JAMA

While vasopressin is certainly the next vasopressor to use after norepinephrine is started in a patient with hypotension from septic shock, nobody has demonstrated the ideal level of norepinephrine dose threshold past which vasopressin should be added.

A group of researchers set out to do just that with a cluster-randomized, cluster-crossover, pragmatic clinical trial and published their results in JAMA.

Data from just under 4,000 patients across 13 hospitals were analyzed.

The researchers had each site use either a low or high dose initiation threshold hospital-wide for a month, then cross over to the opposite strategy.

And when you look at, you know, there was a classic paper written by Juve.

And Reinhart, the health economist, some years ago, it's been sort of buttressed by JAMA studies since.

And the title of it was, It's the Price is Stupid.

Why the United States is so different from other countries.

Huge, huge impact.

So there's a fascinating study that came out in JAMA.

Journal of American Medical Association, just, I'm going to say, three or four months ago, where he had Mel Gibson on his show talking about ivermectin and cancer.

There is zero evidence, zero evidence that ivermectin can cure autism or cancer or COVID, right? It's become an ideological flag.

But that discussion with Joe Rogan and Mel Gibson... resulted in a spike in the prescriptions, not just the sale, the prescription of ivermectin for cancer.

But underneath everything, there must be something or multiple things that male surgeons can learn.

There was that article in JAMA a few years ago that I thought the methods were sound.

It essentially said that female surgeons have better outcomes and fewer complications.

Yeah, it's good for the patients that we have so much invested into their care, but it destroys us.

Let's look at numbers.

There was a study published in 2022 by the Journal... 2024 by the Journal of American Medical Association, JAMA, 2024 study, they looked at 22.8 million children who are insured.

Of those 22.8 million, 85 had gender affirming surgery.

That's 0.00037%.

Let's look at numbers.

There was a study published in 2022 by the Journal... 2024 by the Journal of American Medical Association, JAMA, 2024 study, they looked at 22.8 million children who are insured.

Of those 22.8 million, 85 had gender affirming surgery.

That's 0.00037%.

From the JAMA Network, this is JAMA Internal Medicine Author Interviews, conversations with authors exploring the latest clinical research, reviews, and opinions featured in JAMA Internal Medicine.

Hello and welcome to our listeners around the world.

This is Dr. Eve Rittenberg, and you're listening to JAMA Internal Medicine Author Interviews.

Thanks for joining us for today's conversation about medications for treating alcohol use disorder and a really interesting study of the gaps in public awareness and attitudes towards the use of those treatments.

You can find a link to that article in this episode's description.

Welcome, Dr. Bush.

Thank you.

Dr. Timothy Anderson is my colleague as an editor at JAMA Internal Medicine.

The 2025 Nature Digital Medicine meta-analysis of 83 studies put general AI chatbot diagnostic accuracy at 52% in the wild.

And the JAMA network open study is brutal for both of us.

Giving doctors chat GPT did not improve their accuracy.

The humans largely ignored or overrode the correct AI answer, while chat GPT alone outperformed both groups.

For which diagnoses, in which populations, with what validation, what abstention rules, what liability, and what escalation pathway.

On Claude's strongest point, that human in the loop can make things worse, I agree more than I did before.

The JAMA-style finding is genuinely important.

Doctors given GPT-4 did not necessarily improve much while the model alone performed better.

You are a scientific supervisor for the MProtect trial, which is actually a negative trial for MMA embolization using particles in the prevention of chronic subdural recurrence after surgery.

This article actually just came out in July 2025 in JAMA.

Can you tell us why you think we've achieved a different outcome with particles?

So we chose to use particles in this trial because it was based on the result of the study by Ban et al., published in Radiology in 2018, using microparticles.