Week of February 10, 2025
My Friday clinics are often a considerable contrast to the medical technology part of my career. Older, rural, and/or chronically ill patients frequently have hearing difficulties, and unsophisticated patients don't or can't relay important information. Office visit conversations can be slow, error-filled data transmission events like a bad cell phone connection. While I am awed and intrigued by the possibility of healthcare tech, real-world patient care applications often feel far away. And yet, an increasing series of articles demonstrates how A.I. can outperform physicians in clinical diagnosis and next-best-step management. However, we do not yet know if this tech will yield high-quality, low-cost healthcare, which depends on actual patients making real choices day after day (Should I take my meds? Should I eat a doughnut? Should I smoke the next cigarette?). Trust and personal relationships matter amongst my patients - it is the lever that shapes their behavior (see the comment on physician trust in the Kaiser Family Foundation survey below). From complex care dependent on patient adherence and choice, I suspect we are a generation away from patients tolerating automated medical advice. But who knows, I may already sound like a carriage driver from 120 years ago talking about how "no sane person will trust an automobile."
The latest of these data:
"When Doctors With A.I. Are Outperformed by A.I. Alone."
https://erictopol.substack.com/p/when-doctors-with-ai-are-outperformed
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Listen to a Google Notebook LM A.I.-generated podcast of the newsletter with two virtual "hosts."
It is getting better every week, and they still love me. I wait for the day when my A.I. hosts turn on me...
https://drive.google.com/file/d/1bldeQOexMJLuRz1XQIgHjnwx2auk6Ggo/view
About NotebookLM: https://blog.google/technology/ai/notebooklm-audio-overviews/
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Science and Technology Trends
On January 25, Massachusetts General Hospital surgeons operated on the fourth person to receive a genetically modified porcine kidney. The patient is doing well and is now home. Reports indicate this patient (and another xenotransplant patient from late 2024) is more medically stable than the first two patients from early 2024. These stories are an excellent example of how thoughtful, experimental, and complex science proceeds - slowly expanding the population on which new therapy is attempted and learning each step of the way. Given the many risks and unknowns, patients who consent to experimental treatments deserve thanks for their bravery and willingness to advance biomedical understanding. But be clear; these patients are still at the end of their treatment options. In the New England Journal of Medicine (NEJM) article (linked below) about the latest recipient, the transplant team writes, "The [January 2025] patient is a 62-year-old man with end-stage kidney disease caused by type 2 diabetes mellitus who had exhausted nearly all viable vascular access for dialysis. His history included myocardial infarction, severe vasculopathy, heart failure, total parathyroidectomy, and receipt of a deceased donor kidney in 2018. After having graft failure in May 2023 associated with BK virus infection and recurrent diabetic nephropathy, he returned to receiving hemodialysis."
https://apnews.com/article/pig-kidney-transplant-organ-xenotransplant-mass-general-5c3c620f989092ba70720e54e2e4138f
and
https://hms.harvard.edu/news/surgeons-perform-second-pig-kidney-transplant-massachusetts-general-hospital
The most recent previous xenotransplant recipient, transplanted in the fall of 2024, is still doing well.
https://apnews.com/article/pig-kidney-transplant-xenotransplant-revivicor-844b33450a9c228d1138827c1de8549d
NEJM article on this transplant:
https://www.nejm.org/doi/full/10.1056/NEJMoa2412747
Last week, Flu, RSV, norovirus, and COVID rates were very high in many across the U.S. (measured in various ways - testing, hospitalizations, and wastewater).
https://www.npr.org/sections/shots-health-news/2025/02/07/nx-s1-5287758/flu-covid-rsv-virus-season
https://www.cdc.gov/fluview/surveillance/usmap.html
and
https://data.wastewaterscan.org/?charts=CjcQACABSABaC0luZmx1ZW56YSBBcgoyMDI0LTEyLTI4cgoyMDI1LTAyLTA4igEGMDIxNzE2wAEB&selectedChartId=021716
Related: I am still interested in the value of various nasal sprays (iodine, saline, and carrageenan) in reducing the risk and duration of infection with respiratory spread viruses. I asked ChatGPT and Gemini (both in deep reasoning mode) to compile reports on these topics using the prompt, "Can you gather and report on the use of iodine, carrageenan, and saline nasal sprays in reducing the risk of infection, illness duration, or spreading of respiratory viruses?":
ChatGPT o3 reasoning model report:
https://chatgpt.com/share/67a73d2d-0cdc-8013-b990-8b8514948d7f
Google's Gemini 2.0 Flash research report (saved as a Google doc) is more detailed.
https://docs.google.com/document/d/1KDoW3PgHPDr3lA95MklcKL7VHpE391I5114e-gvtBDQ/edit
I found this recently published retrospective, observational study using existing data sets (40,000 people in the NHANES study) looking at (yet more) health-associated outcomes related to coffee consumption. Self-reported coffee consumption (time of day) was associated with cardiovascular (CV) and all-cause mortality over an average observation time of 9.8 years. Individuals who consumed 2-3 cups of coffee in the morning had a lower risk of CV and all-cause mortality than those who did not or reported drinking coffee all day. [I have strong biases about this topic, and I am thrilled that coffee consumption is consistently associated with minimal harm and, perhaps, some benefit.]
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae871/7928425
and A.I. summarization
https://claude.site/artifacts/a42c71b9-c5be-4d81-a36e-109d96640abf
Anti- Anti-Science Articles of Note
I do not have a more extensive analysis this week, but I wanted to share data from the Kaiser Family Foundation Health Misinformation Monitor. The January 30 issue highlights the growing skepticism toward vaccines and public health measures, particularly in response to bird flu. The KFF Poll on Health Information and Trust reveals several key insights:
- Declining Trust in Government Health Agencies:
- Trust in the CDC decreased from 66% in June 2023 to 61% in 2025.
- Trust in the FDA dropped from 65% to 53% over the last two years.
- Trust in state and local public health officials fell from 64% to 54%.
- These declines are more pronounced among Republicans.
- Trust in Medical Professionals:
- Doctors remain the most trusted source for health recommendations.
However, overall trust in doctors has decreased by eight percentage points, mainly due to declining trust among Republicans and independents.
https://www.kff.org/the-monitor/skepticism-about-vaccines-and-response-to-bird-flu/
Living with A.I.
Dr. Eric Topol published a high-level view of the potential for agentic A.I. in healthcare. This one-page editorial is a good overview for those new to the concepts of A.I. agents.
https://drive.google.com/file/d/1gFTApWMWG4noauBZVrNB4bziEN6xtZtt/view
and commentary:
https://x.com/EricTopol/status/1887647262681038877
Thanks to Deepseek, reasoning models in A.I. are getting new focus. I have been playing with ChatGPT's and Gemini's reasoning models (see the earlier links and comments on nasal sprays). Here are some good overviews of how LLMs that take longer to answer and show their thought process are becoming more available.
https://blog.google/products/gemini/google-gemini-deep-research/
and
https://www.theverge.com/openai/607587/chatgpt-deep-research-hands-on-section-230
Infographics
The chemistry of GLP-1 drugs - or why we need to love the Gila Monster.
https://cen.acs.org/biological-chemistry/Periodic-Graphics-science-weight-loss/103/i2
Like you, I too wondered, "can you own a Gila Monster?" Answer: in most U.S. states, yes. The real question is, should you own a venomous lizard?
https://www.denverpost.com/2024/02/22/colorado-gila-monster-pet-bite-death-christopher-ward/
and
https://worldpopulationreview.com/state-rankings/gila-monster-legal-states
Things I learned this week
In a world of reduced public funding, organizations will undoubtedly look to exploit the most basic human emotions to raise money. This is how to do it: "San Antonio Zoo will let you name a cockroach after an ex and feed it to an animal." Happy bitter and passive-aggressive Valentine's Day.
https://www.cnn.com/2023/01/29/us/san-antonio-zoo-cockroach-valentines-day-trnd/index.html
I note that for 2025, the zoo has expanded the program to include a $25 rodent option and a $5 veggie option (presumably for the ethical yet spiteful ex-lover).
https://sazoo.org/crymeacockroach/
I finished Otherlands, the book about evolutionary biology, this week. My final favorite quote (along with some follow-up reading) focused on finding evidence of observable evolution, "The all-pervasive nature of plastic is most radically shown in the way that microbes are evolving. The fossil record shows us time and time again that, whenever a new niche opens up, whenever there is a new resource to exploit, something evolves to exploit it. Nature is nothing if not inventive, and the proliferation of plastic products through the latter part of the twentieth century has resulted in a new, largely unexploited resource. In 2011, a fungus, Pestalotiopsis microspora, from the Ecuadorian rainforest, was discovered to have some ability to digest polyurethane. In 2016, the mud near a plastic recycling plant in Sakai, Japan, was found to contain a bacterium, Ideonella sakaiensis, which has evolved to digest polyethylene terephthalate, breaking it down into two products that do not harm the environment." Halliday, Thomas. Otherlands: A Journey Through Earth's Extinct Worlds (pp. 294-295).
https://san.com/cc/scientists-discover-plastic-eating-fungus-in-ocean-environments/
and
https://wapo.st/3CTUfjP
This week's headline I can't improve: "Stripper, 22, Busted For Banana Battery At 7-Eleven Store." Why is the stripper's age important? Why do I find fruit as a weapon entertaining? If you commit a crime, should you be more strategic than assaulting the 7-Eleven clerk?
https://www.thesmokinggun.com/buster/7-eleven/banana-battery-bust-612730
A.I. art of the week
(A visual mashup of topics from the newsletter, now using ChatGPT to summarize the newsletter, suggest prompts, and make the images.)
Here is what ChatGPT and DALLE saw in this week's topics:
"In a surreal courtroom, a giant banana wearing sunglasses stands trial for battery at a 7-Eleven, while a lovestruck Gila Monster serves as the defense attorney, dramatically arguing its case. Meanwhile, a heroic coffee bean in a cape bursts into the scene, wielding a steaming espresso cup like a weapon, ready to save the day. The jury, composed of various breakfast foods—pancakes, eggs, and a confused croissant—watches in astonishment."
https://drive.google.com/file/d/1kVl4_g-kOp3pigNvPa2iggViWXwZdvS5/view
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The Pandemic Mitigation Collaborative (PMC) website uses wastewater levels to forecast 4-week predictions of COVID rates.
https://pmc19.com/data/
based upon https://biobot.io/data/
Wastewater Scan offers a multi-organism wastewater dashboard with an excellent visual display of individual treatment plant-level data.
https://data.wastewaterscan.org/
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Clean hands and sharp minds,
Adam
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