Josh Briscoe

Freddie deBoer (@freddiedeboer) Sorry to beat a dead horse, but I am just absolutely bamboozled that people think this problem is some sort of minor inconvenience that we can handwave away. (And yes, this is GPT-5, the latest and gr...

substack.com/@freddiedebo... #medsky #ai

‘I Feel Like I’m Going Crazy’: ChatGPT Fuels Delusional Spirals An online trove of archived conversations shows the artificial-intelligence model sending users down a rabbit hole of theories about physics, aliens and the apocalypse.

Imagine in 2020 if someone had told you “We will soon release a new kind of AI. It will send psychologically vulnerable people right over the edge. Everyone else it will just randomly tell falsehoods. Also: our governments, employers and schools will force us all to use it every day.”

The alternative is to foster a practice of deception that will inevitably bleed over into other areas ("Patients and their families can't handle the truth"). 14/14

Last point: once a code starts, it's the team leader's clinical judgment how long the code lasts. For someone who has died of metastatic cancer, there's no reason to perform 45 min of CPR. You can do a real code for a duration of time you think is clinically indicated. 13/14

Not all of these dilemmas can be dissolved with conversation, but it can go a long way. 12/14

3. They do a poor job of having an actual informed consent discussion about what CPR and the rest of ACLS entails. 4. They frequent substitute preferences (e.g., code status) for goals (e.g., longevity-focused care), and foster entrenchment about preferences. 11/14

Here's the state of things for the vast majority of clinicians I meet. 1. They believe patients are in denial about dying. 2. They don't believe CPR is a good end of life script for someone who is otherwise dying (e.g., metastatic cancer). 10/14

Some of these things can be assuaged with more education, but some of them involve sorting through existential tensions in a relationship of trust over time. 9/14

3. They've received very little prognostic info. 4. They have deep misperceptions about CPR. 5. They don't appreciate that a decision to do or not do CPR is a decision about how they're going to die. 8/14

Here's the state of things for the vast majority of patients I meet: 1. They haven't thought about dying in all (or even most) of its facets, socially, functionally, symptomatically. 2. They haven't recognized that medical care with serious illness involves trade-offs. 7/14

The bedside is no place to adjudicate metaphysical disputes. But articles like this one don't help either. They merely argue that a clinician's only recourse in the face of such metaphysical discordance is deception. I don't think that's right either. 6/14

Anything less is "giving up" or "abandonment." Anything less is leaving something on the table. These are the existential tensions I wrestle with everyday: do you want ot work hard to live longer but sacrifice comfort and independence? Or do you want to do something else? 5/14

We're not just talking about success rates of CPR. Some individuals, families, and cultures really have very little concept of "dying" apart from what happens after CPR fails. Their script is literally, do everything to sustain life, including CPR. If that doesn't work, then it's over. 4/14

Dying is more than a physiological process. It's a social role co-constructed by everyone within a culture. Part of the fallout of living and practicing medicine within a pluralistic society is people are going to disagree with you about constitutes dying. 3/14

The authors touch on one big issue: we're doing a poor job of talking about dying and death as a culture. I agree. But we - clinicians included - fail to appreciate what "dying" is. 2/14

Doctors sometimes fake CPR — and they should If you want to eliminate the half-hearted CPR known as the “slow code,” you have to eliminate the conditions that make them necessary, two bioethicists write.

"Slow codes aren’t an anomaly; they’re a symptom of a deeper dysfunction in how we manage death and dying in America." Hmm. A few thoughts from a #hapc physician on this piece in @statnews.com www.statnews.com/2025/08/07/s... #medsky 1/14

Blueberry Hill ChatGPT 5 was released today. ChatGPT-maker OpenAI has unveiled the long-awaited latest version of its artificial intelligence (AI) chatbot, GPT-5, saying it can provide PhD-level expertise. B...

kieranhealy.org/blog/archive... How many B's are in blueberry? #AI

Writing is not just communicating with others, but also with your own unconscious mind.

Google’s healthcare AI made up a body part — what happens when doctors don’t notice? The basilar ganglia does not exist.

"The question is, again, what are the consequences of it?"

The Verge's Hayden Field interviews Duke AI Health Director Michael Pencina for a story investigating a possible hallucination in a paper highlighting the capabilities of Google's Med-Gemini LLM: www.theverge.com/health/71804...

In the Future All Food Will Be Cooked in a Microwave, and if You Can’t Deal With That Then You Need to Get Out of the Kitchen As a restaurant owner – I’m astounded at the rate of progress since microwaves were released a few short years ago. Today’s microwave can cook a frozen burrito. Tomorrow’s m…

I laughed so hard I thought I was going to cough up an organ. Every line is gold.

"In its initial report the committee noted that “there is great need for the tissues and organs of the hopelessly comatose in order to restore to health those who are still salvageable.”" If we move the line now, why not move the line in the future, and again, and again?

It's worrisome that the push for a re-definition of death is to meet demand for a scarce resource. What is death? It's a question worth answering for its own sake, but not so we can gerrymander our way to increasing organ supply.

‘Sleeping’ cancer cells in the lungs can be roused by COVID and flu Inflammation from the respiratory infections seems to be the culprit, study in mice finds.

Hidden in the lungs of some breast cancer survivors are tumor cells that can remain dormant for decades — until they one day trigger a relapse.

Now, experiments show for the first time these rogue cells can be roused from their slumber by common respiratory illnesses such as COVID-19 or the flu.

Don’t Ask, Don’t Tell Why Oversight Is Missing in BC’s MAiD Deaths

This is horrifying. open.substack.com/pub/aliciadu... #medsky #hapc

Since people love to bring up the false trope of doctors recommending cigarettes (negative health effects have been public for over a century), it’s interesting nobody seems to know the history of leaded gas & how corporations knew it was toxic even before bringing it to market but got away with it…

"So once you’re equipped with information, your next stop is the app store on your phone. There’s an app for every landmark on your journey. Just accept the terms, download, and follow the prompts. And stay alert to the health news filling your inbox. It is on you to journey safely, and older advice can lead you straight off a cliff."

On the fiction that we're in total control of our health.

Building on Nancy Tomes's history of patients becoming savvy consumers. #histmed 🗃️

hedgehogreview.com/issues/after...

What is the point of learning to write in a world with AI? You aren't sending a message - you're running a marathon

substack.nomoremarking.com/p/what-is-th... #meded #AI

This woman upon admission to the intensive care unit had a health status of 5. Today, as the resident gives updates to the patient’s husband, the woman’s health status is a 6, because all else is unchanged apart from the kidney function. In no way should the conversation highlight that things are “better.”

We should avoid misleading language in clinical communication, but it's harder than we might think. familymeetingnotes.substack.com/p/getting-be... #medsky #hapc

New episode of Bio(un)ethical is out now, with @jbcarmody.bsky.social!

Bryan Carmody: Are doctor shortages real?

We discuss:
- Why people think there aren't enough doctors
- Why many access problems reflect misallocation (vs shortages)
- What models projecting shortages miss
- AI (the 🐘 in the 🏥)