medicine
/medicine588
This is a space for doctors and medicine lovers
Patient education is probably where LLMs will have the most profound, unexpected benefit in medicine.
Explaining importance of a medication, disease at their education level and in their words (or language) to allay fears/apprehension about treatment goes a long way with compliance and preventing progression.
Explaining importance of a medication, disease at their education level and in their words (or language) to allay fears/apprehension about treatment goes a long way with compliance and preventing progression.
Probably biggest news this week in preventative medicine was CMS approving coverage for Shield, a blood test for colorectal cancer (CRC) developed by Guardant Health.
CMS will cover $1495 which means most Medicare Fee-for-service patients wont pay anything for the test. To me this is bigger than getting FDA approval as it opens the door for scaling out blood tests for CRC. Medicare Advantage (proving its uselessness) will likely not cover all of it.
CRC is now the #1 cancer in the US by diagnosis. And due to shortages of GI physicians, increased comorbidities of patients making colonoscopies riskier screening can be tough.
Likely blood test (Shield) + Cologuard is the combination that will likely emerge in the future. Colonoscopies then for those at high risk
Longevity aspect: Shield can start at 45yo so likely will see this as an offering for cash pay at longevity clinics alongside other cfDNA based tests like Galleri by Grail, Gemini by Hopkins.
CMS will cover $1495 which means most Medicare Fee-for-service patients wont pay anything for the test. To me this is bigger than getting FDA approval as it opens the door for scaling out blood tests for CRC. Medicare Advantage (proving its uselessness) will likely not cover all of it.
CRC is now the #1 cancer in the US by diagnosis. And due to shortages of GI physicians, increased comorbidities of patients making colonoscopies riskier screening can be tough.
Likely blood test (Shield) + Cologuard is the combination that will likely emerge in the future. Colonoscopies then for those at high risk
Longevity aspect: Shield can start at 45yo so likely will see this as an offering for cash pay at longevity clinics alongside other cfDNA based tests like Galleri by Grail, Gemini by Hopkins.
Google’s AMIE showed promising results using Gemini powered conversational AI as tool to augment long term disease management.
Interesting was that they focused on precision and guidelines but the follow-ups were way too close together. Precision falters as people age and their bodies and environments change.
https://research.google/blog/from-diagnosis-to-treatment-advancing-amie-for-longitudinal-disease-management/
Interesting was that they focused on precision and guidelines but the follow-ups were way too close together. Precision falters as people age and their bodies and environments change.
https://research.google/blog/from-diagnosis-to-treatment-advancing-amie-for-longitudinal-disease-management/
Big news today:
GLP-1 shortage is over. This will have big implications for compounding pharmacies, patients but much much more
Essentially, FDA declared not that Ozempic/Wegovy (semaglutide) shortage resolved, meaning compounded GLP-1s are no longer allowed, tanked HIMS stock.
For perspective, ~25% of GLP-1s are compounded, serving millions of patients. And a big source of revenue for compounders that have shifted biz models, but even more so developed these into robust treatments (ex: B12/sema combo)
Compounders are now challenging in court to continue production, tirzepatide is already in court, semaglutide cases likely will join in. During this time, while the current lawsuit ongoing, FDA is maintaining its enforcement discretion.
Now here is where this turns another corner:
GLP-1 shortage is over. This will have big implications for compounding pharmacies, patients but much much more
Essentially, FDA declared not that Ozempic/Wegovy (semaglutide) shortage resolved, meaning compounded GLP-1s are no longer allowed, tanked HIMS stock.
For perspective, ~25% of GLP-1s are compounded, serving millions of patients. And a big source of revenue for compounders that have shifted biz models, but even more so developed these into robust treatments (ex: B12/sema combo)
Compounders are now challenging in court to continue production, tirzepatide is already in court, semaglutide cases likely will join in. During this time, while the current lawsuit ongoing, FDA is maintaining its enforcement discretion.
Now here is where this turns another corner:
AI ambient scribes are (likely) what brings down Epic’s monopoly. Provided they execute well.
Closest to the customer. On both ends.
Closest to the customer. On both ends.
It’s important to know how to let you being help.
Are you using Mounjaro (tirzepatide) for diabetes management?
I wanted to share a recent experience that might be helpful for those considering or currently using Mounjaro
Mounjaro is a medication designed to help control blood sugar levels in adults with type 2 diabetes. While it's often highlighted for its weight loss benefits, it's crucial to remember that it's primarily a diabetes treatment. My wife, who isn't overweight (around 130 pounds or 55 kg), uses it specifically for her diabetes.
Recently, she experienced significant stomach pain, which led us to the emergency room. Given her family history of gallbladder issues, we were particularly cautious. After thorough examinations, the doctors determined that it was a side effect of Mounjaro.
Common gastrointestinal side effects of Mounjaro include:
Nausea
Diarrhea
Decreased appetite
Constipation
Abdominal pain
Heartburn
These side effects are usually temporary and may subside as your body adjusts to the medication.
Continued 👇
I wanted to share a recent experience that might be helpful for those considering or currently using Mounjaro
Mounjaro is a medication designed to help control blood sugar levels in adults with type 2 diabetes. While it's often highlighted for its weight loss benefits, it's crucial to remember that it's primarily a diabetes treatment. My wife, who isn't overweight (around 130 pounds or 55 kg), uses it specifically for her diabetes.
Recently, she experienced significant stomach pain, which led us to the emergency room. Given her family history of gallbladder issues, we were particularly cautious. After thorough examinations, the doctors determined that it was a side effect of Mounjaro.
Common gastrointestinal side effects of Mounjaro include:
Nausea
Diarrhea
Decreased appetite
Constipation
Abdominal pain
Heartburn
These side effects are usually temporary and may subside as your body adjusts to the medication.
Continued 👇
Intriguing paper making the rounds this morning by Peter Visscher et al. in Nature about the future of Polygenic Gene Editing for reducing disease risk in embryos for complex diseases! Discusses about how a few variants dramatically decrease diseases like diabetes or schizophrenia. It's speculative but fascinating.
https://www.nature.com/articles/s41586-024-08300-4
https://www.nature.com/articles/s41586-024-08300-4
Something doesn't sit right with CHAI. Cant figure out yet, but the members plus use of 'responsible AI in health' can never bode well for patients and physicians. EHRs demonstrated that quite well.
https://chai.org/
https://chai.org/
Information for People in Contact with Livestock:
How to Prevent and Protect Yourself from Q FEVER
Q fever is an infection transmitted from animals to humans, caused by the bacterium Coxiella burnetii. Infected animals shed the microorganism through urine, feces, milk, and especially through products related to birth. Humans become infected primarily by inhaling contaminated particles.
How to Prevent and Protect Yourself from Q FEVER
Q fever is an infection transmitted from animals to humans, caused by the bacterium Coxiella burnetii. Infected animals shed the microorganism through urine, feces, milk, and especially through products related to birth. Humans become infected primarily by inhaling contaminated particles.
Feels like GLP-1 rush day today as patients try to get their last refill before insurance changes tomorrow.
Many insurance cos are dropping GLP-1 coverage for 2025 or making the requirements stricter
Many insurance cos are dropping GLP-1 coverage for 2025 or making the requirements stricter
Feedback loops with wearable and patient biomarkers utilizing LLMs is something every physician should be thinking about.
It’s a paradigm shift in how we are trained to treat temporally. Real time medical data, trials, guidelines.
We will have to go beyond evidence based medicine and data-powered medicine.
It’s a paradigm shift in how we are trained to treat temporally. Real time medical data, trials, guidelines.
We will have to go beyond evidence based medicine and data-powered medicine.
Constipation is something that is not spoken of enough in leading to long term consequences both mild (hemorrhoids) and severe (diverticulitis, colectomy)
Rereading How Doctors Think by Montogomery this morning and found it relevant to the discourse on the value of physicians in the age of AI. Interpretation of what we see as physicians, be it through an EKG, CXR and eventually the assessment of the LLM is built on and for the patient in front of us. Easy to forget sometimes.
The multiple testing problem in GWAS perfectly illustrates why signal-to-noise is so challenging in personalized medicine: we're searching for maybe a few dozen causal genetic variants while running millions of statistical tests, each with a 5% false positive rate. With 1M variants, that's 50,000 "significant" results by chance alone - not even counting true biological effects.
Currently working through some specialization in precision medicine, and one of the stark realization is that most physicians didn’t even learn 95% of the genetics necessary to practice in the field while in med school or residency. Most of what we know today has only been developed the past 5 years. Epigenetic clocks are a good example.
Will work on bringing together resources.
Will work on bringing together resources.
Fun fact: if a doctor leaves a patient paper in their own hospital workroom, they have violated HIPAA and can be charged $50k per page. And get a scarlet letter on their medical license profile for the world to see.
Yet 17M full electronic records getting leaked see no consequence or uproar.
https://www.whittierdailynews.com/2024/12/12/cyber-criminals-claim-they-hacked-17-million-patient-records-at-pih-health-hospitals/
Yet 17M full electronic records getting leaked see no consequence or uproar.
https://www.whittierdailynews.com/2024/12/12/cyber-criminals-claim-they-hacked-17-million-patient-records-at-pih-health-hospitals/
Plants show us that genetics isn’t just about long-term changes—it’s happening in real time.
Their internal clock runs on a daily feedback loop. In the morning, sunlight activates genes that produce proteins (LHY and CCA1) that turn off another protein (TOC1). As night approaches, LHY and CCA1 decrease, allowing TOC1 to rise again, and the cycle repeats.
These shifts allow plants to adapt immediately to changing environments on a day to day basis.
Their internal clock runs on a daily feedback loop. In the morning, sunlight activates genes that produce proteins (LHY and CCA1) that turn off another protein (TOC1). As night approaches, LHY and CCA1 decrease, allowing TOC1 to rise again, and the cycle repeats.
These shifts allow plants to adapt immediately to changing environments on a day to day basis.
At urgent care because my daughters knee went... "Snap Crackle & Pop" today...
This is just to get a referral to sports medicine.
This is just to get a referral to sports medicine.
These hyperstructures look the same but are not. Not gonna lie makes me kinda nervous.
h/t to Weekly Dose of Optimism #114 by Packy (link below)
h/t to Weekly Dose of Optimism #114 by Packy (link below)
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What do you think about family who are not telling the patients the truth about the disease they have to “protect them”?
Massive nationwide shortage of IV fluid due to Baxter’s North Carolina plant getting damaged from Helene. They make 60% of the national supply.
Running low on basic IV fluids everywhere. Both Normal Saline and Lactated Ringers.
Running low on basic IV fluids everywhere. Both Normal Saline and Lactated Ringers.
