So says this NYT headline (gift link). In reality, and in the article itself:

The tool might also be more useful for trainee doctors than for experienced specialists, said Dr. Diane Simeone, a pancreatic surgeon at the University of California San Diego. Some of the tumors that the tool caught in the Nature Medicine study should have been “super obvious” to well-trained radiologists even without A.I., she said.

But she acknowledged that it could be a valuable backstop for hospitals where specialists are in short supply.

This is based on the data So yes, A.I. is finding deadly tumors that an overworked and/or undertrained doctor might miss. Which is valuable, but a different message altogether from the one that the headline was trying to convey.

Separately, is “in China” becoming the new “in mice”? ⊕ The link is to a PLOS One blog from 2021. The most recent post there as of the time of my writing this is a scathing and rather unfair review of the science of Pluribus. I refrained from adding it to my feed reader. What assumptions do writers have, and what emotions do they raise in readers, when they report about things happening “in China”? Was it the same with the Soviet Union? Whenever someone fans the flames of mimetic rivalry, I grab my wallet.

First things first: The Pitt (2025) is miles better than two other era-defining medical shows, ER and House MD. The conceit — one hour per episode, one shift per season — makes for a more realistic pace. The case selection is good, if on the extreme end of any possible presentation. The medical staff personality types are spot on, ⊕ They are all good, but I would like to highlight the charge nurse and the neuro-atypical first-year resident as commonly encountered phenotypes that TV shows never seem to get right.if not quite representative of the variety of English accents one would hear during rounds. And the battle between administrators and clinicians hit all the right notes, even if having the hospital’s Chief Medical Officer hover over ER staff at all hours of the day would be considered atypical for the role.

Kudos are also due for the use of prosthetics, sometimes quite grizzly, with an abundance of open wounds and mangled extremities. With so much exposed tissue I wondered why no one was wearing a mask during procedures even while, in a mid-season episode, admonishing an anti-mask patient about their beliefs. But that is, of course, another conceit, otherwise we would never be able to tell who was saying what. A more believable move was to have one of the medical students ⊕ More kudos for making the two students smart, competent and lovable all at once.present for most of the cases, requiring everyone to explain what they were doing at an 8th grade level (our own 8th grader who was watching with us also appreciated this). Granted, the historical reminiscences and calling out different healthcare-related statistics were much less plausible: they reminded me of the most self-important parts of Studio 60 on the Sunset Strip that its then-arch rival 30 Rock so successfully parodied.

Admittedly, it is an unusual hospital. More than 20 ORs and so much house staff with only one attending physician during a day shift sounds… implausible. It does make for great tension-building, and it was no wonder that Noah Wiley’s character — spoiler alert — by the end of the season gets burnt out to a crisp. Another oddity is how competent and unflappable all of the staff were during — another spoiler — a major traumatic event that no one wanted to experience but everyone was prepared for. Color me skeptical that operations would have been that smooth.

Still. As fanciful as they were, ER and the less-remembered Chicago Hope were, to me at least and I suspect to many others of similar age, ⊕ The less I say about House MD the better. a large part of the draw of medicine. It is good to know that there is a half-decent show out there that may keep the flame going.

A rare day-job update: we have not one but two papers out in the journal Nature Medicine this morning. The first is clinical and the other biomarker data from the same randomized trial, both open access. The last big paper was more than two years ago, and the post-publication feeling hasn’t changed.

• Ruxandra Tesslo and Asimov Press: Clinic-in-the-Loop

The case for faster bench-to-bedside-and-back type of research, with which I agree. It is remarkable, however, how each generation interested in biomedical research reinvents the wheel without checking prior art. I would also argue strongly that the (correct) thesis of the essay is not a refutation of the biotech-as-casino hypothesis but rather its confirmation, unless you enlarge “biotech” to include academia and government research but then what are we even doing. Investors have no patience for nuance and view clinical trials as dichotomous regardless of how companies try to present them, and interpreting translational research results requires even more patience and tolerance of ambiguity.

• Elizabeth Ginexi: The Quiet Power of Program Officers

Ginexi has been a program at the NIH for more than two decades, so caveat lector, but many POs are indeed mini-Moseses in their scientific domains. On one hand they perform important and valuable work, on the other the importance of a single human being to the careers of investigators young and old tend to favor those with soft skills of communication more than those of scientific and intellectual rigor. No judgements on my end because I genuinely can’t tell if the alternative would be any better.

• James L. Olds: A Grant Reviewer’s New Year Advice to Proposers: What I’d Tell My Younger Self

Some genuinely good advice on how to write grants in a way to increase the odds of them being funded, with emphasis on accepting the reviewers' comments and suggestions and approaching the grant resubmission as one would an offer to revise and resubmit a scientific manuscript, with much thanking and back-bending. Do keep that in mind when you read the next item.

• Laurel Raffington: Academia is just a job

This is true for most, as there are far too many academic right now for all of them to have soul in the game. However, academia continues to ask for more than it gives back out of too many people, while at the same time putting a negative selection pressure against people who are stubborn, single-minded and thus predisposed to a soul-in-the-game phenotype (see above). The only reason why the system survives at all is that the churn has been too low to fully reveal the tension, but it continues to creep towards the breaking point providing yet another case study of things that happen gradually and then suddenly.

• Ruxandra Teslo and Jack Scannell: To Get More Effective Drugs, We Need More Human Trials. I maintain that this will be nigh-impossible to do in the US until we break the healthcare ouroboros. AI as used now, to increase the number of drug candidates without making a dent in the speed of actually testing them, will only make things worse.
• Benjamin Mazer for The Atlantic: Yes, Some Children May Have Died From COVID Shots. Indeed, and the attempts to say otherwise can only Streisand the issue that should have been just a footnote to the long list of historical vaccine concerns.
• Simon DeDeo: Advice for Early-Career Academics, Part I: Mentorship. No-nonsense advice I wish I had 20-some years ago. I particularly like the distinction between mentors, supporters, fans, friendly elephants and noble adversaries. Left unmentioned are the many people who don’t have your best interest at heart.
• Michael Levy on YouTube: “Hurrian Hymn no. 6” (c.1400BCE) - Ancient Mesopotamian Musical Fragment. The Hurrian songs come not from Mesopotamia but from Ugarit, a city in what is now northern Syria which was one of many victims of the Late Bronze Age collapse. One would hope this would put to rest any questions on whether the humans of that age were like us, but then there are people alive now who don’t think their contemporaries are anything like them.

• Michael DePeau-Wilson for Asimov Press: Why the FDA Is Slow to Remove Drugs. And more importantly, why this is bad. You can’t accelerate drug approvals without also doing more culling on the back end. Symmetry, please.
• James L. Olds: Why Transformational Science Can’t Get Funded: The Einstein Problem. I disagree with most of it, but it is in fact the institutional point of view.
• Anonymous for the Good Science Project: A Top Scientist’s Ideas as to NIH. Did AI write this? Not great, but again, an institutional point of view masquerading as call to reform.
• Bryan Vartabedian: Physician authority and influence. An important distinction, and kudos to Dr. Vartabedian for coping that he has more influence than authority. I, on the other hand, have neither.
• Joe Boudreau: On 10 Years of Writing a Blog Nobody Reads. I have been doing it for at least 15 (13 of those in English) and it is in fact wonderful.
• Todd Vaziri: The “Mad Men” in 4K on HBO Max Debacle. The best and most concise review of this royal screwup of one of my favorite shows.

“The internet is dying on the outside but growing on the inside”, wrote Yancey Strickler last month in a follow-up to his 2019 essay The Dark Forest Theory of the Internet. To avoid misunderstanding, malicious interpretation, competitive intelligence gathering and cancelation, conversations have been moving from the public-facing “social” “media” to gated, invitation-only services (e.g., your favorite Substack author’s members-only discussion forum) and private group chats (e.g., the Let’s Bomb Yemen Signal texts).

But some parts of this Cozy Web are growing faster than others, and as if often the case doctors and scientists are ruled by inertia. Both groups have the perfect setup, in the form of professional societies, to carve off some gated space in which to have potentially controversial discussions without providing fodder to “the enemy”. ⊕ In these kinds of metaphors I always reach out to Venkatesh Rao’s The Internet of Beefs, which explains quite well why the public Internet has turned into a dark forest in the first place. And yet even the most developed online community program I know of — American Society of Clinical Oncology’s myConnection — is a stuffy, ⊕ ASCO boasts as having more than 50,000 members. The two largest “communities” on MyConnection, “New Member” and “Women in Oncology”, have more than 9,000 members each yet the last post on one was 9 days ago (with zero replies) and 7 days ago (two replies). All of November, the more active WiO group had 9 posts with median 1 reply (range 0–20). formal messaging board that can barely be considered active. Most of ASCO’s online activity is still on X, where the official account has almost 150,000 followers and the hashtag for its annual meeting is heavily promoted. Other large hematology/oncology societies like ASH (hematology) and AACR (general cancer research) don’t even have that. Their “online community” is a member directory and heavy promotion of in-person conferences, which I can only assume are the true money-makers.

So I have to wonder, do they still deserve to call themselves “societies”? It is, after all, 2025 and much of life has moved online. By not providing an avenue for true internal discussion and instead promoting public debate, are they hurting their members' cause more than helping? ⊕ Yes, it was fun to post out in public when there was a slight chance that your favorite celebrity — or the POTUS — would retweet your post, but we have since learned that this is a liability more than a benefit and there are more high-follower accounts on X now that I would rather avoid. I have argued recently that scientists may want to button up their conversations if they are to keep or regain trust. Should these societies not be providing the means to do so, and not only once per year in a stuffy conference room? ASCO’s MyConection is on the right track, but much too formal. Yes, give people the opportunity to create subgroups and even more private chats as you do now. But if you think debating on X with millions of spectators is healthy, why not give all 50,000-plus members a chance to interact by default, and do so in a format that is not an early 2000s web forum?

Concluding the most recent article, Yancey Strickler provided a toolbox for people to create their own communities which he called the Dark Forest OS, of DFOS. While laudable, this effort is to put it bluntly too artsy fartsy for me. Strickler comes from the world of “creators” whose sensibilities are much different from those of doctors and scientists. But then science and medicine already have much of DFOS in place, from a members list to paying dues. The only thing we need now is for the said societies to build their walled gardens — with an app included! — which they would promote instead of X at the annual meetings and other conferences.

Where a SciMeDFOS would come useful is at smaller scale, for collaborative groups and maybe even large individual labs, where members are known but there are no dues, funds, or IT workers ready to build a custom Twitter clone. If I were to make one now I would probably use Hometown, which is a fork of Mastodon that enables local-only posting, though it being a single person’s passion project makes me a bit reluctant. But then what else do we have, Discord, WhatsApp and Signal? Whatever Dave Winer comes up with in collaboration with Wordpress? Maybe Squarspace could make creating private Twitter clones be as easy as creating websites? I will be on the lookout.

• Rachael Bedard: I Went to an Anti-Vaccine Conference. Medicine Is in Trouble. Tragic considering all the good vaccines have brought us, most recently against cervical cancer. And the news from the FDA is, of course, a disaster from any perspective.
• Kurt Streeter: How to Fix a Typewriter and Your Life. A palate-cleanser for the above. And if this piques your interest, Chris Aldrich has a wonderful primer on learning typewriter maintenance and repair.
• Ross Douthat interviews Paul Kingsnorth: ‘This Is the War Against Human Nature’. Not the only interesting interview Dothat made, and they make for better reading than listening.
• Jeff Giles: How I Began to Love Reading Again. I too loved If on a winter’s night…

Enjoy!

Today I learned, thanks to a leaked email from Vinay Prasad to his staff, ⊕ I also learned that Prasad puts a double space after each period which is inexcusable in 2025 when we all use variable fonts on our electronic devices, not a fixed width-font typewriter. Whatever his high school typing teacher told him, he should drop the habit.that FDA’s CBER does actual bench research. This is pure stupidity on my part, as it is right there in the name: Center for Biologics Evaluation and Research. Silly me. They have a page dedicated to describing the work of their 65 principal investigators, and it seems to be at least on par in topics and rigor to the work done at the NIH Intramural Research Program though the latter if of course bigger.

Prasad’s email boils down to this: CBER research staff has strayed from its mission, which is primarily regulatory. We will look at work performed and planned and cut that which is not in line with the mission. He invokes sunken cost fallacy by name, so one would assume work in progress will also be cut, maybe even things completed that haven’t yet been written up — why spend hours formatting a manuscript when you could be reviewing IND Investigational New Drug applications and BLAs Biologics License Application, and let me use this sidebar to note how infuriating it is that one acronym includes the word “application” in it and the other doesn’t, forcing one to resort to clumsy phrases such as the one to the left. I supposed you could write “BLAs and IND applications” but that is listing them out of sequence. instead? And we certainly shouldn’t abuse the privilege of conducting research without having to apply for grants by just padding our CVs with insignificant work that will never be cited, which is another thing Prasad rises against.

My initial reaction was “damn right” but then I realized that regulatory review is just another price scientists-at-heart pay in order to do the work they want, similar to teaching in academia and low pay with no opportunity for outside activities at the NIH IRP. I suppose that eliminating the opportunity for self-directed research — which is what Prasad proposes instead of, let’s say, cutting it down to 10–20% of one’s time — would select for a certain type of a person (I imagine a box-checking blankface) but is that what we want? Is that what Prasad wants?

The tedious and unappreciated work of regulatory review is the price some scientists are willing to pay in order to perform research. Giving scientists the opportunity to do the work that’s meaningful to them is the price the FDA may have to pay to get good people to perform regulatory review. Any important scientific contributions that arise from this concession should be seen as an unexpected gift, not a requirement for staying employed as a reviewer.

• Tom Forsyth on Mastodon: “Recent discussion about the perils of doors in gamedev reminded me of a bug caused by a door in a game you may have heard of called Half Life 2.” Parallels in biology immediately come to mind.
• David Roberts on Blue Sky: “In an era filled with tech dipshits who never developed emotionally past the age of 13 & use their wealth to become odious monsters … listen to Steve Wozniak.” We are where we are in big part because there weren’t enough Steve Wonziaks in key industries when it mattered. Or rather, because they by definition bowed out and gave the sociopaths free space to roam.
• Ruxandra Teslo on X: “We should do smth abt this.” The “this” is the threat of clinical trial infrastructure being flooded by the biotech equivalent of AI slop. And many misguided people think that this is a good thing!
• Joe Janizek on Substack: The birth of Advanced Radiology. Or: radiology as chess. Radiology and pathology are the few areas of medicine in which AI may be produce immediate benefit.
• Nassim Taleb on Substack: Medical Mistakes with Probability, 2. Why the benefit of statins in people with barely elevated cholesterol and no other risk factors is grossly overestimated. Note that this constitutes most of the market for statins! My cynical take: Now that they are all out of patent I don’t think anyone would complain about cutting back.