Randomized controlled trial of therapy for teenagers

“These Teens Got Therapy. Then They Got Worse.” (Atlantic, by Olga Khazan; paywalled, but readable in the Google cache):

Researchers in Australia assigned more than 1,000 young teenagers to one of two classes: either a typical middle-school health class or one that taught a version of a mental-health treatment called dialectical behavior therapy, or DBT. After eight weeks, the researchers planned to measure whether the DBT teens’ mental health had improved.

The therapy was based on strong science: DBT incorporates some classic techniques from therapy, such as cognitive reappraisal, or reframing negative events in a more positive way, and it also includes more avant-garde techniques such as mindfulness, the practice of being in the present moment. Both techniques have been proven to alleviate psychological struggles.

The author and editors forgot to capitalize “Science”!

This special DBT-for-teens program also covered a range of both mental-health coping strategies and life skills—which are, again, correlated with health and happiness. One week, students were instructed to pay attention to things they wouldn’t typically notice, such as a sunset. Another, they were told to sleep more, eat right, and exercise. They were taught to accept unpleasant things they couldn’t change, and also how to distract themselves from negative emotions and ask for things they need. “We really tried to put the focus on, how can you apply some of this stuff to things that are happening in your everyday lives already?” Lauren Harvey, a psychologist at the University of Sydney and the lead author of the study, told me.

But what happened was not what Harvey and her co-authors predicted. The therapy seemed to make the kids worse. Immediately after the intervention, the therapy group had worse relationships with their parents and increases in depression and anxiety. They were also less emotionally regulated and had less awareness of their emotions, and they reported a lower quality of life, compared with the control group.

Most of these negative effects dissipated after a few months, but six months later, the therapy group was still reporting poorer relationships with their parents.

Last year, a study of thousands of British kids who were put through a mindfulness program found that, in the end, they had the same depression and well-being outcomes as the control group. A cognitive-behavioral-therapy program for teens had similarly disappointing results—it proved no better than regular classwork.


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Elon Musk provides inspiration for the damaged

One defining principle of our age is that a damaged human is an economically useless human. Parents weren’t nice to you? You can be mean to others for the next 75 years. Back pain at age 50 when working for the government? Retire on disability (see “A Disability Epidemic Among a Railroad’s Retirees” (NYT): “Virtually every career employee [at the government-owned Long Island Rail Road] — as many as 97 percent in one recent year — applies for and gets disability payments soon after retirement. … The L.I.R.R.’s disability rate suggests it is one of the nation’s most dangerous places to work. Yet in four of the last five years, the railroad has won national awards for improving worker safety.”) Back pain at age 50 when scraping by on minimum wage? Segue to SSDI and Medicaid-funded opioids.

Elon Musk (the book) is a good inspiration to power through the pain, both emotional and physical. Tending to confirm The Son Also Rises: economics history with everyday applications, his mom’s mom was divorced and Elon’s mom was divorced and Elon himself is now thrice-divorced. Elon’s mom could be brutally frank and Elon’s dad was just plain brutal, as was life growing up in South Africa.

His most searing experiences came at school. For a long time, he was the youngest and smallest student in his class. He had trouble picking up social cues. Empathy did not come naturally, and he had neither the desire nor the instinct to be ingratiating. As a result, he was regularly picked on by bullies, who would come up and punch him in the face. “If you have never been punched in the nose, you have no idea how it affects you the rest of your life,” he says. At assembly one morning, a student who was horsing around with a gang of friends bumped into him. Elon pushed him back. Words were exchanged. The boy and his friends hunted Elon down at recess and found him eating a sandwich. They came up from behind, kicked him in the head, and pushed him down a set of concrete steps. “They sat on him and just kept beating the shit out of him and kicking him in the head,” says Kimbal, who had been sitting with him. “When they got finished, I couldn’t even recognize his face. It was such a swollen ball of flesh that you could barely see his eyes.” He was taken to the hospital and was out of school for a week. Decades later, he was still getting corrective surgery to try to fix the tissues inside his nose. But those scars were minor compared to the emotional ones inflicted by his father, Errol Musk, an engineer, rogue, and charismatic fantasist who to this day bedevils Elon. After the school fight, Errol sided with the kid who pummeled Elon’s face. “The boy had just lost his father to suicide, and Elon had called him stupid,” Errol says. “Elon had this tendency to call people stupid. How could I possibly blame that child?”

When Elon finally came home from the hospital, his father berated him. “I had to stand for an hour as he yelled at me and called me an idiot and told me that I was just worthless,” Elon recalls. Kimbal, who had to watch the tirade, says it was the worst memory of his life. “My father just lost it, went ballistic, as he often did. He had zero compassion.” Both Elon and Kimbal, who no longer speak to their father, say his claim that Elon provoked the attack is unhinged and that the perpetrator ended up being sent to juvenile prison for it.

How about back pain, the standard American initiative-killer?

For his forty-second birthday, in June 2013, Talulah [Riley; photo below] rented an ersatz castle in Tarrytown, New York, just north of New York City, and invited forty friends. The theme this time was Japanese steampunk, and Musk and the other men were dressed as samurai warriors. There was a performance of Gilbert and Sullivan’s The Mikado, which had been rewritten slightly to feature Musk as the Japanese emperor, and a demonstration by a knife-thrower. Musk, never one to avoid risks, even needless ones, put a pink balloon just underneath his groin for the knife-thrower to target while blindfolded. The culmination was a demonstration of Sumo wrestling. At the end, the group’s 350-pound champion invited Musk into the ring. “I went full strength at him to try a judo throw, because I thought he was trying to take it easy on me,” Musk says. “I decided to see if I could throw this guy, and I did. But I also blew out a disc at the base of my neck.” Ever since, Musk has suffered severe bouts of back and neck pain; he would end up having three operations to try to repair his C5-C6 intervertebral disc. During meetings at the Tesla or SpaceX factories, he would sometimes lie flat on the floor with an ice pack at the base of his neck.

(I didn’t understand the appeal of SSDI and opioids until, at around age 50, I decided to repeatedly throw a friend’s 7-year-old onto a couch. This required a twisting motion and, the next morning, I could barely move.)

Elon Musk worked like a demon for years after this injury (I think that we can be confident that the surgeries did not render him “good as new”) and also after the malaria+Stanford misdiagnosis that nearly killed him (see previous post).

Maybe all of this damage will eventually catch up with him, but until then I think we can all look to Elon as inspiration to stop making excuses!

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Missing teeth will be the hallmark indicator of working class chumps?

I’ve now reached the age where I can spend 110 percent of my time maintaining my disintegrating body and material possessions (where the house is Exhibit A!). As part of this effort, I’ve had two dental crowns for summer 2023 as well as an old filling that needed to be replaced. I found a Tufts-trained dentist down here who is a refugee from the Maskachusetts lockdowns. She has the CEREC machine for milling same-day crowns:

What does this cost? If you’re a working class chump with less spending power than someone on welfare… more than $2,200 per crown. What if you’re a laptop class member with dental insurance? The “negotiated rate” scam in dentistry is not quite as absurd as in medicine, but the total revenue for the dentist then becomes $1,200 and the patient must pay $500. In other words, those with substantially greater financial resources pay less. What about those who have chosen to refrain from work? If they’re back in my dentist’s old neighborhood around Boston… crowns are free through MassHealth (Medicaid). What about in New York? As of 2023, the 5 million New Yorkers receiving taxpayer-funded health insurance get free crowns, implants, root canals, etc. (NYT)

Whom does that leave to go down the cheaper road of extraction? The working class chumps who fund Medicaid via their tax payments and who therefore can’t pay the $2,200 per crown retail price. These will be the Americans with missing teeth.

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Is immigration killing native-born Americans via overcrowding in health care?

A friend’s daughter in NYC is soon to turn a disposable fetus into a precious baby. This transformation will cost her $5,000 out of pocket. She couldn’t find an ob-gyn in Manhattan without agreeing to the “concierge” plan and says that this is the direction of primary care in the city. In Maskachusetts it was difficult to find a primary care physician who was taking new patients and waiting times to see specialists were generally measured in months if not seasons. Florida is, if anything, even more stressed. Americans fleeing lockdowns have been disproportionately not doctors. A doctor who wanted to escape Andrew Cuomo would have had to get licensed in Florida, which is a complex process, and then build a practice here. Compare to a laptop-based worker who could pick up and move over a weekend.

Can waiting a few months to see a doctor result in death? Yes, concludes “Delayed Access to Health Care and Mortality” (2007):

Veterans who visited a VA medical center with facility-level wait times of 31 days or more had significantly higher odds of mortality (odds ratio = 1.21,p = 0.027) compared with veterans who visited a VA medical center with facility-level wait times of < 31 days.

“The U.S. Has Fewer Physicians and Hospital Beds Per Capita Than Italy and Other Countries Overwhelmed by COVID-19” (KFF, 2020) includes a chart with 2017 data:

Our World in Data shows that there was an upward trend from 1960 to 2004, as the U.S. became wealthier and medicine more advanced, but now we’re in a downward trend as our population expands via low-skill immigration.

Maybe the shortage of docs can be addressed via using non-doctors to do what doctors in Switzerland, Germany, and Sweden do? The trade union for docs says this doesn’t work… “3-year study of NPs in the ED: Worse outcomes, higher costs” (AMA):

Nurse practitioners (NPs) delivering emergency care without physician supervision or collaboration in the Veterans Health Administration (VHA) increase lengths of stay by 11% and raise 30-day preventable hospitalizations by 20% compared with emergency physicians, says a working paper published by the National Bureau of Economic Research.

Overall, the study shows that NPs increase the cost of ED care by 7%, or about $66 per patient. Increasing the number of NPs on duty to decrease wait times raised total health care spending by 15%, or $238 per case—not including the cost of additional NP salaries. In all, assigning 25% of emergency cases to NPs results in net costs of $74 million annually for the VHA.

They don’t bother to try to figure out whether the patients lived or died or what quality of life they might have experienced, but it seems safe to say that “preventable hospitalizations” are not beneficial.

Rich people can buy their way out of waiting to see primary care docs and, perhaps, a handful of specialists who are affiliated (or bribed?) by a concierge practice. A 50ish friend in Boston pays $8,000/year for this. But even the rich may experience a long wait if they need to see a specialist outside of their concierge network.

There have been some recent articles decrying a decline in U.S. life expectancy (example from the public health folks at Harvard, taking a rare break from their mask and COVID-19 vaccine advocacy). But none mention population growth combined with relative stagnation in the number of physicians.


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Question for readers who are old and genetically defective (progressive lenses)

Because I voted for Bernie I wear progressive eyeglasses. These fix a touch of adolescent myopia and astigmatism (for distance vision) and old-guy-needs-reading-glasses on the lower portion. To show my support for our 2SLGBTQQIA+ brothers, sisters, and binary-resisters, these are “Transitions” lenses that darken when I venture out with Mindy the Crippler. The dark glasses ensure that we aren’t recognized by the Paparazzi.

I recently got an updated prescription and things have changed a bit since my previous exam (pre-coronapanic). My frames are in good shape (hard to damage your eyeglasses when you’re ordered to stay at home) so the place that did the exam suggested that I replace the lenses… for about $780:

If memory serves, which it probably doesn’t, the complete frames+lenses back in 2019 were about $400 each. Now the lenses alone are over $600 for the ghetto version. As Californians have recently discovered, living one’s progressive ideals isn’t always cheap. What’s the difference among these three options within the Varilux line? The optician says that it is all about the field of view. This sort of makes sense if you consider eyeglass lenses to be like binoculars, but I’m not sure why they should be.

Muddying the waters to some extent is the fact that Varilux is made (in China?) by Essilor, a French company. They were the pioneers in this area and the French have some history with optics, e.g., Angénieux makes some great lenses for cinematography. Nonetheless, France is not one of the nations that comes to mind when great optics are being discussed. What do the Japanese have to offer? Nikon has a web page, but hardly any retailers in the U.S. Canon and Sony don’t seem to be in this product area at all. Seiko makes eyeglass lenses. Asahi-Lite offers progressives in the U.S. It looks as though Tokai and TALEX are also Japanese companies. I can’t figure out which of these is the best or if any of them compete with Varilux. How about the Germans? Leica offers “Variovid Superior Progressive Lenses”. Zeiss seems to be the big competitor to Varilux in the U.S. market for high-end progressives. Rodenstock, the view camera photographer’s favorite, makes progressives starting from an individual eye scan:

(Sadly, this is available only in Europe and the UK. Is it U.S. regulations or the U.S. legal environment that are keeping this amazing company out of our purportedly competitive market? As noted in the comments, I talked to a Dutch optometrist who sells Zeiss lenses and isn’t all that impressed with the Rodenstock idea. The best Zeiss photochromic lenses over there are €1220 for a pair. For the fancy Rodenstock it would be €1358. Then add a little something for frames!)

I can’t find good information about any of these products, though. I’ll be getting two pairs of lenses, so we’re talking about potentially $1500+ in spending plus 7 percent sales tax (6 percent to support the fascist tyranny of Ron DeSantis and 1 percent to keep Palm Beach County’s luxurious services going).

Readers: Have you ever gone from “basic progressive” to “premium progressive” and noticed an improvement in field of view? Have you figured out which brand of high-end progressive lenses is the best? (I guess there is always the option of assuming that Costco has figured this out and rolled it into their optical shop.)

Update: As part of my two-year boycott of the Jupiter, Florida Target, I stopped into the Jupiter, Florida Walmart. The optical department there sells Nikon wide-field progressive lenses for $$280 plus $85 for the Transitions feature. If you want to show your support for the 2SLGBTQQIA+ community without glasses that darken in UV light, Elton John-brand frames are available:

Nikon seems to be playing the same game that the mattress companies use. The Nikon wide-field progressive lenses at Walmart are branded “Nikon Focus”. At independent opticians, Nikon offers “Presio” and “Seemax”. Is this an alternative to the Essilor Empire? The nikoneyes.com web site has a copyright banner across the bottom that references Essilor:

It’s a little confusing, but it might be because Nikon is using the Essilor TotalShield anti-scratch anti-reflective coating. That’s confusing because Nikon has been coating lenses since at least the 1950s (some mostly-peaceful Germans developed modern A-R coatings in 1935).


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Should everyone buy a home AED now that we’re all vaccinated?

Science proves that cardiac arrest cannot be caused by a COVID attempted vaccine. But Science also proves that we can never be killed by COVID-19 if we have been injected with at least 4 (or 5? or 6?) COVID shots. Therefore, we can move on to worrying about ways to die other than via SARS-CoV-2…. e.g., cardiac arrest!

A friend is a police officer and recently went through recurrent CPR training. Americans who get shot have a 90 percent survival rate, but those who suffer a sudden cardiac arrest survive only about 10 percent of the time. The automated external defibrillator (AED) is the key to survival, not CPR, according to the nurse who provided the training. Why not buy a home AED? They’re compact and available for as little as $700 “recertified”. The refurbished units are typically never-used machines that run out of their 4-year battery certification and the recertification process may be as simple as putting in a new battery.

Will the home AED definitely save you? The nurse training my friend explained that it probably won’t save a married man. “The wife would rather get the insurance money than provide resuscitation.”

“The AED in Resuscitation: It’s Not Just about the Shock” (2011):

Newer guidelines have simplified resuscitation and emphasized the importance of CPR in providing rapid and deep compressions with minimal interruptions; in fact, CPR should resume immediately after the shock given by the AED, without the delay entailed in checking for pulse or rhythm conversion.

Although CPR predated the development of the modern automated external defibrillator (AED), the technique seemed to be relegated to a lower priority after introduction of the modern AED. Recently, CPR has been increasingly recognized as a critical factor in treating cardiac arrest, in combination with the AED.

Readers: Do you have an AED in your house? If not, why not?

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The latest research from Harvard Medical School

If you were wondering where the forefront of medical research is…

A screen shot in case the above is memory-holed:

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Quantifying our incompetence at government-run health care

Almost everything having to do with health care in the U.S. is controlled by our government. A doctor cannot practice unless approved by a state government (can take 6-12 months here in Florida, so the supply of doctors always lags the demand from patients who have moved). Once he/she/ze/they is approved, half of his/her/zir/their salary will be paid for directly by government (Medicare/Medicaid) while the other half comes from government-regulated and government-subsidized “private” health insurance. Bureaucrats often talk about their heroic efforts in controlling costs. Without them in our corner, we would pay 40 percent of GDP for health care instead of 20 percent.

Every now and then we get a window into our own incompetence via an international comparison either for price or quality. “Have Eggs, Will Travel. To Freeze Them.” (New York Times, April 8):

Milvia found that in the United States, the entire process — including the medications, the doctor visits and the average number of years of egg storage — costs about $18,000, and most women can’t count on health insurance to cover it. As of 2020, less than 20 percent of U.S. companies with more than 20,000 employees had health insurance plans to cover the procedure, according to Mercer Health News, though that figure rose from 2015 to 2020.

(Why does the NYT speak of “women”? Men may also want to freeze their eggs!)

Hotels, restaurants, and other labor-intensive services aren’t cheaper in Europe than they are here in the U.S. what about egg-freezing?

Many countries have clinics that are much cheaper. In the Czech Republic and Spain, for example, you can get one round of egg-freezing done for under $5,400, according to the website of Freeze Health, which provides information on egg freezing around the world.

Milvia is taking its first women to Britain, where prices hover in the $7,000 range, because “we wanted to start in a place where there is no language or cultural barrier,” Mr. Ghavalkar said. “We also want to make sure we’re in a place where all clinics operate at very high standards.”

So it is 14X the cost of a decent hotel in London to freeze an egg in London. If we assume that a decent hotel room in a typical U.S. city is now $250 per night, egg-freezing is 72X the cost of a hotel here in the U.S.

How about running a refrigerator? Where electricity is more expensive, cold storage for eggs is about 1/4 the price:

Women who freeze their eggs abroad can choose to keep their eggs in that country where storage costs are usually cheaper. In Canada, for example, it can cost under $200 a year to store your eggs. In Spain you can do it for a little over $200. In Los Angeles, by contrast, a year of storage costs about $750. In New York City, it’s more than $1,000, according to Freeze Health.

(Again, note the hateful anti-2SLGBTQQIA+ assumption that it is “women” who freeze eggs.)

Vaguely along the same lines, the NYT also recently published “In Search of Romance? Try Moving Abroad.”:

For some American women, relocating outside of the United States has improved their dating lives. But some warn that finding love involves more than a change of address.

Now, Ms. Margo is living a dream [having sex with a wide variety of French guys] of many American women who are seeking relationships abroad, some of whom cite the toxic dating scene in the United States.

If you thought that Americans were insufficiently passionate about geriatric parenthood and/or a lifetime of Tinderhood…

Cepee Tabibian, who moved to Madrid at 35 from Austin, Texas, felt similarly. She was excited to meet people in Spain, where she noticed a culture of getting married or having children later in life than in the United States, or not getting married at all. “When I walked into the room, I wasn’t the oldest person,” Ms. Tabibian said. “I wasn’t the only single person.”

Is there a market for successful American divorce plaintiffs?

For Cindy Sheahan, meeting people outside of her circles in Denver was momentous. She started traveling solo shortly after ending her 30-year marriage in 2016.

She found the men she dated in Denver after her divorce to be unadventurous. She said she went on 60 dates in 2017.

“It was like a comedy show,” she said.

At the end of 2017, she quit her job and traveled throughout Southeast Asia for leisure, and she started using Tinder.

“Because they were out there living their life, there was a lot more energy to the dates,” Ms. Sheahan, 61, said about the people she met while traveling. “It wasn’t just somebody meeting after their work at the bank, on their way home to let out the dog in Denver.”

In 2018, she met her partner of five years, Jean-Marie Mas, a 61-year-old professional tandem paraglider from Dordogne, France, in Nepal.

Apparently the divorce lawsuit freed her from ever having to work!


  • Time is ripe for Cubans to become Medicare vendors (2014)
  • A modest proposal for the Carnival Triumph (2013): The Triumph would leave every morning at around 8:00 am. Medicare clients would enjoy a Cracker Barrel breakfast on board the ship. The ship would arrive in Cuba at 12 noon. Those who were well enough to walk could enjoy a stroll around Havana. The Triumph would pick up patients returning from hospital care in Cuba and anyone who’d been enjoying the sights, then depart around 2:30 pm. An early bird special dinner would be served on board starting at 5 pm, with an arrival back in Key West at 6:30 pm.
  • Carnival Sunrise (instead of doing something innovative with international healthcare, the cruise line simply renamed the fire-and-sewage-plagued vessel)
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New book on ChatGPT in medicine

Some friends have put together The AI Revolution in Medicine: GPT-4 and Beyond, a thought-provoking book released today. Health care is nearly 20 percent of our economy (compare to 4 percent in Singapore) and a higher percentage of our tax dollars (Happy Official Tax Day, though April 18 is the deadline this year; the opioid makers thank you for your efforts in the workplace). The book asks the important question “What will LLMs do for an industry to which Americans have decided to devote one working day per week?”

First, let’s ask why we think GPT-4, famous for its writing talents, might matter for doctors. Doctors aren’t primarily writers, after all. Many physicians, however, spend time attempting diagnoses and this is an information processing activity. The patient describes his/her/zir/their symptoms and the doctor matches these to known patterns, possibly asking follow-up questions or ordering tests to confirm or reject explanations. In other words, exactly what computer programs have traditionally done.

Second, let’s ask GPT-4 for its own opinion: “Explain why GPT-4 will change the practice of medicine and the experience of patients.” Our future overlord’s response:

GPT-4 has the potential to significantly change the practice of medicine and the experience of patients in various ways. Here are some key areas where it can have a transformative impact:

  1. Enhanced medical diagnosis: GPT-4’s advanced language processing capabilities enable it to understand complex medical information and provide diagnostic suggestions to doctors. This can help in the early detection of diseases, improving patient outcomes, and potentially saving lives.
  2. Personalized treatment recommendations: GPT-4 can analyze an individual’s medical history, genetic data, and other relevant factors to provide personalized treatment recommendations. This can lead to more targeted and effective therapies for each patient.
  3. Streamlining administrative tasks: GPT-4 can help automate and streamline various administrative tasks, such as scheduling appointments, managing patient records, and handling insurance claims. This will allow healthcare professionals to focus more on patient care and less on paperwork.
  4. Health education: GPT-4 can act as a virtual health educator, providing patients with accessible and accurate information about their conditions, medications, and self-care strategies. This will empower patients to take a more active role in managing their health.
  5. Mental health support: GPT-4 can serve as a virtual therapist, offering support to individuals struggling with mental health issues. It can engage in conversation, provide coping strategies, and help track mood and behavior patterns. While it cannot replace human therapists, it can be a valuable supplemental resource.
  6. Telemedicine: GPT-4 can enhance telemedicine platforms by providing real-time language translation services and facilitating communication between patients and healthcare providers across different languages and cultures. This can expand access to healthcare services for patients in remote or underserved areas.
  7. Research and development: GPT-4 can assist in the analysis of large volumes of medical data, identifying patterns and relationships that may be difficult for humans to detect. This can help accelerate the development of new treatments and technologies in the medical field.
  8. Ethical considerations: The integration of GPT-4 in healthcare can raise various ethical concerns, such as data privacy, algorithmic bias, and the potential for overreliance on AI. However, addressing these challenges and ensuring the responsible use of GPT-4 can lead to a more equitable and effective healthcare system.

Overall, GPT-4 has the potential to revolutionize the practice of medicine and improve the experience of patients by enhancing diagnostic accuracy, personalizing treatment, streamlining administrative tasks, expanding access to healthcare services, and more. As with any new technology, it is essential to address ethical concerns and ensure the responsible and equitable use of AI in medicine.

(Note ChatGPT’s passion for equity! If we put ChatGPT in charge, it might read “Racial Disparities in Maternal and Infant Health” (KFF), learn that “Black and American Indian and Alaska Native (AIAN) women have higher rates of pregnancy-related death compared to White women” and decide to euthanize 15 percent of white pregnant people who come to the hospital. That would be the simplest and fastest way for the AI to accomplish its equity goals of health outcomes based on skin color.)

A primary care doc neighbor says that he uses ChatGPT every day and would pay $1,000 per month for it if he had to. When confronted with a massive hospital discharge note that he is required to summarize in order to get paid, he will ask ChatGPT to summarize it, for example. He also uses ChatGPT to draft follow-up instructions. He says that ChatGPT is surprisingly good at interpreting blood tests. It is interesting to reflect that ChatGPT is useful to him describe the fact that he can’t feed it his institution’s electronic medical record. So the AI doesn’t already know each patient’s full history.

Let’s return to The AI Revolution in Medicine: GPT-4 and Beyond… starting with “Chapter 4: Trust but Verify” from the doctor (Isaac Kohane) and “Chapter 5: The AI-Augmented Patient” from the science journalist (Carey Goldberg).

In “Trust but Verify,” the question of how we would put GPT-4 through a clinical trial is explored. Other computer programs have passed clinical trials and received government approval, so why not GPT-4? The typical clinical trial is narrow, Dr. Kohane points out, while GPT-4’s range of function is wide. Just as an FDA trial probably couldn’t be done to approve or disapprove an individual doctor, it seems unlikely that an FDA trial can approve or disapprove a LLM and, therefore, AI programs are most likely destined to be superhuman partners with human docs and not replacements. The chapter contains a couple of concrete scenarios in which the doctor compares his own work in some difficult cases to GPT-4’s and the AI does fantastic.

In “The AI-Augmented Patient”, the journalist points out that the people who’ve been asking Dr. Google for advice will be the heavy users of Dr. GPT-4. She highlights that the “COVID ‘misinfodemic’ shows[s] that it matters which humans are in the loop, and that leaving patients to their own electronic devices can be rife with pitfalls.” Implicit in the foregoing is the assumption that public health officials are the best human decision-makers. What if the take-away from coronapanic is the opposite? Credentialed Americans refused to read the WHO pandemic management playbook, refused to process any information coming from Europe unless it fit their preconceived ideas about lockdowns, school closures, and mask orders, and refused to consider population-wide effects such as risk compensation. A computer program wouldn’t have any of these cognitive biases.

What happened when people expanded their sources of information? One notable example: Marjorie Taylor Greene turned out to be a better virologist than Dr. Fauci. In August 2021, MTG was suspended from Twitter for noting that the available COVID-19 vaccines did not prevent infection by and spread of SARS-CoV-2 and that masks were not effective. Virologist Greene’s statements were labeled “false” as a matter of Scientific fact by the journalists at the New York Times in January 2022 and then proven correct soon afterwards with a huge study in Spain and the Cochrane review. Plenty of those killed by COVID would be alive today if they’d listened to Marjorie Taylor Greene’s advice rather than the CDC’s. The elderly/vulnerable would have stayed safe at home, for example, instead of entering public indoor environments with masks on.

I’m optimistic that GPT-4 will do better in many areas than American medical officialdom because its judgment won’t be tainted by groupthink and “we’ve always done it this way”. We’ve often had standard of care disagreements with the Europeans, for example, and the Europeans have ended up being correct. The latest discrepancy in Science is that Denmark suggests a newborn get his/her/zir/their first COVID shot at age 50 (in the year 2073) while the CDC suggests four shots over the next 12 months. We might know who was right in 5-10 years, but an orthodox American MD isn’t supposed to question the CDC and would never ask “Are the Danes right?” while GPT-4 surely would be aware of the Danish MD/PhDs’ conclusions.

As long as we’re on the subject of every American’s favorite disease… later in the book, Kevin Scott, the CTO of Microsoft whose degree is in computer science, talks about the epic stupidity of physicians in rural Virginia. Not only did they fail to immediately prescribe Paxlovid to his tested-positive brother, but they actively refused to prescribe it when the life-saving experimental drug was asked for by name (cue the Super Bowl ad for the still-not-FDA-approved drug). Here’s a photo of the West Coast computer programmer who claims to know more about preventing death-by-COVID than doctors in Virginia’s Trump Belt:

Given the scattered nature of American medical records, I think that a patient who is diligent about saving all of his/her/zir/their tests and logging symptoms then running a local copy of GPT-4 will be way ahead in the diagnosis Olympics. There is a limit to what a doctor can do in a 15-minute visit and the typical doctor can see only a fraction of a patient’s medical record (because tests and treatments have been done at other institutions and the $trillions that Americans have spent on electronic health records have not yielded any practical integration).

What will this do to demand for medical services? The chapter quotes “Dr. Jim Weinstein, a leading expert on health equity now at Microsoft” that “[GPT-4] could be a particular valuable partner for the 100 million Americans on Medicaid, and it could cut unnecessary cost and waste across the board by helping patients understand more about their options.” Personal guess: GPT-4 will drive demand and therefore costs in the opposite direction. GPT-4 already covers its ass by providing the worst-case scenarios. Patients will learn that their “options” include aggressive rare cancers and calling 911.

Let’s try a concrete example. Suppose that you live in Maskachusetts and your female-led Social Equity marijuana home delivery was running late so you drink half a bottle of rum while waiting for the daily one-ounce high-potency bong refill. The next morning, despite all of the healing cannabis that you consumed, you wake up on the bathroom tile not feeling your best and ask GPT-4, “I have a lump on my head. What are the possible causes?” Here’s what it says:

There are several possible causes of a lump on the head, including:

  1. Head injury: A bump or lump on the head may be the result of a head injury, such as a concussion, hematoma, or skull fracture.
  2. Scalp infections: Infections of the scalp, such as folliculitis or cellulitis, can cause swelling, redness, and lumps on the scalp.
  3. Cysts: A cyst is a sac filled with fluid or other material that can develop under the skin on the scalp.
  4. Lipomas: A lipoma is a slow-growing, benign tumor made up of fat cells that can develop under the skin on the scalp.
  5. Bone deformities: Certain conditions, such as Paget’s disease or fibrous dysplasia, can cause abnormalities in the bones of the skull that may lead to lumps or bumps on the head.
  6. Tumors: In rare cases, a lump on the head may be a sign of a cancerous tumor.

It’s important to have any new lumps or bumps on the head evaluated by a healthcare provider to determine the cause and appropriate treatment. If the lump is the result of a head injury and you experience symptoms such as loss of consciousness, dizziness, or severe headache, seek emergency medical attention immediately.

The patient who didn’t talk to GPT-4 might wait a few days before seeking healthcare services. After all, plenty of Looney Tunes characters recover quickly from head lumps.

The patient who reads the GPT-4 output, however, is explicitly told that he/she/ze/they must be “evaluated by a healthcare provider” and that injury from an alcohol-and-cannabis-assisted encounter with tile is just 1 out of 6 possibilities. The idea that “the 100 million Americans on Medicaid”, who have $0 copays for going to the emergency room, will ignore GPT-4’s explicit

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Make an appointment to see the doctor to get your opioids

April 5 email from Mass General, below. Customers are reminded that coronapanic officially ends next month and that, to keep the OxyContin flowing, it will be necessary to actually see a physician before taxpayers will pay for the pills. (i.e., for more than three years you’ve been able to get Oxy the same way that Californians with a sniffle get their Paxlovid: an audio or video call from the comfort of your sofa). Given that it takes a month or more to get in and see a physician in the U.S. (the miracle of open borders for the low-skilled and closed borders and onerous re-licensing requirements for qualified European physicians), I’m providing this reminder as a public service.


  • Focusing on race and racism just makes the problem worse. (true or false?) (there is one answer that will enable a person to continue receiving a paycheck from Mass General Brigham)
  • Should you wear a mask when going to the doc to get your opioid prescription? “Were masks in hospitals a waste of time? Hated NHS policy made ‘no difference’ to Covid infection rates, study finds” (Daily Mail, April 7): Researchers from St George’s Hospital in south-west London analysed routinely collected infection control data over a 40-week period between December 4, 2021 and September 10, 2022. … Researchers found removing the mask policy in phase two did not produce a ‘statistically significant change’ in the hospital-acquired Covid infection rate. Equally, they ‘did not observe a delayed effect’ in the Covid infection rate once the policy was removed. … Lead author Dr Ben Patterson said: ‘Our study found no evidence that mandatory masking of staff impacts the rate of hospital SARS-CoV-2 infection with the Omicron variant. … Fellow researcher Dr Aodhan Breathnach added: ‘Many hospitals have retained masking at significant financial and environment cost and despite the substantial barrier to communication.
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