argue that the effects of MAHA will be long-lasting. “[Economist and CEO of ParentData Emily Oster] There’s two really core issues for the future. One is that this [mRNA vaccines] is the fastest technology we have to generate vaccines, full stop. The difference in the amount of time it takes to make a vaccine in the traditional manner versus with this technology is very, very large. If you think about a future pandemic, having access to this technology is the difference between a vaccine and three months or four months or six months and a … Read More
As a Zepbound patient, here are the seven reforms I’d like to see I highlight two: “2. Tighter oversight of manufacturers’ pricing policies and the competitive environment [..] it’s a bit rich (pun intended) for [Lilly CEO Dave] Ricks [whose total compensation was $114 million in 2024 after the company made more than $10 billion in profit last year] to complain about telehealth/compounding pharmacies like Hims & Hers offering cheaper “backdoor generics” of GLP-1s. (Note to Congress: Rather than permitting the Food and Drug Administration to stop the work of compounding pharmacies on GLP-1s — a throttling that is now well … Read More
“Current US guidelines recommend absolute risk estimation of cardiovascular disease (CVD) to guide decisions on preventive therapies, but communicating absolute risk alone can be challenging for patients and clinicians. In 2021, the European Society of Cardiology guidelines added a recommendation to calculate risk age along with absolute risk to improve communication. Risk age represents the age of a hypothetical person with the same predicted absolute risk but optimal risk factor levels. This may help individuals understand how their risk compares with chronological age (is my risk age older than my actual chronological age?) and may motivate adherence to lifestyle modifications … Read More