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A model-eat-model world of AI, living with a rare immunodeficiency disease, & the dearth of Indigenous physicians

October 10, 2023
Reporter, Morning Rounds Writer
And we're back. Lets's get started with more warning flags on AI models, what the pipeline for Indigenous doctors looks like, good news from Egypt on hepatitis C, and how soccer goalies see and hear  the world.

Health tech

It's a model-eat-model world: AI gets worse with use, study says

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This is both counterintuitive and concerning. Just as medicine applies more AI tools to predict serious events like strokes or sepsis, those models can fall victim to their own success. As their performance plummets, their inaccurate results can pose harm instead of prevent it. "There is no accounting for this when your models are being tested," said Akhil Vaid, author of a new paper in the Annals of Internal Medicine on models to predict death and kidney injury in ICU patients. "When it starts to work, that is when the problems will arise."

It's called data drift.  Successful predictive models create a feedback loop: The AI tool helps keep patients healthier, then electronic health records reflect lower rates of kidney injury or mortality — and other predictive models use that data to retrain models over time. STAT's Katie Palmer explains.


global health

Stroke deaths projected to grow by half by 2050

The global number of stroke deaths will climb 50% come 2050, a new report says, an increase that shows sharp differences based on national income. Huge gaps exist in the prevention and treatment of the condition, particularly in low- and middle-income countries, reflecting a recent WHO report's conclusion that high blood pressure, a key risk factor for strokes, is not adequately treated worldwide. 

Yesterday's assessment from the World Stroke Organization and the Lancet Neurology Commission estimates that by 2050, stroke deaths in low- and middle-income countries will account for 91% of stroke deaths worldwide. That's while the rate of such deaths is expected to decline globally, but the absolute number of deaths is set to increase in poorer countries, the report said. "People are dying from stroke, a disease that can be prevented and treated," Sheila Martins, president of the World Stroke Organization, told STAT's Elaine Chen. Read more.


medical education

Absent action, the deficit in Indigenous representation among doctors could take 102 years to correct

Less than half of 1% of working physicians and just 1% of medical students are American Indian or Alaska Native, a group that has seen no increase in numbers in med school enrollment in the past decade. Just 227 students from this group enrolled in medical school in 2021, STAT's Usha Lee McFarling tells us. An analysis that came out in Lancet Americas yesterday — Indigenous People's Day — found that if the number of new Indigenous medical students does not increase, it will take 102 years before the number of physicians in this group reaches parity with their population within the U.S., which is nearly 3%.

The authors, many of whom are Indigenous, proposed a host of remedies to increase numbers, from more federal support for tribal colleges and universities, designated seats for academically qualified Indigenous students, more pathway programs for medicine, a de-emphasis on MCAT scores for admission, and the recruitment of more Indigenous faculty at medical schools so they can help foster a sense of belonging.



Closer Look

Living with a rare immunodeficiency disease, sharing hard lessons LIVING_WITH_CASEY-1600x900

Photo illustration: Casey Shenery for STAT

When he was four months old, Casey Warford (above) was diagnosed with chronic granulomatous disease, an inherited immune deficiency that made him highly vulnerable to infections. In college he had such a serious infection he was in a coma for three days after a fungus attached to his brain, eventually requiring four surgeries. He talked recently with STAT's Isabella Cueto.

When you were a kid, how would you explain your condition?         I'd straight-up tell them I have a low immune system. Like, you can go swim in a lake; I can't. You can mow the lawn; I can't. 

How did you go from being a shy kid to being on stage performing?   That was where I was able to be myself. Just being on stage, I wasn't Casey, the CGD patient. I didn't have to think about doctors' appointments or taking medication. I got to be someone else for that hour and a half. 

Now you speak to young patients, in part as a patient ambassador for Horizon, which makes a CDG drug.                                                           For me, the mindset was: Help these kids avoid what you dealt with. 

Read the full interview. 


global health 

Egypt is on the path to eliminating hep C, WHO says

Egypt is well on its way to eliminating hepatitis C, the viral infection that can lead to liver disease and cancer. There is a cure, but 4 out of 5 people living with hepatitis C don't know they're infected. Egypt has been extraordinarily successful, the WHO said yesterday when naming it the first country on the path to eliminating the disease: It has diagnosed 87% of people living with hep C and provided 93% of those diagnosed with curative treatment, exceeding WHO's targets of diagnosing 80% and treating 70% of those diagnosed. 

Egypt began offering free testing and treatment in 2014 and by 2015 had become a hot spot for delivering what was then a new wave of curative drugs. This 2017 STAT story told us how an Egyptian drug maker turned that into medical tourism ("Come see the Sphinx and save on Sovaldi.") In contrast, last year Nick Florko told us cures are still out of reach in U.S. state prisons.


in the field

Soccer goalies see and hear the world differently

Soccer goalkeepers are different from you and me. Whether playing professionally, on school teams, or just as weekend warriors, they all make split-second decisions about balls screaming toward their impossibly wide nets. New research in Current Biology to explain this ability comes from an impeccable source: Michael Quinn, a Dublin City University researcher, a retired professional goalkeeper and son of former Irish professional Niall Quinn (a striker, but still). He wanted to understand how goalkeepers perceive and process information.

His research team compared how 60 people — goalies, outfielders, mere mortals — managed visual and sound cues in the form of flashes and beeps. Most of us mistakenly blend one flash and two beeps together, saying there are two flashes, especially if there's little time in between stimuli. But goalkeepers were better and quicker at separating the visual and auditory information, which may translate on the soccer pitch as hearing a ball kicked and seeing it (if they're not blocked) move in the air. Still unanswered: Was it training or inherent ability that made them succeed as goalkeepers?


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What we're reading

  • Most childhood cancer survivors face serious health problems as adults, Washington Post

  • Delfi launches its blood test to screen for lung cancer – and reveals challenges for liquid biopsies, STAT
  • A lab test that experts liken to a witch trial is helping send women to prison for murder, ProPublica

  • Long underappreciated, gamma-delta T cells may be key to colon cancer defense, study says, STAT
  • Can cooking and gardening at school inspire better nutrition? Ask these kids, NPR

  • Opinion: Connecticut's comptroller explains how his thinking about GLP-1s for state employees, STAT

Thanks for reading! More tomorrow,

P.S.: Yesterday's Nobel Prize in Economics concludes this year's honors and reminds me that medicine, physics, and chemistry aren't the only categories touching the life sciences. Economics laureate Claudia Goldin won "for having advanced our understanding of women's labour market outcomes." A key driver? The Pill.


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