https://www.justice.gov/opa/pr/opioid-manufacturer-purdue-ph...
https://www.propublica.org/article/purdue-settlement-leaves-...
I'm curious if this will hold up, the people of Utah rejected that mega data center iirc, maybe they feel differently on this one because of what private equity has done to rural healthcare
big /s
I am a big believer in AI for drug discovery. But AI applied to patient care will never be used to benefit the patient or increase quality of care.
Cost reductions will be absorbed for profits. The medical industry has already aggressively implemented AI automation (imaging, automated note taking, etc) and in that period, costs have only increased.
My hour long yearly physical takes 15 minutes and my miscellaneous questions get brushed off. I have some sort of eczema on my hand and he told me to use lotion. After telling him I do, he said to keep doing it. It had been six months then and now 18 months. Problem is still there.
Just today I finally found a dermatologist. Soonest appointment I could get from the ones I called is May of 2027.
At a certain point, I hope LLMs can provide at least basic medical help reliably because I can't get the opportunity to ask a doctor to begin with.
So here, AI isn't doing anything clever, it's just asking "are you sure you don't have a heart condition" and "are you sure you're not a crazy person". We don't really need LLMs for that, but if it's a catalyst for liberalization, fine.
So are we just admitting that the "AI" here is the equivalent of a dialog box and this same change could have been enacted at any point in the last half century?
>We don't really need LLMs for that, but if it's a catalyst for liberalization, fine.
Is this liberalization or is it just further entrenching the bureaucracy that this change implies is already broken?
This whole thing just feels like a Chesterton's fence scenario in which we knock down the fence and then immediately rebuild it, only a few inches shorter and with weaker materials this time. I just don't see how that's any sort of victory for progress.
And the medications that are controlled vs uncontrolled (at least here in Texas) seem completely random.
It sounds like a catalyst for more red tape, more creepy Internet tracking, higher drug costs and more impossible to break subscriptions, all to help some health care companies' bottom lines. I don't consider this fine.
> Only topical acne medications from a restricted list: tretinoin, adapalene, clindamycin with benzoyl peroxide, benzoyl peroxide, and azelaic acid, some combined with niacinamide or topical spironolactone. Each plan includes a morning and an evening treatment. The pilot does not include oral or systemic medications, hormonal therapies, or isotretinoin.
So it's a short list of topical creams. Several of them are already available over the counter. Benzoyl peroxide creams are on the shelf of your nearest grocery store. Some of them are available in higher strengths via prescription only and should be reserved for only severe or refractory cases after escalation. A lot of people go straight for the highest strength they can find on the shelf, so having a prescription gate for the stronger stuff can be justified.
Others on the list like tretinoin are currently prescription only. That one is a strong chemical that will burn your skin if you don't read the instructions about to apply and also makes you prone to sunburn. A lot of people don't read the instructions, they just apply the cream and see what happens. Having a provider, even if it's AI, do something to force them to understand the risks can be arguably justified. Tretinoin is also a risk to fetal development, so having a provider ask if female patients are on birth control is important. That said it is OTC in some other countries, so there's an argument that it should be OTC here as well.
The AI doctor is not allowed to prescribe anything really serious. It's a combination of prescription versions of OTC creams and a few topicals that benefit from some light provider instructions. Having a $5 option to get them with the serious cases shunted to actual doctors is not a bad tradeoff.
And doctors aren't infallible, AI (and rule based systems) can act as an extra safeguard for them as long as they don't blindly trust it.
Drugged with a topical ointment and complacent by having less acne? This is a one-year trial for patients with mild-to-moderate acne. Let's not blow this situation out of proportion. This trial seems rather narrowly scoped and overall a positive idea for well understood treatments that hardly need an MD to begin with.
If you want to get into conspiracy theories of a government wanting a drugged and compliant citizenry just look no further than the sudden push legalizing THC across the country.
I see this same fallacy repeated all the time when we speak about AI.
"I want AI to be 100% accurate and not 99.999%"
"If AI makes even one mistake, why would I even use it?"
"What's the point of using AI if I have to verify it anyway?"
Here's how it could work.
You could always have a CI sort of thing for doctors prescriptions where you run the prescription through AI and it can flag any potential error to the doctor.
The LLM can be accurate enough that it only flags things when necessary
You could always have a CI sort of thing for doctors prescriptions where you run the prescription through AI and it can flag any potential error to the doctor.
> What positive value does the AI actually add that isn't circumventing a legal requirement that we decided to put in place?
You only reply with stuff nobody said. Which explains why you "see those fallacies repeated" every time, if you bring them up. A simple solution is to stick things actually are saying.
"The process works when a person signs up for Nolla Health's $4.99-per-month app and uses it to scan their face. After completing a medical history and personal information form, the AI analyzes their skin..."
Utah is not allowing any general form of no-human-in-the-loop healthcare, but has temporarily allowed this company to operate.
Your summary is misleading. Acne is diagnosed, prescriptions are written and applied, initially with Dr review and then only 10% reviewed by doctors.
Medicines are topical and said to have mild side effects - so I guess no retinoids (or accutane pills).
fwiw, physician assistants generally work under a doctor, who's supposed to review about that many of their cases.
At this point the term "AI" has been so diluted that it doesn't refer to generative image models or LLMs or traditional machine learning so much as it acts as a memetic sonic screwdriver, i.e. whatever journalists, pundits, founders, etc. need it to be. You can see how each party is wielding it in this specific instance quite clearly.
We usually regulate a one-size-fits-all approach to everything in medicine. An M.D. (or whatever NPs have?) is required to prescribe medicines, even medicines which are just the same or slightly stronger formulations of OTC medications like a 400mg Ibuprofen or a 1% hydrocortisone cream. Compare this to Mexico, where you can buy many of our "prescription-only" meds OTC.
A lot of healthcare issues are just not high-stakes. Requiring a doctor in these cases doesn't help the average patient, because the average patient would rather ignore the problem, or now, ask ChatGPT how to treat it with OTC options, than deal with the mess of scheduling doctor appointments, dealing with insurance (or in Canada, long wait times to see the doctor for free), only to get just 5 minutes with the actual doctor who may not even listen to you.
I know it's a tough pill to swallow for doctors, and I recognize that it's not doctors who chose the terrible healthcare system we have or decided that they should have 5-10 minutes with a patient. But I do think we need to change the rules for things that have little risk of causing harm but a great chance of improving the aggregate outcomes by increasing access to healthcare.
> A lot of healthcare issues are just not high-stakes. Requiring a doctor in these cases doesn't help the average patient
Normally, I am not inclined to get involved whenever I see bad takes on the internet but this is one of those "so harmful you really need to nip it in the bud" type of things.
Do not listen to this person's armchair speculation.
If you want to remind yourself why the united states invented an FDA (and why every major medical establishment enjoys the benefits of institutions like ICD and CPT standardization), go reread your Progressive Era history (~1900-1925). Go read about how we already learned all of these lessons the hard way, and save yourself the trouble of reinventing the wheel. Go read about the social impact of Upton Sinclair's The Jungle, "snake oil salesmen", disasters like the Triangle Shirtwaist Fire and the creation of organizations like OSHA.
This commenter may not know any better, but humanity does.
I have for example had tonsilitis 5+ times, and a lot of common colds/flus/etc. I know how my body reacts and how it feels when I have one or the other.
Yet, I have to be screened by nurses, sent around, given weak antibiotics, and in general wasting a lot of time when I could just convince a model to give me the prescription.
I have a friend with acne who has the same issues with tretinoin prescriptions. Endless appointments and time waste.
Step in the right direction
If a 20 minute telehealth visit with a PA is a sufficient level of screening for a medication, it's hard to imagine a compelling reason why an AI system would not be.
To make things more complicated, every message I sent was responded to by a different nurse practitioner. So it seemed everytime i sent a response or question, it would get routed to a random NP and she would respond without reviewing the full conversation.
Works if you know what you need, and I can't imagine AI being a worse process than whatever Amazon is doing.
Hard disagree. The only acne treatment I know by name has serious side effects that IMO should be discussed with a human at length before being used.
Why do you think this is fine?
Acne is a real problem for some people, but comparatively low stakes, mostly visual evaluation, and with pretty well-known solutions. (Of course everything has corner cases, but in general this is a well understood area.)
I have no idea how well this will go, but starting here rather than, say, robotic cancer treatments, can help AI medicine develop into more.
If it does go badly, then after a year we can re-evaluate and either give up or refine the system.
I notice acne.
I have a choice of going to a regular doc, or this ai clinic.
I decide to go to ai clinic (and take the risk of prescription that may be incorrect).
I get the prescription. Probably double check it with Gemini or chatgpt.
I get the medicine and use it.
> In the second phase, the next 400 patients will have their prescriptions submitted to pharmacies by the AI and reviewed retrospectively by a physician weekly.
> The final phase will involve a doctor reviewing at least 10% of the total prescriptions issued once a month.
This is a really good way to go. That's how you get to a proper system. It's the route that should've been taken from the very beginning with all human-facing AI-brokered services, and would've meant far fewer nightmare stories.
Is it? At least as a customer I'd love to replace a doctor with AI. Humans suck, you have to wait so long for an appointment, they spend like 10 minutes on your case, and often have very outdated knowledge. The main issue is that vision still sucks and lack of embodiment is a problem. It could invoke "human subagents" for that.
How do you hold an AI accountable for getting it wrong in ways that fuck you up?
I wouldn't say that, but it's certainly one where the consequences are high and doctor-in-the-loop seems highly desirable for the foreseeable future, especially since most patients are not going to be knowledgeable enough to realize the shortcomings of an LLM and make an informed decision about whether they're OK taking an LLM-prescribed medication.
Don't worry, it's going to be ok... probably.
That's a pretty thin defense when things do go wrong.
Just in case anyone else has the gut "oh ffs" reaction to this.
You don't have to go to medical school to know what bad acne looks like, or how to treat a UTI. We should be working on tiering prescriptions based on ease of diagnosis and risk.
Where I am in BC, Canada, pharmacists can prescribe specific medications for certain pre-approved conditions, and there is also the concept of an "emergency" refill for if you lose your medication or are unable to get an appointment in time, a few days of a previously prescribed medication can be provided.
At the end of the day, a better solution is to have tiers of prescription meds. Not everything needs to be gate-kept by MDs. If an AI can prescribe it, there is no reason a nurse, pharmacist or other medical professional shouldn't be able to as well.
Same for percentages of strength in medicine. If a certain percentage strength of tretinoin does not work, you need to get a new prescription for the stronger one.
Another thing are different providers. If you get care at one provider they won't have the data of the other providers necessarily.
---
None of these things are insurmountable and would just require some good software to fix(connect databases, make hierarchies of medicine, etc) However it's in no-ones incentive to do so.
The doctors, nurses and other medical staff have 0 interest in:
1) making themselves obsolete
2) learn new software systems
3) change their workflow
And will not only express this, but also actively misuse the new tools that they are given (happened in my country) to make a point of how things can't be trusted and why they are necessary.
In order to solve this you need something like the solution proposed coming in from the outside. This way the current medical staff have 0 control and have to change/adapt.
But there are. Costs and wait times go down. Can be handled like a drive-through. No mis-diagnoses due to fatigue, etc.
Great. Perhaps this will motivate the exploration of them. The prevailing racket is in desperate need of disruption.
Sometimes doctors make choices that reflect a landscape of risk the patient is no more prepared to understand than the doctor is ready to run a network test. People who say they “know they need something” are often confidently wrong.
I have for example hypersensitivity to radio waves. I know how my body reacts and how it feels when I'm exposed to such radiation, especially during vaxxine toxicity flareups.
Yet, I have to be screened by nurses, go through appointments with psychologists, and in general wasting a lot of time when I could just convince a model to prescribe the radium water I need.
Step in the right direction.
you're assuming you can "convince" the model
https://school.wakehealth.edu/education-and-training/graduat...
It isn’t unethical for you because you aren’t a medical professional, it’s unethical to make this available without first establishing safety, efficacy, and superiority to previous approaches. You don’t find that out by testing on a whole state!!!
That being said, have you tried more than just basic lotion? Butenafine clears a lot of fungal issues. High content zinc oxide diaper paste is also very useful. There's a brand from Dollar Tree that's very popular but triple paste is another option. The heavy zinc oxide coating cures a wide array of skin issues.
Wash your hands with nizoral then moisturizer with something like Okeefes or just the ZO cream.
https://apnews.com/article/telehealth-prescription-glp1-ftc-...
https://themarkup.org/pixel-hunt/2022/12/13/out-of-control-d...
https://www.foxnews.com/tech/your-health-data-being-sold-wit...
Do you get small blisters on your hands and maybe feet? If so, it's called dyshydrotic eczema.
I was told for years that it was an autoimmune disorder, had tons of different treatments and specialists, only to discover it was an allergy to milk protein. I can't have any mammal milk product, no butter, cheese, etc... but I'm completely cured.
As part of this journey I also found out that a lot of women develop it as a result of nickel allergy and Low Nickel Diet helps.
Sorry to go off the rails, I just wanted to take the chance that I could help someone avoid everything I went through.
> If we believe the doctor's oversight is required, the AI introduces a dangerous potential for error
This assumes that the doctor won't verify what the AI said. This is a fallacy.
> The final phase will involve a doctor reviewing at least 10% of the total prescriptions issued once a month.
Overall, in the United States, I think that prescriptions are far too broadly required.
For example, I get extreme nausea for about 6-8 hours when I get a viral infection. It's truly miserable, and to the point that I must lay down and can't walk for even a few meters (standing up makes the nausea worse). But, the last few times I had this, I had to go completely without treatment (meaning, for me, ondansetron/zofran) because it takes a massive fraction of that time to see a doctor and it's quite difficult to haul myself to an urgent care when I can't walk, and the telehalth doctor that I saw via my insurance company agreed that ondansetron was indicated but his telehealth company didn't have that drug on the allowed prescriptions whitelist, so he refused to prescribe it. This is despite me knowing the exact needed dosage, the exact needed drug, and being reasonably sure that it wasn't a symptom of something more dangerous. Yet, the law says that this knowledge is irrelevant, and I need someone else's permission, resulting in me being in completely unnecessary misery for a day.
And, in that story, it's just a day, and has no lasting consequences. It gets much worse for other people in some cases.
And, could loosening of prescription paternalism result in people making mistakes? Of course. But, I'm allowed to go and buy power tools, to drive a car (licensing requird, but it's realistic to get this license, while the same isn't true for a medical license and even then self prescription is heavily discouraged), and many other dangerous and complex things.
"Lets not write unit tests. We can hire developers to write good code that doesn't break"
I don't think it's automatically true though. In the case of acne medication, I remember there's a well-known one that carries the very real caveat that it'll kill or severely deform the baby if you're pregnant. When you consider the old classic line "Think of the average person. Half of the people are dumber than that" I don't feel comfortable with that medication sitting on the shelf next to the Clearasil, where a busy person will just grab it because they heard it was super effective, or because the other types were out of stock.
The AI inference involved there no doubt costs pennies; so having it screen the patient to ensure that she understands the risks and has taken a pregnancy test recently if unsure, seems like a "why not" kind of thing.
Now, if some AI-healthcare company is capturing 90% of the money saved by not having doctors do this, then it would be barely worth it.
[0] - https://www.mobihealthnews.com/news/nolla-health-launches-ut...
Ad-powered media sells ads. There is plenty of media that is primarily subscription based. The difference is glaring.
unless frontier models (or whatever employs in medicine) are being kind enough to absorb the lawsuits here, I don't see how this ends well.
The accountability is with the company owners. Like with every healthcare startup, there's no reason to assume they'll love being sued or fined so much that they will bake violating HIPAA into their business plan.
Never said that at all.
They have lawsuits built into this, and either by hubris or bribes believe this is the most profitable route. "Its just acne, what could possibly go wrong?"
Statements like this is effectively saying "Nothing will go wrong".
> but they can always add a no liability clause to their ToS
Then why should I trust the output at all?
However, the entire point was to reference the IBM training manual that states: "A computer can never be held accountable, therefore a computer can must never make a management decision".
If the bot cannot be held accountable, it shouldn't be allowed to make decisions.
Again, not at all. There's very clear context and scope for the pilot as presented by the article. Doctors involved approved 8 treatments as appropriate for recommendation in this manner, for mild to moderate acne. And the first 100 cases will be reviewed before the recommendation is finalized.
Even with all that, a "bad" recommendation can still be made at a later time (and there are still views to catch them), but if that case does happen then there's negligible harm. The chances and scope of harm from using public roads (something done regularly by billions worldwide) vastly outweigh this, and unless you can come up with at least one scenario where AI can cause non-negligible harm in the pilot context, you're just fearmongering.
> Then why should I trust the output at all?
Nobody is forcing you to.
If the bot cannot be held accountable, [...]
There is no dependency relationship between accountability and decision making. But, again, it's up to individuals if they want to use this service.
There absolutely is when the decision making is writing a medical prescription
Do you seriously think your doctor is not accountable for what they prescribe?
Given that, shouldn't an AI system also be somehow accountable for what it prescribes?