Latest / Morning Medical with Dr. Chow / Maternal Mortality, Gene-Editing for Cholesterol, and Shadow AI in Healthcare

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Maternal Mortality, Gene-Editing for Cholesterol, and Shadow AI in Healthcare · Morning Medical with Dr. Chow

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Welcome to Morning Medical with Dr.
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Chow, where we dive into the latest in medical and health news from around the globe, all
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powered by artificial intelligence.
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I'm your host, Dr.
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Chi-Ming Chow, a cardiologist and professor of medicine at the University of Toronto.
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Today, we're going to explore a very important topic that may challenge what many of us think
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we know about maternal health.
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Today, we're discussing some surprising findings about the top causes of maternal
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death.
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Traditionally, when we think of maternal mortality, we might think of medical causes
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like cardiovascular disease, hypertension, hemorrhage, and infection.
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However, a recent analysis of data from 2018 to 2023 suggests a different picture.
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This study, led by Dr.
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Hooman A.
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Azad and his colleagues from Columbia University Irving Medical Center, shows that
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drug overdoses, homicides, and suicides account for more than a quarter of all deaths among
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pregnant and postpartum women.
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Over the six-year period analyzed, there were 7,901 maternal deaths.
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The leading cause of death was unintentional drug overdose, responsible for 1,152 of these
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deaths.
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Violence, which includes both homicide and suicide, was the second leading cause, with 866
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deaths.
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These numbers highlight a critical, yet often overlooked, aspect of maternal health.
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Dr.
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Azad points out that the Centers for Disease Control and Prevention typically excludes
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homicides, suicides, and overdoses from their definition of maternal mortality, focusing
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instead on more traditional medical causes.
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But by doing so, we may not be fully addressing the broader spectrum of risks that pregnant and
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postpartum women face.
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Including violence and overdose in maternal mortality discussions could improve our
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understanding and approach to reducing these deaths.
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The study also highlights disparities in pregnancy-associated mortality by race, ethnic
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group, and age.
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Homicides were most frequent among Black women, especially those aged 15 to 24, while suicide
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and unintentional drug overdoses were more common among white women.
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Hispanic women showed lower incidences of homicide, suicide, and overdose compared to
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non-Hispanic women in certain age groups.
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Maeve Wallace from the University of Arizona emphasizes that these findings should not be
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surprising, as research has long shown that violent deaths often surpass obstetrical causes
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for pregnant women.
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She asserts that pregnancy and the postpartum period offer a "critical window of opportunity"
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for intervention.
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Many women experiencing violence, substance use, or severe mental health issues may only
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come into contact with healthcare providers because of their pregnancy, providing a chance
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for support and intervention.
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Dr.
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Azad calls for enhanced screening for intimate partner violence, drug dependency, and mental
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health issues, along with systems to support those who screen positive.
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This comprehensive approach could be key to reducing maternal deaths in these vulnerable
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populations.
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Today, we're delving into a groundbreaking area of research that could potentially
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revolutionize the way we manage high cholesterol and, by extension, heart disease.
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Scientists are exploring gene-editing as a novel treatment approach, which might offer a
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one-time fix for high cholesterol.
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This research is still in its early stages and has been tested on only a few dozen individuals
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so far.
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However, the initial results from two companies show promise that switching off certain genes
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could significantly lower levels of artery-clogging cholesterol.
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This raises the hope that one day, we might prevent heart attacks without the need for
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daily pills.
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Dr.
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Luke Laffin, a preventive cardiologist at the Cleveland Clinic, highlights the desire for a
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permanent solution rather than a temporary fix.
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After co-authoring a promising study published in the New England Journal of Medicine, he
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received numerous inquiries from individuals eager to participate in future clinical trials.
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The need for cholesterol is undeniable, as it plays a crucial role in the body's functions.
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However, excessive amounts, particularly of low-density lipoprotein cholesterol, contribute
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to plaque buildup in the arteries, leading to heart attacks and strokes.
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Cardiovascular disease remains the leading cause of death globally, and while millions
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rely on cholesterol-lowering medications like statins, many struggle to maintain optimal
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cholesterol levels due to side effects or the challenge of lifelong adherence.
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Genetics plays a significant role in how the body manages cholesterol.
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According to the American Heart Association, the liver produces the cholesterol the body
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needs, but some people inherit genes that cause very high cholesterol levels.
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Conversely, others have genes that keep their cholesterol naturally low, reducing their risk
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of heart disease.
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Years ago, Dr.
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Kiran Musunuru, a cardiologist now at the University of Pennsylvania, discovered that
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some individuals have a mutation that turns off the ANGPTL3 gene, resulting in lower levels of
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both low-density lipoprotein cholesterol and triglycerides.
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Similarly, geneticists at the University of Texas Southwestern Medical Center identified
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that other individuals' extremely low low-density lipoprotein levels were due to the
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loss of function of another gene, PCSK9.
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Dr.
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Steven Nissen from the Cleveland Clinic, alongside Dr.
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Laffin, oversaw a study funded by CRISPR Therapeutics that explored the potential of
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altering these genes.
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Currently, there are injectable medications that block proteins produced by the PCSK9 and
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ANGPTL3 genes in the liver, aiding in cholesterol clearance.
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The new research employs CRISPR, a Nobel Prize-winning gene-editing tool, to attempt
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switching off one of these genes in individuals at high risk from uncontrolled cholesterol.
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In one study, 15 adults received a single infusion of particles carrying the CRISPR tool
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to the liver, which successfully switched off the ANGPTL3 gene.
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Within two weeks, those receiving the highest dose experienced a fifty percent reduction in
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both low-density lipoprotein and triglyceride levels.
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Boston's Verve Therapeutics, a subsidiary of pharmaceutical giant Eli Lilly, previously
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reported that their PCSK9-targeted editing infusion achieved a similar reduction in
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low-density lipoprotein cholesterol in a small study.
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Initial studies by both companies were conducted in Australia, the United Kingdom, and
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other countries, with United States study sites now opening.
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Dr.
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Nissen anticipates that the next phase of CRISPR Therapeutics' research will commence
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later this year, with sites yet to be announced.
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Both companies are exploring multiple gene targets to enhance treatment efficacy.
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While individuals with naturally nonfunctioning ANGPTL3 or PCSK9 genes do not appear to suffer
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adverse consequences, longer and more extensive studies are essential to fully understand the
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gene-editing approach's implications.
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Dr.
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Musunuru, who co-founded Verve Therapeutics, notes that participants in an earlier study
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have been monitored for two years, with consistently lowered cholesterol levels.
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Gene editing is considered a permanent solution, as edited liver cells replicate,
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passing the altered genes to their progeny.
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This permanence has been observed in mice, where the edits have lasted a lifetime.
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However, there are significant safety questions that need addressing.
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Dr.
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Joseph Wu from Stanford University, who was not involved in the studies, cautions that
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CRISPR-based therapies for any disease have not been used extensively enough to ascertain
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long-term safety.
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The particles used to deliver the gene-editing tool can potentially irritate or inflame the
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liver.
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Additionally, there is the concern of ensuring that gene-editing precisely targets only the
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intended genes.
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As a result, current studies are primarily focusing on individuals at very high risk to
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mitigate potential risks.
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Today, we're diving into a study that reveals some startling connections between body mass
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index and infection-related outcomes.
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Researchers from the University College London and the University of Helsinki have found that
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obesity may be a contributing factor in more than ten percent of infection-related deaths.
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This extensive study, published in The Lancet, analyzed medical data from nearly five hundred
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fifty thousand adults in Finland and the United Kingdom over a fourteen-year period.
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The findings suggest that individuals with a body mass index of thirty or above, which
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classifies them as obese, are seventy percent more likely to be hospitalized with or die from
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an infection compared to those with a healthier body mass index.
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The study highlights a particularly concerning trend among those with class three obesity,
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defined as a body mass index of forty or higher.
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These individuals were found to be three times more likely to be hospitalized for infection,
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to die, or to experience either outcome compared to those with a body mass index
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between eighteen point five and twenty-four point nine.
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Startlingly, the researchers estimated that obesity played a role in about nine percent of
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infection-related deaths in two thousand eighteen, about fifteen percent in two thousand
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twenty-one, and around eleven percent in two thousand twenty-three.
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One of the intriguing aspects of this study is that the association between obesity and worse
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infection outcomes was observed even in obese individuals who did not have diabetes, heart
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disease, or metabolic syndrome.
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Physical activity levels also did not appear to significantly alter this link.
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The study encompassed a wide range of infectious diseases, including influenza,
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COVID-19, pneumonia, gastroenteritis, urinary tract infections, and lower respiratory tract
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infections.
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Nearly all types of infections were linked to higher risks of poor outcomes in individuals
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with obesity.
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Professor Mika Kivimaki, the study's lead author, pointed out that while obesity is
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already a well-known risk factor for metabolic syndrome, diabetes, cardiovascular disease, and
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other chronic conditions, this study provides robust evidence that it is also linked to worse
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outcomes from infectious diseases.
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According to Professor Kivimaki, recovery from infections is markedly harder for individuals
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with obesity, as their body's defenses against infections are weakened.
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The study also revealed that certain conditions, such as skin and soft-tissue
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infections, were most strongly associated with obesity.
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Furthermore, those who managed to lose weight after being initially classified as obese
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reduced their risk of severe infections by approximately twenty percent.
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This underscores the importance of implementing policies that support weight loss and healthy
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living, such as providing access to affordable healthy food and opportunities for physical
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activity.
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Dr.
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Solja Nyberg, the first author from the University of Helsinki, emphasized the urgency
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of addressing obesity to reduce the risk of severe infections, as well as other health
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issues linked with obesity.
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She noted that as obesity rates are expected to rise globally, so will the number of deaths and
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hospitalizations from infectious diseases linked to obesity.
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Dr.
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Nyberg also highlighted the importance of obese individuals staying up to date with their
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vaccinations to further mitigate these risks.
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While the study provides compelling evidence of the link between obesity and infection
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severity, it's important to note that it does not prove causation.
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Additionally, the study's reliance on body mass index as a measure of obesity has been a topic
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of debate, as body mass index may not fully capture an individual's health status.
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The study's findings are based on data from adults in Finland and the United Kingdom, which
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may limit its applicability to other populations.
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Nonetheless, the research, funded by Wellcome, the Medical Research Council, and the Research
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Council of Finland, provides a crucial insight into the health challenges posed by obesity.
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Today, we're exploring a topic that has sparked debate for years: when it comes to heart
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health, is a low-fat diet better than a low-carbohydrate diet?
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A recent study published in the Journal of the American College of Cardiology adds an
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intriguing layer to this discussion.
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The study suggests that the emphasis on either low-fat or low-carbohydrate diets might be less
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important than focusing on the quality of the foods consumed.
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Researchers compared the effects of different diets on heart health by examining over ten
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thousand adults over a period of several years.
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They found that individuals who followed a diet rich in high-quality carbohydrates, like whole
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grains and vegetables, had better heart health outcomes than those who consumed processed
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foods, regardless of whether their diet was low in fat or carbohydrates.
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Dr.
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Lydia Bazzano, a lead researcher from Tulane University, explains that the focus should
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shift toward the overall quality of the diet rather than strictly limiting fat or
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carbohydrates.
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She emphasizes that whole foods, which are minimally processed and rich in nutrients, can
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support heart health more effectively than simply reducing one macronutrient or another.
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The study also highlights the role of dietary patterns in heart health.
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It found that people who adhered to a Mediterranean-style diet, which includes plenty
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of fruits, vegetables, whole grains, and healthy fats like olive oil, tended to have
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better heart health outcomes.
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This suggests that a balanced approach incorporating a variety of nutrient-rich foods
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can be beneficial.
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Dr.
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Bazzano points out that while low-fat and low-carbohydrate diets can be effective for
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weight loss, they might not always align with what's best for heart health.
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She notes that the key takeaway from the study is the importance of prioritizing whole,
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unprocessed foods rich in fiber, vitamins, and healthy fats.
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This research challenges the traditional view that dietary fat is the main culprit in heart
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disease.
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Instead, it encourages a broader perspective, focusing on the types of foods consumed rather
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than just macronutrient content.
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This means that a diet high in healthy fats from sources like avocados and nuts could be
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more heart-friendly than a diet filled with processed low-fat options.
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In conclusion, the study suggests that for heart health, quality trumps quantity.
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It's not just about cutting out carbs or fats; it's about choosing the right kinds of foods.
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This finding could help guide future dietary recommendations, emphasizing the value of
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whole, nutrient-dense foods for maintaining a healthy heart.
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Today, we're discussing a fascinating and somewhat controversial topic: the quiet, yet
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widespread, use of artificial intelligence by doctors, often without formal approval from
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their institutions.
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This phenomenon is known as "shadow AI." In bustling clinics, it's not uncommon for a
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clinician to use a chatbot to summarize a long consultation note or to draft an appeal letter
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for an insurance denial.
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Although hospitals might not officially sanction these tools, many physicians are
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incorporating them into their daily routines.
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A survey conducted by the American Medical Association in early 2025 found that
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approximately two-thirds of physicians had already started using some form of healthcare
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artificial intelligence, primarily for documentation and messaging, rather than for
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making autonomous diagnoses.
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This is a significant increase from the previous year.
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Similarly, in the United Kingdom, about thirty percent of general practitioners reported using
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tools like ChatGPT for documentation help, diagnostic brainstorming, or exploring
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treatment options, often without formal training or explicit permission from their
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employers.
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Despite the lack of formal approval, large health systems are beginning to implement
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officially sanctioned tools.
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A multi-center quality improvement study found that clinicians who used an ambient AI scribe
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spent less time on documentation and reported significantly lower levels of burnout.
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Health systems such as the Permanente Medical Group have documented millions of patient
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encounters using ambient AI, reducing the amount of "pajama time," or after-hours work,
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for doctors.
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However, much of AI usage in the medical field is still happening in the shadows.
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"Shadow AI" refers to the use of artificial intelligence tools without institutional
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approval or oversight.
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This can include using a public chatbot to clean up language in notes, employing a free
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mobile scribe app during patient visits, or asking a consumer chatbot for help with complex
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portal messages or discharge instructions.
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Until recently, most information about shadow AI came from information technology leaders and
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security firms.
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However, a clearer picture is now emerging from the clinical side.
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A recent survey by Wolters Kluwer Health revealed that around seventeen percent of
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healthcare workers, including clinicians and administrators, admitted to using unapproved AI
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tools at work.
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Among those who did, the primary reasons were the faster workflows and better functionality
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these tools offered compared to the organization's official options.
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Interestingly, this isn't just a problem among early-career clinicians; even more experienced
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doctors are turning to shadow AI to handle the pressures of their workdays.
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Security researchers have flagged shadow AI as a potential contributor to data breaches, and
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enterprise vendors are selling tools to detect and manage its use.
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However, the health sector still tends to treat shadow AI as a behavior to reprimand, rather
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than a reality to govern.
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Current AI policies often assume that governance begins when a health system decides
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to deploy AI, but by that point, the tools are already in use by individual clinicians trying
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to manage their workloads.
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Banning AI tools or sending out memos warning against the use of public chatbots hasn't
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stopped shadow AI's spread.
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In fact, prohibition tends to drive these practices underground, making them less safe.
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Rather than focusing solely on the tools that are officially purchased and integrated, health
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systems need to acknowledge the broader reality of AI use in healthcare.
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There are three practical shifts that could make a significant difference.
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First, make AI use speakable.
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Create non-punitive ways for clinicians to share what they're actually doing, like
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anonymous surveys or focus groups.
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This would help identify which workflows clinicians are trying to improve and where
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unsanctioned tools are filling real gaps.
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Second, build a safe "front door" for AI.
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Offer a governed, easy-to-access interface for generative AI that keeps data within secure
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infrastructure.
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Provide templates for common tasks so that clinicians don't have to rely on public
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chatbots.
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If the official tools are clunky or less effective than public options, shadow AI will
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continue to thrive.
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Finally, treat shadow AI as a discovery tool.
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If many clinicians are using an unapproved tool for a particular task, that's a signal to study
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that workflow, evaluate safer alternatives, and help people transition to vetted options.
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Early trials of ambient scribes have shown that they can reduce documentation time and burnout
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without compromising the quality of notes.
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In conclusion, shadow AI isn't going anywhere.
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The choice isn't between using AI or not; it's about how we manage its use in healthcare.
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Ignoring shadow AI or trying to ban it out of existence only risks creating unmeasured
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clinical influence and unmanaged security exposure.
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A more realistic approach is to acknowledge that unsanctioned AI has become part of the
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infrastructure and to build governance that reflects this reality.
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For health systems, this means making AI use visible and guiding it through safer channels.
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For clinicians, it means being honest about how we're using these tools and pushing for
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policies that catch up to the reality of AI in healthcare.
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Thank you for joining us on Morning Medical with Dr.
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Chow.
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I hope today's discussion has provided you with new insights into the evolving role of
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artificial intelligence in healthcare.
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Until next time, stay informed and stay healthy.