Connect with us

Science

Opinion: It's not just hype. AI could revolutionize diagnosis in medicine

Published

on

Opinion: It's not just hype. AI could revolutionize diagnosis in medicine

The history of medical diagnosis is a march through painstaking observation. Ancient Egyptian physicians first diagnosed urinary tract infections by observing patterns in patients’ urine. To diagnose diseases of the heart and lungs, medieval doctors added core elements of the physical examination: pulse, palpation and percussion. The 20th century saw the addition of laboratory studies, and the 21st century of sophisticated imaging and genetics.

Despite advances, however, diagnosis has largely remained a human endeavor, with doctors relying on so-called illness scripts — clusters of signs, symptoms and diagnostic findings that are hallmarks of a disease. Medical students spend years memorizing such scripts, training themselves to, for example, identify the sub-millimeter variations in electrocardiogram wave measurements that might alert them to a heart attack.

But human beings, of course, err. Sometimes, misdiagnosis occurs because a doctor overlooks something — when the patterns of illness fit the script, but the script is misread. This happens in an estimated 15% to 20% of medical encounters. Other times, misdiagnosis occurs because the illness has features that do not match known patterns — they do not fit the script, such as when a heart attack occurs without telltale symptoms or EKG findings.

Artificial intelligence can help solve these two fundamental problems — if it’s given enough financial support and deployed correctly.

First, AI is less susceptible to common factors that lead doctors to make diagnostic errors: fatigue, lack of time and cognitive bandwidth when treating many patients, gaps of knowledge and reliance on mental shortcuts. Even when illnesses conform to scripts, computers will sometimes be better than humans at identifying details buried within voluminous healthcare data.

Advertisement

Using AI to improve the accuracy and timeliness with which doctors recognize illness can mean the difference between life and death. Ischemic stroke, for example, is a life-threatening emergency where a blocked artery impedes blood flow to the brain. Brain imaging clinches the diagnosis, but that imaging must be performed and interpreted by a radiologist quickly and accurately. Studies show that AI, through superhuman pattern matching abilities, can identify strokes seconds after imaging is performed — tens of minutes sooner than by often-busy radiologists. Similar capabilities have been demonstrated in diagnosing sepsis, pneumonia, blood clot in the lungs (pulmonary embolism), acute kidney injury and other conditions.

Second, computers can be useful for illnesses for which we haven’t developed the right scripts. AI can, in fact, diagnose disease using new patterns too subtle for humans to identify. Consider, for example, hypertrophic cardiomyopathy, a rare genetic condition in which the heart’s muscle has grown more than it should, leading to eventual heart failure and sometimes death. Experts estimate that only 20% of those affected are diagnosed, a process that requires consultation with a cardiologist, a heart ultrasound and often genetic testing. What, then, of the remaining 80%?

Researchers across the country, including at the Mayo Clinic and UC San Francisco, have demonstrated that AI can detect complex, previously unrecognized patterns to identify patients likely to have hypertrophic cardiomyopathy, meaning AI-driven algorithms will be able to screen for the condition in routine EKGs.

AI was able to recognize these patterns after examining the EKGs of many people with and without the disease. The rapid growth in healthcare data — including detailed electronic health records, imaging, genomic data, biometrics and behavioral data — combined with advancements in artificial intelligence technology has created a major opportunity. Because of its unique ability to identify patterns from the data, AI has helped radiologists to find hidden cancers, pathologists to characterize liver fibrosis and ophthalmologists to detect retinal disease.

One challenge is that AI is expensive, requiring large-scale data to train computer algorithms and the technology to do so. As these resources become more ubiquitous, that can make the associated intellectual property difficult to protect, discouraging private investment in these products. More generally, diagnostics have long been considered unattractive investments. Unlike their therapeutic counterparts, which see around $300 billion in research and development investment a year, diagnostics receive a modest $10 billion in private funding.

Advertisement

Then there’s the question of who pays for the use of AI-based tools in medicine specifically. Some applications, such as detecting strokes, save insurers money (by preventing costly ICU stays and subsequent rehabilitation). These technologies tend to get reimbursed more quickly. But other AI solutions, such as detecting hypertrophic cardiomyopathy, may lead to increased spending on costly downstream therapies to treat newly identified chronic illness. Although the use of AI may improve quality of care and long-term outcomes in such cases, without financial incentives for insurers, reimbursement and thus adoption may be slow.

Life sciences companies have on rare occasion agreed to subsidize development or reimbursement of AI-based diagnostics. This will help bridge the gap, but the federal government may need to play a greater role. Federal support for COVID diagnostics during the pandemic drove rapid development of critical tests, and the cancer moonshot project has helped drive R&D in screening and new treatments.

It is usually tough to marshal funding at the scale needed for new medical frontiers. But the National Academies of Medicine has estimated that tens of billions of dollars and countless lives could be saved from improving diagnosis in medicine.

Artificial intelligence offers a path toward that. It should complement, rather than replace, the human expertise that already saves so many lives. The future of medical diagnosis doesn’t mean handing over the keys to AI but, rather, making use of what it can do that we can’t. This could be a special moment for diagnosis, if we invest enough and do it right.

Gaurav Singal is a computer scientist and physician at Harvard Medical School and was previously the chief data officer of Foundation Medicine, a cancer diagnostics company. Anupam B. Jena is an economist, physician and professor at Harvard Medical School and co-author of “Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health” and the Random Acts of Medicine Substack.

Advertisement
Continue Reading
Advertisement
Click to comment

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Science

U.S. Efforts to Cut Emissions Stalled in 2024 as Power Demand Surged

Published

on

U.S. Efforts to Cut Emissions Stalled in 2024 as Power Demand Surged

America’s efforts to cut its climate change pollution stalled in 2024, with greenhouse gas emissions dropping just a fraction, 0.2 percent, compared to the year before, according to estimates published Thursday by the Rhodium Group, a research firm.

Despite continued rapid growth in solar and wind power, emissions levels stayed relatively flat last year because demand for electricity surged nationwide, which led to a spike in the amount of natural gas burned by power plants.

The fact that emissions didn’t decline much means the United States is even further off-track from hitting President Biden’s goal of slashing greenhouse gases 50 percent below 2005 levels by 2030. Scientists say all major economies would have to cut their emissions deeply this decade to keep global warming at relatively low levels.

Since 2005, United States emissions have fallen roughly 20 percent, a significant drop at a time when the economy has also expanded. But to meet its climate goals, U.S. emissions would need to decline nearly 10 times as fast each year as they’ve fallen over the past decade. That seems increasingly unlikely, experts say, especially since President-elect Donald J. Trump has promised to dismantle Mr. Biden’s climate policies and promote the production of fossil fuels, the burning of which generates greenhouse gases.

“On the one hand, it is notable that we’ve now seen two years in a row where the U.S. economy grew but emissions went down,” said Ben King, an associate director at the Rhodium Group. “But it’s far from enough to achieve our climate targets.”

Advertisement

The biggest reason that U.S. emissions have fallen in recent years is that electric utilities have been retiring their older, dirtier coal-fired power plants and replacing them with cheaper and less-polluting natural gas, wind and solar power. That trend mostly continued last year, with a few unexpected ups and downs.

The nation’s demand for electricity, which has stayed more or less flat for two decades, suddenly jumped by roughly 3 percent in 2024, in large part because scorching heat during the summer caused many Americans to crank up their air-conditioners. A smaller factor was that tech companies have been building more energy-hungry data centers in states like Virginia and Texas.

While power companies installed large numbers of wind turbines, solar panels and batteries last year to meet rising demand, natural gas use also rose to record highs, while coal use declined only slightly. The net result was that emissions from the power sector increased an estimated 0.2 percent, according to the Rhodium Group.

At the same time, transportation, the nation’s largest source of greenhouse gases, saw an 0.8 percent rise in emissions last year. Gasoline and jet fuel consumption both increased as Americans continued to drive and fly more after the pandemic. Nearly 10 percent of new car sales in 2024 were less-polluting electric vehicles, but those models still make up a small fraction of total cars on the road and have yet to put a major dent in transportation emissions.

On the flip side, emissions from America’s industrial sector — which includes steel, cement and chemicals — fell by 1.8 percent in 2024. Some of that may have been the result of lost output, as two hurricanes and a strike at the nation’s ports disrupted some factory activity in the fall, Mr. King said.

Advertisement

“It’s a reminder that there’s always some bumpiness in emissions,” Mr. King said. “It’s not just a question of how many electric vehicles are on the road or how much solar we’ve installed. A big portion of our economy still relies on fossil fuels.”

One of the most striking findings in this year’s data was that emissions from oil and gas operations dropped roughly 3.7 percent in 2024. Even though the United States produced record amounts of oil and near-record amounts of natural gas last year, many companies appear to have curbed leaks of methane, which is the main ingredient in natural gas and which can seep into the atmosphere and contribute significantly to global warming.

Over the past few years, the Biden administration and several states have adopted new regulations that require oil and gas producers to detect and fix methane leaks. Many companies also have financial incentives to capture methane to sell rather than vent it into the air.

Between 2014 and 2024, U.S. companies appear to have reduced the amount of methane that escaped, per each cubic feet of gas they produced, by 40 percent, according to the Rhodium Group.

Several experts have estimated that greenhouse gases generated in the United States could start dropping sharply in the years ahead if many clean energy policies stay in place, particularly the 2022 Inflation Reduction Act that pumped hundreds of billions of dollars into low-carbon energy technologies such as electric vehicles, wind turbines, solar panels, nuclear reactors, green hydrogen and batteries.

Advertisement

While Mr. Trump has pledged to scrap many of Mr. Biden’s subsidies and tax credits for electric vehicles and low-carbon energy, it remains to be seen whether Congress will agree.

That law has not yet had a major impact on the country’s emissions, said Mr. King, since it takes time for new factories to open and power plants to get built. But, he said, data shows that low-carbon energy and transportation now make up fully 5 percent of total U.S. private investment.

“That’s a leading indicator that things are changing quickly,” he said.

Continue Reading

Science

How to protect yourself from the smoke caused by L.A. wildfires

Published

on

How to protect yourself from the smoke caused by L.A. wildfires

You don’t have to live close to a wildfire to be affected by its smoke. With severe winds fanning the fires in and around Pacific Palisades, the Pasadena foothills and Simi Valley, huge swaths of the Southland are contending with dangerous air quality.

Wildfire smoke can irritate your eyes, nose, throat and lungs. The soot may contain all kinds of dangerous pollutants, including some that may cause cancer. The tiniest particles in smoke can travel deep into your lungs or even enter your bloodstream.

Conditions like these aren’t good for anyone, but they’re particularly bad for people in vulnerable groups, including children, those with asthma or other respiratory conditions, people with heart disease and those who are pregnant.

Here’s what you should know to keep yourself safe.

Advertisement

Stay indoors

Minimize your exposure to unhealthy air by staying inside and keeping your doors and windows shut.

If you have a central heating and air conditioning system, you can keep your indoor air clean by turning it on and keeping it running. Make sure the fresh-air intake is closed so that you’re not drawing in outdoor air.

Keep your pets inside

They shouldn’t breathe the unhealthy air either.

Check your air filters

Clean filters work better than dirty ones, and high-efficiency filters work better than regular ones. The California Air Resources Board and the South Coast Air Quality Management District recommend filters with a MERV rating of 13 or higher.

You might consider using portable high-efficiency air cleaner in a room where you spend the most time. The U.S. Environmental Protection Agency has information about them here, and CARB has a list of certified cleaning devices here.

Advertisement

Don’t pollute your indoor air

That means no burning candles or incense. If your power is out and you need to see in the dark, you’re much better off with a flashlight or headlamp.

If you’re cold, bundle up. This is not the time to start a cozy fire in the fireplace. Don’t use a gas stove or wood-fired appliances, since these will make your indoor air quality worse, not better, the AQMD says.

The CDC also advises against vacuuming, since it can stir up dust and release fine particles into the air.

Take care when cleaning up

You don’t want your skin to come into contact with wildfire ash. That means you should wear long sleeves, pants, gloves, socks and shoes. The AQMD even wants you to wear goggles.

If you’re sweeping up ash outdoors, get a hose and mist it with water first. That will keep it from flying up in the air as you move it around. Once the ash is wet, sweep it up gently with a broom or mop. Bag it up in a plastic bag and throw it away.

Advertisement

It’s a good idea to wash your vehicles and outdoor toys if they’re covered in ash. Try not to send ashy water into storm drains. Direct the dirty water into ground areas instead, the AQMD advises.

Those with lung or heart problems should avoid clean-up activities.

Discard spoiled food…

If you lost power for a significant length of time, the food in your refrigerator or freezer may be spoiled.

Food kept in a fridge should stay safe for up to four hours if you’ve kept the door closed. If you’ve been without power for longer than that, you’ll need to toss all perishable items, including meat, poultry, fish, eggs, milk and cut fruits and vegetables. Anything with “an unusual smell, color, or texture” should be thrown out as well, according to the U.S. Centers for Disease and Control Prevention.

Refrigerated medicines should be OK unless the power was out for more than a day. Check the label to make sure.

Advertisement

…even if it was in the freezer

Your freezer may be in better shape, especially if it’s well-stocked. Items in a full freezer may be safe for up to 48 hours if it’s been kept shut, and a half-full freezer may be OK for up to 24 hours. (The frozen items help keep each other cold, so the more the better.)

If items have remained below 40 degrees Fahrenheit (4 degrees Celsius) or you can still see ice crystals in them, they may be OK to use or refreeze, according to the federal government’s food safety website.

Ice cream and frozen yogurt should be thrown out if the power goes out for any amount of time. Meat, poultry, seafood, eggs, milk and most other dairy products need to go if they were exposed to temperatures above 40 degrees F for two hours or longer. The same goes for frozen meals, casseroles, soups, stews and cakes, pies and pastries with custard or cheese fillings.

Fruit and fruit juices that have started to thaw can be refrozen unless they’ve started to get moldy, slimy or smell like yeast. Vegetables and vegetable juices should be discarded if they’ve been above 40 degrees F for six hours or more, even if they look and smell fine.

Breakfast items like waffles and bagels can be refrozen, as can breads, rolls, muffins and other baked goods without custard fillings.

Advertisement

Consider alternative shelter

If you’ve done everything you can but your eyes are still watering, you can’t stop coughing, or you just don’t feel well, seek alternative shelter where the air quality is better.

Hold off on vigorous exercise

Doing anything that would cause you to breathe in more deeply is a bad idea right now.

Mask up outdoors

If you need to be outside for an extended time, be sure to wear a high-quality mask. A surgical mask or cloth mask won’t cut it — health authorities agree that you should reach for an N95 or P-100 respirator with a tight seal.

Are young children at greater risk of wildfire smoke?

Very young children are especially vulnerable to the effects of wildfire smoke because their lungs are still rapidly developing. And because they breathe much faster than adults, they are taking in more toxic particulate matter relative to their tiny bodies, which can trigger inflammation, coughing and wheezing.

Any kind of air pollution can be dangerous to young children, but wildfire smoke is about 10 times as toxic for children compared to air pollution from burning fossil fuels, said Dr. Lisa Patel, clinical associate professor of pediatrics at Stanford Children’s Health. Young children with preexisting respiratory problems like asthma are at even greater risk.

Advertisement

Patel advises parents to keep their young children indoors as much as possible, create a safe room in their home with an air purifier, and try to avoid using gas stoves to avoid polluting the indoor air.

Children over the age of 2 should also wear a well-fitting KN95 mask if they will be outdoors for a long period of time. Infants and toddlers younger than that don’t need to mask up because it can be a suffocation risk, Patel said.

What are the risks for pregnant people?

Pregnant people should also take extra precautions around wildfire smoke, which can cross the placenta and affect a developing fetus. Studies have found that exposure to wildfire smoke during pregnancy can increase the risk of premature birth and low birth weight. Researchers have also linked the toxic chemicals in smoke with maternal health complications including hypertension and preeclampsia.

What about other high-risk populations?

Certain chronic diseases including asthma, chronic obstructive pulmonary disease or other respiratory conditions can also make you particularly vulnerable to wildfire smoke. People with heart disease, diabetes and chronic kidney disease should take extra care to breathe clean air, the CDC says. The tiny particles in wildfire smoke can aggravate existing health problems, and may make heart attacks or strokes more likely, CARB warns.

Get ready for the next emergency

Living in Southern California means another wildfire is coming sooner or later. To prepare for the bad air, you can:

Advertisement
  • Stock up on disposable respirators, like N95 or P-100s.
  • Have clean filters ready for your A/C system and change them out when things get smoky.
  • Know how to check the air quality where you live and work. The AQMD has an interactive map that’s updated hourly. Just type in an address and it will zoom in on the location. You can also sign up to get air quality alerts by email or on your smartphone.
  • Know where your fire extinguisher is and keep it handy.
  • If you have a heart or lung condition, keep at least five days’ worth of medication on hand.

Times staff writer Karen Garcia contributed to this report.

Continue Reading

Science

Punk and Emo Fossils Are a Hot Topic in Paleontology

Published

on

Punk and Emo Fossils Are a Hot Topic in Paleontology

Mark Sutton, an Imperial College London paleontologist, is not a punk.

“I’m more of a folk and country person,” he said.

But when Dr. Sutton pieced together 3-D renderings of a tiny fossil mollusk, he was struck by the spikes that covered its wormlike body. “This is like a classic punk hairstyle, the way it’s sticking up,” he thought. He called the fossil “Punk.” Then he found a similar fossil with downward-tipped spines reminiscent of long, side-swept “emo” bangs. He nicknamed that specimen after the emotional alt-rock genre.

On Wednesday, Dr. Sutton and his colleagues published a paper in the journal Nature formally naming the creatures as the species Punk ferox and Emo vorticaudum. True to their names, these worm-mollusks are behind something of an upset (if not quite “anarchy in the U.K.”) over scientists’ understanding of the origins of one of the biggest groups of animals on Earth.

In terms of sheer number of species, mollusks are second only to arthropods (the group that contains insects, spiders and crustaceans). The better-known half of the mollusk family tree, conchiferans, contains animals like snails, clams and octopuses. “The other half is this weird and wacky group of spiny things,” Dr. Sutton said. Some animals in this branch, the aculiferans, resemble armored marine slugs, while others are “obscure, weird molluscan worms,” he said.

Advertisement

Punk and Emo, the forerunners of today’s worm-mollusks, lived on the dark seafloor amid gardens of sponges, nearly 200 million years before the first dinosaurs emerged on land. Today, their ancient seafloor is a fossil site at the border between England and Wales.

The site is littered with rounded rocky nodules that “look a bit like potatoes,” Dr. Sutton said. “And then you crack them open, and some of them have got these fossils inside. But the thing is, they don’t really look like much at first.”

While the nodules can preserve an entire animal’s body in 3-D, the cross-section that becomes visible when a nodule is cracked open can be difficult to interpret “because you’re not seeing the full anatomy,” Dr. Sutton said.

Paleontologists can use CT scans to see parts of fossils still hidden in rock, essentially taking thousands of X-rays of the fossil and then stitching those X-ray slices together into one digital 3-D image. But in these nodules, the fossilized creatures and the rock surrounding them are too similar in density to be easily differentiated by X-rays. Instead, Dr. Sutton essentially recreated this process of slicing and imaging by hand.

“We grind away a slice at a time, take a photo, repeat at 20-micron intervals or so, and basically destroy but digitize the fossil as we go,” Dr. Sutton said. At the end of the process, the original fossil nodule is “a sad-looking pile of dust,” but the thousands of images, when painstakingly digitally combined, provide a remarkable picture of the fossil animal.

Advertisement

Punk and Emo’s Hot Topic-worthy spikes set them apart from other fossils from the aculiferan branch of the mollusk family. “We don’t know much about aculiferans, and it’s unusual to find out we’ve suddenly got two,” Dr. Sutton said.

Stewart Edie, the curator of fossil bivalves at the Smithsonian National Museum of Natural History, said that Punk and Emo’s bizarre appearances shook up a long-held understanding of how mollusks evolved. Traditionally, scientists thought that the group of mollusks containing snails, clams and cephalopods “saw all of the evolutionary action,” said Dr. Edie, who was not involved with the new discovery. “And the other major group, the aculiferans, were considerably less adventurous.” But Punk and Emo “buck that trend,” he said.

The new alt-rock aculiferans reveal the hidden diversity of their group in the distant past and raise questions about why their descendants make up such a small part of the mollusk class today. “This is really giving us an almost unprecedented window into the sorts of things that were actually around when mollusks were getting going,” Dr. Sutton said. “It’s just this little weird, unexpected, really clear view of what was going on in the early history of one of the most important groups of animals.”

Continue Reading

Trending