Search Medical Journals & Research Articles

Preempting the Trough of Disillusionment in Surgical AI

Artificial intelligence (AI) is being hailed as a panacea in clinical decision-making, operational efficiency, and quality improvement. However, its use in real-world clinical settings remains limited. Thornton et al describe implementation and deimplementation of the OR Black Box, an intraoperative data collection and analysis product (Surgical Safety Technologies, Inc), outlining several challenges in implementing and extracting value from the tool. These challenges arose from unmet expectations of functionality, its need for extensive local algorithmic training, and latency in the delivery of insights. As more AI systems are deployed, we will soon find ourselves in a “trough of disillusionment” unless important steps are taken.

Minor Papillotomy for Pancreas Divisum and Idiopathic Recurrent Pancreatitis

Given that the etiology of pancreatitis often remains idiopathic, many patients develop acute recurrent or even chronic pancreatitis that significantly affects their quality of life. A long-held belief was that the anatomical and morphological features of the pancreatic duct, particularly pancreas divisum, could play a role in the pathophysiology of recurrent pancreatitis. Pancreas divisum is a congenital condition in which the ventral and dorsal ducts fail to fuse, leading the smaller dorsal duct to provide drainage of the pancreas body and tail through the smaller duct of Santorini across the minor papilla instead of the usual drainage through the duct of Wirsung across the ampulla of Vater. The prevalence of pancreas divisum is estimated to be up to 10% in the general population and it is usually an incidental finding on radiographic imaging. Pancreas divisum is the most common congenital anomaly of the pancreatic duct and it is thought to increase the potential for duct obstruction via impaired drainage.

Fever, Rash, and Dizziness in a 32-Year-Old

A patient in the upper Midwest had fever, rash, dizziness, multiple erythematous annular rashes on the back and lower extremities, and third-degree AV block. The patient reported frequently hiking outdoors but no recent travel, new medications, sick contacts, or ticks on the skin. What is the diagnosis and what would you do next?

The US Food and Drug Administration’s Regulation of Mifepristone

This qualitative analysis uses information from US Food and Drug Administration (FDA) documents obtained through a Freedom of Information Act request to characterize the FDA’s decision-making with respect to the regulation of mifepristone, especially the agency’s rationale for establishing, maintaining, or modifying key components of its regulatory approach over time.

Expanding the Arsenal of Lipid-Lowering Therapies

More than 4 decades ago, the advent of statins ushered in a transformative era in lipid-lowering therapy. Since then, a robust and extensive body of clinical evidence has consistently validated the efficacy and safety of statins across diverse patient populations, including those with familial hypercholesterolemia. To date, statins remain the cornerstone of lipid-lowering therapy, offering the advantages of broad accessibility, favorable cost, and proven efficacy. However, long-term adherence remains suboptimal. A range of factors, including both objective adverse effects and perceived statin intolerance, contribute to frequent discontinuation of treatment.

Mifepristone and the Future of FDA Drug Regulation

On September 19, 2025, US Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr and US Food and Drug Administration (FDA) Commissioner Martin Makary announced that HHS would be conducting “a study on the safety of the current [Risk Evaluation and Mitigation Strategy (REMS)]” for mifepristone to “determine whether modifications are necessary.” This announcement came in response to a letter from the attorneys general of 22 states, seeking a review of the mifepristone REMS. Secretary Kennedy and Commissioner Makary wrote that their decision was “informed by the lack of adequate consideration underlying the prior REMS approvals” and further justified their review in light of “recent studies raising concerns about the safety of mifepristone as currently administered” that the attorneys general had cited in their letter.

A Scalable Model to Improve Cancer Care for Older Adults

Individuals aged 70 years and older account for more than 40% of patients with cancer in the US and 25% of those with incident cancers. Yet older adults have been largely neglected by cancer research and care improvement efforts. Less than 3% of older patients with cancer are enrolled in oncology clinical trials, and the landscape of treatments received by older adults is not well understood. Comorbid conditions, frailty, and resource limitations can necessitate modifications to cancer treatments and render older patients more vulnerable to complications. Moreover, many may be ineligible for or choose to forgo anticancer therapy and therefore see oncology practitioners infrequently—despite experiencing symptoms and conditions that require ongoing management. These complexities beg for scalable strategies to monitor and support older adults with cancer.

Rheumatoid Arthritis and Vesicular Rash

A patient receiving adalimumab for rheumatoid arthritis had ulcerated plaques on the anterior and lateral aspects of the neck, upper chest, and nape and erythroderma on the dorsum of the hands, corresponding to areas of sun exposure, as well as swelling of the proximal interphalangeal hand joints bilaterally. What is the diagnosis and what would you do next?

Tofersen, SOD1 , and the Treatability of Amyotrophic Lateral Sclerosis

For years, amyotrophic lateral sclerosis (ALS) has universally been defined as a progressive, fatal disease with limited treatment options. Numerous therapeutic treatment trials failed to significantly slow disease progression or prolong survival. Until recently, there have been only 2 drugs approved in the US for treatment of ALS: riluzole and edaravone, which slow disease progression and prolong survival modestly. The reason for the lack of therapeutic success has been largely attributed to minimal understanding of the cause(s) of ALS and that treatment is generally initiated late in the pathological progression of disease, once neurodegeneration has become profound.

Benzodiazepine Use in Pregnancy—Understanding Risks for Informed Decision-Making

Benzodiazepines are used in an estimated 2% of pregnancies in the US. Benzodiazepines cross the placenta and have been associated with a number of adverse pregnancy outcomes. Therefore, many clinicians advise avoiding benzodiazepines during pregnancy. However, benzodiazepines can play an important role in treatment of some conditions, including seizure disorders, neurological conditions and tremors, alcohol withdrawal, anxiety, and panic disorder. Furthermore, for patients with long-term benzodiazepine use, abrupt cessation can lead to withdrawal and seizure. Thus, in some circumstances, complete avoidance of benzodiazepines may be contraindicated. Understanding the risks of benzodiazepine use during pregnancy may help pregnant people and their clinicians weigh treatment benefits and risks, and make informed decisions about benzodiazepine use and management.

Mobile Health Smoking Cessation Treatment for People With Tuberculosis

Almost 150 years ago, Lyubov, Fyodor Dostoevsky’s 11-year-old daughter, recorded a terse but poignant note: “January 28, 1881—Papa died.” It was not the content but the location of the inscription that was most remarkable—she chose to write it on her father’s cigarette case. Dostoevsky died at age 59 years of a pulmonary hemorrhage. He had pulmonary tuberculosis, and he was also a chain smoker. Long before the medical world expressed any understanding of the devastating health synergy of tuberculosis and tobacco smoking, this grieving child may have left a prescient clue.

Sociodemographic Characteristics in Clinical Algorithms

Although widely acknowledged as a social construct, race has historically been used as a factor in assessing and treating patients. Race-based clinical algorithms are presently being eschewed due to systematic biases, often underestimating the severity of disease or symptoms among Black patients. Instead, race is increasingly being substituted for alternate measures, such as social determinants of health, that are thought to more directly reflect social disadvantage and to influence health outcomes. For instance, the American Heart Association’s Predicting Risk of Cardiovascular Disease Events (PREVENT) equations, which were released in 2023 and are beginning to replace the Pooled Cohort Equations in cardiovascular disease guidelines, removed race and added, optionally, Social Deprivation Index–calculated at the zip code level. Despite these shifts, little is known about how the public views the changing role of patient race in medical decision-making.

Mitigating Suicide Risk for Minors Involving Artificial Intelligence (AI) Chatbots

In this Viewpoint, a California artificial intelligence law is described, including its positive contributions to making these companion chatbots safer for minor and adult users and the limits of the law, and recommends further steps California and other states can adopt to improve protections for mental health and chatbot safety, especially for minors.

Glucagon-Like Peptide-1 Receptor Agonists and Cancer

To the Editor Dai and colleagues, along with others, have recently highlighted the potential role of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on cancer prevention. Specifically, the study by Dai et al used a target trial emulation (TTE) method, which enhances causal inference and has the potential to inform clinical guidelines and policy. The TARGET Statement on reporting of observational studies of emulating a target trial states that TTE studies can be used to answer causal questions about the comparative effects of interventions when randomized clinical trials are unavailable or not feasible. This is the case here because there are no available cancer prevention trials using GLP-1RAs. Because clinical trials would require large sample sizes, long-term follow-up, prohibitive costs, and risk of contamination, this direct evidence is unlikely to ever materialize. A TTE approach is therefore justified, but we believe there are 2 major deviations of the TTE methodology in the study by Dai et al that weaken the presented evidence.

Glucagon-Like Peptide-1 Receptor Agonists and Cancer

To the Editor Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have become among the most widely used medications worldwide, though their use has raised concerns regarding a potential increased risk of cancer. Dai et al conducted a retrospective cohort study assessing the incidence of 13 distinct cancers, which yielded a pooled hazard ratio (HR) of 0.83 (95% CI, 0.76-0.91), suggesting an overall decreased risk, although a notable increase in risk was identified for kidney cancer. The authors described the risk as follows: “However, GLP-1RAs were associated with a marginally nonsignificant increased risk of kidney cancer (HR, 1.38; 95% CI, 0.99-1.93; P =.04).” The term marginally nonsignificant likely reflects the fact that the lower bound of the CI was 1.0, despite the P value of.04, which is conventionally considered statistically significant. This apparent discrepancy may be attributable to differences in the statistical methods used to calculate the CIs vs the P value.