A doctor’s touch

A recent online edition of The Journal of the American Medical Association features an essay by two doctors titled “The iPatient Meets the iDoctor.”  The authors acknowledge the time-saving benefits of AI, such as its ability to assimilate and consolidate clinical documentation, imaging, and laboratory results. They also tell us that AI gives less-trained health workers "the diagnostic performance of the most experienced physicians.” In fact, AI already matches or exceeds physician performance on standardized knowledge multiple-choice examinations. This advantage is particularly useful in under-resourced areas where patients may receive “expert-level care where none previously existed.”

But they mourn the accompanying losses, which include the “hollowing out of longitudinal patient-physician relationships,” as seen in the loss of primary care doctors and increased use of emergency departments, telehealth, and urgent care clinics.  Such short-term relationships are likely to overlook subtle changes in a patient’s health, such as a change in gait.  

Most important, perhaps, is the loss of physical touch. The ritual of the physical examination, the authors maintain, “…localizes the patient’s complaint on their body (and not on a laboratory printout, an inbox message, a biopsy report, or a radiologic finding) …When we care for patients without physical touch, we distance ourselves from their embodied identity and in time from our own.”

The authors, both MDs, are David Rosenthal and novelist Abraham Vergese, author of A Covenant of Water and Cutting for Stone. I recommend the latter. I’m sure it’s semi-autobiographical.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

I turned 90

August 23^rd is/was my 90^th birthday. Ack!

I started writing a weekly blog in January 2015, when I was only 79. Since that date I have created over 600 posts. Somehow, I’ve managed to write a new one every week. 

My main sources are The New York Times, Scientific American, The Atlantic, and a bunch of online medical journals. My sources also include books, such as Mistreated: Why We Think We’re Getting Good Health Care—and Why We’re Usually Wrong, by Robert Pearl, MD; and Over-diagnosed: Making People Sick in the Pursuit of Health, by Drs. H. Gilbert Welch, Lisa M. Schwartz, and Steven Woloshin. (The main menu on my blog page includes a Bibliography with a list of about 90 books. That number surprised me. I haven’t updated it in ages. Must get to it!)

I try to keep my blogs short. If my source material is extensive and complicated, they take a long time to write. After I write them, my friend Betsy proofreads them, often finding mistakes.

Lately, AI has become a ubiquitous topic in most of my sources. For this reason, I've also been writing on the topic, but I worry about boring my readers. On the other hand, AI is an undeniable game-changer. Attention must be paid!

I guess I’ll keep writing these blog posts unless I lose more marbles.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Macular degeneration and inflammation

Inflammation seems to be getting more attention these days, mostly, I think, because scientists keep making new discoveries. As The New York Times reported, “Inflammation is the product of an incredibly complex network that we’re just beginning to understand.” While inflammation is a very complicated regulatory network, new discoveries are beginning to yield some treatment results.

Inflammatory responses, such as fever, swelling, and redness, are signs that your immune system is engaged in battle, destroying invaders or repairing injuries. If that process doesn’t work quite right, some inflammation lingers, resulting in low-level chronic inflammation, a condition that has been shown to correlate with aging and serious health problems.

The challenge for scientists is figuring out how to reduce inflammation without weakening the body’s ability to fight disease. As one scientist notes, “Turning off the inflammation without knowing exactly why it’s present risks doing more harm than good.”

(The new GLP-1 weight loss drugs seem to reduce inflammation by influencing pathways throughout the body that cause inflammation, but scientists don’t fully understand how it works.)

Researchers are making some progress in developing some helpful drugs. One new drug has been shown to reduce the risk of macular degeneration (and Alzheimer’s) by blocking a specific group of inflammatory proteins. Trials conducted by the Center for Advanced Vision Science at the University of Virginia School of Medicine has shown “very promising results.”  The drug may be available in the next 18 to 24 months. I don’t have macular degeneration, but I know several people who do. I hope the new drug works.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

AI wrote this post

I’ve never used AI to write anything. Out of curiosity, I asked Google’s chatbot, Gemini, to write a 250 word summary about the pros and cons of older people using weight loss drugs. In a few seconds, here’s what I got, exactly as written:

“The rise of GLP-1 weight loss medications (such as semaglutide and tirzepatide) offers new possibilities for senior health, but using these drugs in older adults requires balancing significant health benefits against unique risks.

The Pros

• Cardiometabolic Improvements: Substantial weight loss helps control type 2 diabetes, lowers blood pressure, and reduces the risk of heart attacks and strokes.
• Joint & Mobility Relief: Shedding extra weight alleviates mechanical strain on aging joints, easing knee and hip pain from osteoarthritis.
• Broader Systemic Protection: Clinical studies show additional benefits, including reduced systemic inflammation, improved kidney function, and reduced sleep apnea severity.

The Cons

• Muscle & Bone Loss: Rapid weight loss causes loss of lean muscle alongside fat. In seniors, this accelerates sarcopenia (age-related muscle loss) and reduces bone density, increasing frailty and fall risks.
• Gastrointestinal & Dehydration Risks: Common side effects like nausea, vomiting, and diarrhea can quickly lead to severe dehydration, orthostatic hypotension (sudden blood pressure drops upon standing), and dizziness in older adults.
• Polypharmacy & Pharmacokinetics: Age-related declines in kidney and liver function affect how drugs are metabolized. Adding GLP-1s to an existing multi-medication regimen increases the likelihood of adverse drug interactions.

The Bottom Line

For older adults, weight loss drugs are most effective when paired with resistance training and high protein intake to preserve crucial muscle mass. Careful physician supervision is essential to adjust existing medications and monitor hydration levels.” [230 words]

(FYI: A recent article in Scientific American states that “the evidence supporting their use in the age-60-and-older population is limited. …we simply don’t have enough evidence yet to make informed conclusions….")

The reason I chose technical writing as a profession is that I like researching a topic, organizing the information, and writing about it. Sometimes it takes a long time. Now, a chatbot can do the same thing in seconds. It’s disheartening.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.