Who would you rather make your medical decisions – a nurse or doctor – or a computer? This bizarre question is becoming a frightening reality for the medical profession – and for people like you and me.

Yes, artificial intelligence or “A.I.” is now influencing the way we practice medicine. Lisa Bannon, writing for The Wall Street Journal, tells us of a real-life experience of Melissa Beebe, an oncology nurse at UC Davis Medical Center in California. An alert signal prompted by the computer said her patient in the oncology unit was having sepsis, but Melissa knew that was wrong. “I’ve been working with cancer patients for 15 years so I know a septic patient when I see one,” she said. “I knew this patient wasn’t septic.”

The alert correlates elevated white blood cell count with septic infection. It wouldn’t take into account that this particular patient had leukemia, which is also associated with high white blood cell counts. The algorithm, which was based on artificial intelligence, triggers the alert when it detects patterns that match previous patients with sepsis. The algorithm didn’t explain its decision.

Hospital rules require nurses to follow protocols when a patient is flagged for sepsis. While Beebe can override the AI model if she gets doctor approval, she said she faces disciplinary action if she’s wrong. So, she followed orders and drew blood from the patient, even though that could expose him to infection and run up his bill. “When an algorithm says, ‘Your patient looks septic,’ I can’t know why. I just have to do it,” said Beebe, who is a representative of the California Nurses Association union at the hospital.

As she suspected, the algorithm was wrong. “I’m not demonizing technology,” she said. “But I feel moral distress when I know the right thing to do and I can’t do it.”

How did things get so out of hand?

Artificial intelligence and other high-tech tools, though nascent in most hospitals, are raising difficult questions about who makes decisions in a crisis: the human or the machine? The technologies, which can analyze massive amounts of data with a speed beyond human capacity, are making extraordinary advances in medicine, from improving the diagnosis of heart conditions to predicting protein structures that could speed drug discovery. When it is used alongside humans to help assess, diagnose and treat patients, AI has shown powerful results, academics and tech experts say.

But there is always another side to the story, as Nurse Beebe has experienced. The tools can be flawed and are sometimes implemented without adequate training or flexibility, say nurses and healthcare workers who work with them regularly, putting patients at risk. Some clinicians say they feel pressure from hospital administration to defer to the algorithm.

“AI should be used as clinical decision support and not to replace the expert,” said Kenrick Cato, a professor of nursing at the University of Pennsylvania and nurse scientist at the Children’s Hospital of Philadelphia. “Hospital administrators need to understand there are lots of things an algorithm can’t see in a clinical setting.”

Sounds to me like the administrators trust the computers more than their nurses and doctors. But there’s an old saying about computers, “Garbage in, garbage out.” The computer is only as good as the information it is given.  One has to wonder how many hours of experience practicing medicine the computer programmer had.

In a survey of 1,042 registered nurses published this month by National Nurses United, a union, 24% of respondents said they had been prompted by a clinical algorithm to make choices they believed “were not in the best interest of patients based on their clinical judgment and scope of practice” about issues such as patient care and staffing.” Of those, 17% said they were permitted to override the decision, while 31% weren’t allowed and 34% said they needed doctor or supervisor’s permission.

(Note: More on this subject in my next post.)

They really are coming for your gas stove. We first talked about this in February, when it was only a rumor. In an earlier post, Are Gas Stoves Dangerous to Your Health?, I said there were climate activists who were pressuring the White House to ban all gas stoves. Among those groups was Climate Imperative Foundation, the Rocky Mountain Institute, and Rewiring America.

At the time, Kimberley Strassel of The Wall Street Journal said, ““The reason gas stoves are in the news is simple: There is a coordinated, calculated – and well-funded – strategy to kill them off. It’s the joint enterprise of extremely powerful climate groups, working with Biden administration officials who have publicly stated their aim to eliminate all “combustion appliances” in homes. Only after the GOP called them out did anyone pretend otherwise.”

Fast forward four months and now it is clear it was not a rumor. The Biden Energy Department issued an attack on gas stoves which was disguised as an “efficiency” regulation. The proposed rule would ban most current gas models and make replacements far less functional. The Energy Information Administration says that in 2020 nearly 40% of Americans used gas to cook in their homes. But since this is an offense against the climate activists, the rule is designed to make gas products too hard to make or use.

The Wall Street Journal editorial board says, “The rule would cap a stove’s annual energy use- at no more than 1,204 thousand British thermal units a year. This would limit or eliminate features that are a reason people buy them. The rule would make it all but impossible to sell stoves that have more than one high-input(large) burner, which cooks use for searing, stir-frying or quickly heating water. Technical aspects of the rule could also limit the availability of smaller, low-heat burners – which are used to melt, simmer and keep food warm without burning. The rule also targets cast-iron grates, which let users safely handle pots or move them more easily around burners.”

How will this impact those who use gas stoves?

The Association of Home Appliance Manufacturers notes that more than two-thirds of gas cook tops feature more than one large burner, a priority for most buyers. Even the Energy Department admits that half of today’s stove models won’t comply with its rule. Critics say the share is actually much higher, pointing to a table buried in a supporting DOE document that shows that, when DOE tested models, 20 of 21 failed to comply with its new threshold. Outlawing 96% of stove models is effectively a ban.

The Biden Administration is trying to promote the fiction that they are targeting appliance efficiency to save consumers money. But the stove rule makes it clear this is a de facto ban on gas stoves. The House Republicans are responding with a bill called Save Our Gas Stoves Act, which bars the DOE from finalizing the proposed rule or any that is substantially similar. A second bill, The Gas Stove Protection and Freedom Act, would bar the Consumer Product Safety Commission from regulating or banning stoves based on the false claim that they are health hazards. It has already passed in the House, 248 – 180, with 29 Democrats joining the GOP majority.

You have to wonder why Democrats would push such an unpopular idea as banning gas stoves. WJS says it is a political loser for Democrats, which is why they want to disguise the scheme as a regulation that the media will ignore. Overriding the rule in the House would put Democrats on the record and put pressure on Senate Democrats to allow a vote too.

I don’t have a dog in this fight, since we have electric stoves in our home. But this is another example of climate activism that is out of hand. If the science truly supports their position, they should be confident to present the scientific facts to make their case for an outright ban. If not, they shouldn’t resort to false claims about “improving efficiency” to pass a de facto ban.

In the world of complex healthcare costs and calculating your out-of-pocket expense, getting a mammogram may be the most confusing. It all depends upon whether your mammogram is considered a “screening” procedure or a “diagnostic” procedure.

I’m a physician and this makes no sense to me. Screening procedures are done to make a diagnosis in most cases. You don’t do a colonoscopy just to find out if you need a colonoscopy! But it seems that analogy may not work for mammograms.

Here’s what I’m talking about: Let’s say you’re a woman of 50 years and you get a routine mammogram. The scan shows something suspicious so your doctor tells you to get another mammogram “to be on the safe side.” After you get the second scan you find a bill in your mail for $350 – one you didn’t get for the first mammogram! About now you’re thinking, “There has to be a mistake. If I didn’t have to pay for the first one, why am I getting a bill for the second one?”

Leslie Albrecht, writing for MarketWatch.com says this is a very real scenario happening to many women. She says blame it on the Affordable Care Act.

In 2010, the Affordable Care Act (ObamaCare) was passed by the Democratic-controlled Congress without a single Republican vote. I’ve been fascinated with this historic piece of legislation that is misnamed, like most bills in Congress. (I’ve written two books on the subject.) The ACA certainly did not make healthcare more affordable for most people – in fact, it made it more expensive. The main reason for this increased expense is that the bill forced insurance companies to provide coverage for all sorts of procedures whether you needed this coverage or not. Insurance companies were not allowed to write policies that didn’t provide so-called essential health benefits.

That meant all policies provided coverage for routine screening exams such as mammograms, regardless of whether or not you were a woman! But only for the “screening exams” – not the “diagnostic exams.” That means your diagnostic exam is not covered and thus you get the $350 bill. What’s the difference in the two exams? Molly Guthrie, the vice-president of policy and advocacy at Susan G. Komen, a non-profit that raises awareness and money for breast-cancer research, has answers. She says health insurers can, and do, make patients pay out-of-pocket costs for follow-up “diagnostic” mammograms, even though the machines and procedures are exactly the same.

“When the ACA was passed, it was hammered into everyone’s head that all screening was free of charge,” Guthrie told MarketWatch. “So, it’s really confusing when patients get the screening done that they’re told that they need, and they have to pay up front or they get surprised by a bill after the procedure is done.”

Who gets screening mammograms v. who gets diagnostic mammograms?

Screening mammograms are the ones done typically on women every two years if they’re “average risk” for breast cancer and have no strong family history. Women have traditionally started these at age 50, but new draft guidelines suggest it should be age 40. Between 12% and 20% of people who get a screening mammogram are then told they need a follow-up “diagnostic scan,” according to Guthrie.

The “diagnostic scan” can seem like it’s the same procedure, but insurers don’t treat them the same. Billing codes change when the name changes. Diagnostic mammograms are also recommended for a host of other reasons, including for women who have so-called “dense breasts”, which is about half of all women, according to the American Cancer Society. Anyone with a family history of breast cancer, people with certain genetic conditions, and anyone who’s gone through breast-cancer treatment are also told to get diagnostic mammograms.

Some states are addressing this financial conundrum and it’s a rare instance where both red and blue states are on the same page. Texas, New York, Oklahoma, Washington state, Maryland and Tennessee are among those that have passed laws eliminating out-of-pocket costs for diagnostic imaging. However, these laws only apply to people in state-regulated health plans, which are used mostly by smaller employers or state employees. Federal legislation to address the issue was introduced in 2021 with bipartisan support, but didn’t move forward. A Komen spokesperson says it is due to be reintroduced soon.