David W. Bates

Yining Hua, Hang Jiang, Shixu Lin et al. · amazon-science, harvard

Understanding public discourse on emergency use of unproven therapeutics is crucial for monitoring safe use and combating misinformation. We developed a natural language processing-based pipeline to comprehend public perceptions of and stances on coronavirus disease 2019 (COVID-19)-related drugs on Twitter over time. This retrospective study included 609,189 US-based tweets from January 29, 2020, to November 30, 2021, about four drugs that garnered significant public attention during the COVID-19 pandemic: (1) Hydroxychloroquine and Ivermectin, therapies with anecdotal evidence; and (2) Molnupiravir and Remdesivir, FDA-approved treatments for eligible patients. Time-trend analysis was employed to understand popularity trends and related events. Content and demographic analyses were conducted to explore potential rationales behind people's stances on each drug. Time-trend analysis indicated that Hydroxychloroquine and Ivermectin were discussed more than Molnupiravir and Remdesivir, particularly during COVID-19 surges. Hydroxychloroquine and Ivermectin discussions were highly politicized, related to conspiracy theories, hearsay, and celebrity influences. The distribution of stances between the two major US political parties was significantly different (P < .001); Republicans were more likely to support Hydroxychloroquine (55%) and Ivermectin (30%) than Democrats. People with healthcare backgrounds tended to oppose Hydroxychloroquine (7%) more than the general population, while the general population was more likely to support Ivermectin (14%). Our study found that social media users have varying perceptions and stances on off-label versus FDA-authorized drug use at different stages of COVID-19. This indicates that health systems, regulatory agencies, and policymakers should design tailored strategies to monitor and reduce misinformation to promote safe drug use.

Hao Guan, David Bates, Li Zhou

Artificial intelligence (AI) is increasingly integrated into modern healthcare, offering powerful support for clinical decision-making. However, in real-world settings, AI systems may experience performance degradation over time, due to factors such as shifting data distributions, changes in patient characteristics, evolving clinical protocols, and variations in data quality. These factors can compromise model reliability, posing safety concerns and increasing the likelihood of inaccurate predictions or adverse outcomes. This review presents a forward-looking perspective on monitoring and maintaining the "health" of AI systems in healthcare. We highlight the urgent need for continuous performance monitoring, early degradation detection, and effective self-correction mechanisms. The paper begins by reviewing common causes of performance degradation at both data and model levels. We then summarize key techniques for detecting data and model drift, followed by an in-depth look at root cause analysis. Correction strategies are further reviewed, ranging from model retraining to test-time adaptation. Our survey spans both traditional machine learning models and state-of-the-art large language models (LLMs), offering insights into their strengths and limitations. Finally, we discuss ongoing technical challenges and propose future research directions. This work aims to guide the development of reliable, robust medical AI systems capable of sustaining safe, long-term deployment in dynamic clinical settings.