The Curious Side Effects of Medical Transparency

“Transparency has always been seen as a hallmark of honesty and integrity. The logic is familiar: democracies aspire to be transparent, but dictatorships are opaque; faithful spouses are guileless, while philanderers lie; reputable businesses operate in the open, but shady operations literally draw the shades. Collectively, we’ve embraced Louis Brandeis’s dictum that sunlight is the best disinfectant. We demand transparency in government, charitable institutions, nutrition labels, and middle-school grading rubrics. The medical record should be no different. [..] In 2008, Ethan Bernstein, an associate professor at Harvard Business School, travelled with a team of students to a vast mobile-phone-manufacturing plant … Read More

Corporate Citizenship and Institutional Responses Post-Dobbs — Critical Lessons from Two Restrictive States

“When Roe v. Wade was decided in 1973, a group of 100 U.S. professors of obstetrics and gynecology predicted that teaching hospitals would emerge as leaders in compassionate abortion care, creating outpatient clinics to meet the demand for legalized abortion. But most hospitals did not embrace abortion provision; many of them in fact adopted policies that were more restrictive than was legally required. Freestanding clinics instead emerged as the primary provider of abortion care, and this siloing was further reinforced by stigma, threats of violence, and the exclusion of abortion coverage by major health care payers. In 2020, hospitals accounted … Read More

Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum

“Some patient messages are unsolicited questions seeking medical advice, which also take more skill and time to answer than generic messages (eg, scheduling an appointment, accessing test results). Current approaches to decreasing these message burdens include limiting notifications, billing for responses, or delegating responses to less trained support staff. Unfortunately, these strategies can limit access to high-quality health care. For instance, when patients were told they might be billed for messaging, they sent fewer messages and had shorter back-and-forth exchanges with clinicians. Artificial intelligence (AI) assistants are an unexplored resource for addressing the burden of messages. While some proprietary AI assistants show … Read More

Dr. Fauci Looks Back: ‘Something Clearly Went Wrong:’ In his most extensive interview yet, Anthony Fauci wrestles with the hard lessons of the pandemic — and the decisions that will define his legacy.

“Over several hours and multiple Zoom and phone calls in April, I spoke with Fauci about that: how he saw the full story of this historic public-health emergency and the role he played in it. At times, he was defensive, even combative, particularly when it came to episodes in which he felt that his own positions had been misconstrued and on the matter of gain-of-function research and the origins of the pandemic. But on the whole, he was reflective, even humble, especially about the way that Covid-19 exposed the limits of public health and, in his telling, kept surprising him … Read More

Patients and Their Physician’s Perspectives About Oral Anticoagulation in Patients With Atrial Fibrillation Not Receiving an Anticoagulant

“Oral anticoagulation reduces thromboembolic events in patients with nonvalvular atrial fibrillation (AF); however, underuse of anticoagulation is a major issue in treating patients with nonvalvular AF at high stroke risk. Prior data from the American College of Cardiology’s (ACC) Practice Innovation and Clinical Excellence Registry (PINNACLE Registry) has found approximately 40% of patients are not receiving anticoagulants, with little change over time, despite the availability of the nonvitamin K antagonists. Studies examining the reasons for nonuse are sparse. Because underuse may relate to both physician prescribing and patient factors, some studies have looked at physician assessment of the risk of bleeding … Read More

Valuable

The New England Journal of Medicine’s Lisa Rosenbaum speaks with University of Pennsylvania’s internal medicine physicians Paula Chatterjee (also a health services researcher) and Atheen Venkataramani (also a health economist and founder of Penn’s Opportunity for Health lab) about the role of values in health care, social determinants of health and what physicians can do to improve U.S. health care. An excerpt of the audio interview: [Rosenbaum] Atheen, I know that you also had a formative experience, I think when you were a resident at MGH. Can you talk a little bit about that and how that experience informed your … Read More

What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss

“we examine real-world data from a cohort based in a UK primary care clinic offering a low-carbohydrate approach to people with T2D [type 2 diabetes] from 2013 to 2021. The physiological mechanisms behind remission induced by dietary weight loss were first demonstrated in 2011. Since then the idea of drug-free T2D remission has gained international momentum. [..] Advice on lowering dietary carbohydrate was offered routinely by our team of nine specially trained GPs and three practice nurses to patients with T2D (defined as HbA1c >48 mmol/mol on two occasions) starting in March 2013. Our protocol includes important information around the deprescribing of … Read More

The Habit America’s Historians Just Can’t Give Up

“In its attempt to explode particular myths, however, Myth America engages in its own mythmaking. The book fundamentally misunderstands the crises facing the U.S. and the world. By implying that misinformation is the principal cause of the partisan rancor, violence, and general dysfunction that mark our current political moment, the collection obscures our much bigger problems. And by localizing the threat of misinformation and disinformation almost exclusively within certain far-right segments of the conservative movement and the Republican Party, Myth America absolves not only other stripes of conservatism, but also the milquetoast technocratic liberalism that helped set the stage for this moment. It’s not … Read More

Healthy Eating Patterns and Risk of Total and Cause-Specific Mortality

“[Introduction] According to the Global Burden of Disease Study 2017, unhealthy diet is estimated as one of the leading causes of death globally. [..] using 2 large prospective cohorts with data on repeated measures of dietary habits, we derived dietary scores for 4 healthy dietary patterns, including the Healthy Eating Index 2015 (HEI-2015), Alternate Mediterranean Diet (AMED) score, Healthful Plant-based Diet Index (HPDI), and Alternate Healthy Eating Index (AHEI). We then examined their associations with total and cause-specific mortality. We also specifically examined these associations stratified by race and ethnicity and other potential risk factors. [Methods] This cohort study used … Read More

Unhealthy histories: sports and addictive sponsorship

“Professional sport has been criticised for its role as a vehicle to market addictive products or services. Despite the harmful health effects on society, football audiences are inured to seeing sponsors of such products not only on pitch-side hoardings and shirts, but also embedded in television rights, competition names, prematch build-up, corporate hospitality, and social media. Tobacco’s successful movement into sports sponsorship established the template on which other addictive sponsors, notably the alcohol and gambling industries, built their strategies. The integration of sports and addictive commodities highlights strategies to influence consumption by those within the unhealthy commodities industry. [..] historically … Read More