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Tag: doctors

  • Doctors increasingly see AI scribes in a positive light. But hiccups persist

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    When Jeannine Urban went in for a checkup in November, she had her doctor’s full attention.

    Instead of typing on her computer keyboard during the exam, Urban’s primary care physician at the Penn Internal Medicine practice in Media, Pennsylvania, had an ambient artificial intelligence scribe take notes. At the end of the 30-minute visit, Urban’s doctor showed her the AI summary of the appointment, neatly organized into sections for her medical history, the physical exam findings, and an assessment and treatment plan for her rheumatoid arthritis and hot flashes, among other details.

    MORE: Colorectal cancer is now the top cause of cancer death among young adults

    The clinical note, which Urban could also review on the patient portal at home, was incredibly thorough, she said. It summarized all of her questions and concerns and the doctor’s responses. The scribe “made sure we didn’t miss anything,” Urban said.

    Ambient AI scribes are being hailed by physicians as a game changer that helps free them to focus on their patients rather than their computer keyboard. By releasing doctors from the onerous and time-consuming task of documenting what happens during every patient encounter, early studies show, AI scribes may help reduce physician burnout and after-hours “pajama time” catching up on work in the evening.

    The potential of AI to transform every aspect of the health care system — from patient care to clinical efficiency to medical innovation — is an area of intense focus, including by the Trump administration.

    Last January, President Donald Trump issued an executive order to remove barriers to American leadership in AI. Later in the year, a press release from the federal Department of Health and Human Services invited stakeholders to weigh in on how the department can accelerate the adoption of AI in health care.

    Several startup vendors in recent years have introduced ambient AI scribe products that can be integrated into electronic health records. EHR market leader Epic is piloting its own AI scribe technology, which it expects to release widely early this year, according to Jackie Gerhart, a family medicine physician who is chief medical officer and vice president of clinical informatics at Epic.

    Health tech experts estimate that a third of providers have access to ambient AI scribe technology. As adoption looks likely to grow rapidly over the next few years, many expect it to become more of a recruiting tool, a minimum requirement for incoming clinicians, who reports indicate are increasingly prioritizing work-life balance.

    “It’s part of keeping doctors happy,” said Robert Wachter, a professor and the chair of the Department of Medicine at the University of California-San Francisco, whose forthcoming book, A Giant Leap, explores how AI is transforming health care. “Health systems that initially might have done a hard-nosed return-on-investment calculation — many are softening on that and realizing that the cost of recruiting and retaining doctors is pretty high.”

    But many questions remain. Does the use of ambient AI scribes improve patient care and health outcomes? Will doctors use time they gain by employing an AI scribe to improve the quality of the time they spend with their patients or just boost the number of patients they see? To what extent will expanding the amount of detail available from a patient visit lead to bigger bills if the AI scribe is integrated with a coding app that optimizes provider charges?

    For now, these questions remain mostly unanswered.

    Urban said that the AI scribe didn’t change her experience as a patient very much. Typically, after a patient gives verbal permission, the AI scribe records the visit on a phone and organizes the conversation into the structure of a clinical note, filtering out small talk that isn’t pertinent to the medical visit but incorporating relevant details about a family member’s recent cancer diagnosis, for example. The scribe’s note is often then integrated into the provider’s EHR. The doctor later reviews the note and signs off on it.

    Even though the visit may not feel very different to patients, some clinicians report that ambient AI scribes are changing patient encounters in unanticipated ways.

    “Now, when I’m doing a physical exam, I have to say what I’m doing and what I’m finding out loud in order for the AI scribe to document it,” said Dina Capalongo, Urban’s primary care doctor. “People find that very interesting,” she said.

    When Capalongo places her stethoscope over the carotid artery under a patient’s jaw, for example, she might say that she doesn’t hear a “bruit,” or vascular murmur, whose presence could indicate atherosclerosis. Patients have told her, “I never knew why a doctor would listen there,” she said.

    Saying things out loud for the AI scribe that would typically appear only in a clinical note can create its own set of challenges, particularly during sensitive physical exams. Doctors may feel it’s important to adjust their conversation accordingly.

    “Sometimes patients are anxious and scared and my saying things that they don’t understand or they may worry about during an uncomfortable examination does not help the situation and honestly is insensitive to what the patient is going through,” said Genevieve Melton-Meaux, a professor in the Division of Colon and Rectal Surgery at the University of Minnesota, who is also chief health informatics and AI officer at Fairview Health Services in Minneapolis. “I’ll keep that top of mind and make sure I record it” after the visit.

    “How we have conversations with patients about these tools is really important, in particular for maintaining trust and ensuring accurate information,” Melton-Meaux said.

    Studies have found that, across a range of measures such as completeness, timeliness, and coherence, the notes created by ambient AI scribes are generally at least as good as, and sometimes better than, traditional documentation, said Kevin Johnson, a pediatrician who is vice president for applied informatics at the University of Pennsylvania Health System.

    An ongoing concern is around AI “hallucinations,” in which false, sometimes fabricated information appears in an AI output.

    Kaiser Permanente, an early adopter of ambient AI scribe technology, provides it to more than 25,000 doctors, advanced practice providers, and pharmacists systemwide. It has found hallucinations to be “quite rare,” said Daniel Yang, an internist who is vice president of AI and emerging technologies at KP.

    But they happen. An AI-scribe-generated note, for instance, might say that the doctor planned to refer someone to a neurologist or to follow up in two weeks. The problem? The doctor might not have said that.

    “The technology is not perfect, and that’s why physicians are reviewing it,” Yang said. It’s learning from regular physician visits as it goes, he said. That’s why having a person check the work product is critical.

    Still, even such a “human-in-the loop” system is fraught, Wachter said. “Humans stink at maintaining vigilance over time,” he said.

    As the use of ambient AI scribes becomes routine, some clinicians worry that the technology will widen the divide between health care haves and have-nots.

    Large health systems are able to move forward with the technology, Melton-Meaux said. But what about critical access hospitals or small private practices? “There need to be more resources,” she said.

    Physicians’ enthusiasm for ambient AI scribes stands in sharp contrast to their negative reaction to electronic health record systems that have become widely adopted in recent years to replace paper charts.

    “During the last 10 years, when EHRs became a thing, we all became very grumpy, overworked data scribes,” Wachter said.

    The introduction of AI scribes makes physicians feel like technology is working for them rather than the other way around, health care AI experts said.

    And AI scribes are “training wheels” for more consequential adoption of AI in health care, Wachter said.

    To improve health care value and save costs, Wachter said, we need a system that makes it more likely that physicians will practice evidence-based medicine to order the right tests and prescribe the right medications.

    “It’s a few years away, but it’s all AI-dependent,” he said.

    Epic has introduced roughly 60 AI use cases for patients, clinicians, and administration, with over 100 more in the works.

    “It’s so much bigger than a scribe,” said Epic’s Gerhart. “It’s literally listening and acting in a way that tees things up for me so that I can take action.”

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    This article first appeared on KFF Health News and is republished here under a Creative Commons Attribution-NoDerivatives 4.0 International License.

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    Michelle Andrews, KFF Health News

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  • Doctors warn frostbite risk rising as dangerous cold grips the DC region – WTOP News

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    As extreme cold grips the D.C. region, doctors warn the risk of frostbite is rising.

    As extreme cold grips the D.C. region, doctors warn the risk of frostbite is rising.

    Frostbite is more than a skin injury. It affects blood flow and the body’s blood vessels, according to Dr. Adam Friedman, chair of dermatology at the George Washington University School of Medicine and Health Sciences.

    “(When) we think about frostbite, this is not just about skin, it’s about blood flow. It’s about our blood vessels,” he said.

    Friedman said the extreme cold can constrict blood vessels, reduce oxygen flow and allow ice crystals to form, damaging the skin and deeper tissues.

    What to do if frostbite is suspected

    Signs can develop quickly, sometimes during routine winter tasks such as scraping ice or shoveling for long periods of time.

    “Early on, patients may feel intense cold, tingling or burning that ultimately gives way to numbness,” Friedman said.

    People may also notice their fingers losing feeling or turning pale.

    “The skin may look red at first, but then it often turns maybe pale or white and has this kind of waxy or firm feel to it,” he said.

    If frostbite is suspected, rewarming should be done gently indoors.

    “Rapid rewarming is key, ideally in warm, not scalding hot water, because often when you lose sensation, you can burn yourself,” he said.

    Rewarming should usually last 20 to 30 minutes. He also said rubbing the area should be avoided.

    “Addressing it early is going to be essential to preventing long term damage,” he said.

    How to prevent frostbite

    Friedman said the most effective protection is limiting time in the cold.

    “Limit exposure, check skin sites often and rewarm early if numbness or pain sets in,” Friedman said.

    He advised dressing in layers, keeping your skin dry, blocking out the wind and avoiding tight clothing that can restrict circulation.

    “It’s all about preparation with respect to protecting as much as the exposed sites as possible, dressing in layers, making sure that you’re wearing clothing that maybe can wet wick or isn’t wet or damp to begin with, as that can lead to additional injury,” he said

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    Mike Murillo

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  • A Fort Collins family is trying to raise millions to test gene therapy that could help kids trapped in bodies they can’t move

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    At first, Everly Green’s parents didn’t understand why her doctors wanted genetic testing. Their daughter was behind on her milestones at 18 months, but was gradually making progress, and they expected that to continue.

    Then, when she turned 2, the seizures started. She suddenly began to lose skills. Three months later, Everly needed a feeding tube. Now, at 8, she can only move her eyes, allowing her to communicate via a screen.

    Everly, whose family lives in Fort Collins, has a rare mutation in a gene called FRRS1L, pronounced “frizzle,” which affects how cells in her brain communicate. Her parents, and other members of the tiny community of children with the condition, have worked with researchers and small-scale manufacturers to develop a treatment that could restore some of her ability to move — but only if they can raise $4 million to develop and test it.

    Everly clearly understands what happens around her and loves school, where she learns in a mainstream classroom with support and has several best friends, said Chrissy Green, Everly’s mother. Still, she wants to do things she can’t, such as holding toys on her own or going on the occasional family trip with her brothers, Green said.

    “These kids are in there, they want to play like other kids, they just can’t move,” she said.

    Green is co-president of the foundation Finding Hope for FRRS1L, which is collecting funds for the next stage of drug development. Children with FRRS1L gene disorder, the foundation’s website says, “are trapped in a body they can’t move, however still retain high cognitive function, understanding, communication and awareness.”

    Worldwide, only a few dozen children currently have a diagnosis of the same mutation in FRRS1L, meaning there’s little interest from drug companies. Families are on their own to fund research and, if all goes well, convince the U.S. Food and Drug Administration that the treatment is safe and effective enough to go on the market.

    And, even if they succeed with the FDA, they’ll still face a battle with insurance companies that may not want to pay the steep price for a drug to correct a faulty gene. (Even though the families aren’t looking to make a profit, these types of treatments are expensive, and the company under contract to do the manufacturing isn’t doing it for free.)

    Chrissy Green sits with her daughter Everly, 8, as her two boys Colton, 9, left, and Ryle, 4, play at their home in Fort Collins on Dec. 18, 2025. (Photo by RJ Sangosti/The Denver Post)

    Gene therapy involves replacing a faulty gene with a healthy one, usually via a harmless virus engineered to insert a specific snippet of genetic code. It has offered a new way to treat infants born without functioning immune systems, who previously relied on bone marrow transplants. Trials have also shown good results with a liver problem causing ammonia to build up in the body, and one form of inherited deafness.

    The technology also carries risks. Patients have died after receiving gene therapies, with liver problems emerging as a potential risk.

    Normally, drug companies take on the financial risk of turning basic research that’s often publicly funded into treatments, with the hope of eventually making a profit. For gene therapies, that model can break down because of the small number of patients. Green’s FRRS1L foundation knows of about three dozen patients worldwide, though other children with unexplained seizures could have the mutation.

    A drug that treats so few patients will never be profitable, so parents are largely on their own in trying to fund research and development, said Neil Hackett, a researcher who has worked with families on gene therapies and advised the FRRS1L foundation. Usually, they can’t do it unless they happen to have one or more business-savvy parents with the time and resources to run a foundation while caring for a child with complex needs, he said.

    “They need specific expertise, which is not easy to find, and they need massive amounts of money,” he said.

    Steve Green supports his daughter Everly's head as the family plays with toys together at their home in Fort Collins on Dec. 18, 2025. (Photo by RJ Sangosti/The Denver Post)
    Steve Green supports his daughter Everly’s head as the family plays with toys together at their home in Fort Collins on Dec. 18, 2025. (Photo by RJ Sangosti/The Denver Post)

    When they first received Everly’s diagnosis, her doctor told the family to make the most of the time they had left, because medicine couldn’t offer anything to extend her life or reduce her symptoms, Green said. She didn’t initially question that, but focused on loving her daughter and trading tips for daily life with other families via Facebook.

    Green connected with a mother in London who had a child the same age as Everly. Viviana Rodriguez was exploring whether researchers had found any evidence to suggest they could repurpose existing drugs to reduce FRRS1L symptoms.

    Everly Green, 8, lies next to her mother, Chrissy Green, as she reads to her at their home in Fort Collins on Dec. 18, 2025. (Photo by RJ Sangosti/The Denver Post)
    Everly Green, 8, lies next to her mother, Chrissy Green, as she reads to her at their home in Fort Collins on Dec. 18, 2025. (Photo by RJ Sangosti/The Denver Post)

    Through a “providential” series of events, one of Rodriguez’s contacts knew a doctor at the University of Texas Southwestern Medical Center who worked on gene therapies. That doctor had read a paper from a German researcher who bred mice with the FRSS1L mutation so he could study it. The German scientist had given the mice a gene therapy as part of his experiments, but his work wasn’t focused on the clinical applications, Green said.

    Green and Rodriguez, along with a small group of other parents, formed the foundation to raise $400,000 for the UT Southwestern researchers to breed their own group of FRSS1L mice and give them a gene therapy in a study that was set up to show results. The mice that received the gene therapy had near-normal movement after it took effect, she said.

    “We saw major recovery in the animals, so we’re really hopeful for our kids,” she said.

    The next step was testing for toxic side effects, then finding a manufacturer who could do the complicated work of inserting the corrected gene into a harmless virus, Green said. If they can raise the necessary money and all goes as expected, children could receive their doses through a clinical trial starting in September, she said.

    Colton Green, 9, pushes his sister Everly, 8, into the family's living room at their home in Fort Collins on Dec. 18, 2025. (Photo by RJ Sangosti/The Denver Post)
    Colton Green, 9, pushes his sister Everly, 8, into the family’s living room at their home in Fort Collins on Dec. 18, 2025. (Photo by RJ Sangosti/The Denver Post)

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    Meg Wingerter

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  • Brickbat: Still Waiting

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    Many Australians are waiting years to see public medical specialists. In some cases, the wait stretches more than six years for a neurologist or over three and a half years for urgent neurosurgery. Doctors warn these delays are causing “irreversible complications” and even life-threatening conditions. Under the taxpayer-funded Medicare system, patients can see public specialists at little or no cost with a referral from a general practitioner. Yet demand far exceeds capacity. Health authorities insist they are adding more specialists and improving referrals, but shortages persist, especially in the most understaffed specialties.

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    Charles Oliver

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  • After 8-year legal battle, Dracut doctor pleads guilty in landmark opioid case

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    WOBURN — A case that stretched more than eight years reached its conclusion this week, as retired Dracut physician, Dr. Richard Miron, pleaded guilty to involuntary manslaughter and other charges tied to the illegal prescribing of opioids that led to a Lowell patient’s death.

    Attorney General Andrea Campbell’s office said Miron, 83, became the first doctor in Massachusetts to be convicted on involuntary manslaughter for prescribing opioids — a conviction that stemmed from the 2016 death of 50-year-old Michelle Craib. He also pleaded guilty to defrauding MassHealth and illegally prescribing medication to patients for no legitimate medical purpose.

    Miron was ultimately sentenced in Middlesex Superior Court in Woburn on Monday to what amounts to five years of probation, allowing him to avoid prison time.

    Miron’s attorney, Stephen Weymouth, said on Wednesday that he was prepared and confident to go to trial in a case that has faced a series of delays over the years, but after a conversation with his client earlier this month, the main concern became the possibility of serving time behind bars.

    “From the very beginning he said, ‘I didn’t do anything wrong, and I want to go to trial,’” Weymouth said about Miron. “But then he said he did not want to go to jail.”

    Weymouth pointed out that Miron was facing 47 charges, and any one of them could have resulted in a jail sentence. He said that prosecutors had previously sought four to five years in a plea deal, and the involuntary manslaughter charge carried a maximum of 20 years.

    “Going to trial would have been a mistake because all it would have taken was one guilty hook and he would have gotten a pretty lengthy sentence, and I just couldn’t do that. I just couldn’t take any chances,” Weymouth said. “If he had gone to trial and lost, who knows what would have happened.”

    Miron was indicted by a Middlesex County grand jury in December 2018 following an investigation that began in September 2017 by the AG’s Office, then headed by now-Gov. Maura Healey. Aside from involuntary manslaughter, he was charged with 23 counts of illegally prescribing controlled substances and 23 counts of filing false Medicaid claims.

    From September 2015 to February 2016, the AG’s Office said Miron, a solo practitioner of internal medicine, was the largest provider of high-dose, short-acting oxycodone prescriptions among all MassHealth care providers statewide.

    The Chief Medical Examiner’s Office determined Craib’s death was caused by acute intoxication from the combined effects of fentanyl, morphine, codeine, and butalbital — all prescribed by Miron. The AG’s Office said Miron was aware that Craib had previously overdosed on opioids he had prescribed, yet he continued to issue large doses to her on multiple occasions leading up to her death.

    Prosecutors also said Miron illegally prescribed opioids to several other at-risk patients for no legitimate medical purpose. The illegal prescriptions Miron issued led pharmacies to unknowingly submit false bills to MassHealth for medication.

    MassHealth terminated Miron from its program in September 2017, and he stopped practicing medicine in November 2018, following an agreement with the Massachusetts Board of Registration in Medicine.

    In 2023, Miron’s daughter, Linda Miron, penned a 17-page letter to the AG’s Office urging that the case be dropped. She argued that prosecuting her father — who had already relinquished his medical license and lived under pretrial probation since 2018 — was not in the interest of justice.

    “To bring this flawed case to trial does not seem to me to be the best use of the Commonwealth’s resources, and I urge you to drop your prosecution of this case in the interest of justice,” Linda Miron said in the letter. “More broadly, I fear that prosecuting someone who was willing to take on disenfranchised, medically and psychologically complicated patients here in the Commonwealth, when some other physicians refused to take on MassHealth patients, will further discourage other physicians from treating these patients who deserve compassionate care.”

    The case marched on until Monday, when Miron appeared in Middlesex Superior Court before Judge Cathleen Campbell, where it was finally resolved.

    According to the AG’s Office, Miron was sentenced to two and a half years in a house of correction on illegal prescribing, suspended for five years — meaning he will serve the term as probation rather than prison time, unless he violates probation, in which case the sentence could be imposed. He was sentenced to five years of probation on the involuntary manslaughter charge. For Medicaid fraud, Miron was sentenced to six months in a house of correction, suspended for five years.

    As part of his probation, Miron was ordered to pay full restitution to MassHealth and barred from practicing medicine or seeking reinstatement of his license.

    According to Weymouth, Miron was glad to put the case behind him and most of all to avoid prison time. He noted that Miron had already given up his medical career and had no intention of practicing again.

    “I’m glad it’s over,” Weymouth added. “I know he’s glad it’s over.”

    In a press release announcing the case’s conclusion on Tuesday, the AG’s Office said the case reflects their “commitment to addressing the root causes of the opioid crisis and holding companies and individuals accountable for their role in contributing to the nationwide epidemic.”

    Earlier this year, the release states, Campbell helped negotiate a $7.4 billion settlement in principle with Purdue Pharma and the Sackler family, which is expected to bring up to $105 million to Massachusetts. To date, the office said they have secured more than $1 billion in opioid-related recoveries, with more than $390 million already received. Those funds are being directed to the state’s Opioid Recovery and Remediation Fund and distributed to cities and towns to support prevention, harm reduction, treatment and recovery efforts.

    The AG’s Office added in the release that valuable assistance with the investigation into Miron’s case was provided by the Lowell Police Department, the State Police, the Drug Enforcement Administration, and MassHealth.

    Follow Aaron Curtis on X @aselahcurtis, or on Bluesky @aaronscurtis.bsky.social.

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    Aaron Curtis

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  • I Was So Close To Becoming A Doctor. Then I Was Forced To Complete A Truly Humiliating ‘Assignment.’

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    I sat in a conference room surrounded by four white women ― Dr. Westwood-Court, Dr. Bleekman, Maddie, and Bella. Blue and green eyes watched me with measured expressions, all communicating concern. The pale faces seemed to be commanding me to get out.

    My emotions bounced like a tossed tennis ball, ricocheting from confusion to rage to helplessness. My inner voices, a vortex. My outer voice, silent.

    I had arrived at this place innocently enough, in pursuit of a better life — for myself and my people. My 7-year-old self’s desire to be a doctor was one step away from being a reality.

    Study hard and get good grades so you can get into college. Check. Make A’s in college. Check. Volunteer at mental health clinics. Check. Apply and get into graduate school. Do well in graduate school. Make your white professors and supervisors like you. Check. Check. Check.

    I had pursued the plan to the letter. I was now at my final hurdle: completing the yearlong doctoral internship at the Indianapolis Midway Academic Medical Center.

    Although there was little evidence in the Psychology Department, the all-white, all-heterosexual diversity committee agreed that diversity was a priority. They had codified it in their trainee handbook as one of the five domains in which we interns needed to demonstrate competency.

    “All of our clients are diverse. They bring with them diverse backgrounds and experiences. As psychologists, it is very important that we understand how to respect and treat clients from backgrounds different from our own. To facilitate getting outside our comfort zones and understanding what it’s like to be a minority, you will complete a diversity project.”

    Dr. Westwood-Court, the training director, beamed with enthusiasm as she began to describe a required assignment to my intern cohort during one of our clinical group supervision meetings. She was a psychologist in her late 30s. Her specialty was trauma and personality disorders.

    She often engaged us in discussions about “meeting patients where they are,” and seemed open-minded concerning all things cultural. I respected her clinical expertise but questioned her cultural humility when it came to people from the global majority.

    Dr. Jillian Bleekman, a staff psychologist, continued the explanation. “You will put yourself in a situation where you are a minority for at least two hours. We want you to experience what it is like to be the odd person out. You will then come back to group supervision and share with us what you learned from your experience.”

    The voices in my head protested: “Excuse me? Wait…what? What did you say? Are you telling us to go be a minority for two hours? Ma’am, that’s called my life. How is this assignment at all appropriate for someone who is already a minority? This is fucked up.”

    My Southern Black father’s warning fired off in my head: “Never tell white people the truth. They can’t handle it. Even when they are wrong, they will find a way to make it your fault.” Heeding his internalized advice, I did not give voice to my thoughts. I was offended and hurt by how they trivialized diversity with this weird project that clearly only had white, heterosexual, cis-gender, able-bodied interns in mind.

    Although I was fuming, I kept my face smooth and used a tactic I knew would work. I feigned confusion and hesitantly raised my hand.

    “What should I do? This is my life. I’m always a minority.” I tried to sound as meek as possible. I tried to cultivate a look of openness so as to not seem annoyed or averse to learning.

    Dr. Westwood-Court smiled warmly and said, “Well, put yourself in a situation where you are a different type of minority. What ways are you not usually a minority?”

    Again, I sat there silently. The training director attempted to console me, saying, “Don’t worry. No one has ever failed this assignment. We just want you to have an experience of being a minority and come back and tell us about it and what you learned.”

    Dr. Westwood-Court went on to describe a gold-star diversity project. “Bella, you remember Caroline? She was an intern here last year?”

    Bella nodded yes. “Caroline was one of our best interns that trained with us last year. For her diversity project, she attended a service at an all-Black Protestant church.” She paused and looked at each of us. “This was a significant shift for her. She had grown up in predominantly white environments where everyone looked like her.”

    Dr. Westwood-Court articulated each syllable with care as she described how all of Caroline’s classmates, teachers and clergy were just like her in skin color and values. Caroline’s childhood place of worship had been the Catholic church where Parishioners kneeled in silence and crossed their chests as they listened to scripture. The rituals were precise, polite.

    “Given this rearing, it made sense that Caroline was apprehensive. She told us that she was unsure of whether she would be accepted by the Black congregants. But she challenged herself to move beyond her anxiety. And she learned a lot. After completing the project, she shared with us that the congregants made her feel so welcomed. She felt at home.”

    Dr. Westwood-Court’s pride for Caroline radiated into the room. I rejected it, and refused to beam it back. Dr. Westwood-Court continued, “Caroline learned that their worship experiences were not so different from hers, except they were much more lively and the music was so rhythmic. She was impressed by the big, colorful hats that many of the women wore and the way people danced in the aisles. She really put herself out there and came back with a better understanding of what it was like to be a minority.”

    Dr. Westwood-Court finished her story and looked intently at each of us. I put on a happy face; my torn and raging heart was not her business. But my internal world was frenzied. I … was … appalled.

    The author in front of a laptop.

    Photo Courtesy Of Jonathan Lassiter

    I wanted to jump on the table and scream. My inner voice raged, “What did she expect them to do? Rob and rape her in the church? This is how I know white people crazy!” I felt as if I had just been assaulted physically, mentally, and spiritually.

    Before listening to that story, I sensed that I was separated from my white supervisors and peers due to culture and professional training. After listening to that story, I felt separated from them due to humanity. Could they not recognize the innate humanity in others?

    Caroline’s diversity project was voyeuristic and dehumanizing. It was as if she was visiting a foreign land that was rumored to be dangerous. To her surprise, she left with the stunning revelation that the inhabitants were civilized. For me, and apparently only for me in that space, the story and its telling represented the sickness of the whiteness mindset. The project fragmented the “regular white people” from the “diverse Black people.”

    Clearly Caroline and the diversity committee carried the whiteness mindset within them. They set themselves as the default. As the default, the way they saw the world was always most important.

    Caroline had achieved the goal of putting herself in a situation where she was a statistical minority. But was that good enough? Did she not still carry unspoken power in that space? Caroline crept into the church and soaked up the artistic, spiritual gifts. But there was no evidence that she had confronted what she represented as a white woman in that place.

    Had she reckoned with the legacy she carried on her skin? Did she realize she represented the scores of white women whose deceptive words incited murder? Did she know that she evoked the well-meaning white women social workers who ripped children from their families?

    For several congregants in that church, the combination of Caroline’s gender and race was likely triggering, insidious. But their love of the Lord instructed them to pray for those who persecuted them. It had probably never occurred to Caroline that the congregants could welcome their enemy, offer her peppermint and wish her a blessed day.

    The assignment did not require Caroline to reflect on herself as a person with a heritage of destruction. It only requested that she put herself in a situation where she was a minority for two hours.

    This positioning is consistent with a primary assumption of whiteness, fragmentation, and a value of whiteness, competition. The assignment did not encourage cultural exploration of the environment before engagement. It did not require reverence for the people before reaching out to them. There was no reckoning with how our presence in the environment would impact a community, only what we would take from it. It was a one-sided scene, defined by individualism.

    My direct supervisors called the project “one of those American Psychological Association things that’s required” — the same APA that sets regulatory and ethical guidelines for psychologists’ and psychology trainees’ professional conduct. The same organization that had perpetuated racist stereotypes and provided scientific support to justify Black intellectual inferiority, mental illness, and harm for over a century. The same APA that issued an apology in 2021 for its “role in promoting, perpetuating, and failing to challenge racism, racial discrimination, and human hierarchy.”

    The APA was in existence for 110 years before it finally published “Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists.” This document attempted to provide recommendations on how to understand one’s own culture and the culture of others while practicing psychology. In reality, it suggested how a group of overwhelmingly white mental health professionals should conduct themselves.

    We decided that I would visit a sports bar and try to understand sports culture because I was not at all familiar with or interested in sports. My direct supervisors and I reasoned that I would be a different type of minority in such an environment. Although this did not totally make sense to me, Dr. Westwood-Court accepted this plan. So, with much trepidation, I committed to completing the assignment.

    The author, seen here speaking.
    The author, seen here speaking.

    Photo Courtesty Of Jonathan Lassiter

    One cold November night I ventured to a sports bar in downtown Indianapolis. That night there was supposed to be a basketball game playing on television. The plan was to go watch the game with sports enthusiasts in the bar and soak up sports culture. It was hard to leave the house that night. It all seemed dumb. I did not understand why people — mostly men — would dress up, sometimes even paint themselves, and holler and hoot about someone shooting an alley-oop.

    Despite my reservations, I picked an outfit that wasn’t too gay or too nerdy. A pair of regular-fit jeans. A long-sleeve T-shirt as opposed to one of my regular button-downs. I gave myself a pep talk in the mirror.

    “You can do this! You’ll sit at the bar, order a Shirley Temple.”

    “Wait, that’s so gay. Maybe you should get a beer?” a stern voice in my head interrupted.

    “But I don’t like beer.”

    “Order a Coke. That’s more manly,” the stern voice suggested.

    The pep talk continued: “You’ll watch the game, drink your Coke, spot someone or a group, and strike up a conversation about sports.”

    “But what if they think I’m trying to hit on them? What if they beat me up? You’ve seen The Matthew Shepard Story.” My mind was racing with all the what-if, worst-case scenarios.

    “Use your man-voice when you talk to them.”

    When I arrived at the sports bar, barely anyone was there. The floor felt sticky. Announcers’ voices and the screams of fans bounced from the TVs and off the walls. The sounds took me back to the excruciatingly long and boring Sundays of my childhood. I remembered my father sucking his thumbs watching football from sunup to sundown.

    As a child, I wanted to watch “Breakfast with the Arts” on A&E and “In Living Color” on Fox. I was fascinated with the stories of artists and amused by Homey D. Clown. But Joshua didn’t play that. He hogged the TV in the living room, not seeming to care that my brother and I did not have one of our own. I suffered in silence and hoped he would fall asleep so I could switch the channel. The ache of powerlessness pulsed in my chest as I stepped into that bar and back into those memories. I hopped up onto a barstool.

    “A Coke, please. With a straw,” I managed to eke out. I prayed I didn’t sound too gay.

    The bartender put the drink in front of me. I paid. Another stool separated me and a blond, burly man in a yellow-and-blue Pacers hat. He ordered a Budweiser and reached into his blue jeans for his wallet.

    I made eye contact with the man. “I’m Jonathan,” I said in my best man-voice. “Who’s your favorite team?”

    The guy looked at me with skepticism. “Bill.” He nodded.

    “I’m rooting for the Pacers, of course.” He looked at me like I was a Black gay man in a place he didn’t belong. I knew that look and took a deep breath. I powered through and rattled off my questions: “How long have you been following them? What do you like most about basketball?”

    Honestly, I had no clue what I was doing. I hoped he did not call me the f-word or the n-word. Would he call me both? I guess God was with me. Bill obliged in answering my questions hastily. After he finished, he did not query me. He took another sip of his beer and quickly moved away.

    I was embarrassed. Feelings of inadequacy flooded me as his curt responses triggered memories of laughter and ridicule and, alternatively, disregard from my peers due to my lack of knowledge of sports. The shame my father made me feel all those years during my youth for not being the right kind of boy resurfaced.

    On the drive home, I listened to Kirk Franklin’s “More Than I Can Bear.” I felt like I had gone through the fire that Kirk sang about and been broken down. But I tried to remember my dignity. I tried to remember the end goal of the exercise. At home, in the shower, I tried to wash away the humiliation.

    The author's book, from which this essay is excerpted.
    The author’s book, from which this essay is excerpted.

    The following week, I reported back to Maddie, Bella, Dr. Bleekman and Dr. Westwood-Court. I tried to pretend that it was enlightening to be surrounded by team spirit and pride. Truthfully, I had not learned anything. It was traumatizing. My performance was not convincing.

    “Jonathan, we appreciate how you tried to experience being a minority in a different way. But to be honest, we think you should redo the assignment,” the training director and diversity committee director announced. “It sounds like you experienced more bar culture than sports culture. We want you to try it again. Maybe pick something where you will be more immersed? How does that sound?”

    I failed the diversity project. My Black, same-gender-loving, born-poor, nonapparent-disability-having ass failed the diversity project.

    If I could go back in time, I would suggest to Drs. Linwood and Shulman that they advocate for a diversity project that challenges the whiteness mindset. I would de-emphasize diversity and center cultural humility.

    Cultural humility is the active engagement in an ongoing process of self-reflection to better understand ourselves and others with the goal of establishing and maintaining honest, mutually beneficial, and healing-oriented relationships.

    In contrast, diversity emphasizes welcoming and indoctrinating people into the whiteness mindset or “the norm.” The mindset and the systems behind it are rarely examined.

    By the end of my internship, my morale had been halved. I was more competent in my psychotherapy and diagnostic skills, and I finished my program as Dr. Jonathan Mathias Lassiter. But that achievement came with a devastating cost. Many Black and other students from the global majority must do more than just put in long nights of studying. We have to not only effectively regulate the intense emotions that arise when working with suffering clients, we must also suppress our pain when our culture is ignored and our intelligence and skills are challenged because of our supervisors’ and professors’ subtle and overt bias.

    The predominately white field of psychology that is structured by the whiteness mindset demands that people from the global majority pay with our peace, mold our professional passion to its will by pursuing goals whiteness deems worthy and forgo our cultural values and ways of being to master its methods. To succeed, we must center whiteness or fail.

    Adapted from HOW I KNOW WHITE PEOPLE ARE CRAZY AND OTHER STORIES. Copyright © 2025 Jonathan Lassiter. Published by Legacy Lit, an imprint of Grand Central Publishing, a Hachette Book Group company. Reproduced by arrangement with the Publisher. All rights reserved.

    Do you have a compelling personal story you’d like to see published on HuffPost? Find out what we’re looking for here and send us a pitch at pitch@huffpost.com.

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  • Meet the world’s youngest self-made billionaire, who skipped finals to make an empire out of teaching AI ‘what only humans know’ | Fortune

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    In the spring of 2023, while his classmates at Georgetown were cramming for finals, Brendan Foody was busy testing out his new theory of work.

    “I knew I wanted to drop out before finals my sophomore year,” he told Fortune. “I just didn’t go to finals.”

    By then, Foody had already found something he couldn’t learn in a lecture hall. A few months earlier, at a hackathon in São Paulo, he and his co-founders had stumbled onto a simple but powerful model: match companies with skilled engineers abroad, handle the logistics, and take a small cut of each deal. Their first client agreed to pay $500 a week for a developer; Mercor paid the engineer roughly 70% and kept the rest as a service fee.

    What began as a way to connect talent soon evolved into something more ambitious: a marketplace where humans could help train the AI systems that might one day replace them. Mercor now hires professionals—consultants, lawyers, bankers, and doctors—to create “evals” and rubrics that test and refine models’ reasoning.

    “Everyone’s been focused on what models can do,” Foody said. “But the real opportunity is teaching them what only humans know—judgment, nuance, and taste.”

    Within nine months, he and his co-founders—high school friends and debate teammates Adarsh Hiremath and Surya Midha—had turned that fledgling idea into a company with a $1 million revenue run rate. The trio’s early success was less a fluke than a proof of concept: that the same structured reasoning they once practiced on the debate circuit could be codified to teach machines how to think.

    Two years later, Mercor has become a $10 billion company, turning the trio into the world’s youngest self-made billionaires. The product of that São Paulo experiment had transformed into one of the fastest-scaling startups of the AI era, attracting major investors who view it as a linchpin in the future of human-in-the-loop automation.

    To Foody, the leap from college dropout to billionaire founder was rational.

    “When I was in college, work was something I had to be disciplined to do,” he said. “When I started Mercor, it became something I couldn’t stop thinking about.”

    Foody still hasn’t taken a day off in three years. He says even when he’s at the dinner table with his parents, he thinks about work, which, to him, doesn’t feel like work. 

    “People burn out when they work hard on things that don’t feel compounding,” he explained. “I see the ROI of my time every day.”

    That mindset has become the philosophical core of Mercor’s mission. In Foody’s view, AI isn’t eliminating labor: it’s reallocating it. As software automates repetitive white-collar tasks, humans will move up the value chain, teaching machines how to reason, decide, and create. 

    “It’s like we have this bottleneck of only so much human labor in the economy,” he said. “That shape is going to change radically over the next decade.”

    How is Mercor alleviating the bottleneck? Its platform allows enterprises to commission thousands of micro-tasks that measure model performance in real professional contexts: writing a financial memo, drafting a legal brief, or analyzing a medical chart. Human evaluators grade each output against detailed rubrics, feeding structured feedback back into the model. Every evaluation helps AI learn how people make decisions, and how they measure quality.

    At the center of that system is APEX—the AI Productivity Index, Mercor’s proprietary benchmark for assessing how well AI performs economically valuable work. Rather than test abstract reasoning or mathematical puzzles, APEX evaluates large models on 200 tasks drawn from the workflows of investment bankers, lawyers, consultants, and physicians. To build it, Mercor enlisted a heavyweight advisory group that includes former Treasury Secretary Larry Summers, ex-McKinsey managing partner Dominic Barton, legal scholar Cass Sunstein, and cardiologist Eric Topol. Each helped design the evaluation rubrics and case structures to mirror the realities of high-stakes professional labor.

    As the company puts it: “It’s great to have 10,000 PhDs in your pocket—it’s even better to have a model that can reliably do your taxes.”

    The implications of Mercor’s success are sweeping. In Foody’s eyes, this new labor market could employ millions of people globally while accelerating AI progress. 

    “We’ll automate maybe two-thirds of knowledge work,” he said. “And that’ll be incredible, because it lets us do things like cure cancer and go to Mars.”

    For investors, Mercor’s growth story is irresistible. It sits at the intersection of two seismic shifts: the mainstreaming of AI and the rise of flexible, project-based work. Each corporate client adds new evaluators, and each evaluator helps refine more models, creating a flywheel of both data and demand. 

    “We have one of the fastest revenue ramps of any company in history,” Foody said matter-of-factly.

    Foody likes to describe it as the next industrial revolution. He knows people are afraid of being replaced by AI, and constantly fields questions on the ethics of training AI to replace jobs. Foody argues we ought to just bite the bullet. 

    “It’s easy to fall into a Luddite mindset and see productivity gains as bad because they cause short-term job losses,” Foody said. “But every major technical revolution has ultimately made life better.”

    After the industrial revolution, the economy went from 75% of Americans working as farmers to about 1%, and that freed people to do everything else, Foody said. 

    “The challenge now is to be thoughtful about what comes next: the higher, better things humans will spend time on,” Foody said, “and how quickly we can help make that future real.”

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    Eva Roytburg

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  • Your latest prescription is to get outside

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    Find a shady spot under a tree, take a breath of fresh air and call me in the morning.Health care providers have long suggested stressed-out patients spend time outdoors. Now, hundreds of providers are going a step further and issuing formal prescriptions to get outside. The tactic is gaining momentum as social media, political strife and wars abroad weigh on the American psyche.Of course, no one needs a prescription to get outside, but some doctors think that issuing the advice that way helps people take it seriously. “When I bring it up, it is almost like granting permission to do something they may see as frivolous when things seem so otherwise serious and stressful,” said Dr. Suzanne Hackenmiller, a Waterloo, Iowa, gynecologist who started issuing nature prescriptions after discovering time outdoors soothed her following her husband’s death. Spending time in natural areas can lower blood pressure, reduce stress hormones and boost immunity, multiple studies have found.”Study after study says we’re wired to be out in nature,” said Dr. Brent Bauer, who serves as director of the complementary and integrative medicine program at the Mayo Clinic in Rochester, Minnesota. The program focuses on practices that usually aren’t part of conventional medicine, such as meditation, acupuncture, massage and nutrition. “That’s more than just ‘Woo-woo, I think nature is cool.’ There’s actually science.”Telling someone to go outside is one thing. The follow-through is something else. Starting about a decade ago, health care providers began formalizing suggestions to get outside through prescriptions.Dr. Robert Zarr, who doubles as a nature guide, launched an organization called Park Rx America around 2016, offering providers protocols for prescribing nature outings. The guidelines call for talking with patients about what they like to do outside — walking, sitting under a tree, maybe just watching leaves fall — how often to do it and where to go. That all then gets included in a prescription, and Park Rx America sends patients reminders.Nearly 2,000 providers have registered with the organization across the U.S. and a number of other countries, including Australia, Brazil, Cameroon and Spain. They’ve issued more than 7,000 nature prescriptions since 2019, said Dr. Stacy Beller Stryer, Park Rx America’s associate medical director. About 100 other organizations similar to Park Rx America have sprung up around the U.S., she said. Bauer specializes in treating CEOs and other business leaders. He said he issues about 30 nature prescriptions every year. The chief executives he treats sometimes don’t even know where to begin, and a prescription can give them a jump start, he said.”I recommend a lot of things to a lot of patients,” he said. “I’m not under the illusion all of them get enacted. When I get a prescription, someone hands me a piece of paper and says ‘you must take this medication’ … I’m a lot more likely to activate that.”Hackenmiller, the Iowa gynecologist, said she’s having more discussions with patients about getting outside as a means of escaping a world locked in perpetual conflict.”When so many things are out of our control, it can be helpful to step away from the media and immerse ourselves in nature,” she said. “I think time in nature often resonates with people as something they have found solace in and have gravitated to in other times in their life.” The effectiveness of nature prescriptions is unclear. A 2020 joint study by the U.S. Forest Service, the University of Pennsylvania and North Carolina State University concluded that more work was needed to gauge follow-through and long-term health outcomes. But unless you’re choking on wildfire smoke or swatting swarms of mosquitoes, getting outside — no matter what motivates you — can be helpful. At William & Mary college in Williamsburg, Virginia, students issue nature prescriptions to their peers. “Patients” obtain prescriptions by filling out online applications indicating how far they’ll travel to get to a park, times they can visit, whether they need a ride and favorite outdoor activities. Students issued an average of 22 online prescriptions per month in 2025, up from 12 per month in 2020.Kelsey Wakiyama, a senior, grew up hiking trails around her home in Villanova, Pennsylvania, with her family and their dog, Duke. When she started her first year in Williamsburg, she didn’t know where to walk. She saw an advertisement for nature prescriptions in the weekly student email and eventually got one that helped her find trails near campus.”I love the greenery,” Wakiyama said. “When you’re sitting inside — I was in the library for four hours today — the fresh air feels very nice. It calms my nervous system, definitely. I associate being outside with a lightness, a calmness, good memories. That kind of comes back to me when I’m outside.”

    MADISON, Wis. —

    Find a shady spot under a tree, take a breath of fresh air and call me in the morning.

    Health care providers have long suggested stressed-out patients spend time outdoors. Now, hundreds of providers are going a step further and issuing formal prescriptions to get outside. The tactic is gaining momentum as social media, political strife and wars abroad weigh on the American psyche.

    Of course, no one needs a prescription to get outside, but some doctors think that issuing the advice that way helps people take it seriously.

    “When I bring it up, it is almost like granting permission to do something they may see as frivolous when things seem so otherwise serious and stressful,” said Dr. Suzanne Hackenmiller, a Waterloo, Iowa, gynecologist who started issuing nature prescriptions after discovering time outdoors soothed her following her husband’s death.

    Spending time in natural areas can lower blood pressure, reduce stress hormones and boost immunity, multiple studies have found.

    “Study after study says we’re wired to be out in nature,” said Dr. Brent Bauer, who serves as director of the complementary and integrative medicine program at the Mayo Clinic in Rochester, Minnesota. The program focuses on practices that usually aren’t part of conventional medicine, such as meditation, acupuncture, massage and nutrition. “That’s more than just ‘Woo-woo, I think nature is cool.’ There’s actually science.”

    Telling someone to go outside is one thing. The follow-through is something else. Starting about a decade ago, health care providers began formalizing suggestions to get outside through prescriptions.

    Dr. Robert Zarr, who doubles as a nature guide, launched an organization called Park Rx America around 2016, offering providers protocols for prescribing nature outings. The guidelines call for talking with patients about what they like to do outside — walking, sitting under a tree, maybe just watching leaves fall — how often to do it and where to go. That all then gets included in a prescription, and Park Rx America sends patients reminders.

    Nearly 2,000 providers have registered with the organization across the U.S. and a number of other countries, including Australia, Brazil, Cameroon and Spain. They’ve issued more than 7,000 nature prescriptions since 2019, said Dr. Stacy Beller Stryer, Park Rx America’s associate medical director. About 100 other organizations similar to Park Rx America have sprung up around the U.S., she said.

    Bauer specializes in treating CEOs and other business leaders. He said he issues about 30 nature prescriptions every year. The chief executives he treats sometimes don’t even know where to begin, and a prescription can give them a jump start, he said.

    “I recommend a lot of things to a lot of patients,” he said. “I’m not under the illusion all of them get enacted. When I get a prescription, someone hands me a piece of paper and says ‘you must take this medication’ … I’m a lot more likely to activate that.”

    Hackenmiller, the Iowa gynecologist, said she’s having more discussions with patients about getting outside as a means of escaping a world locked in perpetual conflict.

    “When so many things are out of our control, it can be helpful to step away from the media and immerse ourselves in nature,” she said. “I think time in nature often resonates with people as something they have found solace in and have gravitated to in other times in their life.”

    The effectiveness of nature prescriptions is unclear. A 2020 joint study by the U.S. Forest Service, the University of Pennsylvania and North Carolina State University concluded that more work was needed to gauge follow-through and long-term health outcomes.

    But unless you’re choking on wildfire smoke or swatting swarms of mosquitoes, getting outside — no matter what motivates you — can be helpful.

    At William & Mary college in Williamsburg, Virginia, students issue nature prescriptions to their peers. “Patients” obtain prescriptions by filling out online applications indicating how far they’ll travel to get to a park, times they can visit, whether they need a ride and favorite outdoor activities.

    Students issued an average of 22 online prescriptions per month in 2025, up from 12 per month in 2020.

    Kelsey Wakiyama, a senior, grew up hiking trails around her home in Villanova, Pennsylvania, with her family and their dog, Duke. When she started her first year in Williamsburg, she didn’t know where to walk. She saw an advertisement for nature prescriptions in the weekly student email and eventually got one that helped her find trails near campus.

    “I love the greenery,” Wakiyama said. “When you’re sitting inside — I was in the library for four hours today — the fresh air feels very nice. It calms my nervous system, definitely. I associate being outside with a lightness, a calmness, good memories. That kind of comes back to me when I’m outside.”

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  • How This AI Tool Is Reducing Burnout in the Medical Field

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    There used to be a lot of jokes about the terrible nature of doctors’ handwriting, until much of the process of seeing a physician was digitized, improving things no end for both doctors and patients. But consulting a medical expert still involves a whole lot of note-taking, and that’s an increasing burden for many healthcare workers, from physicians to clerical staff. A new report says things are changing yet again, however, and a new generation of digital tools is improving the way health care workers make notes. The new innovations are powered by AI, and even if your business has nothing to do with practicing medicine, there are lessons here for your company.

    The study, led by a research group from the Yale School of Medicine, cited previous reports that showed over half of a clinician’s typical workday gets consumed dealing with electronic health records, leaving just a quarter of the day for direct time with patients. Documentation time has been trending upwards too, which has been linked to burnout, depleted efforts at work and more staff thinking of quitting, industry news site MedicalXPress reports. 

    But when medical professionals used what’s described as an ambient AI scribe platform — a system that unobtrusively takes part in a patient consultation, capturing the audio of the conversation and then transcribing it via specialized AI models into notes for the clinician to review later — things were very different.

    Between the nearly 200 participants in the investigation, most of them attending physicians, the proportion of doctors reporting feelings that qualified as burnout fell from nearly 52 percent at the start to just under 39 percent after 30 days. 

    That’s a dramatic downward shift. The study measured how the AI tool, which the researchers pointedly did not identify, was helping, and showed it was lowering the cognitive burden of the physicians, easing up the amount of time eaten up by working on documentation, decreasing the effort the professionals felt they had to deliver at work, and lowering their mental demands. The time needed per week in “after hours” moments to complete documentation also fell by nearly one hour, reducing pressure still further. Overall the report suggests this leads to doctors having more energy to give the proper attention to patients’ concerns, and frees them up for more urgent care access. 

    This is, of course, just one single use case for AI tools. And it’s easy to see how having a reliable automatic note-taking system could dramatically change the working day of a typical frontline health care worker. Freeing up time needed to write things down would easily translate into more face-time with patients, and as long as the overall pressure on a typical physician to achieve a certain workload doesn’t go up because of this extra time, then the risk of burnout would be reduced.

    How does this impact your company, though?

    It’s a giant thumbs-up for the benefits of AI technology. In this case, as the Yale report says, it’s specialized tools “that can produce professional appearing text,” which are “taught to listen, instantaneously transcribe, assimilate, and assemble a document, with fine-tuning by human training.”

    The study shows that in the right setting, using exactly the right tools, AI can achieve some of the big promises that AI evangelists make. Instead of threatening to take over people’s jobs, AI proponents argue that it can take on mundane tasks on behalf of a worker, thus freeing up staff to do more frontline, more productive tasks. The Yale report, for example, says AI scribes allowed doctors “more time for meaningful work and professional well-being.” 

    This means that for your office, tools other than an AI scribe may prove useful and could genuinely reduce workloads and burnout risks for your staff. Choosing AI tools in a careful, considered way is important, however, and upskilling and training staff on the correct use of the technology is likely a key for this process to work properly. Many reports say organizations are failing to do this when they roll out AI systems.

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    Kit Eaton

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  • Most Colorado counties lack access to aid-in-dying, abortion or gender-affirming care at hospitals

    Most Colorado counties lack access to aid-in-dying, abortion or gender-affirming care at hospitals

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    For the first time, Coloradans have a clear picture of where they can go for sometimes-controversial health services such as abortion, gender-affirming care or medical aid-in-dying.

    In much of the state, though, the answer is “nowhere close.”

    Hospitals are required to disclose data about restrictions on 66 services related to reproductive, gender-affirming and end-of-life care to the Colorado Department of Public Health and Environment under a law passed in 2023. Starting this month, they also must provide copies of their disclosure forms to patients ahead of their appointments.

    Only three Colorado counties — Denver, Douglas and Weld — have unrestricted access in at least one hospital to three services from the list that The Denver Post sampled.

    Access to gender-affirming surgery was especially limited; only 13 of Colorado’s 64 counties have a hospital without non-medical restrictions on a double mastectomy, also known as “top surgery,” for gender affirmation. (Eighteen counties have no hospital within their borders, and the rest either don’t offer mastectomies to anyone or restricted who could receive one.)

    Nor was access to the other sampled services much broader.

    Thirteen Colorado counties have a hospital that would assist with a request for medical aid-in-dying without religious or other non-medical limitations, and 15 have one that would provide comprehensive treatment for a miscarriage, which can include drugs and procedures used in induced abortions.

    Click to enlarge

    Facilities that restrict the services they offer aren’t likely to make changes because of the law — particularly since many of the restrictions stem from religious beliefs — but at least patients will know what to expect when they go for care, said Dr. Patricia Gabow, a former CEO of Denver Health who has written about the intersection of religion and health care.

    Of course, transparency only does so much for people who live in a county where the only hospitals are Catholic-owned, Gabow said. Catholic hospitals, which include those owned by CommonSpirit Health and some belonging to Intermountain Health, generally don’t offer contraception, sterilization, gender-affirming care, medical aid-in-dying or abortion.

    “People who live in Durango, I don’t know what they’re supposed to do,” she said.

    Mercy Hospital in that city follows Catholic ethical and religious directives for health care, and the closest hospital that offers comprehensive reproductive services or assistance with medical aid-in-dying is in Del Norte, about two and a half hours away.

    Catholic doctrine requires health care providers to “respect all stages of life,” and not participate in procedures such as medical aid-in-dying or sterilization without a medical reason, said Lindsay Radford, spokeswoman for CommonSpirit Health, which owns Mercy.

    The system’s hospitals work with patients and their families to provide appropriate pain and symptom relief as they near death, she said.

    “We respect and honor the physician-patient relationship, and medical decisions are made by a patient and their doctor. Patients who seek care at a CommonSpirit Health hospital or clinic are fully informed of all treatment options, including those we do not perform,” she said in a statement.

    Geographic and political differences

    Generally, access to potentially controversial services was greater in more areas with larger populations, though with significant exceptions.

    Both of Jefferson County’s hospitals, St. Anthony Hospital in Lakewood and Lutheran Hospital in Wheat Ridge, won’t allow measures to end a pregnancy if a fetus still has a heartbeat.

    The state’s form conflates “threatened” and “completed” miscarriages, said Sara Quale, spokeswoman for Intermountain Health, which owns Lutheran Hospital. The hospital doesn’t restrict care once a fetus has died, but if it still has a heartbeat, doctors attempt to treat whatever is causing the miscarriage, she said. The most common cause of miscarriages is a problem with a fetus’s chromosomes, which doesn’t allow it to survive and has no treatment.

    In contrast, people in rural Prowers County on the Eastern Plains can get comprehensive miscarriage treatment without driving elsewhere. So can residents of Rio Grande County.

    Local politics also don’t necessarily match up with access.

    The three counties that had at least one hospital offering unrestricted access to the three sampled services were deep-blue Denver and thoroughly red Weld and Douglas.

    While their residents might differ on many issues, Weld and Douglas counties shared one common characteristic with Denver: They’re home to at least one hospital owned by a secular system, such as UCHealth, Denver Health or HCA HealthOne.

    At least 22 hospitals in Colorado have religious restrictions on care options: 17 owned or formerly owned by Catholic organizations, and five affiliated with the Adventist faith. In some cases, when a hospital changes hands, provisions of the deal require the new owner to honor the seller’s religious and ethical rules, even if the buyer is secular.

    Some secular organizations also listed certain services as restricted.

    UCHealth generally doesn’t serve patients under 15, while Denver Health doesn’t provide abortions under certain circumstances because of concerns about losing federal funding, spokesman Dane Roper said.

    The seven HealthOne hospitals also had non-religious restrictions, but didn’t specify their nature. Banner Health didn’t respond to inquiries about service limitations at its five Colorado hospitals.

    Informed decision-making

    So far, Colorado is the only state that requires hospitals to directly tell patients when they don’t offer services for religious or other non-medical reasons, said Alison Gill, vice president of legal and policy with American Atheists, which supported the law as it went through the legislature.

    That provision will be important not only for Coloradans seeking care, but for people traveling to the state because of its welcoming policies around reproductive and gender-affirming care, she said.

    “We are encouraging other states to enact similar provisions because it is essential to provide patients with information about service availability so that they can make informed decisions about their health care,” she said.

    The law has some limitations, said Gabow, formerly of Denver Health. For example, an outpatient gynecology office owned by a religious health system doesn’t have to give patients the disclosure form, and insurers don’t have to include hospitals offering care without limitations in their networks, she said.

    Colorado’s law won’t inherently increase access to health care, but it may prevent surprises for patients who don’t know to look up the closest hospital’s religious affiliation or don’t realize it could affect them, said Dr. Sam Doernberg, a physician researcher at Brigham & Women’s Hospital in Boston.

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    Meg Wingerter

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  • Getting an IUD can hurt. New guidelines say doctors should help patients manage the pain

    Getting an IUD can hurt. New guidelines say doctors should help patients manage the pain

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    Gynecology nurse practitioner Stephanie Edwards-Latchu has performed over 450 intrauterine device insertions. Some women will barely notice when the device is placed, she said, but others report the worst pain they will ever feel.The devices, which are placed within the uterus to prevent pregnancy, are the third most common form of birth control in the U.S. Still, some patients have come to her after being dismissed by other providers — told to “calm down” or that their pain is “not that bad” or even “you’re being dramatic.”In new contraceptive guidance published this week, the U.S. Centers for Disease Control and Prevention gave updated recommendations for clinicians on how to help manage the pain some people may have when the devices, known as IUDs, are inserted. Lidocaine “might be useful for reducing patient pain” when injected as a local anesthetic or applied topically as a numbing gel, cream or spray, the CDC said in the update, the first since 2016.The CDC also recommends doctors inform all patients about potential pain and personalize IUD placement and pain management plans for each individual.The individualized and patient-centered language is a large shift from the 2016 guidelines, which were less specific and less detailed, according to Dr. Tessa Madden, professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.Madden’s research on the use of lidocaine was referenced in the updated guidelines. However, she noted, her research is nearly 12 years old — highlighting the longstanding challenge in improving pain management during the procedure.In a 2019 survey of about 1,000 family planning providers, less than 5% reported using a lidocaine injection during IUD insertion. Instead, they more frequently suggested ibuprofen, which research has shown does not reduce insertion pain.”Saying to take ibuprofen is the bare minimum, and it’s not enough,” said Edwards-Latchu, whose campus health clinic at University of North Carolina Chapel Hill offers lidocaine gel and injections, heating pads, Valium and the option to bring a supporting person. The clinic is also experimenting with umbilical vibration devices that might reduce discomfort during the procedure.The procedure to insert an IUD takes about 15 minutes or less. A health care provider performs a pelvic exam and then uses a speculum to widen the vagina, through which they place the device within the uterus.”Any one of those steps can be uncomfortable for people—from the pelvic examination to the IUD insertion—although it’s typically the insertion that’s the most uncomfortable, when they experience the highest level of pain,” said Dr. Beverly Gray, an associate professor of obstetrics and gynecology at Duke University and an obstetrician and gynecologist at Duke Health.Cramping and other uncomfortable or painful sensations can occur during and after insertion, as the procedure involves using pointed forceps called a tenaculum to stabilize the cervix and passing the intrauterine device through the narrow cervical canal.”Patients have clearly spoken out about their traumatic or painful experiences,” Gray added. “These guidelines highlight the importance of discussing pain management and being frank about the spectrum of experiences that people might have.”‘My pain is not being taken seriously’Female pain has long been underrecognized and undertreated.”Women have been saying for decades, ‘my pain is not being taken seriously,” Edwards-Latchu said. “It feels like screaming into the void.”A 2021 study found that pain in female patients is consistently underestimated due to gender stereotypes, and women are judged to benefit less from pain medicine than men, despite equal likelihood of seeking care.”In medicine, we historically have not done a very good job of taking women’s pain, in particular, seriously,” added Madden.Edwards-Latchu described a female patient whose appendix ruptured after her abdominal pain was dismissed as menstrual cramps, pointing to a broader issue of women’s pain being mismanaged. Research echoes this, showing women in emergency rooms with similar abdominal pain scores to men waited longer and were less likely to receive pain relief.This issue also extends to IUD insertion, where studies have shown patients report significantly higher pain levels than providers perceive.There is no guaranteed way to predict an individual’s response to an IUD insertion, according to Madden, who said that some of her patients have high levels of pain while others experience “very little.”However, increased pain during the procedure is more likely if the patient hasn’t had a vaginal birth, has a history of painful periods or has experienced trauma.Some research also suggests that anxiety is associated with worse pain across various medical procedures.”There is a variety of experiences that people have. It’s sometimes hard to predict who will have an easy experience with insertion and who will have a more challenging experience,” Gray added. “Understanding that is important.”A 2014 study of 109 IUD recipients found that 78% reported pain ranging from moderate to severe upon insertion. That range is clear on TikTok, where numerous women have shared live videos from the exam table as their IUDs were inserted.”IUD insertion is the worst pain imaginable,” wrote one user who showed herself writhing in pain.”This was the most excruciating pain I’ve ever experienced,” another shared.In both videos, the health-care providers inserting the IUDs could be heard telling their patients to expect pressure or a “pinch.”Social media shows part of the picture”It’s heartbreaking,” Edwards-Latchu said of the videos on her social media feed. “The first thing that I think is, ‘I doubt they were given anything for their pain,’ and to me, that is upsetting.”The videos bring awareness to the potential pain, she said, adding that it’s important “to know about the negative experiences so that something changes.”However, according to Madden, the videos can also dissuade viewers from considering a contraceptive option that could be a viable option for them.”Patients come into the office talking about videos that they’ve seen on TikTok or Instagram, which is where a lot of times patients are getting their information from,” she said. “Seeing a video like that could be a significant deterrent.”Intrauterine devices have had a tumultuous history. Notably, the Dalkon Shield in the 1970s caused cases of severe infection and other complications, casting a long shadow over the safety of IUDs. However, modern IUDs have been proven to be safe and effective, and are used by over 10% of women aged 15 to 49, according to CDC data from 2017-2019. They can last for up to 10 years or more and are 20 times better at preventing unintended pregnancies than birth control pills and other short-term contraceptive methods, according to a 2012 study.” is a highly effective method that many patients are very satisfied with,” Madden added. “For some patients, the concern about pain with insertion is the reason that they’re not using .”If patients feel like we’re addressing their concerns about the pain, and taking the concerns seriously, then that might increase people’s willingness to use the method.”What to ask your doctorThe updated guidelines come as there’s a rise in demand for contraception after the reversal of Roe v. Wade in 2022.Edwards-Latchu explained that each year around graduation, her campus health clinic sees a surge of students seeking IUDs. Many of these students were preparing to move to areas with restrictive reproductive health laws and are unsure about future access to reproductive care.”They are looking at long-acting, reversible contraceptive methods like the IUD, and if they have one already, they want a newer one so they have longer protection,” she said. “It is something that you can hide and that somebody can’t take away from you, especially if you’re going to a state where contraception could be a target.”This context makes comprehensive and individualized conversations on insertion pain management more important than ever, she added.Gray, Madden and Edwards-Latchu say the increasing attention to insertion pain, long-term contraceptives and the new guidelines present an opportunity for providers to listen to their patients to create better personal experiences for them.Patients should actively ask questions during their consultation appointments to facilitate this, particularly about pain management options and anxiety support, they said.Edwards-Latchu suggests asking about lidocaine blocks, gels, sprays and other pain control methods as described in new CDC guidelines.”If a patient feels like the clinician is not taking their concern seriously or not willing to offer them some of these potential interventions.. then maybe that individual doesn’t want to get IUD with that clinician,” Madden added.”We need to be taking this pain seriously.”CNN’s Jacqueline Howard contributed to this report.

    Gynecology nurse practitioner Stephanie Edwards-Latchu has performed over 450 intrauterine device insertions. Some women will barely notice when the device is placed, she said, but others report the worst pain they will ever feel.

    The devices, which are placed within the uterus to prevent pregnancy, are the third most common form of birth control in the U.S. Still, some patients have come to her after being dismissed by other providers — told to “calm down” or that their pain is “not that bad” or even “you’re being dramatic.”

    In new contraceptive guidance published this week, the U.S. Centers for Disease Control and Prevention gave updated recommendations for clinicians on how to help manage the pain some people may have when the devices, known as IUDs, are inserted. Lidocaine “might be useful for reducing patient pain” when injected as a local anesthetic or applied topically as a numbing gel, cream or spray, the CDC said in the update, the first since 2016.

    The CDC also recommends doctors inform all patients about potential pain and personalize IUD placement and pain management plans for each individual.

    The individualized and patient-centered language is a large shift from the 2016 guidelines, which were less specific and less detailed, according to Dr. Tessa Madden, professor of obstetrics, gynecology and reproductive sciences at the Yale School of Medicine.

    Madden’s research on the use of lidocaine was referenced in the updated guidelines. However, she noted, her research is nearly 12 years old — highlighting the longstanding challenge in improving pain management during the procedure.

    In a 2019 survey of about 1,000 family planning providers, less than 5% reported using a lidocaine injection during IUD insertion. Instead, they more frequently suggested ibuprofen, which research has shown does not reduce insertion pain.

    “Saying to take ibuprofen is the bare minimum, and it’s not enough,” said Edwards-Latchu, whose campus health clinic at University of North Carolina Chapel Hill offers lidocaine gel and injections, heating pads, Valium and the option to bring a supporting person. The clinic is also experimenting with umbilical vibration devices that might reduce discomfort during the procedure.

    The procedure to insert an IUD takes about 15 minutes or less. A health care provider performs a pelvic exam and then uses a speculum to widen the vagina, through which they place the device within the uterus.

    “Any one of those steps can be uncomfortable for people—from the pelvic examination to the IUD insertion—although it’s typically the insertion that’s the most uncomfortable, when they experience the highest level of pain,” said Dr. Beverly Gray, an associate professor of obstetrics and gynecology at Duke University and an obstetrician and gynecologist at Duke Health.

    Cramping and other uncomfortable or painful sensations can occur during and after insertion, as the procedure involves using pointed forceps called a tenaculum to stabilize the cervix and passing the intrauterine device through the narrow cervical canal.

    “Patients have clearly spoken out about their traumatic or painful experiences,” Gray added. “These guidelines highlight the importance of discussing pain management and being frank about the spectrum of experiences that people might have.”

    ‘My pain is not being taken seriously’

    Female pain has long been underrecognized and undertreated.

    “Women have been saying for decades, ‘my pain is not being taken seriously,” Edwards-Latchu said. “It feels like screaming into the void.”

    A 2021 study found that pain in female patients is consistently underestimated due to gender stereotypes, and women are judged to benefit less from pain medicine than men, despite equal likelihood of seeking care.

    “In medicine, we historically have not done a very good job of taking women’s pain, in particular, seriously,” added Madden.

    Edwards-Latchu described a female patient whose appendix ruptured after her abdominal pain was dismissed as menstrual cramps, pointing to a broader issue of women’s pain being mismanaged. Research echoes this, showing women in emergency rooms with similar abdominal pain scores to men waited longer and were less likely to receive pain relief.

    This issue also extends to IUD insertion, where studies have shown patients report significantly higher pain levels than providers perceive.

    There is no guaranteed way to predict an individual’s response to an IUD insertion, according to Madden, who said that some of her patients have high levels of pain while others experience “very little.”

    However, increased pain during the procedure is more likely if the patient hasn’t had a vaginal birth, has a history of painful periods or has experienced trauma.

    Some research also suggests that anxiety is associated with worse pain across various medical procedures.

    “There is a variety of experiences that people have. It’s sometimes hard to predict who will have an easy experience with insertion and who will have a more challenging experience,” Gray added. “Understanding that is important.”

    A 2014 study of 109 IUD recipients found that 78% reported pain ranging from moderate to severe upon insertion. That range is clear on TikTok, where numerous women have shared live videos from the exam table as their IUDs were inserted.

    “IUD insertion is the worst pain imaginable,” wrote one user who showed herself writhing in pain.

    “This was the most excruciating pain I’ve ever experienced,” another shared.

    In both videos, the health-care providers inserting the IUDs could be heard telling their patients to expect pressure or a “pinch.”

    Social media shows part of the picture

    “It’s heartbreaking,” Edwards-Latchu said of the videos on her social media feed. “The first thing that I think is, ‘I doubt they were given anything for their pain,’ and to me, that is upsetting.”

    The videos bring awareness to the potential pain, she said, adding that it’s important “to know about the negative experiences so that something changes.”

    However, according to Madden, the videos can also dissuade viewers from considering a contraceptive option that could be a viable option for them.

    “Patients come into the office talking about videos that they’ve seen on TikTok or Instagram, which is where a lot of times patients are getting their information from,” she said. “Seeing a video like that could be a significant deterrent.”

    Intrauterine devices have had a tumultuous history. Notably, the Dalkon Shield in the 1970s caused cases of severe infection and other complications, casting a long shadow over the safety of IUDs. However, modern IUDs have been proven to be safe and effective, and are used by over 10% of women aged 15 to 49, according to CDC data from 2017-2019.

    They can last for up to 10 years or more and are 20 times better at preventing unintended pregnancies than birth control pills and other short-term contraceptive methods, according to a 2012 study.

    “[An IUD] is a highly effective method that many patients are very satisfied with,” Madden added. “For some patients, the concern about pain with insertion is the reason that they’re not using [it].

    “If patients feel like we’re addressing their concerns about the pain, and taking the concerns seriously, then that might increase people’s willingness to use the method.”

    What to ask your doctor

    The updated guidelines come as there’s a rise in demand for contraception after the reversal of Roe v. Wade in 2022.

    Edwards-Latchu explained that each year around graduation, her campus health clinic sees a surge of students seeking IUDs. Many of these students were preparing to move to areas with restrictive reproductive health laws and are unsure about future access to reproductive care.

    “They are looking at long-acting, reversible contraceptive methods like the IUD, and if they have one already, they want a newer one so they have longer protection,” she said. “It is something that you can hide and that somebody can’t take away from you, especially if you’re going to a state where contraception could be a target.”

    This context makes comprehensive and individualized conversations on insertion pain management more important than ever, she added.

    Gray, Madden and Edwards-Latchu say the increasing attention to insertion pain, long-term contraceptives and the new guidelines present an opportunity for providers to listen to their patients to create better personal experiences for them.

    Patients should actively ask questions during their consultation appointments to facilitate this, particularly about pain management options and anxiety support, they said.

    Edwards-Latchu suggests asking about lidocaine blocks, gels, sprays and other pain control methods as described in new CDC guidelines.

    “If a patient feels like the clinician is not taking their concern seriously or not willing to offer them some of these potential interventions.. then maybe that individual doesn’t want to get IUD with that clinician,” Madden added.

    “We need to be taking this pain seriously.”

    CNN’s Jacqueline Howard contributed to this report.

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  • Colorado legislators demand answers from Aurora VA about patient safety, halt in surgeries due to mysterious residue

    Colorado legislators demand answers from Aurora VA about patient safety, halt in surgeries due to mysterious residue

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    Colorado’s senators and a congressman are demanding answers from U.S. Department of Veterans Affairs leadership over a series of troubling reports about its Aurora hospital.

    Sens. Michael Bennet and John Hickenlooper, both Democrats, and Rep. Jason Crow, an Aurora Democrat, sent a letter to VA leadership on Monday requesting an accounting of patient safety issues, further explanation over its current pause in surgeries due to a mysterious residue on its medical equipment, and steps the hospital has taken to address pervasive cultural problems among its staff.

    “As problems persist within the (Eastern Colorado hospital system), we are increasingly concerned about the quality of care Colorado veterans receive, a lack of adherence to the required medical and employee procedures, and how recent leadership changes have impeded the system’s effectiveness,” the lawmakers wrote.

    The letter comes on the heels of two scathing reports from the VA’s Office of Inspector General, which investigates departmental waste, fraud and abuse.

    The probes, released June 24, found Aurora’s Rocky Mountain Regional VA Medical Center paused surgeries for more than a year in 2022 and 2023 because the hospital didn’t have the staff to care for those patients after their procedures. They never told the federal VA as required, the investigation found.

    The second inspector general report said the Aurora VA suffered from poor organizational health, citing widespread fear among staff that promoted disenfranchisement. Doctors stopped performing high-risk procedures, one staffer said, for fear of punishment if something went wrong.

    The investigation mirrored The Denver Post’s reporting since last fall, which found the toxic workplace and culture of fear had permeated a wide swath of departments, leading to high turnover, especially among senior leadership positions. The Post also found that the head of the hospital’s prosthetics department was instructing employees to cancel veterans’ orders to clear a large backlog. The VA later confirmed The Post’s reporting.

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    Sam Tabachnik

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  • Doctors Join Call To Regulate Intoxicating Hemp Cannabinoids | High Times

    Doctors Join Call To Regulate Intoxicating Hemp Cannabinoids | High Times

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    A professional organization of physicians who support drug policy reform is calling for the regulation of intoxicating hemp-derived cannabinoids including delta-8 THC, arguing that the safety of products containing the compound is unknown. The recommendation was recently made by Doctors for Drug Policy Reform (D4DPR), a group of healthcare professionals formerly known as Doctors for Cannabis Regulation.

    “Our stance at D4DPR is that all intoxicating cannabinoids should be subject to a regulatory framework to ensure public safety,” the group wrote in a policy paper released this month.

    In the paper, D4DPR notes that the legalization of hemp with the 2018 Farm Bill “may have inadvertently legalized the chemical conversion of hemp-derived cannabidiol (CBD) and other phytocannabinoids (those derived directly from the plant) into intoxicating minor cannabinoids like delta-8 tetrahydrocannabinol (∆8-THC, also known as delta-8).” The legislation, however, did not include provisions to regulate hemp-derived cannabinoids, leading to a thriving industry of products containing intoxicating compounds that is unregulated in many jurisdictions.

    “Taking advantage of this opportunity, ∆8-THC (chemically synthesized from hemp CBD) quickly became available in various retail outlets such as gas stations, CBD shops, convenience stores, smoke shops, and online platforms,” the group notes in the paper. “Several states have now either banned or imposed regulations on its sale. However, in 22 states (as of November 2023), ∆8-THC remains legal and unregulated, with limited laboratory testing and taxation, lacking warnings about its intoxicating effects, without dosing limits, and easily accessible to minors.”

    To address the issue, D4DPR called on policymakers to develop and enact a regulatory framework for all intoxicating cannabinoids, regardless of their source. The group included several recommendations for the regulations, including a provision that would only allow the sale of intoxicating compounds by licensed dispensaries. The group also called for “appropriate taxation” to fund public health initiatives and regulatory oversight of the cannabinoid market.

    The group also recommended that sales of intoxicating cannabinoids be restricted to adults aged 21 and older. The recommendations call for intoxicating hemp products to be sold only in child-resistant packaging that does not appeal to minors, with clear labeling about the intoxicating effects of the product. Packages should also include the International Intoxication Cannabinoid Product Symbol (the silhouette of a cannabis leaf) to indicate their contents in graphic form.

    The recommendations also call for required lab testing of intoxicating cannabinoid products for purity, potency and safety, with certificates of analysis available to consumers for inspection. The group also recommended that research into the clinical safety and toxicology of minor cannabinoids be conducted, noting that many of the compounds are new to the market 

    D4DPR also recommended that regulations for intoxicating cannabinoids be aligned with those in place in states with medical marijuana or adult-use cannabis programs and that states without regulations develop them as soon as possible. The group also called for the rescheduling of cannabis at the federal level, noting that a ban on intoxicating or minor cannabinoids “will result in a continuation of the drug war, leading to negative outcomes on public health.”

    “This policy stance reflects our commitment to safeguarding public health while ensuring reasonable access to cannabis- and hemp-derived products within a responsible regulatory framework,” the D4DPR concluded in its recent policy paper.

    The policy paper from D4DPR joins a chorus of calls to regulate intoxicating cannabinoids. Last month, 21 state attorneys general sent a letter to congressional leaders asking them “to address the glaring vagueness created in the 2018 Farm Bill.” 

    “The reality is that this law has unleashed on our states a flood of products that are nothing less than a more potent form of cannabis, often in candy form that is made attractive to youth and children — with staggering levels of potency, no regulation, no oversight, and a limited capability for our offices to rein them in,” they wrote in the letter.

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    A.J. Herrington

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  • This Trauma Doctor Shares How He Deals with Loss and How It Will Change Your Perspective on Failure | Entrepreneur

    This Trauma Doctor Shares How He Deals with Loss and How It Will Change Your Perspective on Failure | Entrepreneur

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    Opinions expressed by Entrepreneur contributors are their own.

    If you are an emergency room physician, death and the fear of failure are constant companions. A countdown timer starts when a patient arrives with a fatal wound or condition. If that timer reaches zero, the patient will die. If it is prevented from reaching zero, the patient will survive and live to fight another day.

    It is literally a race against the clock, and the role of the ER physician is to battle that timer directly through medical interventions and keep the patient alive long enough for a trauma surgeon, interventional cardiologist or other specialist to solve the issue that is killing them.

    As you might imagine, when the ER staff wins that fight and saves a life, it is a fantastic feeling, but when they fail and lose a patient, it is devastating. Worse yet is when they lose a patient who could have been saved because they either made an error or did not have the required resources to save the person. Every ER Doctor has memories of the patients that they lost. In fact, a requirement for a long and healthy career in emergency medicine is the ability to find peace with this notion.

    I recently had the opportunity to spend time with Dr. Dan Dworkis, a Trauma and ER physician, Professor at the USC Keck School of Medicine, Medical Director of the Mission Critical Teams Institute, Podcast host and the author of The Emergency Mind. Dan has spent his career working in emergency rooms. In fact, not just emergency rooms but a busy trauma center in Los Angeles.

    As you might imagine, Dan has seen it all and, as a result, carries the stories and memories that come with working at a hospital that is frequented by children who have been shot, traumatic car accidents and people with life-threatening injuries and illnesses.

    Dan has spent a big part of his career studying how we make decisions under stress, how to operate in high-stress environments and how to create a culture of continuous improvement. Not surprisingly, I learned a lot from Dan. But, by far, the most profound thing I learned from Dan was a unique way to approach failure and, in the process, open ourselves up to growth and learning.

    Related: The 5 Key Qualities of a Good Leader

    The ritual: Learning by embracing loss

    As you can imagine, trauma physicians see quite a bit of death. No matter how good a doctor you are, you will lose patients, and some of those people certainly could have been saved with different skills or different resources. It would be easy to simply block yourself off from these feelings, to harden your heart, and to put these bad experiences into a mental box that you lock away. While this might not be great for your mental health, it is certainly a seemingly easier thing than confronting these memories and feelings. Yet, Dan actually advocates doing the complete opposite, leaning into the failure and attacking it directly.

    When a patient dies, there is an awkward moment immediately afterward where the team that treated the patient must transition away from that fight and move on to another. Despite just a few minutes before waging a war to save their life, the team must move on from this person. Machines must be turned off, tubes and wires removed, and each team member must emotionally reset and get back to work.

    It would be easy at that point to block the feelings and doubts that arise, place them in a box and move on to the next task while hoping never to think about those feelings again. But that is not what Dan does or advocates. Instead, he engages in a ritual that he was taught as a young doctor, which is to gather the team at the bedside of the patient, place a hand on the deceased patient, and utter the following phrase: “Thank you for teaching me. I am sorry that all I could do for you today was learn.”

    This seemingly simple act and brief statement is more than just a ritual to clear the mind before moving on. Instead, it is a deeply profound approach to situations where we cannot succeed and lays a strong foundation for learning and growth.

    Related: 2 Phrases I Learned From a Senior CIA Officer That Changed My Leadership Style

    Embracing failure

    The first significant thing that this ritual does is acknowledge and embrace failure. Rather than moving on and pretending that something profoundly negative didn’t just happen, this ritual looks failure square in the eye and leans into the discomfort of the situation. It embraces failure and immediately triggers the learning process.

    The first step to growth is the recognition and admission that what we currently do or know is not sufficient. To learn from others, we have to accept our own shortcomings, and this practice opens the door to that and to discovering something better. If we do not admit to our shortcomings, we cannot improve, and this is precisely the point of this ritual.

    Simply look at the phrase, “Thank you for teaching me. I am sorry that all I could do for you today was learn.” By its nature, it says I failed you today, and I wish I had more to give. It doesn’t say, “It’s too bad you died,” or “Wow, rough break you got.” It says, “I am sorry.” It embraces that the team didn’t have enough to save the person (and to be fair, no one may have been able to save them), but simply that acknowledgment doesn’t go far enough. Rather, it says I “learned from you.” It implicitly says, “I will be better next time” and “I am growing and improving my skills.” It is active, not passive, and immediately takes the first step toward learning.

    Conclusion

    A profound lesson extends far beyond the medical field and this single ritual to all of us. Whether you are an entrepreneur, a business leader, or even a parent, creating a culture of learning from mistakes and continuous improvement is critical to getting better. We should never run from our errors or try to hide them. We should embrace our failures and view them as perfect opportunities to grow. By establishing a process that immediately addresses our failures or shortcomings, we also immediately focus our attention on how we can improve, where we have deficiencies and perhaps most importantly, we immediately begin the process of learning and growth.

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    Jon B. Becker

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  • Caribbean Medical School New Campus Groundbreaking Ceremony

    Caribbean Medical School New Campus Groundbreaking Ceremony

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    Saint James School of Medicine commences construction of its new campus in St. Vincent and the Grenadines


    KINGSTOWN, Saint Vincent and the Grenadines, March 29, 2024 (Newswire.com)
    –
    In a significant milestone towards expanding medical education and healthcare development in the Caribbean, Saint James School of Medicine is proud to announce the groundbreaking of its new campus on the island of St. Vincent. The ceremony, which took place on March 25, 2024, marks the beginning of a new chapter for the institution, promising advanced facilities and opportunities for aspiring medical professionals.

    The event was graced by the Minister of Finance, Hon. Camillo Gonsalves, who highlighted the government’s support for the project, and the Hon. Prime Minister Ralph Gonsalves, whose arrival underscored the national importance of this development. Additionally, the event was attended by the Minister of Education, Hon. Curtis King, and the Minister of Health, Hon. St. Clair Prince. Their participation signifies a strong partnership between Saint James School of Medicine and the Government of St. Vincent and the Grenadines, aiming to foster a nurturing environment for medical education and healthcare services in the region.

    The new campus is envisioned as a state-of-the-art facility that will provide cutting-edge resources and technologies for students. It is designed to accommodate more students, aiming to address the growing need for healthcare professionals globally, particularly in underserved areas. The campus will feature modern classrooms, simulation labs, research centers, and student support services, all constructed with sustainability and the local ecology in mind.

    “Today’s groundbreaking is not just about laying the foundation of a building; it’s about laying the groundwork for the future of healthcare education in the Caribbean and beyond,” said Kaushik Guha, the Executive Vice-President of Saint James School of Medicine. “In the first phase, we are building a 5,500sf facility to house classrooms and student space. Additionally, we are building one of the first outdoor amphitheaters, a space that will be shared by students and members of the local community. The completion of this phase is expected by the end of August. After that, we will construct the main 42,000sf building to house the rest of the SJSM community. Thanks to our partners from ARGO Development Studio, who designed and are overseeing the project, this facility will surely become a jewel of this area of the island.”

    The construction of the new campus is expected to have a significant positive impact on the local economy, creating jobs and fostering community development. Saint James School of Medicine is committed to integrating with the local community, ensuring that the benefits of this expansion are shared widely.

    Saint James School of Medicine wishes to express gratitude to the Government of St. Vincent and the Grenadines, Minister Camillo Gonsalves, Prime Minister Ralph Gonsalves, and all who have supported this endeavor.

    For more information about Saint James School of Medicine and updates on the new campus development, please visit www.sjsm.org.

    Source: Saint James School of Medicine

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  • US surgeons transplant genetically modified pig kidney into patient

    US surgeons transplant genetically modified pig kidney into patient

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    NEW YORK — Doctors in Boston announced Thursday they have transplanted a pig kidney into a 62-year-old patient.

    Massachusetts General Hospital said it’s the first time a genetically modified pig kidney has been transplanted into a living person. Previously, pig kidneys have been temporarily transplanted into brain-dead donors. Also, two men received heart transplants from pigs, although both died within months.

    The experimental transplant was done at the Boston hospital on Saturday. The patient, Richard “Rick” Slayman of Weymouth, Massachusetts, is recovering well and is expected to be discharged soon, doctors said Thursday.

    Slayman had a kidney transplant at the hospital in 2018, but had to go back on dialysis last year when it showed signs of failure. When dialysis complications arose, his doctors suggested a pig kidney transplant, he said in a statement released by the hospital.

    “I saw it not only as a way to help me, but a way to provide hope for the thousands of people who need a transplant to survive,” said Slayman.

    The announcement marks the latest development in xenotransplantation, the term for efforts to try to heal human patients with cells, tissues, or organs from animals. For decades, it didn’t work – the human immune system immediately destroyed foreign animal tissue. More recent attempts have involved pigs that have been modified so their organs are more humanlike – increasing hope that they might one day help fill a shortage of donated organs.

    More than 100,000 people are on the national waiting list for a transplant, most of them kidney patients, and thousands die every year before their turn comes.

    ___

    The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

    Copyright © 2024 by The Associated Press. All Rights Reserved.

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    AP

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  • Saint James School of Medicine Celebrates Unprecedented Success in Residency Match Results

    Saint James School of Medicine Celebrates Unprecedented Success in Residency Match Results

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    PARK RIDGE, Ill., March 19, 2024 (Newswire.com)
    –
    Saint James School of Medicine (SJSM) is thrilled to announce a historic achievement in its 2024 residency match results. With over 100 SJSM graduates securing positions in renowned US residency programs, Saint James School of Medicine reaffirms its position as a leading institution in medical education.

    The news marks a moment of triumph for both the school and its students, reflecting years of hard work, dedication, and passion for medicine. SJSM takes pride in its holistic approach to education, providing students with a supportive environment and hands-on experience that prepares them for success in their medical careers.

    Mr. Kaushik Guha, the Executive Vice-President of Saint James School of Medicine, expressed immense pride in the students’ achievements, stating, “Last year we had 83 students attain residency. This year, with over 100 matched students, we have already realized an over 20% increase in the number of our graduates entering residency. It is important to note that these numbers are not final.  We are still awaiting the results from the Canadian match, as well as some post-match updates, so this match total will increase in the coming weeks. This incredible outcome is a testament to the talent and commitment of our students, as well as the dedication of our faculty and staff. We are thrilled to see our graduates embark on the next phase of their medical journey.”

    “Our students have matched into some of the most prestigious and competitive programs in the US, including placements at prestigious institutions such as Cook County Health, Brown University, and Johns Hopkins,” continued Guha. “These outcomes confirm our commitment to training the highest quality future physicians in the industry.”

    The success of Saint James School of Medicine in this residency match cycle highlights the effectiveness of its approach to medical education. By combining rigorous academics with real-world experience, the school equips students with the skills and knowledge they need to thrive in today’s healthcare landscape.

    As SJSM continues to empower future generations of healthcare professionals, it remains committed to fostering a supportive community where students can excel and make a difference in the world of medicine.

    About Saint James School of Medicine

    Saint James School of Medicine is an international medical school with two campuses on the Caribbean islands of Anguilla and St. Vincent and the Grenadines. Our students study Basic Sciences at one of our Caribbean campuses then study Clinical Sciences through a clinical rotation program at affiliated hospitals in the US. Saint James School of Medicine was founded in 1999 by a consortium of medical educators and physicians from universities and colleges in the United States and Europe. Hundreds of students have graduated from Saint James since the school was founded. Our current enrollment exceeds 850 students.

    Source: Saint James School of Medicine

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  • Girl, 17, diagnosed with stage 4 cancer after doctors said her back pain was a pulled muscle

    Girl, 17, diagnosed with stage 4 cancer after doctors said her back pain was a pulled muscle

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    In late 2022, Shimia Nord experienced such intense back pain that she failed her driver’s test. Stepmom Rikelle Hendrickson took Shimia to urgent care, where doctors said it was likely a muscle strain. While a dull pain remained, in July 2023, her symptoms intensified dramatically.

    “I would throw up constantly,” Shimia, 17, of Duluth, Minnesota, tells TODAY.com. “I can barely stand, and then finally we’re like, something is seriously wrong.”

    Hendrickson took Shimia to the emergency room, and they eventually learned that Shimia had renal cell carcinoma, a rare type of kidney cancer, and she’d need urgent surgery.

    “You don’t really have much time to react when they’re like, ‘Oh, well, we have to get it out now,’” Hendrickson tells TODAY.com. “(I felt) scared and overwhelmed.”

    Consistent back pain worsens

    Before her cancer diagnosis, Shimia enjoyed sports and played soccer and volleyball for years. Three years ago, she found dance and fell in love.

    Shimia Rikelle (Courtesy Rikelle Hendrickson)

    Shimia Rikelle (Courtesy Rikelle Hendrickson)

    “When I joined the dance team, it was like joining a family and I was always surrounded by love and support,” she says. “I (danced) six days a week from like 4 to 9:45.”When she first experienced back pain in November 2022, she was in the middle of competitive dance season. Doctors at urgent care thought it was a pulled muscle. The family had also recently recovered from COVID-19, so doctors took images of Shimia’s chest to make sure she didn’t have a pulmonary embolism, when a blood clot gets stuck in an artery in the lungs.

    “They did some testing for that, and sent her home with lidocaine patches,” Hendrickson explains. “They didn’t find anything … because (the images were) higher than where her kidneys were.”

    Shimia returned to dance and school with a constant twinge in her side. By Fourth of July weekend 2023, though, the pain worsened, and she was vomiting. They went to the emergency room.

    Doctors ran tests and noticed something on Shimia’s kidney and said it was inflamed. They wanted her to go to Children’s Minnesota Hospital for follow-up care. On the drive there, Shimia read the paperwork and saw she had “a tumor they suspected was cancerous.” After they arrived, doctors told the family the mass needed to be removed immediately.

    “They still couldn’t say for sure what it was because they hadn’t been able to test it,” Hendrickson says. “They told us from looking at the scans that they were thinking that it was renal cell carcinoma, but there wasn’t a way to say that for sure until they actually got it out.”

    But they knew the mass was “large enough that the tumor had to come out with her whole kidney.” This news felt ominous.

    “I was terrified,” Shimia says. “When I was in 10th grade, we were talking about our biggest fears health-wise and mine was literally getting cancer. To hear it was really scary for me.”

    Surgery went well, and she was diagnosed with stage 2 papillary renal cell carcinoma.

    “They said they were able to remove the tumor that was encapsulated,” Hendrickson says. “They did remove (some) lymph nodes.”

    Shimia had an incision that ran from her breastbone to her pubic bone that caused intense pain that immobilized her.

    “She didn’t want to get up. She didn’t want to eat,” Hendrickson says. “She was refusing to do a lot of things.”

    After a few days — and a few bribes of friend visits — Hendrickson convinced Shimia to walk and shower. By July 11, she was able to go home.

    When the pathology results returned, doctors believed they removed all the cancerous spots and recommended surveillance every three months. At the first three-month scan, doctors noticed spots in Shimia’s lungs. They continued monitoring it for another six weeks, but by December, it became clear the spots were growing. After testing her lymph nodes, doctors realized Shimia’s cancer had progressed to stage 4.

    “It did change the treatment plan dramatically at that point,” Hendrickson says.

    Shimia Rikelle (Courtesy Rikelle Hendrickson)Shimia Rikelle (Courtesy Rikelle Hendrickson)

    Shimia Rikelle (Courtesy Rikelle Hendrickson)

    She’s receiving immunotherapy and chemotherapy to treat her cancer. She experiences nausea, constipation and headaches from the treatment.

    “It’s like one pill after another just to make the other pill not seem so bad,” Shimia says.

    Shimia recently began her new treatment plan and will undergo a scan in a few months to see if the masses in her left lung are shrinking. Future treatment will depend on how well this protocol works, but Self says she will continue to consult with her colleagues to help Shimia have the best outcome possible.

    Renal cancer in young adults

    The type of cancer Shimia has, renal cell carcinoma, remains rare in a pediatric population, Dr. Chelsea Self says.

    “In general, there are probably somewhere around 600ish new pediatric renal cancers … diagnosed every year, and only about 3% to 4% of them are renal cell carcinomas,” the pediatric hematology oncologist at Children’s Minnesota tells TODAY.com. “It’s relatively uncommon.”

    Self, who is Shimia’s oncologist, worked with other doctors, including adult oncologists, to create a treatment plan that works for the teen. It’s part of the Adolescent and Young Adult Oncology program, which treats patients from 15 up to 30.

    “Some of the cancers diagnosed behave more like pediatric cancers,” Self explains. “Some certainly behave more like adult cancers, and that’s why it’s so important to collaborate with our adult counterparts and figure out what we need to do to optimize care for each patient.”

    Self says symptoms of kidney cancer can include:

    • Side or flank pain

    • Back pain

    • Blood in urine

    • Nausea

    • Vomiting

    • Unexplained weight loss

    • Fatigue

    • Bump on the side

    “These (symptoms) are more generally for any kind of cancer diagnosis,” Self says. “But really the flank pain, the lump on the side … is more tailored toward something going on in the kidneys.”

    Treatment usually involves surgery to remove the mass and often the kidney, she says. If cancer any remains, the treatment can vary to include chemotherapy or immunotherapy. While back pain remains a common symptom, Self wants to reassure parents that not all back pain is a sign of cancer.

    “It is so unfortunate what happened to Shimia, but I would remind parents that this is exceedingly rare,” she says. “I would also probably remind families that it highlights the importance of having a good relationship with your general pediatrician and making sure you’re doing all your well child checks and you are able to call them and be evaluated if you have concerns.”

    High school and cancer treatment

    Some days, cancer treatment makes Shimia feel lousy. But she has activities she wants to do so she persists.

    “I still have so much to do, so even if I’m tired or I don’t feel as well, I still try to do everything even feeling crappy and pretend I’m not,” she says.

    Shimia Rikelle (Courtesy Rikelle Hendrickson)Shimia Rikelle (Courtesy Rikelle Hendrickson)

    Shimia Rikelle (Courtesy Rikelle Hendrickson)

    Shimia recently danced again, the first time she’d done it since undergoing a lung biopsy after the scan found the spots in her lung.

    “It was really tiring,” she says. “It was hard because it’s the first time I’ve ever done any endurance since before the bronchoscopy.”

    Shimia hopes to become a lawyer and takes college classes so she can graduate college early and head to law school. The love she’s received from friends and family helps her as she juggles high school and cancer treatment.

    “I’ve always been lucky to have a supportive family,” she says. “Not everybody does.”

    Hendrickson feels impressed by Shimia’s strength.

    “She had her kidney removed in July and was back dancing before school started. Her resilience to me is just amazing,” she says. “To watch her do the things she loves and push through everything that’s she been doing now, lots of adults can’t do it. I’m so incredibly proud of her.”

    This article was originally published on TODAY.com

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  • Survey: Majority of Sports Medicine Doctors Have Favorable Attitudes About MJ Use | High Times

    Survey: Majority of Sports Medicine Doctors Have Favorable Attitudes About MJ Use | High Times

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    Looking at recent cases like that of Sha’Carri Richardson, who was barred from competing in the 2020 Tokyo Olympics over a failed THC test, it’s clear that cannabis use among athletes is still a somewhat taboo topic. Still, looking at the slowly changing regulations in institutions like the NBA and NFL, the sports world is steadily embracing the potential benefits that cannabis has to offer athletes in regard to recovery and chipping away at the penalties for cannabis use of years past.

    And it’s evident when we look beyond these large stages that the status quo is beginning to shift. Namely, a new anonymous survey of physicians from the American Medical Society for Sports Medicine (AMSSM) looking to assess opinions on the use of CBD and cannabis found that these doctors generally have favorable attitudes toward the substances, though there are still varying views.

    The study, which appears in the journal Translational Sports Medicine, also found that most sports medicine physicians from the survey showed support for legal medical and recreational cannabis use.

    Exploring Sports Physicians Views on Cannabis Reform, in Sports and Beyond

    The study begins noting the “growing evidence regarding cannabinoid use in sports medicine and performance,” highlighting CBD as a particular point of interest. Authors note that cannabis and cannabinoid use has been studied through other areas of medicine, though data in regard to sports medicine is sparse. 

    To analyze sports physicians’ views on cannabis, physician members of the AMSSM received a survey via email on two separate occasions, with a total of 333 completed responses. 

    According to the results, 72% of the respondents supported the 2018 removal of CBD from the World Anti-Doping Agency’s banned substance list, while 66% supported its removal from the National Collegiate Athletic Association’s (NCAA) banned substance list. Fewer, 59%, supported removing cannabis as a whole from the WADA banned substances list, though 81% said that sports physicians should have formal training on cannabis and cannabinoids and an overwhelming 93% majority were interested in continued medical education for cannabinoids.

    A majority of respondents also showed support for medical cannabis legalization, 77%, and recreational legalization, 57%.

    Cannabis and CBD Relating to Sports Performance

    As many conversations around cannabis use in sports, including those surrounding Richardson back in 2021, revolve around its potential as a performance-enhancing substance, the survey also recorded physicians’ opinions on that topic. 

    A majority of respondents said that CBD and THC are not performance enhancing (approximately 76% and 66%, respectively). Most physicians also agreed that CBD was not detrimental to athletic performance (approximately 61%), though the opinion shifted when it came to THC, at approximately 37% saying it was not detrimental to athletic performance.

    The survey also examined demographic information, finding that women, older doctors and rural respondents were less likely to favor legal adult-use cannabis. Authors note that these factors were also associated with a higher likelihood of disagreeing with the WADA removing cannabis from the prohibited substances list and the NCAA allowing college athletes to use cannabis.

    Men and younger physicians were also less likely to identify cannabis as performance enhancing.

    An Invitation For Further Research on an Understudied Topic

    The study concludes noting that a number of sports doctors are already recommending CBD and cannabis products, noting that they are often used for chronic musculoskeletal and neuropathic pain. Authors also claimed that this was the first study to reveal that providers are recommending these products for sports-related concussions and performance anxiety.

    “This advancing cultural shift motivates ongoing research and education for sports medicine providers to better answer questions posed by athletes about the safety, dosing, and potential effects of CBD and cannabis in sports,” researchers wrote.

    When looking at data from the survey showing that more doctors would recommend CBD (40.8%) instead of cannabis (24.8%), authors said that the reasons “are not entirely clear.” Though, “given the overall safety profile of CBD, its lack of ‘intoxicating’ effects, and the general infiltration of CBD into mainstream consumer products, providers may see CBD as a safer option for patients compared to Cannabis and THC-containing products.”

    Similarly, authors said that the reason more doctors believe that cannabis is detrimental to performance than CBD is unclear but that these perceptions could influence how sports medicine providers counsel athletes using these products.

    “It is important to note that the ergogenic versus ergolytic effects of CBD compared to cannabis are still largely unknown,” the authors said. “Therefore, these perceptual differences can largely, if not exclusively, be attributed to marketing and advertising. In addition, one must recognize the seemingly ubiquitous addition of CBD to countless consumer products, which may also contribute to this evolving distinction.”

    Authors also acknowledged the small sample size, accounting for only about 7% of the membership in the AMSSM, and due to the data coming from a single point in time, the study also can’t describe changing opinions. 

    “Lastly, although the survey was anonymous, this is still considered a fringe topic by many in sports medicine and medicine in general, which may limit the divulgence of actual behaviors and attitudes of respondents,” authors conclude.

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    Keegan Williams

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  • BMI Won’t Die

    BMI Won’t Die

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    If anything defines America’s current obesity-drug boom, it’s this: Many more people want these injections than can actually get them. The roadblocks include exorbitant costs that can stretch beyond $1,000 a month, limited insurance coverage, and constant supply shortages. But before all of those issues come into play, anyone attempting to get a prescription will inevitably confront the same obstacle: their body mass index, or BMI.

    So much depends on the simple calculation of dividing one’s weight by the square of their height. According to the FDA, people qualify for prescriptions of Wegovy and Zepbound—the obesity-drug versions of the diabetes medications Ozempic and Mounjaro—only if their BMI is 3o or higher, or 27 or higher with a weight-related health issue such as hypertension. Many who do get on the medication use BMI to track their progress. That BMI is the single biggest factor determining who gets prescribed these drugs, and who doesn’t, is the result of how deeply entrenched this metric has become in how both doctors and regular people approach health: Low BMI is good and high BMI is bad, or so most of us have come to think.

    This roughly 200-year-old metric has never been more relevant—or maligned—than it is in the obesity-drug era. BMI has become like the decrepit car you keep driving because it still sort of works and is too much of a hassle to replace. Its numerous shortcomings have been called out for many years now: For starters, it accounts for only height and weight, not other, more pertinent measures such as body-fat percentage. In June, the American Medical Association formally recognized that BMI should not be used alone as a health measure. Last year, some doctors called for BMI to be retired altogether, echoing previous assertions.

    The thing is, BMI can be an insightful health metric, but only when used judiciously with other factors. The problem is that it often hasn’t been. Just as obesity drugs are taking off, however, professional views are changing. People are so accustomed to seeing BMI as the “be-all, end-all” of health indicators, Kate Bauer, a nutritional-sciences professor at the University of Michigan, told me. “But that’s increasingly not the way it’s being used in clinical practice.” A shift in the medical field is a good start, but the bigger challenge will be getting everyone else to catch up.

    BMI got its start in the 1830s, when a Belgian astronomer named Adolphe Quetelet attempted to determine the properties of the “average” man. Using data on primarily white people, he observed that weight tended to vary as the square of height—a calculation that came to be known as Quetelet’s index.

    Over the next 150 years, what began as a descriptive tool transformed into a prescriptive one. Quetelet’s index (and other metrics like it) informed height-weight tables used by life-insurance companies to estimate risk. These sorts of tables formed “recommendations for the general population going from ‘average’ to ‘ideal’ weights,” the epidemiologist Katherine Flegal wrote in her history of BMI; eventually, nonideal weights were classified as “overweight” and “obese.” In 1972, the American physiologist Ancel Keys proposed using Quetelet’s index—which he renamed BMI—to roughly measure obesity. We’ve been stuck with BMI ever since. The metric became embedded not only in research and doctor’s visits but also in the very definitions of obesity. According to the World Health Organization, a BMI starting at 25 and less than 30 is considered overweight; anything above that range is obese.

    But using BMI to categorize a person’s health was controversial from the start. Even Keys called it “scientifically indefensible” to use BMI to judge someone as overweight. BMI doesn’t account for where fat is distributed on the body; fat that builds up around organs and tissues, called visceral fat, is linked to serious medical issues, while fat under the skin—the kind you can pinch—is usually less of a problem. Muscularity is also overlooked: LeBron James, for example, would be considered overweight. Both fat distribution and muscularity can vary widely across sex, age, and ethnicity. People with high BMIs can be perfectly healthy, and “there are people with normal BMIs that are actually sick because they have too much body fat,” Angela Fitch, an assistant professor at Harvard Medical School and the president of the Obesity Medicine Association, told me.

    For all its flaws, BMI is actually useful at the population level, Fitch said, and doctors can measure it quickly and cheaply. But BMI becomes troubling when it is all that doctors see. In some cases, the moment when a patient’s BMI is calculated by their doctor may shape the rest of the appointment and relationship going forward. “The default is to hyper-focus on the weight number, and I just don’t think that that’s helpful,” Tracy Richmond, a pediatrics professor at Harvard Medical School, told me. Anti-obesity bias is well documented among physicians—even some obesity specialists—and can lead them to dismiss the legitimate medical needs of people with a high BMI. In one tragic example, a patient died from cancer that went undiagnosed because her doctors attributed her health issues to her high BMI.

    But after many decades, the medical community has begun to use BMI in a different way. “More and more clinicians are realizing that there are people who can be quite healthy with a high BMI,” Kate Bauer said. The shift has been gradual, though it was given a boost by the AMA policy update earlier this year: “Hopefully that will help clinicians make a change to supplement BMI with other measures,” Aayush Visaria, an internal-medicine resident at Rutgers Robert Wood Johnson Medical School who researches BMI’s shortcomings, told me.

    Physicians I spoke with acknowledged BMI’s flaws but didn’t seem too concerned about its continued use in medicine—even as obesity drugs make this metric even more consequential. BMI isn’t a problem, they said, as long as physicians consider other factors when diagnosing obesity or prescribing drugs to treat it. If you go to a doctor with the intention of getting on an obesity drug, you should be subject to a comprehensive evaluation including metrics such as blood sugar, cholesterol levels, and body composition that go “way beyond BMI,” Katherine Saunders, a clinical-medicine professor at Weill Cornell Medicine, said. Because Wegovy and other drugs come with side effects, she told me, doctors must be absolutely sure that a patient actually needs them, she added.

    But BMI isn’t like most other health metrics. Because of its simplicity, it has seeped out of doctor’s offices and into the mainstream, where this more nuanced view still isn’t common. Whether we realize it or not, BMI is central to our basic idea of health, affecting nearly every aspect of daily life. Insurance companies are notorious for charging higher rates to people with high BMI and lowering premiums for people who commit to long-term weight loss. Fertility treatments and orthopedic and gender-affirming surgery can be withheld from patients until they hit BMI targets. Workplace wellness programs based on BMI are designed to help employees manage their weight. BMI has even been used to prevent prospective parents from adopting a child.

    The rise of obesity drugs may make these kinds of usages of BMI even harder to shake. Determining drug eligibility by high BMI supports the notion that a number is synonymous with illness. Certainly many people using obesity drugs take a holistic view of their health, as doctors are learning to do. But focusing on BMI is still common. Some members of the r/Ozempic Subreddit, for example, share their BMI to show their progress on the drug. Again, high BMI can be used to predict who has obesity, but it isn’t itself an obesity diagnosis. The problem with BMI’s continued dominance is that it makes it even harder to move away from simply associating a number on a scale with overall health, with all the downstream consequences that come along with a weight-obsessed culture. As obesity drugs are becoming mainstream, “there needs to be public education explaining that BMI by itself may not be a good indicator of health,” Visaria said.

    In another 200 years, surely BMI will finally be supplanted by something else. If not much sooner: A large effort to establish hard biological criteria for obesity is under way; the goal is to eliminate BMI-based definitions once and for all. Caroline Apovian, a professor at Harvard Medical School, gives it “at least 10 years” before a comparably cheap or convenient replacement arises—though any changes would take longer to filter into public consciousness.” Until that happens, we’re stuck with BMI, and the mess it has wrought.

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    Yasmin Tayag

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