Ezekiel J. Emanuel and Abe Baker-Butler have been debating the proper place for AI in medicine with American Medical Association CEO John Whyte. Now, they are taking their discussion to STAT’s First Opinion. Read Emanuel and Baker-Butler’s essay below and read Whyte’s essay here.

In 1867, Joseph Lister published his research on carbolic acid and antiseptic surgical technique.  In September 1871, he was summoned to Queen Victoria, who had a rapidly growing abscess in her left armpit. Using his antiseptic surgical technique, Joseph Lister successfully drained the pus. Queen Victoria recovered without fever or other complications. The antiseptic technique quickly gained approval in the U.K. and Europe, but not among American physicians.  

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Ezekiel J. Emanuel and Abe Baker-Butler have been debating the proper place for AI in medicine with American Medical Association CEO John Whyte. Now, they are taking their discussion to STAT’s First Opinion. Read Whyte’s essay below and read Emanuel and Baker-Butler‘s essay here.

Would you want artificial intelligence to tell you that you have cancer?

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The World Health Organization has declared a new public health emergency. Bundibugyo, an Ebola strain for which we have no vaccine and no treatment, is now spreading across the eastern Democratic Republic of Congo. So far, there have been more than 900 suspected cases and about 220 suspected deaths, according to the World Health Organization. Centered in a region with active conflict and fragile health systems, the outbreak has already crossed the borders into Uganda.

Public health advocates will spend the next several months talking about transmission, case fatality, contact tracing, and vaccine development. But one critical topic will go largely undiscussed: what this outbreak will do to women and girls.

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On Sunday, the World Health Organization (WHO) declared an Ebola outbreak in the Democratic Republic of the Congo and Uganda to be a public health emergency. This outbreak is deadly, with hundreds of cases across at least two countries, including, by report, one American who was working in the area.

At the same time, a cluster of hantavirus cases linked to a Dutch cruise ship in the South Atlantic has killed three and exposed hundreds more.

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Sen. John Cornyn: How many patents do you [have?]
AbbVie CEO Richard Gonzalez: … A hundred and thirty-six patents.
Cornyn: A hundred and thirty-six patents on one drug?
Gonzalez: But, well, remember, Humira is like nine different drugs, or 10 different drugs. So —
Cornyn: I thought you said to Sen. [Debbie] Stabenow it was the same
molecule.
Gonzalez: It is the same molecule, but it treats different conditions. And if you look at that patent portfolio —
Cornyn: So you use the same molecule to treat different conditions and you can get a patent on that treatment?
Gonzalez: Certainly.

The above exchange comes from a 2019 congressional hearing. Sen. John Cornyn, a Republican from Texas, was asking AbbVie’s CEO, Richard Gonzalez, to explain to the Senate Committee on Finance how his company had amassed so many patents on this single drug called Humira. Gonzalez, who was no stranger to controversy, chose to respond by likening it to multiple drugs. After AbbVie had received the first regulatory approval for Humira to treat rheumatoid arthritis, a condition that causes inflammation of the joints, it thought the drug might also work on inflammatory bowel disease. In fact, AbbVie would eventually test, obtain patents for, and get FDA approval of the drug for several inflammation-related conditions. For Gonzalez, the 136 patents AbbVie had accumulated up until that point were justified. They were “innovations they had created,” he said. This would mean another 18 years of patent protection beyond the expiry of Humira’s original patent in 2016.

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Below is a lightly edited, AI-generated transcript of the “First Opinion Podcast” interview with Patricia Bencivenga and Adriane Fugh-Berman. Be sure to sign up for the weekly “First Opinion Podcast” on Apple Podcasts, Spotify, or wherever you get your podcasts. Get alerts about each new episode by signing up for the “First Opinion Podcast” newsletter. And don’t forget to sign up for the First Opinion newsletter, delivered every Sunday.

Torie Bosch: Brain fog and weight gain and hair loss and insomnia — those are the calling cards of perimenopause. At least that’s what the new perimenopause awareness movement claims. But what’s real and what’s just social media misinformation?

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I didn’t expect to find myself face to face with leaders and activists from the “Make America Healthy Again” movement in respectful dialogue, or to consider inviting one into a public health classroom. But that’s exactly where I found myself this spring.

At a national public health meeting in March, I attended a session that brought together public health professionals, physicians, and MAHA leaders for a rare, good-faith conversation. I went out of curiosity. I left with a level of clarity I hadn’t expected — and a few unexpected connections.

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The past few weeks have been nothing but discouraging for those of us who helped create the Make America Healthy Again movement, including a silly executive order on glyphosate that feels anathema to what we have fought for. I’d be lying if I said that my heart hasn’t been bent toward repentance for my part in the whole thing. I helped champion Bobby Kennedy as a campaign volunteer, and when he joined up with then-candidate Donald Trump, I reluctantly decided that the trade-offs were worth what I believed Kennedy could advocate for within the walls of a Trump White House: the best fixes for a very sick and broken nation. 

Yet I found myself recently, and reluctantly, headed to the citadel of arrogance: Washington (well, Arlington, Va., to be more specific). At the invitation of Brinda Adhikari — one of the hosts of the podcast “Why Should I Trust You?” — I attended the Association of Schools and Programs of Public Health’s annual meeting, where I spoke on a panel about engaging in civil conversation in a session called “A Dialogue Between Academic Public Health and MAHA.”

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About 20 years ago, I stepped on stage at one of our Geisinger town halls and looked out upon a sea of people: thousands of full-time employees at an integrated health system charged with the health and well-being of millions of Pennsylvanians. 

Only a fraction of the people in that room were clinicians. 

That was the first time I fully visualized the problem: We employed more people in our revenue cycle department to process bills and reconcile data than we did doctors. And we weren’t alone. It’s the same story at every health system in America, large and small, and over the past two decades, the ratio has become dramatically more disparate. 

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In medicine, we like to believe that progress is linear. That once a patient stabilizes, regains lost skills, and returns to work, the hardest part is behind them. But in addiction care, stability is fragile because the systems supporting patients are weak.

Recently, I sat with a patient who has done everything we ask of people in recovery. She has been abstinent for years. She attends visits. Her urine drug screens are consistently appropriate. She works. She parents. She plans for the future. And yet, halfway through our appointment, her voice changed, not when we discussed cravings or trauma, but when she told me her insurance premium was about to triple.

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