Two Inflection Points in Alzheimer’s Diagnostics

 

Two Inflection Points in Alzheimer’s Diagnostics:
The Market Arrives as the Science Moves On

Summary — Two seemingly different September 2026 articles offer a useful combined view of where Alzheimer’s diagnostics is headed. GenomeWeb describes a rapidly maturing blood-test market in which FDA clearance, pTau217 performance, reimbursement, cost, EHR integration, and physician convenience increasingly determine adoption. Meanwhile, De Strooper and Karran in Nature argue that Alzheimer’s unfolds through distinct biological “inflection points,” not a single linear cascade. Together, the articles suggest a two-step future: today’s tests are making Alzheimer pathology broadly detectable; tomorrow’s diagnostics may need to identify which biological transition a patient has reached, which processes remain modifiable, and which therapy fits that state.

• Bonislawski A. As Alzheimer’s Blood Tests Jockey for Market Share, Convenience and Cost Will Be Key. GenomeWeb. September 16, 2026.
• Full link: https://www.genomeweb.com/diseases/neurological/alzheimers/gnw-alzheimers-blood-test-fda-510k-20260915/ 2026 Genomeweb 0916 Bonislawski…
• De Strooper B, Karran E. Inflection points and transitions in Alzheimer’s disease. Nature. Published September 16, 2026. doi:10.1038/s41586-026-11110-5. Nature
• Full link: https://www.nature.com/articles/s41586-026-11110-5

Note: the GenomeWeb PDF itself does not expose its own article URL as a hyperlink; the URL above is the GenomeWeb Alzheimer’s article link associated with the September 15/16 item in the PDF.

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These two articles look as if they belong in different folders. The GenomeWeb piece is about FDA clearances, competing blood tests, pricing, reimbursement, EHR integration, and physician adoption. The new De Strooper–Karran Nature paper is a deep biological reconsideration of how Alzheimer’s actually progresses. 

Read together, however, they give remarkably coherent “today versus around-the-corner” views of Alzheimer’s diagnostics.

The short version

GenomeWeb describes the first commercial wave of Alzheimer’s blood testing: making amyloid-associated disease easy enough, cheap enough, reimbursed enough, and embedded enough in ordinary care that physicians actually order the test. Several FDA-cleared products now revolve around pTau217, with somewhat different combinations of pTau, amyloid ratios, and other markers. Uptake is already reaching primary care, while the commercial battle increasingly turns on workflow, price, insurance coverage, and ease of interpretation—not merely analytic performance. 2026 Genomeweb 0916 Bonislawski… 2026 Genomeweb 0916 Bonislawski…

De Strooper and Karran describe what the second wave may have to do. Their central argument is that Alzheimer’s is not simply one smooth Aβ → tau → neurodegeneration cascade. It consists of biological phases separated by inflection points—thresholds at which local tissue moves into a qualitatively different state. Different regions of the same brain can occupy different states simultaneously. 2026 nature Strooper Inflection… 2026 nature Strooper Inflection…

That distinction has enormous diagnostic implications.

Today: “Does this patient have Alzheimer-type amyloid biology?”

That is largely the market GenomeWeb is describing.

The current blood-test field has converged surprisingly strongly on pTau217. Roche can measure essentially pTau217 alone; Fujirebio combines pTau217 with Aβ42; C2N uses pTau217-related and Aβ42/40 ratios; Quanterix adds GFAP and NfL. The marketplace question is becoming less “Can somebody invent a useful blood biomarker?” and more “Which implementation wins?” 2026 Genomeweb 0916 Bonislawski…

And GenomeWeb makes a particularly important point: once several tests are good enough, market adoption may be determined downstream of science. Which test is in the EHR dropdown? Which one does the health system contract for? Which one is covered by the patient's insurer? What does the patient owe? Can a PCP understand the result? 2026 Genomeweb 0916 Bonislawski… 2026 Genomeweb 0916 Bonislawski…

That is exactly what a maturing diagnostics market looks like. The scientific breakthrough is turning into infrastructure.

But Nature quietly changes what we think pTau217 is telling us

Here is where the two papers really meet.

De Strooper and Karran place pTau217 at a specific biological transition. They argue that soluble pTau217 and pTau231 are best understood as markers of amyloid-associated tau induction: an early neuronal response to an amyloid-primed tissue environment. Importantly, pTau217 rises before substantial fibrillar tau pathology is detectable. 2026 nature Strooper Inflection…

So the enormously successful pTau217 blood-test marketplace described by GenomeWeb is, in the Nature framework, not merely discovering “Alzheimer’s.” It is detecting one particularly important transition in Alzheimer biology.

That is a more interesting way to understand why pTau217 has become so powerful—and also why it may not be the end of the diagnostic story.

The next diagnostic question becomes: “Where in the biology is this patient?”

The Nature framework distinguishes, roughly, amyloid aggregation; glial remodeling; amyloid-associated tau induction; self-amplifying tau propagation; irreversible neuronal loss; and eventual clinical expression. Crucially, the authors emphasize that these are not neat whole-brain stages. A patient can contain a mosaic of tissue domains occupying different biological states at the same time. 2026 nature Strooper Inflection…

That immediately suggests a diagnostic evolution:

First-generation blood diagnostics:

Is Alzheimer-type amyloid pathology likely present?

Next-generation diagnostics:

Has the patient crossed the amyloid→tau transition? Is tau propagation established? Is neuronal injury occurring? Which processes remain reversible or therapeutically actionable?

The authors themselves make this translational leap: future biomarkers need to distinguish biological states well enough to guide treatment timing and rational combination therapy, and the eventual goal should not merely be assigning a disease stage but determining which biological transitions can still be prevented, delayed, or reversed. 2026 nature Strooper Inflection…

That is almost a product-development brief for the next generation of Alzheimer diagnostics.

And it explains why panels may come back into fashion—but for a different reason

GenomeWeb describes today's tension between elegantly simple pTau217 tests and multi-analyte products containing Aβ ratios, GFAP, NfL, and other markers. Today, panels may compete by improving accuracy, reducing indeterminates, or handling comorbidities.

The Nature framework provides a more profound rationale for multiplexing. Different biomarkers may eventually be needed because they report on different biological processes, not simply because averaging several biomarkers gives a slightly better ROC curve.

For example, in the paper:

• pTau217 is associated with the amyloid→tau induction transition.
• GFAP provides a partial readout of astrocytic/glial activity. 2026 nature Strooper Inflection…
• Tau imaging becomes more informative as propagation advances.
• Structural imaging, functional measures, and injury biomarkers become increasingly relevant as neuronal reserve is lost. 2026 nature Strooper Inflection…

That potentially changes the design philosophy from “the best Alzheimer classifier” to “a biological dashboard of where the patient sits along several interacting processes.”

The commercial article therefore may be describing a temporary plateau

The current market could consolidate rapidly around a relatively small number of well-performing pTau217-centered assays. If their clinical discrimination becomes similar enough, cost, reimbursement, distribution, automation, EHR placement, and health-system contracts will decide substantial market share. GenomeWeb essentially says as much.

But that does not mean Alzheimer diagnostics has scientifically commoditized.

Quite the opposite. The Nature paper suggests the next differentiation could occur one level deeper: not merely identifying amyloid-positive Alzheimer biology, but resolving disease state, transition, resilience, progression, and therapeutic opportunity.

And treatment development will force that change. If amyloid drugs, tau-directed therapies, anti-inflammatory approaches, neuronal-protection strategies, and eventually combinations work best at different biological transitions, a binary or near-binary “AD positive” test becomes insufficient.

Bottom line

The two papers describe successive layers of the same transformation.

GenomeWeb shows Alzheimer blood diagnostics crossing the market-adoption inflection point: FDA clearance is becoming commonplace, pTau217 is emerging as a common technological core, primary-care use is appearing, and the winners will increasingly be determined by reimbursement, workflow, price, and usability.

De Strooper and Karran describe the scientific inflection point immediately behind it: Alzheimer’s is increasingly being conceived not as one continuous cascade but as a set of biologically distinct transitions. That raises the next diagnostic challenge from detecting Alzheimer pathology to locating an individual within the active biology of Alzheimer disease.

So for anyone trying to see around the corner in Alzheimer diagnostics, these are not disparate stories at all. One describes the commercialization of the biomarker revolution we have just had; the other sketches the diagnostic requirements of the revolution likely to come next.

Etzioni et al: An ACS Position on MCED Trial Design

 

The New “Peachtree Consensus” for MCED Trials: Cryptic and Vague—or Actually Quite Specific?

The short version

The MCED field is suddenly moving from theory to decisions. Today, September 23, GRAIL’s Galleri test is before an FDA advisory committee, which is considering its PMA for population screening in adults age 50 and older. U.S. Food and Drug Administration 

Meanwhile, numerous other blood-based multicancer tests are in development, creating a practical problem: waiting years for cancer-mortality endpoints could make conventional screening trials extraordinarily slow and expensive. The new American Cancer Society-sponsored “Peachtree Consensus” tries to establish rules for using reduction in late-stage cancer incidence as an earlier endpoint. 2026 Cancer Consensus MCED Trials...

See Etzioni et al.

https://pubmed.ncbi.nlm.nih.gov/42775648/

See also: Reboij et al.

https://pubmed.ncbi.nlm.nih.gov/40694037/

I have heard the Etzioni paper characterized as cryptic or vague. 

That is only half right. It is actually quite explicit about how an MCED trial should be designed, analyzed, and reported. What it deliberately does not say is the thing regulators, payers, manufacturers, and guideline writers most want to know: How much stage shift is enough?

In other words: the methodology is fairly concrete; the decision rule is not.

What the Consensus is trying to solve

Cancer mortality remains the ultimate goal of screening. The panel says that plainly. But mortality trials take years, whereas an effective screening test should first manifest its effect by preventing cancers from presenting at an advanced stage. The authors therefore conclude that both mechanistic reasoning and prior trial evidence support late-stage incidence as a legitimate primary trial outcome. But they stop short of declaring it a universally validated surrogate for mortality. 2026 Cancer Consensus MCED Tria…

That distinction is central to the whole paper:

Late-stage incidence can be a primary endpoint without being accepted as a proven surrogate for mortality.

That sounds subtle, and perhaps this is where some of the “cryptic” reaction comes from. But conceptually it is not muddled. The panel is saying: we can make an earlier statistically valid measurement; we cannot automatically translate that measurement into lives saved.

Indeed, recent reviews have found a relationship between reductions in late-stage cancers and mortality, but the relationship varies by cancer and is not sufficiently uniform to say that, for example, a 20% reduction in advanced cancers means a 20% reduction in deaths. PubMed

The seven recommendations are surprisingly concrete

The paper ends with a seven-item summary that is much less mysterious than the surrounding prose. 2026 Cancer Consensus MCED Tria… In practical English:

1. Do not define “late stage” identically for every cancer. Stage III/IV may make sense for ovarian cancer; for colon cancer, stage IV may be the meaningful dividing line; pancreatic cancer might better be divided by resectability. Non-stageable cancers should generally be left out of the primary stage-shift endpoint. 2026 Cancer Consensus MCED Tria… 2026 Cancer Consensus MCED Tria…

2. Make sure the two trial arms are staged comparably. Otherwise more intensive imaging in one arm could manufacture an apparent difference. The panel recommends a minimum staging protocol, documentation of imaging, biomarkers, biopsies and other work-up, and a target maximum time to final staging. 2026 Cancer Consensus MCED Tria…

3. Do enough rounds of screening and enough follow-up. Screening initially pulls cancers forward in time and can paradoxically increase observed cancer incidence—including advanced cancers. Too short a trial can therefore make an effective test look ineffective. The authors explicitly recommend erring toward more rather than fewer screening rounds when natural-history information is uncertain. 2026 Cancer Consensus MCED Tria…

4. Report both the pooled MCED result and the individual cancers. The trial may be powered only for the aggregate endpoint, so individual-cancer results will often be descriptive, but readers need to know which cancers produced the aggregate result. 2026 Cancer Consensus MCED Tria…

5. Give absolute as well as relative benefit. A 20% relative reduction can mean very different things depending on baseline incidence. The authors specifically point to measures such as the number needed to screen to avert one late-stage diagnosis. 2026 Cancer Consensus MCED Tria…

6. Translate the stage shift into predicted mortality—but label it as modeling. The predicted mortality calculation should disclose assumptions and inputs and include sensitivity analyses. The panel expressly warns that different models can give different answers and that predicted mortality should contextualize—not be mistaken for proof of—clinical utility. 2026 Cancer Consensus MCED Tria…

7. Do not wait passively for mortality results. If a trial produces a statistically significant and clinically important late-stage reduction, the panel supports moving into large demonstration, consortium, implementation, and observational studies while the randomized trial continues following mortality. 2026 Cancer Consensus MCED Tria…

None of that is particularly cryptic.

Where the paper really is vague

The missing sentence is something like:

“An MCED test demonstrating at least X% reduction in late-stage cancer, with Y confidence interval and Z safety profile, has shown adequate clinical benefit.”

There is no X, Y, or Z.

The authors acknowledge the issue directly. They say there may be a desire for a single threshold for an adequate late-stage incidence reduction, but that setting one is difficult in a multicancer test. 2026 Cancer Consensus MCED Tria…

That omission is consequential. Earlier MCED work has sometimes used roughly 20% reduction in late-stage incidence as a trial-design benchmark, but the literature itself notes that the magnitude that should count as clinically significant remains unresolved. AACR Journals

Likewise, phrases such as “significant late-stage reduction suggestive of meaningful clinical benefit” sound decisive until one asks who decides what meaningful means. 2026 Cancer Consensus MCED Tria…

So does the conclusion's formulation that complementary studies should begin when the data give “confidence” that the test is likely to produce meaningful clinical utility. 2026 Cancer Consensus MCED Tria…

Those are judgment standards, not quantitative standards.

An additional source of apparent vagueness: “late stage” itself moves

This is perhaps the most intellectually interesting part of Peachtree.

One might have expected a consensus statement to standardize the endpoint: say Stage III + IV cancers. Instead, the panel essentially says that such simplicity would sometimes be scientifically wrong.

A stage III colon cancer is often curable; stage III ovarian cancer behaves very differently. For pancreas, resectability may matter more than the Roman numeral attached to the tumor. The paper therefore substitutes a cancer-specific clinical concept of consequential advanced disease for a mechanically uniform staging rule. 2026 Cancer Consensus MCED Tria…

That makes the guidance less plug-and-play—but arguably more scientifically coherent.

The tradeoff is obvious: the more clinically intelligent the endpoint becomes, the less universal and easily audited the rule becomes.

And it does not say that stage shift is enough for population screening

This is an important guardrail that can disappear in summaries of the paper.

The authors explicitly conclude that late-stage incidence alone is currently insufficient as the basis for a population screening recommendation. A convincing stage shift may justify moving rapidly into implementation-oriented studies while mortality follow-up continues; it does not terminate the evidentiary process. 2026 Cancer Consensus MCED Tria…

That is broadly compatible with the UK National Screening Committee's 2026 position: late-stage incidence is considered the most promising interim endpoint, while mortality, harms, quality of life, resource use, and cancer-specific results remain important to a definitive screening judgment. BMJ

The Galleri problem sitting in the background

The timing makes this much more than an academic exercise.

The NHS-Galleri randomized trial used combined Stage III/IV incidence as its primary endpoint. It did not demonstrate a significant reduction in that aggregate primary endpoint, although GRAIL reported reductions in Stage IV disease, including reductions in later screening rounds. GRAIL The FDA panel considering Galleri today therefore confronts almost exactly the methodological questions Peachtree discusses: What definition of advanced disease matters? How much weight should Stage IV receive? How should effects after repeated screening rounds be interpreted? And what can stage shift legitimately tell us about ultimate mortality benefit?

Peachtree does not provide an escape hatch that converts a missed primary endpoint into a positive trial. But it does argue that Stage III/IV is not necessarily the biologically or clinically optimal endpoint for every cancer, that results should be examined by cancer type and screening round, and that predicted mortality can add context.

That makes the Consensus exceptionally timely.

Bottom line for busy readers

Calling the Peachtree Consensus “cryptic” overstates the problem. Calling it “vague” identifies something real—but only at the most important decision point.

The document is quite specific about trial architecture: cancer-specific definitions of late disease, comparable staging, adequate numbers of screening rounds, aggregate plus cancer-specific reporting, absolute plus relative effects, mortality modeling, and continued post-trial evidence generation.

What it does not provide is a regulatory or guideline threshold for success. It tells researchers how to produce a credible stage-shift result, but not exactly when that result becomes good enough to conclude that an MCED test should be used.

Perhaps the cleanest description is:

Peachtree is a rulebook for measuring MCED benefit, not a rulebook for declaring victory.

And with Galleri literally before FDA today, that unresolved second question is no longer theoretical. U.S. Food and Drug Administration

September 22: Open AI Models Today

 As of September 22, 2026, the confusion comes from OpenAI mixing three models with different reasoning-effort settings. Those five or six choices are not really five or six independent intelligences.

My recommendation for you

Use Astra Medium as your normal setting.

Move to Astra Extra High when the task is especially consequential or genuinely knotty—for example:

• dissecting a MolDx noncoverage rationale;

• developing Roche’s TROP2 coding strategy;

• reconciling six stakeholder letters;

• finding weaknesses in an argument before it goes to a client;

• synthesizing conflicting evidence into a defensible policy conclusion.

Use Sol Medium for serious but more bounded work: summarizing documents, researching CPT history, revising a draft, or producing a polished client memo.

You have almost no reason to select Luna manually.

What the names actually mean

Model	What it is for	Your likely use
GPT-6 Astra	OpenAI’s most capable model, emphasizing sustained reasoning, research, judgment, and multi-step work	Your difficult analytical and strategic work
GPT-6 Sol	Strong general professional model; faster and less resource-intensive than Astra	Routine research, summaries, rewriting, coding/payment lookups
GPT-6 Luna	Efficient model for narrow, repetitive, high-volume tasks	Extracting fields, formatting lists, classifying rows

OpenAI describes Astra as its strongest option for complete workflows requiring sustained reasoning and judgment; Sol for difficult everyday professional work; and Luna for clearly specified, repeatable tasks. (ChatGPT Learn)

Then each model can be given different amounts of thinking:

• Light: quick, well-defined work.

• Medium: meaningful planning and analysis.

• High/Extra High: difficult work involving several steps, sources, or tradeoffs.

• Max: the model gets still more time for one extremely hard problem.

• Ultra: the task can be divided among multiple agents working on different components.

Thus Astra Medium means “the best model, thinking fairly hard.”
Astra Extra High means “the best model, take your time and really work through this.”

Why you may see exactly six choices

The standard “Power” slider currently contains these six presets:

1. Luna High

2. Sol Light

3. Sol Medium

4. Astra Light

5. Astra Medium

6. Astra Extra High

OpenAI says some plans may omit Astra Extra High. More granular choices—including Max and Ultra—may appear under Advanced or require enabling them in settings. (ChatGPT Learn)

The simple Bruce Quinn rule

• Astra Medium: Leave it here by default.

• Astra Extra High: “This problem is worth several thousand dollars if handled correctly.”

• Sol Medium: Competent research, drafting, summarization, and revisions.

• Sol Light: Straightforward factual or editorial work.

• Luna: Mechanical extraction and reformatting.

For something like “return these 20 CPT codes, one per line,” Luna or Sol Light is perfectly adequate. For “What is the real strategic path for this $300 TROP2 assay when PLA is blocked by physician work?” use Astra Medium or Extra High.

What to ignore

GPT-5.6 Sol, Terra, and Luna may remain visible temporarily while GPT-6 rolls out. They are the outgoing generation; there is little reason for you to choose them for a new project when the corresponding GPT-6 option is available. GPT-5.5 is scheduled to disappear from ChatGPT, Work, and Codex on October 14, 2026. (ChatGPT Learn)

One important distinction: GPT-6 Sol and Luna launched today in ChatGPT Work and Codex, not ordinary Chat mode. Availability is still rolling out, so what appears depends on the particular screen, account, and workspace. (ChatGPT Learn)

Bottom line: Choose Astra Medium and largely forget the picker exists. Escalate to Astra Extra High for the small pile of doom that needs to become a thoughtful, defensible essay.

Chat GPT AI Analysis of POKER FACE (S1 E1)

In which AI tells us alot about why Poker Face S1E1 is so brilliant.

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Rewatching the first episode of Poker Face, I was really struck by the relationship between Charlie Cale and Sterling Frost Jr. 

It's not romantic; the episode simply gives them unusually rich time to talk, understand one another, and develop a real rapport. Charlie genuinely wants to help him—until she realizes he ordered her friend’s murder and she must completely reframe who he is. Their human relationship is the emotional heart of the episode, and I could not think of an obvious parallel in other crime shows. I put that observation to ChatGPT, and its discussion became unexpectedly articulate.

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Yes. I think you’ve identified what makes “Dead Man’s Hand” unusually rich even by Poker Face standards: the real dramatic plot isn’t Charlie solving Natalie’s murder. It’s Charlie gradually forming a relationship with Sterling Frost Jr., and then discovering that she has completely misunderstood the moral nature of the man she’s been talking to.

Adrien Brody’s Sterling is introduced not simply as “the villain.” He’s the disappointing son of a powerful father, newly entrusted with the casino, trying to prove that he can run it, and fascinated by this strange working-class woman whom he cannot successfully lie to. Charlie, meanwhile, doesn’t treat him as a monster or even particularly as a boss. She listens to him. She understands his predicament. She is willing to use her gift to help him. And he seems genuinely to enjoy talking to her. The episode gives that relationship an extraordinary amount of oxygen. (TVLine)

That matters because Charlie is not investigating Sterling during most of those conversations. That is the huge distinction from Columbo, which is the obvious formal ancestor of Poker Face. Columbo can spend forty minutes having wonderfully intimate conversations with a murderer, but underneath every exchange there is usually an asymmetry: Columbo already suspects the person, and the murderer knows—or gradually realizes—that this funny little man may be hunting him. Their intimacy is essentially combat.

Charlie and Sterling are different. For a substantial stretch, she thinks they are on the same side.

And I think Rian Johnson goes out of his way to make that credible. Sterling doesn't merely hire Charlie as a mechanism for the plot. He explains himself to her. He wants her to appreciate his problem with the high roller. She can see the humiliating shadow cast by Sterling Sr. over him. Sterling recognizes that Charlie is unusually intelligent despite her social position. There is almost a peculiar friendship forming: two people who, under completely different circumstances, might actually have liked one another.

That produces the devastating pivot you mention. Charlie has been investigating Natalie's death while still thinking roughly:

Sterling may be compromised, spoiled, ambitious, even sleazy—but he is one of the people who can help me figure out what happened.

Then the evidence rearranges itself and suddenly becomes:

Sterling ordered Natalie killed.

The wonderful thing is that Charlie has to reinterpret not merely the clues ...but all those previous conversations. Sterling’s sympathetic qualities don't disappear. His insecurity about his father was real. His rapport with Charlie was real. His amusement at her gift was real. His desire to succeed was real. And the same man calmly authorized the murder of her friend when Natalie became inconvenient. The story doesn’t reveal that everything Charlie believed about Sterling was false. It reveals that everything she believed was radically incomplete.

That is much more unsettling.

And the episode’s form helps enormously. Because Poker Face is a “howcatchem,” we have already seen Sterling and Cliff arrange the murder. (TV Insider) So during those Charlie/Sterling scenes, we know something Charlie doesn’t. We can watch her sincerity colliding with his compartmentalization. He can genuinely like Charlie while simultaneously concealing the fact that he had Natalie killed. That makes their scenes psychologically interesting rather than merely suspenseful.

I'm struggling too to think of a close television parallel.

There are plenty of detective–murderer relationships: Columbo, Morse, Cracker, Monk. There are cop/criminal relationships that become genuine friendships or quasi-friendships: Justified with Raylan and Boyd, for example. And noir constantly gives us protagonists who trust someone before discovering betrayal.

But this particular configuration is rare:

ordinary person + powerful employer + sincere nonromantic rapport + extended conversational intimacy + protagonist actively trying to help him + late realization that he casually ordered the murder she is investigating.

It’s almost closer to a character drama about discovering that somebody you like is evil than to conventional detective plotting.

And Brody is essential. Sterling isn't played with villainous menace. Brody gives him that familiar slightly wounded, intelligent, anxious quality—almost a man perpetually explaining why life has been unfair to him. Consequently Charlie's sympathy doesn't make her seem gullible. We feel some of it too.

Then comes the 180.

That may also explain why the pilot feels somewhat different from many later Poker Face episodes. The weekly format subsequently becomes wonderfully elastic—Charlie arrives somewhere, makes human connections, a death occurs, and she gradually gets tangled in the truth. But “Dead Man’s Hand” has something more like a two-character dramatic spine. Charlie and Sterling keep returning to one another, talking, negotiating, understanding, misunderstanding.

The murder mystery is the machinery.

Charlie and Sterling are the episode.

And there’s a particularly nasty little moral insight buried in it: Charlie’s lie-detecting ability doesn't protect her from this. Sterling can tell her perfectly sincere things about himself. She correctly perceives that sincerity. The mistake is assuming that sincerity implies decency. His most important secret isn't exposed because he blurts out a lie—it has to be reconstructed from what he did.

That is a very sophisticated limitation to give a character whose supposed superpower is knowing when people are lying.

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 That’s an excellent discussion. One further point: although we know something Charlie does not—that her friend was murdered—our own knowledge is fragmented. We, too, see pieces of conversations from different points of view, sometimes 10 or 15 minutes apart: one side of a phone call at minute 10, the other side at minute 20. So the audience is solving its own puzzle, separate from Charlie’s. 

In effect, we are playing one board game while Charlie is playing another, and both are fitting together a different set of jigsaw pieces.

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Exactly. That is a sharper description of what the pilot is doing formally.

The audience is not simply placed “ahead of Charlie.” We the audience are given a different puzzle from Charlie’s, and our information arrives in a deliberately broken, staggered way. The episode keeps replaying or revisiting the same stretch of time from another character’s position, so an apparently stray line heard at minute 10 may only acquire meaning when we hear the matching half of the exchange much later.

So there are really two simultaneous games.

Charlie’s game is basically: What happened to Natalie, and which statements or circumstances don’t fit? Her lie-detection ability gives her a peculiar set of puzzle pieces.

Our game is: How do these partially overlapping scenes fit together chronologically and causally? We are assembling the murder almost like a mosaic. We may know the broad fact of the killing before Charlie does, but the episode still withholds enough connective tissue that we’re continually revising our own model of exactly who did what, who knew what, and when.

That is quite different from ordinary dramatic irony, where the audience simply knows “Macbeth killed Duncan” while another character doesn’t. Here the audience’s superior knowledge is itself constructed laboriously. We have privileged access, but not omniscience.

And that makes your board-game metaphor very apt. Charlie and the viewer are sitting at neighboring tables playing related games with overlapping pieces.

Sterling is playing yet another game: concealment and damage control.

Cliff has his own operational game.

And Rian Johnson keeps shifting the camera among them so that information itself becomes the dramatic currency.

What is especially elegant is that the episode makes the audience experience something analogous to Charlie’s gift without literally giving us her gift. Charlie detects contradiction in speech. We detect contradiction in editing, chronology, and perspective. A scene we thought we understood gets reclassified when another fragment appears.

That may be why the pilot feels so satisfying on rewatch. The first time, you are assembling the mechanism. The second time, you can watch the mechanism being assembled and appreciate how carefully each informational fragment has been planted.

And it strengthens the Charlie–Sterling relationship we were talking about. Because while we are doing our own reconstruction, Charlie is still emotionally inhabiting a world in which Sterling may be troubled, compromised, ambitious, perhaps dangerous in a general casino-boss way—but not yet that. So the audience is experiencing two tensions at once:

the intellectual tension of fitting together the crime
and
the emotional tension of watching Charlie continue to trust a man whose moral reality we are gradually discovering.

That double structure is probably one reason episode one feels unusually rich. It isn’t merely a murder mystery with a clever nonlinear reveal. It is two epistemological stories running in parallel: how the audience comes to know the crime, and how Charlie comes to know the person.

Dr Zhivago Revisited: The Secret Lamarck/Lysenko Deal

 

The Balalaika Conspiracy:
Doctor Zhivago’s Last-Minute Concession to Lysenko

David Lean’s Doctor Zhivago begins with General Yevgraf Zhivago searching for a young woman named Tanya Komarova, whom he suspects is the lost daughter of his half-brother Yuri and Lara. The film then retreats into its enormous central flashback. Only in the final moments does it complete the frame: as Tanya walks away, Yevgraf notices that she carries a balalaika. Her companion tells him that she does not merely play it; “she’s an artist.” Yevgraf smiles. Yuri’s mother had also possessed an extraordinary gift for the instrument.

“Ah,” he says. “Then it’s a gift.”

Ordinarily, this is taken as a delicate final suggestion that Tanya really is Yuri’s daughter. That interpretation, however, overlooks the scene’s remarkable biological claim. Tanya has apparently inherited not merely musical aptitude, but proficiency with one particular Russian stringed instrument—an ability first acquired through practice by her paternal grandmother. This is not Mendelian genetics. It is Lamarckism with three strings.

We propose that the balalaika ending was imposed upon the film as a discreet tribute to Trofim Lysenko, the Soviet agronomist who rejected conventional genetics and maintained that acquired characteristics could be transmitted to later generations. 

• Wheat exposed to winter could beget winter-ready wheat. 
• A woman who mastered the balalaika could apparently beget a granddaughter who did the same.

Several features support the hypothesis.

First, the Tanya framework is structurally detachable. The great romantic narrative would remain intact without it. Its industrial setting, older Yevgraf and unfamiliar young couple belong to a visibly separate layer of the production. The balalaika itself arrives only in the final seconds, too late to influence the plot but precisely in time to dictate its ideological meaning. This is the signature of a late political insertion: narratively unnecessary, symbolically overdetermined and positioned where no audience can escape before receiving it.

Second, Yevgraf’s reasoning is otherwise inexplicable. A balalaika is not mitochondrial DNA. Thousands of Russians played one. Yet the general treats Tanya’s virtuosity as near-genealogical confirmation. The film asks the audience to accept a chain of inheritance running from Yuri’s mother, through Yuri—who exhibits no comparable instrumental ability—to Tanya. The trait has passed silently through one generation and then flowered in the next. It is difficult to imagine a more cinematic demonstration of an acquired characteristic awaiting favorable environmental conditions.

Third, the crucial word “gift” is suspiciously diplomatic. To Western audiences it means innate music talent. To a Lysenkoist censor it could signify specifically the genetic transmission of environmentally cultivated capacity. One line thus supports two mutually incompatible theories of heredity. It is less dialogue than a carefully negotiated communiqué.

The probable production history can be reconstructed. At some late stage, several vital reels got entangled in an otherwise obscure political embargo. Producer Carlo Ponti, needing their release, offered the balalaika scene as a bargaining counter: no overt praise of Soviet biology, certainly, but a final image showing that the disciplined achievements of one generation might reappear spontaneously in another. The officials received their ideological gesture; Ponti received his reels; Lean received an ending sufficiently poetic that nobody would examine its agronomy.

And fourth - There remains the most intriguing evidence. In the hydroelectric-dam sequences, a heavyset, balding man of approximately Lysenko’s age can—or can almost—be detected among the background workers. He never faces the camera squarely. Production records do not identify him. Enlargements are inconclusive. Yet his placement is suggestive: he stands within the vast machinery of Soviet modernization while Yuri’s supposedly inherited balalaika talent is being rediscovered nearby.

• Could Lysenko himself have been smuggled into the film as an extra, memorializing the bargain?

Chronology, geography and ordinary probability all argue strongly against it. On the other hand, these objections rely upon conventional evidence—the very epistemological regime Lysenko devoted his career to overcoming. Absence of documentation may therefore be counted, in appropriately Lysenkoist fashion, as evidence that the theory has adapted successfully to hostile archival conditions.

Conclusion

The closing scene of Doctor Zhivago is consequently more than a sentimental recognition scene. It is a compressed parable of heredity, diplomacy and film finance. Tanya does not inherit Yuri’s poetry, Lara’s courage or even her grandmother’s general musicality. She inherits the balalaika.

The instrument is not simply a family keepsake. It is the acquired characteristic made audible.

NIH Holding Series of Meetings on Parkinson's Research and Services

 

200-word summary

[See videos at the HHS YouTube Channel]

The Advisory Council on Parkinson’s Research, Care, and Services (ACPRCS) is a federal advisory council, a mixed public–federal stakeholder body, and essentially a national policy-and-coordination forum for Parkinson’s disease and related disorders (PDRD). 

Created by the 2024 National Plan to End Parkinson’s Act, it advises the HHS Secretary and is helping shape the first integrated federal National Plan addressing prevention, diagnosis, treatment, care, and research. Its membership combines 10 public members with 13 federal representatives.

The August 24, 2026 meeting—the Council’s second—was primarily a listening and agenda-setting meeting, featuring 15 nonprofit organizations, public commenters, development of a federal PDRD inventory, and initial reports from the Research/Regulatory and Care/Services subcommittees.

Across remarkably diverse speakers, several themes converged: substantially greater research investment; earlier and more accurate diagnosis; inclusion of prodromal disease and atypical parkinsonisms; environmental prevention; better clinical-trial infrastructure and biomarkers; and, above all, a severe delivery problem—too few specialists, fragmented multidisciplinary care, inadequate rehabilitation and social-work support, rural disparities, and heavy caregiver burden. The Council increasingly framed research and care around a common “patient journey”, from risk and prodromal disease through advanced illness, with measurable outcomes and accountability rather than a simple list of aspirations.

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Detailed Meeting Summary

Purpose and status of the Council

The August 24 meeting showed a Council still early in its development but moving rapidly from statutory mandate toward a working structure. ACPRCS does not itself run Parkinson’s programs or regulate medical care; its central task is to assemble evidence and stakeholder perspectives and translate them into recommendations to HHS and Congress. The National Plan encompasses not only conventional Parkinson disease but related parkinsonisms including MSA, PSP, corticobasal degeneration, and Lewy body dementias, a breadth that repeatedly affected discussion of diagnosis, research methods, care models, and endpoints.

Public engagement was already substantial. NINDS reported almost 400 responses to the formal RFI, from patients, caregivers, professionals, researchers, nonprofits, industry, and people affected by several atypical parkinsonian disorders. The Council emphasized that these responses would help identify priorities for both its recommendations and the National Plan.

Building a federal inventory

A major operational presentation concerned creation of a federal inventory of Parkinson’s-related programs and investments. Importantly, NINDS did not envision this as merely a catalog. The intent is to identify what government is doing well, where duplication or gaps exist, and what should change.

The proposed system would pull standardized information from federal agencies, apply a common PDRD classification framework, use AI/machine learning for initial categorization followed by human validation, and feed the results into a dashboard. Categories include disease mechanisms, diagnosis and monitoring, interventions, epidemiology, care and impact, research infrastructure, common mechanisms across neurodegenerative disease, and workforce/training. Eventually nonprofits may also contribute, permitting comparison of public and philanthropic activity rather than viewing them separately.

Council members strongly supported that broader vision, particularly because it could reveal gaps, duplication, and opportunities for coordinated investment. A draft inventory is planned for spring 2027, with finalization during summer for use in the Council’s fall report.

What the nonprofits told the Council

Although the 15 organizations represented very different constituencies, the striking feature of the presentations was their convergence.

The Michael J. Fox Foundation made the strongest quantitative funding proposal: a long-term federal strategy reaching at least $1.5 billion annually by 2032. Its argument was that scientific opportunity—biomarkers, therapeutic targets, trial infrastructure and precision medicine—has advanced faster than federal investment. APDA likewise sought greater research funding but paired it with development of a longitudinal integrated-care model, including caregivers, and greater attention to nonmotor symptoms and environmental neurotoxicity.

The Parkinson’s Foundation stressed a dual mandate: accelerate cures while improving life now. Its examples highlighted genetic research, environmental prevention, workforce shortages, care navigation, rehabilitation and decentralized trials. The Davis Phinney Foundation expressed essentially the implementation version of the same argument: what is known scientifically is not necessarily what patients experience. The Plan should therefore finance the bridge from evidence into everyday community life.

The atypical-parkinsonism organizations ensured that the Plan would not quietly become a conventional-PD plan. CurePSP emphasized earlier diagnosis, research-ready registries and biomarker platforms, innovative trials, specialty care and provider education. Mission MSA proposed inclusive/platform trial structures, biospecimen and natural-history infrastructure, elimination of Medicare’s disability waiting period for rapidly progressive atypical disorders, telehealth access and reimbursement for multidisciplinary care. LBDA made an especially important conceptual point: cognition and dementia cannot remain peripheral outcomes in a Parkinson’s plan. Biomarkers and trials should be validated against cognition and function as well as motor outcomes.

The workforce and care-delivery problem

Perhaps the strongest theme of the entire meeting was that scientific knowledge is outrunning the system’s ability to deliver good care. Speakers repeatedly described shortages of movement-disorder specialists, long waits, rural access problems, inadequate training of general neurologists, and the underuse of advanced practice providers.

AMDAPP argued that APPs should augment rather than replace movement-disorder neurologists, with formal education, mentorship and certification. Its larger proposal was continuous multidisciplinary care rather than the current episodic model in which PT, OT, speech therapy or mental-health services are restarted only after deterioration.

Discussion broadened that argument to social workers and care navigators. Members noted the irrationality of treating rehabilitation and psychosocial support as short “episodes” when Parkinson’s is a lifelong progressive condition.

State and community organizations added the implementation perspective: pilot locally, measure quickly, scale nationally. Alabama and Connecticut proposed state needs assessments, stronger referral and navigation systems, rural outreach, multidisciplinary care and formal caregiver strategies. PD Avengers stressed measurable accountability, better payment for comprehensive care, and a national approach to environmental prevention.

Public comments

Public commenters made these abstractions concrete. One woman described living in a prodromal/nonmotor state, including REM sleep behavior disorder, while clinicians failed to recognize the neurological significance of her symptoms. Others raised young-onset disease, medication safety in hospitals and long-term-care facilities, exercise and wellness, research methods, and the need to maintain a relentless focus on disease modification and cure.

Staff summarized the public record as emphasizing urgency and accountability, young-onset and atypical disease, research and innovation, whole-person care, diagnostic delay, specialist access, caregiver and financial burden, and environmental, genetic, and veteran-specific risks.

The emerging architecture of the National Plan

The most consequential conceptual development came from the two subcommittees. The Research and Regulatory Programs Subcommittee proposed organizing the Plan around the patient journey, beginning with risk and prodromal disease and continuing through diagnosis, treatment and advanced disease. Federal activities, evidence gaps, goals and metrics could then be mapped against that journey. The intent is explicitly to avoid producing a disconnected “laundry list” of worthy Parkinson’s initiatives.

The Care, Services and Supports Subcommittee found the same framework useful, provided the “patient journey” explicitly includes families and care partners, rehabilitation, mental and behavioral health, education, telehealth, social services, end-of-life needs and differing trajectories of atypical parkinsonism.

Thus the meeting ended with an emerging philosophy: research and care should not become two separate National Plans. Workforce, diagnosis, research participation, care delivery and outcomes overlap. Both subcommittees will meet monthly, share a common organizing framework, bring in additional experts, and feed their work into two NASEM workshops planned for spring 2027. The Council also recognized important missing voices—notably neurology, physical therapy, nursing and other professional organizations—and intends further targeted outreach.

The August meeting therefore produced few final policy decisions, but considerable convergence about what the eventual Plan must accomplish: more science, better prevention, and substantially better translation of existing knowledge into accessible, longitudinal, measurable care.

RFK Jr's War on AMA CPT: The Long-Form Essay

 Essay by Chat GPT.  See short blog pointing to RFK video (August 26,, 2026).

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CPT’s “Social Bias” Requirements Land in a Very Different Washington

A small addition to the American Medical Association’s CPT application process illustrates how quickly the political meaning of technical language can change.

Beginning with applications reviewed at the September 2024 CPT Editorial Panel meeting, the AMA added a series of questions for proposed medical services involving artificial intelligence or software. Two of the questions are especially notable:

Generalizability
“Please describe efforts to ensure broadest generalizability of this software, e.g. curation of training databases, plans for surveillance of real-world data, etc., (give references).”

And immediately afterward:

Social Bias
“Characterize the potential for perpetuation, propagation, or mitigation of social bias, which might reasonably be anticipated (give references).”

These were genuinely new questions. Barbara Levy, then vice chair of the CPT Editorial Panel, explained in a November 2024 Cancer Letter article that the panel had been receiving an influx of AI applications that were sometimes unclear about what the algorithm actually did. She said the additional questions were intended to help CPT understand AI-based services more precisely. The article reproduced all eight new AI questions, including the two above. (Open access at the journalist's blog; McKenzie Prillaman)

That history is important, because it shows that the language was not written for the political environment of 2026. It was written in 2024, near the end of the Biden administration, when “health equity,” “algorithmic fairness,” “bias mitigation,” “representative datasets,” and related terminology were deeply embedded and often required in federal and academic discussions of healthcare.

Two years later, those same words have landed in a very different Washington.

Generalizability Is Not a Special DEI Problem

There is a scientific case for AMA’s first question.

A medical algorithm developed at three academic medical centers may not perform equally well when deployed in community hospitals. A dermatology algorithm trained primarily on light skin can fail on darker skin. A pathology algorithm may be sensitive to staining protocols or scanner platforms.  

Those are conventional questions of external validity, transportability, analytical performance and patient safety. Asking an applicant about training populations, relevant subgroups and real-world surveillance isn't unreasonable.

The intellectual lineage is easy to see. 

A 2023 open-access npj Digital Medicine article, “Considerations for addressing bias in artificial intelligence for health equity,” discussed how bias can enter healthcare AI, how it can affect different populations, and how it can be identified and mitigated across an AI product’s lifecycle. Several authors were senior FDA Center for Devices and Radiological Health officials. Another author, Michael Abràmoff, was a member of the AMA Digital Medicine Payment Advisory Group’s AI Workgroup. (PubMed)

Abràmoff had also coauthored the 2022 npj Digital Medicine paper explaining development of CPT Appendix S, the AMA taxonomy distinguishing assistive, augmentative and autonomous AI. That paper explicitly arose from an AMA workgroup and was intended to help innovators construct CPT code-change applications for machine-performed medical services. (PubMed)

There is no evidence that the AMA copied its 2024 CPT application text, verbatim from either paper. But the conceptual genealogy is not hard to reconstruct. And language in the 2022, 2023, and 2024 documents align.

 

“Social Bias” Is Something Different

The problem begins when CPT moves from asking whether services work properly across the intended patient population to asking whether they will cause the “perpetuation, propagation, or mitigation of social bias.”

That is not quite the same inquiry.

Suppose a company develops an AI-based genomic test for cancer. It is completely reasonable to ask:

Does the test demonstrate comparable clinically relevant performance in the populations for whom it is intended?

That is answerable with data.

It is considerably less clear what the company is supposed to do with:

Characterize the potential for perpetuation or propagation of social bias.

Where are physicians, or most medical scientists, trained in the sociology of whether new technologies will 'propogate social bias?"  Where are the AMA's instructions for these terms and expected research ("add references.")

What counts as “social bias”? How indirect will an AMA reviewer expect the causal chain be?  Where are his/her instructions?

Is the applicant expected to discuss unequal access to sophisticated oncology centers? Or the tragedy of historical racial disparities?  Or will the Administration view those answers as "un-American?"

Insurance coverage? Socioeconomic differences in genetic testing? The possibility that genomic classifications themselves could reinforce stereotypes? Structural inequities several steps removed from the actual analytical performance of the test?

AMA deliberately provided no guardrails or stopping rules.

That is why the historical contrast with ordinary CPT coding is striking. When PET imaging was developed, CPT did not ask whether three-dimensional reconstruction of positron emissions might perpetuate racial inequities. When robotic surgery emerged, code applicants were not asked whether access to surgical robots might propagate socioeconomic harms. When new pathology procedures were coded, the applicant was not normally required to characterize whether the technology might reinforce structurally embedded social disparities or racism.

There were plenty of scientific questions. There were questions about clinical use, efficacy, distinctiveness of the service, FDA status where applicable, adoption, and eventually valuation.

And It Really Is a Required Question

There is an additional point that makes the wording more consequential than an aspirational AMA ethics statement.

The AMA’s current CPT application FAQ explains how staff determine whether an application is complete. AMA staff “verifies that all application questions have been answered.” If they have not, the application is returned to the applicant for completion within a defined time period. (American Medical Association)

Thus, for an application to which these AI questions apply, this is not merely optional reading material about responsible innovation. The company cannot simply decide that a discussion of “social bias” falls outside the purpose of a coding application and leave the box blank.

It must answer.

A Linguistic Fossil From a Different Administration

The wording is especially interesting because it now reads almost like a linguistic fossil from another policy era.

Indeed, there is something slightly séance-like about it. In 2026, CPT appears to be channeling the language of peak 2022–2024 Biden-era health-equity and responsible-AI policy into an administration that has explicitly repudiated much of that vocabulary.

This is not an inference based merely on campaign rhetoric.

President Trump’s July 2025 executive order “Preventing Woke AI in the Federal Government” identifies DEI as an ideology that can distort AI and expressly includes within its description of DEI concepts such as “unconscious bias,” “intersectionality,” and “systemic racism.” The order establishes “truth-seeking” and “ideological neutrality” principles for large language models procured by the federal government. (The White House)

The administration has used still stronger language elsewhere.

A January 2025 executive order on education describes certain equity-oriented teachings as “radical, anti-American ideologies” and specifically objects to requirements involving “White Privilege” and “unconscious bias.” (The White House)

A March 2025 White House order and fact sheet concerning the Smithsonian and federal historical sites directs the administration to eliminate “improper, divisive, or anti-American ideology” and attacks what it describes as race-centered narratives portraying American institutions as fundamentally oppressive. It specifically criticizes programs discussing institutional racism and racial systems of power and directs Interior to review historical markers and other materials that “inappropriately disparage Americans.” (The White House)

By July 2026 the White House had gone even further, issuing another executive order after a review of the Smithsonian. The administration ordered temporary National Park Service signage outside the National Museum of American History warning visitors about what it called the museum’s ideological capture. (The White House)

The White House’s underlying report is unusually explicit: in criticizing Smithsonian educational programming, it juxtaposes discussion of “systemic racism” with what it calls an “anti-American ideology.” (The White House)

The administration has repeatedly placed concepts such as systemic racism, unconscious bias and race-centered structural analysis within a category of DEI or ideological frameworks it considers objectionable, and in some contexts it has quite literally labeled related narratives anti-American ideology.

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Then Came RFK Jr. — Directly at CPT

AMA CPT is already under extraordinary scrutiny from the same administration.

In July 2026, CMS placed a Request for Information inside the proposed 2027 Medicare Physician Fee Schedule examining the AMA’s CPT system and the RUC. The language is unusually confrontational for a Medicare rule. Among other things, CMS asks for evidence concerning harms associated with “AMA’s monopoly over CPT-4 licenses” and cites longstanding concerns about federal reliance on a private organization with what the rule calls an “obvious conflict of interest.” (MSV)

On August 27, 2026, HHS Secretary Robert F. Kennedy Jr. personally released a roughly two-and-a-half-minute video urging Americans to submit comments on AMA control of CPT.

This is worth emphasizing.

The Secretary of Health and Human Services did not leave the CPT RFI buried in a 1,500-page Medicare regulation for coding specialists and Washington lawyers to discover. He took the issue directly to the public.

Medical Economics reported that Kennedy described AMA’s CPT position as a “de facto monopoly,” criticized licensing charges, and explicitly directed viewers to the Medicare comment docket. The article also carefully notes the limits of the RFI: CMS has not actually proposed how to replace the CPT, and some of Kennedy’s numerical assertions didn't include supporting documentation. (Medical Economics)

Still, the sitting HHS Secretary has personally decided that AMA control of CPT is a top priority issue worth taking to the American public on video.

That is a dramatically different situation from a technical disagreement between CMS career staff and AMA coding experts.

And it makes the new “Social Bias” language much more combustible.

Other Pressures Are Already Present

The July RFI is not AMA’s only CPT problem.

On August 13, PatientRightsAdvocate.org filed suit against AMA in federal court in Chicago. The group seeks a declaration permitting it to republish CPT freely and challenges AMA’s copyright position. The litigation remains at an early stage; there has been no ruling on the merits. (Justia Dockets & Filings)

Again, the “social bias” question has essentially nothing to do with copyright law.

But the institutional backdrop matters. AMA is simultaneously defending a coding system whose government-backed importance and licensing structure are under attack in court, facing a CMS RFI that explicitly uses the word “monopoly,” and being criticized personally by the HHS Secretary.

That is a very inopportune moment to discover that the CPT application form contains a mandatory section headed:

SOCIAL BIAS

followed by:

“Characterize the potential for perpetuation, propagation, or mitigation of social bias.”

One does not need to speculate very far about what an administration official hostile to DEI might make of it.

 

The Unforced Error

The most important point, therefore, is not that AMA suddenly invented an absurd problem in 2024.

The language arose from a serious and recognizable medical-AI literature. In the Biden-era policy environment in which it was written, the words “health equity,” “bias mitigation,” “representative populations,” and “social bias” occurred together so often that the CPT question probably seemed like a reflex to the people writing it.

The underlying science has not changed. The political meaning of the vocabulary has.

In 2024, asking an AI developer to discuss the “perpetuation, propagation, or mitigation of social bias” sounded like responsible-AI housekeeping.

In 2026, the federal executive branch has formally attacked DEI, expressly identified “systemic racism” and “unconscious bias” as part of the ideology it wants removed from federal AI, labeled certain race-centered narratives “anti-American,” ordered changes at the Smithsonian and national historical sites, and—most importantly for AMA—seen its own HHS Secretary go directly before the public to challenge AMA’s control of CPT.

And this is not merely an AMA position paper that an applicant is free to ignore. AMA’s own application rules say that all application questions must be answered before an application is complete. (American Medical Association)

That is where a technical wording problem becomes an institutional one.

A medical-technology company should certainly be prepared to show that its product works across the patients for whom it is intended. An AI company should be able to explain its training data, external validation, subgroup performance and real-world surveillance.

But requiring that company, merely to complete its application for a CPT code, to characterize the possible “perpetuation” or “propagation” of “social bias” is something different.

AMA can obtain every medically important fact it needs without requiring that excursion.

At a time when the Secretary of HHS is already publicly challenging AMA's stewardship of CPT, continuing to place a mandatory “Social Bias” inquiry in the coding application looks less like sophisticated future-proofing than like a remarkably avoidable collision between two political eras.

It is, in short, an unforced error at almost the worst possible moment.

Key source links

Medical Economics — Kennedy asks the public to weigh in on AMA control of CPT

White House — Preventing Woke AI in the Federal Government

White House — Restoring Truth and Sanity to American History

White House — Ending Radical Indoctrination in K-12 Schooling

AMA — CPT code change application FAQs

The Cancer Letter / McKenzie Prillaman — the 2024 report reproducing the new CPT AI questions

npj Digital Medicine — Considerations for addressing bias in artificial intelligence for health equity

Federal court docket — PatientRightsAdvocate.org v. American Medical Association