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40. Joann Elmore, MD: Mammography Guidelines and Other Controversies

Joann Elmore

In this episode, Daniel Belkin and Mitch Belkin interview Joann Elmore, MD, about screening mammography. Dr. Elmore shares insights on the USPSTF’s new draft mammography recommendations, which lowers the breast cancer screening age from 50 to 40. They discuss the difference in American and European call back rates for biopsy and whether mammography screening programs have substantially improved breast cancer mortality rates or if improvements are primarily due to enhanced treatment methods. They also touch on the potential for AI to transform radiology and pathology.

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Who is Joann Elmore?

Joann G. Elmore is as a professor at the David Geffen School of Medicine at UCLA and the UCLA Fielding School of Public Health. Her research interests include diagnostic accuracy, physician variability, cancer screening, patient engagement, and AI/machine learning in diagnostics. She has over 200 publications.

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39. Dan Morgan, MD: Diagnostic Stewardship, Medical Overuse, and Contact Precautions

Dan Morgan

In this conversation, Daniel Belkin and Mitch Belkin interview infectious diseases physician and epidemiologist Dan Morgan, MD, about infection prevention, diagnostic stewardship, diagnostic reasoning, and medical overuse. They discuss regional differences in medical use and delve into a cluster-randomized controlled trial of contact precautions in ICU patients to evaluate whether this prevents C. Diff, MRSA, and VRE. They also touch on AI’s potential role in clinical decision support, and the question of how to improve clinician statistical reasoning.

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Who is Dan Morgan?

Dan Morgan, MD, MS is a physician and epidemiologist at University of Maryland School of Medicine. He directs the Center for Innovation in Diagnosis and is Chief of Epidemiology at the VA Maryland Healthcare System. His research interests include probability in medicine, medical overuse, diagnostic stewardship, and infection prevention.

References:

If you enjoyed this episode, be sure to check out our episodes with Paul Offit and Deborah Korenstein on medical overuse.

 

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38. Robin Hanson, PhD: Healthcare Signaling, the Conspicuous Caring Hypothesis, and Prediction Markets in Medicine

Robin Hanson

In this conversation, Daniel Belkin and Mitch Belkin interview Robin Hanson, PhD, about healthcare and medicine. They discuss three randomized controlled trials on the population-wide benefits of medicine (RAND health insurance experiment, Oregon Health Insurance Experiment, and the Karnataka Hospital Insurance Experiment), which do not demonstrate benefit for more medical care. They talk about the conspicuous caring hypothesis put forward in Robin’s book The Elephant in the Brain. Other topics discussed include end-of-life care, medicine as something Sacred, and prediction markets in medicine.

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Who is Robin Hanson?

Robin Hanson, PhD, is an associate professor of economics at George Mason University and a research associate at Oxford University. He is known for his wide-ranging interests, including artificial intelligence, prediction markets, and signaling. He is the author of several books, including The Age of Em and The Elephant in the Brain.

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37. Simon Whitney, MD, JD: Unethical Research, Unintended Consequences, and the Critical Need for IRB Reform

Simon Whitney

In this conversation, Daniel Belkin and Mitch Belkin interview Simon Whitney, MD, JD, about his book From Oversight to Overkill. They discuss the history of Institutional Review Boards (IRBs), including ethically questionable experiments such as Chester Southam’s cancer cell injections, the Willowbrook experiment, as well as the US Public Health Service Syphilis Study (AKA Tuskegee experiment). They then discuss Peter Buxton, Henry Beecher, James Shannon, and the congressional oversight of federally funded research. Finally, they touch on the ISIS-2 study, Pronovost’s checklist, OHRP’s crackdown in the late 1990s, and discuss whether research is too safe, IRB infallibility, autonomy in the Belmont Report, and the risks and benefits of restricting research in the name of safety.

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Who is Simon Whitney?

Simon Whitney, MD, JD, is a family medicine physician and ethicist. He previously taught at Baylor College of Medicine for 22 years. He is currently retired from the practice of medicine but continues to publish and teach medical ethics. He is the author of the book “From Oversight to Overkill: Inside the Broken System That Blocks Medical Breakthroughs—And How We Can Fix It.”

References:

If you enjoyed this episode, be sure to check out our episode with Carl Schneider.

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36. John Ayers, PhD: ChatGPT and the Future of Medicine

John Ayers

In this conversation, Daniel Belkin and Mitch Belkin interview John Ayers, PhD, about ChatGPT and its potential to revolutionize the practice of medicine. We delve into his recent JAMA internal medicine study, which evaluated ChatGPT answers to questions posed on the subreddit r/AskDocs. We also touch on responses to his article discussed on a recent Sensible Medicine Podcast. Finally, we discuss Dr. Ayer’s previous work on e-cigarettes, cannabis, and the sociology of suicide.

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Who is John Ayers?

John Ayers, PhD is a computational epidemiologist who uses big data to study public health. He is the Vice Chief of Innovation in the Division of Infectious Diseases and Global Public Health at UCSD.

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