HealingWell
Search Close Search
☰

Johns Hopkins Pathology, Surprising development

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
1 23
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 10/23/2023 11:14 PM (GMT 0)

Pratoman said...

Tim G said...
All of this will moot in a few years when Artificial Intelligence will take over reading pathology slides and radiology slides. This scares the liver and a few other organs out of people, but it will be much more accurate than humans reading them, even experts like the good doctor Jonathan Epstein.

As scary as it may seem, Tim, I agree that AI will be the new Dr. Epstein. Like you, I follow Dr Eric Torpor, both on Twitter and on Substack. Very smart guy, and does a lot of commentary on Medical AI.

Yes, Eric Topol, who is the research chief at Scripps Institute (who wouldn't want to live in La Jolla, CA?), is one smart dude! His book on the use of Artificial Intelligence, "Deep Medicine" is a great introduction to the advantages of AI in modern medicine. I have followed his insights on Covid, and in my view, he has been right!

A reminder, Gentlemen, unless you are a vaccination agnostic or unbeliever, there are three ouchies to get this Fall: Covid monovalent updated vaccine, RSV and the annual Flu shot. As the Monkees sang it, "I'm a Believer!"
Posted 10/24/2023 1:21 AM (GMT 0)
PAdude - A second opinion is a little different than an independent investigation in many cases. It is more of an opinion based on an opinion. The original pathologist actually prepared the slides so I assume the second opinion wants to know the whole story of the pathology, not just the slides. Decipher also wants pathology information for their genomic analysis, probably for their database, but you have to give them the info.
Posted 10/24/2023 3:37 AM (GMT 0)
I hope they go slow on AI reading or rating biopsies. The AI has to be programmed and programmers can make mistakes just like everybody else. Any initial tries at AI reading biopsies will have to be cross checked by the best pathologists that can be found.

Biases from programmers can and do work their way into programs.
Posted 10/24/2023 12:41 PM (GMT 0)
@TIM, I too, started following him for Covid data . Yup, very smart, with a lot of foresight.

@Shinytop - I think AI is a freight train that will be hard to slow down. Both positives, and some very obvious negatives.
Posted 10/24/2023 9:42 PM (GMT 0)
Any time I hear “second opinion” I think “and you’re ugly too”
Posted 10/24/2023 10:43 PM (GMT 0)
As I understand, the AI ability to read prostate slides is currently poor. Of all the cancers, PCa is very nuanced and difficult to be accurate and consistent. That is why so few (Epstein and Bostwick in the USA) have been so highly regarded. Now we will have neither.

And when AI gets it wrong, as is assured, whom, or what, do we hold accountable? Oops…computer error.
Posted 10/24/2023 10:57 PM (GMT 0)
Dr. H. Bonkhoff in Germany has been the best PCa pathologist in the world for the past 40 years. He was the one that discovered the ploidy aspects of PCa, the 24 variants and two decades ago posted a DNA based matrix that matched the bio-chemical based diagnosis to specific treatment methods. Bostwick attempted to follow this in the US, but it proved far too nuanced for the mainstream treatment regimens of surgery, radiation and drugs with little attention to the specifics of any individual. In other words, individualized treatment wasn’t projected to be easy nor profitable.
Posted 10/25/2023 5:36 AM (GMT 0)
JNF: Key point is profitable. If the question is, "why don't we do THIS thing that is going to help get better outcomes for the patient?", the answer is always, "that's not where the money is to be made".

I'm not a cynic. I'm a realist.
Posted 10/25/2023 3:23 PM (GMT 0)
AI is still in it's infancy. But there is a definite place for it in the field of medicine, particularly after technology advances further and the art is perfected. In fact, I was just reading about a study conducted whereas AI predicted Pca outcomes based on medical profiles whether it was worthwhile to give androgen suppression therapy to patients undergoing salvage radiation for Pca recurrence following prostatectomy. It was remarkably accurate. I would not hesitate to use it in conjunction with professional human opinions if I found myself in such a situation. Human judgement can be flawed. Even when communicated by those with advanced degrees and expertise in a particular field. We've read story after story about flawed human judgement by so-called "experts". There will come a time when AI takes precedent over human opinion in medicine. Will it completely replace it? Of course not. And it shouldn't. But when both are given weighted consideration in determining the best course of action in combating human disease, society will surely benefit.
Posted 10/25/2023 8:12 PM (GMT 0)
I just read a fairly complete article on this topic:

https://nypost.com/2023/10/23/news/johns-hopkins-doctor-allegedly-bullied-staff-to-match-his-wifes-diagnoses-improperly-removed-bladder-report/

(I forgot how to make this clickable--could someone help).

I am dismayed at the glaring lack of ethics by someone I had a great deal of respect for.

To intimidate fellow professionals to change their decisions (to support his wife's interpretation)?
That is absolutely disgusting and it can hurt patients big time. Whatever happened to the oath including "At first, do no harm."

VERY disappointing.
I'm also dismayed at some answers here that seem to whitewash this. We are not talking about a simple error/mistake.

Mel
Posted 10/25/2023 9:17 PM (GMT 0)
Clickable per Mel's request: https://nypost.com/2023/10/23/news/johns-hopkins-doctor-allegedly-bullied-staff-to-match-his-wifes-diagnoses-improperly-removed-bladder-report/

Jim
Posted 10/25/2023 11:20 PM (GMT 0)

compiler said...
I just read a fairly complete article on this topic:

https://nypost.com/2023/10/23/news/johns-hopkins-doctor-allegedly-bullied-staff-to-match-his-wifes-diagnoses-improperly-removed-bladder-report/

(I forgot how to make this clickable--could someone help).

I am dismayed at the glaring lack of ethics by someone I had a great deal of respect for.

To intimidate fellow professionals to change their decisions (to support his wife's interpretation)?
That is absolutely disgusting and it can hurt patients big time. Whatever happened to the oath including "At first, do no harm."

VERY disappointing.
I'm also dismayed at some answers here that seem to whitewash this. We are not talking about a simple error/mistake.

Mel

You hit the nail on the head with surgical precision, Mel. Thank you.
Posted 10/26/2023 4:12 AM (GMT 0)

compiler said...
I just read a fairly complete article on this topic:

https://nypost.com/2023/10/23/news/johns-hopkins-doctor-allegedly-bullied-staff-to-match-his-wifes-diagnoses-improperly-removed-bladder-report/

(I forgot how to make this clickable--could someone help).

I am dismayed at the glaring lack of ethics by someone I had a great deal of respect for.

To intimidate fellow professionals to change their decisions (to support his wife's interpretation)?
That is absolutely disgusting and it can hurt patients big time. Whatever happened to the oath including "At first, do no harm."

VERY disappointing.
I'm also dismayed at some answers here that seem to whitewash this. We are not talking about a simple error/mistake.

Mel

Trigger happy much Mel? I read the same article. You put an awful lot of faith in the media. 😊

The funniest thing about this whole thing is…Dollars to doughnuts Dr. Epstein doesn’t even know what “bullying” is. If he does, it’s something strong, mean guys do to smaller weaker guys in H.S.

Maybe his wife is right more than any other pathologists in his department. Anyone here know she’s not?

Years ago, JH was hauled into congress to explane why their Medicare charges were higher than the norm. Turns out…JH came back with some facts…(something that’s rarely seen in Congress, or the media). Turns out that the facts showed treatment at Hopkin’s pricing is actually lower than the national average for healthcare. This is due to the fact that patients did not have to return to JH for more follow up near as much as at other hospitals. This lowered total costs. That story quietly went away.

Don’t bite on the first shinning object in the water. It may be just a spinner and you’re going to be dinner tonight. 😊
Posted 10/26/2023 4:33 AM (GMT 0)
Tim G:
I would love to believe that the media got it completely wrong. But I just won't yell "fake news" when I read a story I don't like.
.
So, Tim, was Epstein not suspended? If that's a fact, then JH must have facts that are very concerning

Mel
Posted 10/26/2023 4:41 AM (GMT 0)

compiler said...
Tim G:
I would love to believe that the media got it completely wrong. But I just won't yell "fake news" when I read a story I don't like.
.
So, Tim, was Epstein not suspended? If that's a fact, then JH must have facts that are very concerning

Mel

I did not use the term “fake news”. I made the point that one news strory does not make a reality and gave an example of how it’s not. I wait before jumping.

“Fake news” is a political insinuation. Mel…I thought politics were off limits here now. You’ve proved me sooo wrong. What you’re doing is unhealthy for this website. Surely we’ve learned that much.
Posted 10/26/2023 5:11 AM (GMT 0)
I was going to post my recent PSA here and ask a question about it.

This nips that in the bud. I might find myself on the wrong side of the isle if I did.
Posted 10/26/2023 5:22 AM (GMT 0)
I was late to the game here having already been biopsied twice before asking questions on this board. With a Gleason score of eight and my PC being aggressive, I was asking questions about surgery versus radiation. It was later that I started reading post about getting a second opinion. I felt for a long time that I was left out of a step that might result in a different Gleason score and with that a possible different treatment plan. After reading this article about Dr. Epstein, I’m not so sure it would’ve mattered one way or the other. I’m sure many here never thought that the doctor might not be the one reading their slides. I’m sure his wife is very proficient and trained well. However, in almost all cases, it is the trainer that is most proficient, not the trainee. I would be curious to find out how many here had their Gleason score changed after getting a second opinion from any source.
This is now water under the bridge for all of us. We have all made our decisions to move forward and hopefully those decisions will result in great outcomes.
My best to all,
Jack
Posted 10/26/2023 12:06 PM (GMT 0)
I might point out as someone who has been in charge of engineers, it is not always fun to be a technical boss. Sometimes you have to make decisions where the justification is “because I am the mommy and I say so” or the issue never ends. Most respect the fact that someone has to do that but there are always a few that think you are a “bully” and imposing martial law. People in charge are routinely praised and skewered by employees so a thick skin is required.

The classic comparison is when you see a top, highly respected surgeon and find a cocky a-hole that is full of themself. Your choice, top surgeon or friendly ordinary surgeon.
Posted 10/26/2023 4:51 PM (GMT 0)
Hi

I used Dr Epstein for a second opinion on my PCa biopsy more than 11 years ago. He lowered the Gleason score from 7 to 6 in my case. At the time I specifically asked that Dr. Epstein review the case himself. A few days later I called his office to find out if the biopsy specimens arrived. The secretary asked me if I wanted to speak with Dr. Epstein directly. I did and in the conversation it was clear that he was very informed about the case and told me some details that did not show up in the second opinion report. In addition he did not hesitate to recommend that I "just watch it". This was one of the main reasons I have used Active Surveillance since my diagnosis in 2012.
Posted 10/26/2023 6:09 PM (GMT 0)
I recall a few other guys on the forum saying that Epstein was accessible and personable on the phone. That doesn't necessarily mean that he's personable with his colleagues. The fact that Epstein is on leave may seem like it gives weight to the accusations, but not necessarily. These days, if a claim is towards someone you can bet HR is going to act on it, regardless of merit. And the threshold for "bullying and intimidation" probably is much lower today than in the past. I believe Epstein's wife has worked in the lab for 10 years. Why suddenly this problem? I just sense that he's getting screwed, and hopefully not a terrible ending to a great career.
Posted 10/26/2023 11:01 PM (GMT 0)
If there's one thing I've learned in this long life of mine, it's that there are ALWAYS two sides to every story. I NEVER take one side as gospel until I've had the opportunity to listen to the other side. At that point, I can concoct an opinion on who's right and who's wrong - and even that is vulnerable to error and miscalculation.

Oh, and I NEVER believe what I read in the media anymore after the preponderance of lies and deception that we've been fed for well over 25 years now on a routine basis. In fact, today I just assume the media is lying until it's been proved otherwise.

That's where I stand on this issue.
Posted 10/26/2023 11:10 PM (GMT 0)

turpT1a said...
Hi

I used Dr Epstein for a second opinion on my PCa biopsy more than 11 years ago. He lowered the Gleason score from 7 to 6 in my case. At the time I specifically asked that Dr. Epstein review the case himself. A few days later I called his office to find out if the biopsy specimens arrived. The secretary asked me if I wanted to speak with Dr. Epstein directly. I did and in the conversation it was clear that he was very informed about the case and told me some details that did not show up in the second opinion report. In addition he did not hesitate to recommend that I "just watch it". This was one of the main reasons I have used Active Surveillance since my diagnosis in 2012.

My experience was similar. After hearing that Dr E was reachable, especially if calling early in the morning, I tried and did reach him. I have to say he was very giving of his time and also was familiar with my case. He ultimately lowered my score from an unusual G8(5+3) to G6, And both in the report and in our conversation, it was stated that the premise the original pathologist used in scoring me, was an incorrect premise.

So I am probably biased in that he's a guy who helped me in a major way, and even affected my treatment decision.
As I think I said earlier in this thread, is he guilty as charged? Maybe, I don't think any of us know. Mel is right to say that the fact that he was suspended in May at JH, carries some weight. With that said, who knows, it could be that some of his subordinate pathologists had very thin skin, started talking to each other, and decided that there is strength in numbers. Just hypothesizing, I don't think, or at least haven't seen, any statement from JH finalizing findings of investigation.
Posted 12/8/2023 2:51 PM (GMT 0)
The article suggests that JE only looked at a small subset of slides. His team of pathologists handles the many thousands of slides that are sent in. No doubt there is a different moderator now for pathology, but all the same well-trained people.

Post Edited (mathias81) : 12/8/2023 9:55:27 AM (GMT-8)

Posted 12/9/2023 1:37 PM (GMT 0)
I think I remember what Dr. Epstein said in one interview:

He reviews every decisions he doesn't do. When he is away e.g., for a conference, he appoints someone to do the final review for him and he will check work when he returns. If you want to ensure Dr. Epstein's review before their opinion is sent, state so on the review application.
Posted 12/9/2023 1:38 PM (GMT 0)
I think I remember what Dr. Epstein said in one interview:

He reviews every decision he doesn't do. When he is away, e.g., for a conference, he appoints someone to do the final review for him and he will check work when he returns. If you want to ensure Dr. Epstein's review before their opinion is sent, state so on the review application.
✚ New Topic ✚ Reply
123