Physician in the Loop

Asthma guideline ranks steroid rescue inhalers above albuterol alone

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The American Thoracic Society on Nov. 3 strongly recommended steroid-containing rescue inhalers over short-acting beta-agonists alone for adolescents and adults with mild asthma, in a new guideline.

The same day, the Food and Drug Administration warned that holes can form in some ButterflyBVM bag-valve-mask resuscitators and told users to remove the worst-affected lots. A National Institutes of Health cohort found that half of adults with long COVID at one year improved meaningfully by three years, and a Columbia study of nearly 1 million portal replies found that Epic's AI drafts did not shorten clinicians' overall response times.

In this episode

• Thoracic society strongly recommends steroid-containing rescue inhalers over short-acting beta-agonists alone for mild asthma
• FDA warns holes can form in ButterflyBVM bag-valve masks, letting breaths leak away from patients
• Half of adults with long COVID at 1 year improve meaningfully by 3 years, but only about a quarter fully recover, RECOVER finds
• Columbia clinicians answered portal messages 8.6% slower after Epic's AI draft replies arrived, a 983,154-message study finds
• Humana opens electronic prior authorization to more than 180,000 athenahealth clinicians nationwide
• A quarter of Kaiser emergency patients with six common conditions were treated at home, in clinics or in observation instead of a bed
• Stents and bypass surgery show matching 10-year survival for left main disease in a 5,379-patient registry

A weight-loss prescription can now take a questionnaire and a card number. Patients deserve a clinician who knows them and a drug the FDA has checked.

Read the special topic and its sources: https://physicianintheloop.org/specials/glp1-telehealth-compounding/

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Child's measles death is New York's first in more than 30 years

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A child in Lewis County, N.Y., has died in association with the state's measles outbreak, New York's first known measles-associated death in more than 30 years, the state health department said Nov. 2.

The department did not release the child's age or vaccination status. New York had counted 178 measles cases this year as of Oct. 24, and the governor declared a state disaster emergency about four weeks before the death was announced to widen who may give the vaccine.

In a Japanese validation study in NEJM AI, an AI model listening through a digital stethoscope identified reduced ejection fraction more accurately than cardiologists in a 100-patient comparison, and a German trial in the same journal found AI lay summaries shortened specialist visits by about 8 minutes. In cardiology, the PROGRESS trial found that early valve replacement for moderate aortic stenosis reduced death or heart failure events at two years.

In this episode

• A child in Lewis County dies in New York's measles outbreak, the state's first measles-associated death in more than 30 years
• AI listening through a digital stethoscope flags ejection fractions of 40% or less, beating cardiologists 82% to 62% in a 100-patient test
• AI plain-language summaries sent before visits cut neurosurgery consultations from 33 to 25 minutes in a 300-patient randomized trial
• Early valve replacement for moderate aortic stenosis cuts death or heart failure events at 2 years, 744-patient PROGRESS trial finds
• Bicarbonate for metabolic acidosis in the ICU shows no clear survival gain but likely fewer dialysis starts, 1,544-patient meta-analysis finds

The Bundibugyo Ebola outbreak has passed 10,000 confirmed cases and reached Kenya and Nigeria. There is no approved vaccine or treatment, and American rules turn on a 21-day window.

Read the special topic and its sources: https://physicianintheloop.org/specials/ebola-2026-what-clinicians-need/

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More Americans said they would use a therapist three months away than a chatbot available immediately. The wait is the thing to fix, and the handoff to a person is the thing to require.

Read the special topic and its sources: https://physicianintheloop.org/specials/wait-is-the-risk/

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Flu admissions jump 27% in a week to the highest late-October rate since 2010

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Hospitals admitted 6,100 patients with lab-confirmed influenza in the week ending Oct. 24, up 27% from the week before, the Centers for Disease Control and Prevention reported Friday.

The agency's surveillance network put the hospitalization rate at its highest for that week of the season since 2010-11, with nearly every subtyped influenza A virus an H1N1 strain. The CDC said an early rise does not necessarily mean a higher peak or a more severe season.

In cardiology, a 1,105-patient trial presented at the Transcatheter Cardiovascular Therapeutics meeting found that coronary CT angiography planned stenting as well as intravascular ultrasound with shorter procedures. Epic said it will keep supplying AI model documentation that a new federal rule no longer requires, and the FDA authorized a robotic system whose needle-sized arms work through a rigid endoscope.

In this episode

• Flu admissions rise 27% in a week to 6,100, the highest late-October hospitalization rate since 2010, almost all H1N1
• Coronary CT angiography matches intravascular ultrasound for guiding stents and cuts procedure time 17 minutes, 1,105-patient trial finds
• Epic says hospitals will keep its AI model documentation and evaluation tools after HHS dropped the federal requirement
• FDA authorizes Virtuoso's endoscopic surgery robot, whose needle-sized arms work through a rigid endoscope
• Britain commits £100 million to reach 500,000 robotic operations a year by 2035 and orders a review of AI and NHS productivity

Affordable Care Act premiums rise another 13% as sign-ups open

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Average benchmark premiums for Affordable Care Act marketplace plans are rising 13% for 2027, KFF reported, as open enrollment began Sunday after a 26% increase for 2026.

The two increases add up to about 42% since 2025, according to KFF's analysis, which attributes the rise to higher underlying care costs and changes in the risk pool after enhanced premium tax credits expired. Enrollment on HealthCare.gov runs through Jan. 15, 2027, the Centers for Medicare & Medicaid Services said, and the Congressional Budget Office projects marketplace enrollment will fall to 13.1 million in 2027 from a 2025 peak of 22.4 million.

Separately, a Doximity analysis of more than 8,500 dosing questions found general-purpose AI models gave seriously wrong or potentially lethal doses in about 2% of answers, and fewer employers are paying for GLP-1 weight-loss drugs, a WTW survey found.

In this episode

• Affordable Care Act benchmark premiums rise 13% for 2027 after a 26% jump this year, as enrollment opens Nov. 1
• General-purpose AI models gave seriously wrong drug doses in about 2 of every 100 answers, Doximity analysis reports
• AI reading 25,000 primary care notes a week found about 7 times as many missed specialist referrals at Singapore clinics
• Employer coverage of GLP-1 weight-loss drugs falls to 53%, and 30% of employers still paying are weighing dropping it
• Penn Medicine AI trained on 400,000 CT images screens for hundreds of conditions a scan was not ordered to find

AI chatbots recommend care costing 3 times what physicians order

The voices on this episode are generated, and so is the script, from the day's post at Physician in the Loop. Every fact in the post links to its source.

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Twenty general-purpose AI chatbots given 200 outpatient and emergency department notes recommended care costing an average of $314 per visit, more than three times the $97 the treating physicians ordered, a NEJM AI study found.

Most of the gap came from tests the chatbots suggested at visits where physicians had ordered none, the authors reported. A separate Annals of Internal Medicine benchmark found six commercial models usually held back on low-value care but recommended thyroid ultrasound for incidental subcentimeter nodules in 42.8% of responses.

In other news, Medline is removing or correcting all of its beds after reports of two deaths and 16 serious injuries, U.S. measles cases reached 4,852 for the year, STAT reported that Epic has used its market power against rival app makers, and the Food and Drug Administration approved the first plasmid DNA immunotherapy, for recurrent respiratory papillomatosis.

In this episode

• AI chatbots recommend care costing 3.2 times what physicians ordered, mostly by adding tests at visits where doctors ordered none
• Medline pulls all its beds from the market after two deaths and 16 serious injuries from fire and entrapment
• U.S. measles cases reach 4,852 in 2026 as Pennsylvania tells clinicians to treat every newborn of an infected mother as exposed
• Twelve app makers tell STAT that Epic cut off data access, spread rumors or charged high fees to undercut them
• Congo's Ebola outbreak passes 10,000 confirmed cases, with nearly 5,000 deaths
• FDA approves Voceryq, the first plasmid DNA immunotherapy, for adults with recurrent respiratory papillomatosis

A randomized trial found a glucose sensor lowered blood sugar in adults with type 2 diabetes who take no insulin. Medicare's rule still turns mainly on the insulin rather than the evidence.

Read the special topic and its sources: https://physicianintheloop.org/specials/sensor-before-insulin/

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Medicine's answer to every worry about AI is a human who checks the machine's work. Almost nobody checks how well the humans do, and somebody should.

Read the letter and its sources: https://physicianintheloop.org/letters/2026-10-26/

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