Is There Any Way Such Incompetence And Incapacity To Act Can Be Excused?

This saga popped up last week.

Climate crisis

Scientific journal retracts article that claimed no evidence of climate crisis

Publisher Springer Nature says 2022 article ‘not supported by available evidence’ as editors launch investigation

Graham Readfearn

@readfearn

Sat 26 Aug 2023 01.00 AEST

Last modified on Sat 26 Aug 2023 01.01 AEST

One of the world’s biggest scientific publishers has retracted a journal article that claimed to have found no evidence of a climate crisis.

Springer Nature said it had retracted the article, by four Italian physicists, after an internal investigation found the conclusions were “not supported by available evidence or data provided by the authors”.

Climate sceptic groups widely publicised the article, which appeared in the European Physical Journal Plus in January 2022 – a journal not known for publishing climate change science.

Nine months later the article was reported uncritically in a page one story in the Australian newspaper and promoted in two segments on Sky News Australia – a channel that has been described as a global hub for climate science misinformation. The segments were viewed more than 500,000 times on YouTube.

The article claimed to have analysed data to find no trend in rainfall extremes, floods, droughts and food productivity.

“In conclusion on the basis of observational data, the climate crisis that, according to many sources, we are experiencing today, is not evident yet,” the article said.

Several climate scientists told the Guardian and later the news agency AFP that the article had misrepresented some scientific articles, was “selective and biased” and had “cherrypicked” information.

After those concerns were raised, Springer Nature announced in October it was investigating the article.

In a statement Springer Nature said its editors had launched a “thorough investigation”, which included a post-publication review by subject matter experts.

The authors of the article also submitted an addendum to their original work during the course of the investigation, the statement said.

“After careful consideration and consultation with all parties involved, the editors and publishers concluded that they no longer had confidence in the results and conclusions of the article,” the journal said.

“The addendum was not considered suitable for publication and retraction was the most appropriate course of action in order to maintain the validity of the scientific record.”

A retraction note appearing on the article says concerns were raised “regarding the selection of the data, the analysis and the resulting conclusions of the article”.

The note says the article’s conclusions “were not supported by available evidence or data provided by the authors”.

More here:

https://www.theguardian.com/environment/2023/aug/26/scientific-journal-retracts-article-that-claimed-no-evidence-of-climate-crisis

That a reputable journal publisher takes more that 18 months to notice that an off-topic article it published was untrue evidence-free rubbish really makes it hard to understand just how we poor ignoramuses at the end of the information food chain are to discern fact from fiction etc.

When you think about it the implications of all this are really scary – to say the least! Even if material is not taken down surely it can be flagged a possibly misleading in a week or two. No properly conducted peer-review process gets it this wrong unquestioningly!

Springer this is just not OK! What do others think?

David.

 

AusHealthIT Poll Number 711 – Results – 27 August, 2023.

Here are the results of the poll.

Are The ADHA, ATO And Federal Government Doing Enough To Counter E-Mail Scams And Fraud?

Yes                                                                     22 (50%)

No                                                                      19 (43%)

I Have No Idea                                                     3 (7%)

Total No. Of Votes: 44

A mixed outcome suggesting that a small majority of readers feel enough is being done but many don’t!

Any insights on the poll are welcome, as a comment, as usual!

A good number of votes. But also a rather mixed outcome. 

3 of 44 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

 

It Is Hard To Pass Up Cold Hard Cash.

This appeared last week:

Pharmacies to charge for blood pressure checks and medication deliveries amid profits squeeze

By Natasha Robinson  Health Editor  

9:00PM August 16, 2023

Chemists will begin charging customers for blood pressure checks, medication home deliveries, wound dressing and baby weighing – all services previously provided for free – as community pharmacies face reduced revenues amid plunging confidence in the sector’s financial outlook.

The CommBank Pharmacy Insights 2023 report reveals four out of five community pharmacies intended to begin charging for previously free services to offset the impact of the federal government’s 60-day dispensing policy, with 90 per cent expecting profits to decrease by one-third.

While confidence in the sector prior to this May was at its highest point in 10 years with strong business value outlook, sentiment declined sharply after the announcement of the 60-day dispensing policy, plunging almost 100 points on the UTS Community Pharmacy Barometer Index to the lowest ebb in a decade.

After May, some 72 per cent of community pharmacies expected the value of their business to decrease compared to 10 per cent six months earlier.

The report, produced in partnership with the University of Technology Sydney and health analytics company IQVIA, is the most comprehensive research available on community pharmacies on an annual basis in Australia and tracks the confidence, perceptions and attitudes of pharmacy owners and employees. It is due to be publicly released on Thursday.

“Many are considering whether keeping their workforce and opening hours intact is financially viable, while others are still grappling with shortages,” said CommBank Health chief Albert Naffah.

Pharmacists in NSW will march in the Sydney CBD on Thursday in protest at the 60-day dispensing policy, an action organised by grassroots pharmacy owners independent of the Pharmacy Guild, which has been waging an organised campaign.

The policy, which will allow 60 days’ worth of 320 common medications to be prescribed for the price of one PBS co-payment, cleared the Senate last week amid a Coalition attempt to block it, and the legislation will formally come into effect next month.

Southwest Sydney pharmacy owner Quinn On said the plans by most chemists to open up extra revenue streams would soon come into effect.

“Many pharmacies do free deliveries of medication for their regulars and elderly patients, and that won’t happen anymore after 60-day dispensing,” he said. “We are having lots of meetings about how we can mitigate the impact of 60-days dispensing, we’re doing everything we can.”

Mr On named free wound dressing and blood pressure checks as services that would no longer be provided for free. Blood pressure checks would attract a $10-$15 charge. He currently employs a midwife 4½ hours a week who does baby weighing and advises new mums. “I get a line-up of people every Friday morning … I am now looking at can I continue to provide that service.”

Pharmacies were also planning to join more pharma programs, in which patients are enrolled on to pharmaceutical company programs that monitor blood pressure, cholesterol and medication compliance.

Pharmacies get a small fee for enrolling each patient.

The CommBank Pharmacy Insights confirmed moves across the sector to expand service delivery and push for a greater role in patient care.

“The breadth and size of the expected (profits) decrease is leading to a range of strategic responses,” the report said. “The top growth opportunity for pharmacists in November 2022 was expanding professional services.

More here:

https://www.theaustralian.com.au/nation/politics/pharmacies-to-charge-for-blood-pressure-checks-and-medication-deliveries-amid-profits-squeeze/news-story/8a55bf5db1ee38903d44a1b1b6312596

I guess this had to come!

David.

 

It Seems Doctors Are A Little Wary Regarding The AI Push Presently Underway.

This appeared last week:

Docs Using AI? Some Love It, Most Remain Wary

Christine Lehmann, MA

August 15, 2023

When OpenAI released ChatGPT-3 publicly last November, some doctors decided to try out the free AI tool that learns language and writes human-like text. Some physicians found the chatbot made mistakes and stopped using it, while others were happy with the results and plan to use it more often.

"We've played around with it. It was very early on in AI and we noticed it gave us incorrect information with regards to clinical guidance," said Monalisa Tailor, MD, an internal medicine physician at Norton Health Care in Louisville, Kentucky. "We decided not to pursue it further," she said.

Orthopedic spine surgeon Daniel Choi, MD, who owns a small medical/surgical practice in Long Island, New York, tested the chatbot's performance with a few administrative tasks, including writing a job listing for an administrator and prior authorization letters.

He was enthusiastic. "A well-polished job posting that would usually take me 2-3 hours to write was done in 5 minutes," Choi said. "I was blown away by the writing — it was much better than anything I could write."

The chatbot can also automate administrative tasks in doctors' practices from appointment scheduling and billing to clinical documentation, saving doctors time and money, experts say.

Most physicians are proceeding cautiously. About 10% of more than 500 medical group leaders said their practices regularly use AI tools when they responded to a March poll by the Medical Group Management Association.

More than half of the respondents not using AI said they first want more evidence that the technology works as intended.

"None of them work as advertised," said one respondent.

MGMA practice management consultant Dawn Plested acknowledges that many of the physician practices she's worked with are still wary. "I have yet to encounter a practice that is using any AI tool, even something as low-risk as appointment scheduling," she said.

Physician groups may be concerned about the costs and logistics of integrating ChatGPT with their electronic health record systems (EHRs) and how that would work, said Plested.

Doctors may also be skeptical of AI based on their experience with EHRs, she said.

"They were promoted as a panacea to many problems; they were supposed to automate business practice, reduce staff and clinician's work, and improve billing/coding/documentation. Unfortunately, they have become a major source of frustration for doctors," said Plested.

Drawing the Line at Patient Care

Patients are worried about their doctors relying on AI for their care, according to a Pew Research Center poll released in February. About 60% of US adults say they would feel uncomfortable if their own healthcare professional relied on artificial intelligence to do things like diagnose disease and recommend treatments; about 40% say they would feel comfortable with this.

"We have not yet gone into using ChatGPT for clinical purposes and will be very cautious with these types of applications due to concerns about inaccuracies," Choi said.

Practice leaders reported in the MGMA poll that the most common uses of AI were nonclinical, such as:

·         Patient communications, including call center answering service to help triage calls, to sort/distribute incoming fax messages, and outreach such as appointment reminders and marketing materials

·         Capturing clinical documentation, often with natural language processing or speech recognition platforms to help virtually scribe

·         Improving billing operations and predictive analytics

Some doctors also told The New York Times that ChatGPT helped them communicate with patients in a more compassionate way.

They used chatbots "to find words to break bad news and express concerns about a patient's suffering, or to just more clearly explain medical recommendations," the story noted.

Is Regulation Needed?

Some legal scholars and medical groups say that AI should be regulated to protect patients and doctors from risks, including medical errors, that could harm patients.

"It's very important to evaluate the accuracy, safety, and privacy of language learning models (LLMs) before integrating them into the medical system. The same should be true of any new medical tool," said Mason Marks, MD, JD, a health law professor at the Florida State University College of Law in Tallahassee.

In mid-June, the American Medical Association approved two resolutions calling for greater government oversight of AI. The AMA will develop proposed state and federal regulations and work with the federal government and other organizations to protect patients from false or misleading AI-generated medical advice.

Marks pointed to existing federal rules that apply to AI. "The Federal Trade Commission already has regulation that can potentially be used to combat unfair or deceptive trade practices associated with chatbots," he said.

In addition, "the US Food and Drug Administration can also regulate these tools, but it needs to update how it approaches risk when it comes to AI. The FDA has an outdated view of risk as physical harm, for instance, from traditional medical devices. That view of risk needs to be updated and expanded to encompass the unique harms of AI," Marks said.

There should also be more transparency about how LLM software is used in medicine, he said. "That could be a norm implemented by the LLM developers and it could also be enforced by federal agencies. For instance, the FDA could require developers to be more transparent regarding training data and methods, and the FTC could require greater transparency regarding how consumer data might be used and opportunities to opt out of certain uses," said Marks.

What Should Doctors Do?

Marks advised doctors to be cautious when using ChatGPT and other LLMs, especially for medical advice. "The same would apply to any new medical tool, but we know that the current generation of LLMs are particularly prone to making things up, which could lead to medical errors if relied on in clinical settings," he said.

More here:

https://www.medscape.com/viewarticle/994892?icd=login_success_email_match_norm

I have to say this all seems like pretty sensible advice for those who want to start getting a feel for what is possible and how well it can work.

There is no need to hurry, but being King Canute and hoping to resist is also not wise.

In passing, I would be keen to pass on any references in the space that others have found useful!

David.

 

A Major Deadline Is Fast Approaching To Have E-Prescribing Fully Set Up!

This appeared last week:

Deadline looms for sign-up to centralised prescribing

The Department of Health and Aged Care is urging practices that have not registered for the national Prescription Delivery Service to do so.

Jolyon Attwooll

17 Aug 2023

More than 150 million e-prescriptions have been issued since May 2020.

Reimbursement for an e-prescription SMS will stop from 30 September unless prescribers have signed up to the new national Prescription Delivery Service (PDS), the Department of Health and Aged Care (DoH) has warned.
 
It said practice owners and managers should check whether they have registered and if their software providers advise any necessary updates.
 
The centralised PDS, run by eRx Script Exchange, is designed to streamline prescription delivery and dispensing, according to the DoH.
 
A $99.6 million deal was signed this May, with eRx Script Exchange contracted to provide the PDS from 1 July this year until 30 June 2027.
 
According to Services Australia, clinicians and pharmacies need to connect to the PDS by the end of next month to continue prescribing or dispensing eligible medications.
 
Reimbursements for e-prescription tokens are currently paid by the Australian Digital Health Agency (ADHA), an arrangement that had been extended several times while DoH officials considered a permanent solution.  
 
The Government-funded prescription exchange will continue to cover SMS fees but only for practices that have signed up to the new PDS.
 
The DoH says the move to the new system will simplify the prescribing process, as well as give ‘long-term funding certainty to enable innovation and efficiency … clearer governance … and enhanced capacity for patient-centred support and care’.
 
The DoH says other policy reforms, including the mandated use of e-prescribing for high risk and high-cost medicines, ‘are on the horizon’.
 
The move to a model directly contracted by the Federal Government was announced as part of the 7th Community Pharmacy Agreement, with the tender going out in June last year.
 
The majority of practices are believed to have signed up to eRx Script Exchange already, and do not need to take further action.
 
Set up in April 2009, the prescription exchange service is a subsidiary of the Fred IT Group, which is part owned by the Pharmacy Guild.
 
The other software vendor that runs a prescription exchange service, MediSecure, will continue providing private prescriptions, which will remain free to send by SMS or email after the transition period according to a statement on the company’s website.
 
The ADHA states there have now been more than 150 million e-prescriptions issued since May 2020, with the pandemic proving a significant catalyst.

More here:

https://www1.racgp.org.au/newsgp/professional/deadline-looms-for-sign-up-to-centralised-prescrib

It seems we have just set up a small partial national monopoly here with the Pharmacy Guild at least somewhat involved. At least it is not the total monopoly I am sure they would have liked!

It is certainly a good thing all this will not we stable and can be bedded in to provide what will become an essential service I am sure.

I guess we will just have to wait and see how well the arrangements work in the longer term, but it is good to have a national e-prescribing service in place!

David.

 

AusHealthIT Poll Number 710 – Results – 20 August, 2023.

 Here are the results of the poll.

Overall, Has The Australasian Institute Of Digital Health Made A Positive Difference To The Australian Health System Since Its Founding In February 2020?

Yes                                                                     10 (24%)

No                                                                      32 (76%)

I Have No Idea                                                     0 (0%)

Total No. Of Votes: 42

A clear outcome suggesting that a majority of readers feel the AIDH is only partially successful at best!

Any insights on the poll are welcome, as a comment, as usual!

A good number of votes. But also a very clear outcome. 

0 of 42 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

 

This Is A Useful Introduction To AI In Healthcare.

This appeared a few months ago, but is well worth the read:

We need to chat about artificial intelligence

Enrico W Coiera, Karin Verspoor and David P Hansen

Med J Aust || doi: 10.5694/mja2.51992
Published online: 12 June 2023

With the arrival of large language models such as ChatGPT, AI is reshaping how we work and interact

Long foretold and often dismissed, artificial intelligence (AI) is now reshaping how we work and interact as a society.1 For every claim that AI is overhyped and underperforming, only weeks or months seem to pass before a new breakthrough asks us to re-evaluate what is possible. Most recent, it is the very public arrival of large language models (LLMs) such as the generative pre-trained transformers (GPTs) in ChatGPT. In this perspective article, we explore the implications of this technology for health care and ask how ready the Australian health care system is to respond to the opportunities and risks that AI brings.

GPTs are a recent class of machine learning technology. Guided by humans who provide it with sample responses and feedback, ChatGPT was initially trained on 570 gigabytes of text, or about 385 million pages of Microsoft Word, and, at first release, the language model had 175 billion parameters.2 This massive model of the relationships between words is generative in that it produces new text, guided by the model, in response to prompts. It can answer questions, write songs, poems, essays, and software code. Other generative AIs such as DALL‐E, which is trained on images, can create startlingly good pictures, including fictitious or “deep fake” images of real people.3

Today's LLMs are story tellers, not truth tellers. They model how language is used to talk about the world, but at present they do not have models of the world itself. The sheer size of ChatGPT means that it can perform tasks it was not explicitly trained to do, such as translate between languages. ChatGPT amassed 100 million users in the first two months that it was available.4 So compelling are the linguistic skills of LLMs that some have come to believe such AI is sentient,5 despite the prevailing view that as statistical pattern generators, they cannot have consciousness or agency. Australian singer Nick Cave called ChatGPT “a grotesque mockery of what it is to be human” after seeing it generate new songs in his style.6

The health care uses of generative models will soon become clearer.7 Epic has agreed with Microsoft to incorporate its GPT‐4 model into their electronic health records, which have been used for over 305 million patients worldwide.8 LLMs are likely to find application in digital scribes, assisting clinicians to create health records by listening to conversations and creating summaries of the clinical content.9,10 They can create conversational agents, which change the way we search medical records and the internet, synthesising answers to our questions rather than retrieving a list of documents.11

We should prepare for a deluge of articles evaluating LLMs on tasks once reserved for humans, either being surprised by how well the technology performs or showcasing obvious limits because of the lack of a deep model of the world.12 Especially when it comes to clinical applications, producing text or images that are convincing is not the same as producing material that is correct, safe, and grounded in scientific evidence. For example, conversational agents can produce incorrect or inappropriate information that could delay patients seeking care, trigger self‐harm, or recommend inappropriate management.13 Generative AI may answer patients’ questions even if not specifically designed to do so. Yet all such concerns about technology limitations are hostage to progress. It would be foolish indeed to see today's performance of AI as anything other than a marker on the way to ever more powerful AI.

The unintended consequences of AI

It is the unintended consequences of these technologies that we are truly unprepared for. It was hard to imagine in the early innocent days of social media, which brought us the Arab Spring,14 just how quickly it would be weaponised. Algorithmic manipulation has turned social media into a tool for propagating false information, enough to swing the results of elections, create a global antivaccination movement, and fashion echo chambers that increasingly polarise society and mute real discourse.

Within two months of the release of ChatGPT, scientific journals were forced to issue policies on “non‐human authors” and whether AI can be used to help write articles.15 Universities and schools have banned its use in classrooms and educators scramble for new ways to assess students, including returning to pen and paper in exams.16 ChatGPT is apparently performing surprisingly well on questions found in medical exams.17

The major unintended consequences of generative models are still to be revealed.18 LLMs can produce compelling misinformation and will no doubt be used by malicious actors to further their aims. Public health strategies already must deal with online misinformation; for example, countering antivaccination messaging. Maliciously created surges of online messages during floods, heat events, and pandemics could trigger panic, swamp health services, and encourage behaviours that disrupt the mechanics of society.19

The national imperative to respond to the challenges of AI

With AI's many opportunities and risks, one would think the national gaze would be firmly fixed on it. However, Australia lags most developed nations in its engagement with AI in health care and has done so for many years.20 The policy space is embryonic, with focus mostly on limited safety regulation of AI embedded in clinical devices and avoidance of general purpose technologies such as ChatGPT.

Much more here: Here is the link:

https://www.mja.com.au/journal/2023/219/3/we-need-chat-about-artificial-intelligence

This is a good start on the way to starting to understand the AI in healthcare field and it is well worth following up the various leads in the article. We are much closer to the beginning of all this than the end!

David.

 

I Am Not Sure The AMA Really Has Its Head Around AI And Its Possible Impact

This appeared last week:

https://www.miragenews.com/robust-rules-enable-ai-to-enhance-australian-1064459/

Robust Rules Enable AI to Enhance Australian Healthcare

Media release

Medical care delivered by human beings should never be replaced with Artificial Intelligence (AI), but AI technology can potentially achieve improved healthcare, the AMA said today.

The AMA’s first Position Statement on the use of AI in healthcare outlines a set of ethical and regulatory principles based on safety and equity which should be applied to the application of AI technologies in healthcare.

The position statement covers the development and implementation of AI in healthcare and supports regulation which protects patients, consumers, healthcare professionals and their data.

AMA President Professor Steve Robson said with appropriate policies and protocols in place, AI can assist in the delivery of improved healthcare, advancing our healthcare system, and the health of all Australians.

“The AMA sees great potential for AI to assist in diagnosis, for example, or recommending treatments and at transitions of care, but a medical practitioner must always be ultimately responsible for decisions and communication with their patients.

“There’s no doubt we are on the cusp of big changes AI can bring to the sector and this will require robust governance and regulation which is appropriate to the healthcare setting and engenders trust in the system.

“We’d like to see a national governance structure established to advise on policy development around AI in healthcare.

“Such a structure must include all health-sector stakeholders like medical practitioners, patients, AI developers, health informaticians, healthcare administrators and medical defence organisations.

“This will underpin how we carefully introduce AI technology into healthcare. AI tools used in healthcare must be co-designed, developed and tested with patients and medical practitioners and this should be embedded as a standard approach to AI in healthcare.

“Decisions about healthcare are the bedrock of the doctor-patient relationship and these will never be replaced by AI. People worry when they hear that machine learning is perfecting decision-making, but this is not the role AI should play in healthcare. Diagnoses, treatments and plans will still be made by medical practitioners with the patient – AI will assist and supplement this work.  

“We need to get ahead of any unforeseen consequences for patient safety, quality of care and privacy across the profession. This will require future changes to how we teach, train, supervise, research and manage our workforce.

“One of the key concerns for any healthcare organisation using AI must be the privacy of patients and practitioners and their data. The AMA’s position is very clear about protecting the privacy and confidentiality of patient health information. This is where regulation and oversight is really important; the healthcare sector must establish robust and effective frameworks to manage risks, ensure patient safety and guarantee the privacy of all involved.

“The AMA’s position statement shows doctors are engaging with this rapidly evolving field and laying down some guiding principles. If we can get the settings right, so that AI serves the healthcare needs of patients and the wider community, we think it can enable healthcare that is safe, high quality and patient centred.”

Read the AMA position statement

/Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.

This release has a bit of a feel of “well we are not sure about all this but we need to say something!” about it. There is a lot of ‘motherhood’ here I reckon!

IF ever there was an area / domain where the technology is far ahead of the administrators this has to be it!

It is good we have a specialist committee of experts in this domain to help the AMA when they get out of their depth! See https://aihealthalliance.org/

David.