Chasing Life

Welcome to Paging Dr. Gupta. You know, I really love these episodes in large part because they're all about you. Your questions, your concerns, your curiosity, about health and medicine, topics that are near and dear to my heart. Whether it's something in the headlines or something that's happening in your own life, share it and I'll try my best to try and help break it down. New week, new questions, Kyra is back. Who do we have first?

Okay, we're kicking things off today with a question from Kim. She's a nurse out in Los Angeles, and she's thinking ahead about how tech might change her day to day. Here's her question:

Hi, Dr. Gupta, my name is Kim and I'm a nurse. Um, with the incoming era of AI, what's in store for the medical community, whether that's medical procedure, a surgical procedure, diagnostics, or even as simple as making our notes on the patient's medical chart. Looking forward to hear what we have. Thank you so much.

'Okay, Kim, thank you very much for this. This is a topic that I think about a lot. In full disclosure, I sit on the National Academy of Medicine, and there is a subcommittee on artificial intelligence that I sit on that as well, so I've been pretty immersed in the intersection of AI and healthcare for a while. And I'll tell you two things as top lines. One is that I'm bullish on it. It's here, it's definitely here to stay. And it's already being transformative. And two is that you have probably already been affected by AI in healthcare. If you've had any kind of recent visits to the doctor, to a hospital, to a clinic, your care was probably already impacted by AI in some way. Let me break down a few basics as I often do. You will hear about two main types of AI in health care: Predictive AI and Generative AI. Okay, so predictive AI is basically analyzing large sets of data, everything from age of patients, symptoms, test results, and that can help doctors make more informed decisions. It looks at lots and lots of data. Maybe it finds lots and lot of people who are just like the person they are investigating and they say, okay, here's the problem this person had. Here's the outcomes that we see in thousands, hundreds of thousands of people around the country around the world and that helps predict what we should do best. During colonoscopies AI can for example flag polyps that might otherwise be deemed inconsequential. With mammograms, the FDA has already cleared two dozen AI tools to help spot early signs of breast cancer, predicting breast cancer. In Stroke care AI models now pinpoint the timing of a stroke sometimes twice as accurately as humans, which is really crucial because that will determine in part if someone can receive certain life-saving or life-altering treatments. Hospitals are using AI to catch signs of sepsis before they become obvious. There are also tools a company say can now detect things like bone fractures that may go undetected by the patient, signs of over a thousand diseases that may exist even before symptoms show up. And then there is generative AI, and I think that's what people often think of when they think of the ChatGPT style stuff. It's mostly happening behind the scenes. One big use case for generative AI is documentation. So maybe you've heard of Microsoft's Dragon Copilot, so this is a platform that kind of listens in during a visit and then writes up the clinical note that is generated afterwards, helps draft letters that are sent to insurance companies to get medications or procedures approved. More advanced versions combine AI with real world medical data, that's called ChatRWD, and they are continuously being tested to reliably answer doctor's clinical questions. There's a platform that I use quite a bit and I think about a quarter of physicians in the country now use it called OpenEvidence, which again is looking at these large sets of data and then using that data in real time to answer questions. How long do we wait to start aspirin after a person has had a procedure, had an operation? These are tools that I'm already using. Now, I will tell you one thing that's interesting about these platforms is that there is very high expectations of how well they will work. You know, I think a lot of people think of AI platforms like they think of a computer. If you go to your computer and you ask your computer, you know, any question you might ask... You get an answer, you sort of expect that that answer is accurate. You don't then go to another computer and ask another computer to verify what the first computer said. But AI is a little bit different in this regard. In some ways, it's less like a computer and more like a tool that is trying to replicate human consciousness, which can falter, right? So there's a trust gap. There was this 2023 survey that found most Americans feel discomfort with doctors using AI to manage their care. So high expectations, low trust. There aren't many things in society like that. I would think, for example, autonomous vehicles might fall into that category. Even though there are car accidents all the time, it's one of the leading causes of preventable death in the United States, if an autonomous vehicle gets into an accident, it almost feels existential because the expectations are so much higher. So high expectations, low trust, when it comes to things like AI. AI can make mistakes. It can hallucinate, that's how it's often referred to, especially if the platform's been trained on incomplete data or biased data. Privacy is still an issue. I mean, HIPAA applies to AI platforms and healthcare, but I think that there's concerns about how might that information be stored or shared. So bottom line, Kim, AI is here. I'm bullish on it. I think it's already making an impact. It's already working in the background. It's improving diagnostics, documentation, access. But with many things in life, we often adopt a trust but verify model. And I think AI and healthcare should be treated the same way.

Coming up, there are a lot of pain medications out there, but not all of them are right for every kind of pain. It's sometimes surprising what works best for what. I'll break it down after the break.

Last week, I told you that I've been working on a book all about pain, it's called "It Doesn't Have to Hurt". It comes out September 2nd. It's something I've thinking about for a long time. Big part of writing a book like this is to try and give you some real takeaways when dealing with pain. And I thought I would start here, this podcast, Paging Dr. Gupta podcast, to share some of what I've learned. And I asked Kyra, in this case, just to give me the first question that came to her mind.

All right, Sanjay, well, you know what this sound means. I just had to do it, considering this is my first official page to Dr. Gupta. So my question, I'm asking this for myself and hopefully a lot of the people listening, you know, there are so many pain medications out there with all these different brand names and it's hard to know which ones are alike or when to take what. So my questions is, are they basically all the same and created equal? Or should we actually be picking different ones for different kinds of pain?

'Okay, that is a good place to start, Kyra, thank you. First of all, let me just preface by saying, again, that 20% roughly of the country, one in five people suffers with chronic pain. It's an enormous number. I mean, when you have chronic pain, that is your whole life. You are defined by it. So they're thinking about pain all the time, they're suffering with pain all of the time. Their mood is different, they eat differently. Everything is different because of chronic pain so this is a big issue. But let's break down the different categories. The common ones, acetaminophen, Tylenol reduces fever very well. That is a analgesic pain medication that essentially works in the brain to reduce mild to moderate pain by increasing the body's pain threshold and also changing to some extent how the body senses pain. So it actually makes the threshold at which you experience pain higher and changes the way that you actually sense it. Then you have a very large category of what are called NSAIDs, non-steroidal anti-inflammatory drugs. That's ibuprofen, Advil, Motrin, Naprosyn, Aleve. They reduce fever and they also block something known as prostaglandins, which are compounds that cause pain and inflammation. So they work in a different part of the pain cascade. Aspirin is also considered an NSAID, reduces pain, reduces inflammation, also reduces blood clotting. That's why a lot of people will use that as a sort of mild blood thinner. You're gonna wanna avoid NSAIDs like aspirin and ibuprofen if you are already taking blood thinners, okay? Because if you have uncontrolled high blood pressure, if you've ulcers, if you're other bleeding risks, they may thin your blood even a little bit more, probably avoid the non-steroidals. And generally speaking, ibupropin's gonna be a safer choice than aspirin for those with bleeding risks. And then after that, just in the over the counter sort of categories, you have topical pain relievers. These are anesthetics that temporary relief pain at the skin surface. Think of things like Voltaren. Obviously don't use it on open wounds or sores, but a lot of the topical pain relievers are gonna have some component of lidocaine in them. If you've ever had an allergy to lidocain, probably want to avoid this. Now, when should you use each one? So headaches, that's one of the most common sources of pain. Any of these oral painkillers could work for that. Some people will have better luck with some of them other than others. As I mentioned earlier, when it comes to fevers, Tylenol is gonna be probably a better bet. One little pro tip, if you have a headache because you've had a little too much to drink the night before, too much alcohol, then Tylenols not a good option because alcohol and Tylenol both are pretty hard on the liver. So I would avoid Tylenol certainly after a hangover. Really if you can avoid most of those medications for hangover type pain better get hydrated and the pain will pass. Now if you're talking about pain that's caused by things like arthritis, non-steroidal anti-inflammatories is what you should use. They're also best by the way for sunburn. Acetaminophen best for people who. May have gastrointestinal issues because the non-steroidal anti-inflammatories are pretty hard on the stomach. Neuropathic pain or nerve pain. So that's the sort of lancinating pain that might go down your arms or your legs, sort of stabbing or even electric-like pain sometimes. Sometimes the topical pain relievers can help there. Then there are different medications for neuropathetic pain that may require prescription as well. And those types of medications typically change the way the nerve is conducting a signal. And sometimes it just disrupts the conduction of the signal. Sometimes it slows it. But there are different medications that are totally different class of drugs than Tylenol or non-steroidal anti-inflammatories that can help with that nerve sort of pain. You know, a lot of what I write about in the book is how to best choose these medications. But a lot what the book is about is creating strategies where you hopefully never need any of these medications. Obviously everyone's going to have some pain in their life, but you can have a lot less pain, a lot less intense pain, and a much shorter duration of pain, with some pretty simple strategies. And I hope that everyone can get a better understanding of that, how to control pain, how to understand it when my book comes out, September 2nd, "It Doesn't Have To Hurt".

'Big thanks to everyone who sent in the questions, Kyra, thank you. We're still building the show. We're doing it together and I'm glad you're part of it. If there's something health-related you've been curious about, don't be shy, share it, record a voice memo, email it to AskSanjay@CNN.com, or give us a call at 470-396-0832 and leave a message. Thanks for listening, I'll be back next Tuesday. Chasing Life is a production of CNN Audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai, Grace Walker, Lori Galaretta, Jesse Remedios, Sofia Sanchez, Kyra Dahring, and Madeleine Thompson. Andrea Kane is our medical writer, our senior producer is Dan Bloom, Amanda Sealy is our showrunner, Dan Dzula is our technical director, and the executive producer of CNN Audio is Steve Lickteig. With support from JJamus Andrest, Jon Dianora, Haley Thomas, Alex Manasseri, Robert Mathers, Leni Steinhardt, Nichole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker and Nadia Kounang of CNN Health and Wendy Brundige.