Ari Ciment
Subject: Using AI With Your Doctor
Bio: Pulmonologist and President of Medical Staff at Mount Sinai Medical Center in Miami Beach
Transcript:
Larry Bernstein:
My name is Larry Bernstein.
What Happens Next is a podcast which covers economics, politics, and culture.
Today’s topic is Using AI with Your Doctor!
Our speaker is Dr. Ari Ciment who is the President of the Medical Staff at Mount Sinai Hospital in Miami Beach. Ari ran the COVID ward at Mt. Sinai during the pandemic and has appeared more on this podcast than any other guest which is 12 times.
I want to learn from Ari how doctors are using AI in their medical practice with patients right now.
Ari, you are a pulmonologist at the Miami Beach Mount Sinai Hospital. What is this new medical AI and what does it do?
Dr. Ari Ciment:
This new medical AI is Openevidence.com. When I asked the question I got not only a great answer, but what I really loved, it gave you references that you could double check and look up.
It has over 350,000 physicians logging into it every day. The growth is something like 40,000 doctors per month and it's a billion-dollar valuation.
Larry Bernstein:
Where is it sourcing its information? Where do other AI sources information and why do you trust this one more than the others?
Dr. Ari Ciment:
It started out with Mayo Clinic's platform. It has partnered with the New England Journal of Medicine. JAMA just signed on. What makes it different than the regular AI is that it's plugged into up-to-date guidelines as well as PubMed and all the clinical journals that we typically use. It does cull some information from regular patient experience.Larry Bernstein:
How have you been using it in your day-to-day medical situations?
Dr. Ari Ciment:
I'm a pulmonary critical care fellowship director. Initially I used it just to make sure that I was teaching the current guidelines with each specific subspecialty in pulmonary and critical care.
But I started using it during my evaluation with patients, partly to solidify what I'm doing but also to show the patient that Open Evidence agrees. It gives them the peace of mind and it gives the physician more confidence.
Larry Bernstein:
There's going to be times where you're going to disagree with this. What are you going to say then?
Dr. Ari Ciment:
I have disagreed multiple times and sometimes evidence isn't quite up to date. There could be an article on a new medicine that was just published in the New England Journal of Medicine, and it's not FDA approved yet. So, it is still lagging behind, so it doesn't have that button yet for what's right at the cutting edge, meaning what's in the last few weeks of publication.
The subtlety of knowing your patient experience, like what's Ari Cement’s experience with using Nintedanib versus Pirfenidone, two medicines that are widely used for pulmonary fibrosis. The trick is in knowing what to ask the artificial intelligence. In other words, it's only as good as your question.
Larry Bernstein:
You ran the COVID ward at Mount Sinai Miami Beach in June, 2020, the literature was behind what was going on in the field. Do you suspect this program could have helped you while the medical profession was in flux?
Dr. Ari Ciment:
I was thinking about that and that's one of the reasons why I reached out to you because it's so interesting. I wonder if this would've helped in a pandemic because at that point everybody is just struggling to get out anything into the literature. And it would still be the same problem of do I trust this? Because articles were all over the place. You could find the Pro-Plaquenil article and you could find the anti-Plaquenil article.The New England Journal of Medicine was very political. They chose to write an op-ed, whether you're a Republican or a Democrat, against the President of the United States at that time. It gave you an impression that what's being published by New England Journal of Medicine, maybe they're going to only accept articles that are going to be against the president. Now, to me, when I saw that Open Evidence is being supported by just institutions like New England Journal of Medicine, JAMA and the Mayo Clinic platform, that should raise some red flags. We should include other journals as well, like Chest to make sure that we're not limiting.
I've asked Open Evidence 665 questions and it's stored everything. Like here's a question from 4/18/2025 that I asked. HIV newly diagnosed with a good CD4 count has strep pneumonia, but then if I want to have new evidence updates, I just press a click and then if new evidence subsequently comes about, it will shoot me an email.
Larry Bernstein:
Let's do a test. Should an individual take a COVID vaccine today?
Dr. Ari Ciment:
I'll say 65-year-old with no health conditions, number two 65-year-old hypertension and diabetic.
Let's see what happens.
It says, 65-year-old with no health conditions, strongly recommended mRNA vaccines highly effective. And these are older references. See, this is where it's a little tricky. So, this is where you have to use your medical judgment because I wouldn't agree with this. Then it says 65-year-old with hypertension, diabetes, strongly recommend.
What about 20-year-old healthy? And you know that the report just came out saying that if you're young and healthy, they don't recommend it.
It says a healthy 20-year-old with no underlying health conditions should receive the COVID-19 as the benefits of vaccinated outweigh the risks and supported by national guidelines and robust evidence.
When it comes to the COVID vaccine, that's a perfect example of how it's not up to date.
Literally, it just changed over the last few days and it's still telling me you should give it.
Larry Bernstein:
Sometimes we go visit a physician and he gives advice, then we go visit a second physician and she gives different advice. We ask Open Evidence and it gives a third suggestion of what to do.
How is a patient supposed to make his or her decision based upon contradictory evidence by experts and now by an AI program.
Dr. Ari Ciment:
I think most patients feel more comfortable knowing what's out there, what are people saying, and the doctor's experiences.
Larry Bernstein:
Let's pick something straight down the center of the court, like how to deal with high blood pressure. My blood pressure is slightly raised, it was 130 over 90 and when I came into your office to discuss it, we placed it into Open Evidence and then Open Evidence started asking questions about more information about the patient. Let's do a test run using my facts.
Dr. Ari Ciment:
Putting in 58 male with blood pressure 130/90.
It's retrieving sources. It'll probably say diet and exercise.
Larry Bernstein:
I got to work on that.
Dr. Ari Ciment:
Yeah. This is one of the cool features of Open Evidence when it's such a basic question, it will not only give you an answer, but it will link you into the practice guideline. It says next step in the management of this 58-year-old man includes non-pharmacologic therapy including weight loss, heart healthy diet, the dash diet, sodium restriction, and then it goes over the American College of Cardiology definition of stage one hypertension, which is 130-139 and then it tells you your 10-year cardiovascular risk. It's less than 10%, but then it tells you, you should repeat your blood pressure checks in three to six months. It gives me all the outcomes based on your blood pressure from some JAMA articles and it's saying a choice of anti-hypertensive agent if indicated, should be individualized based on your tolerability and patient preferences.
Larry Bernstein:
Let's do a pulmonology case.
Dr. Ari Ciment:
What are unusual treatments for refractory cough meaning somebody who is coughing despite your treatment for allergies and inhalers and Robitussin DM and they're coming to your office, you ruled out everything. What else am I missing?
Beyond standard therapies are multimodality speech pathology therapy, going to a speech pathologist and baclofen. Baclofen is a neuromodulator and that is shown to help with some reflux induced cough. Gabapentin is the one that we typically use, but it gave me the dose to use based on my question. It's found me an article in elementary pharmacology and therapeutics.
That's a journal that I would never open up.
Larry Bernstein:
And why is that?
Dr. Ari Ciment:
It is not one of the bigger journals like Chest or Lancet.
Larry Bernstein:
And so given it is a journal you would never read, it reflects a lack of prestige. It's from a physician who couldn't get published in other majors. How do you use that information?
Dr. Ari Ciment:
It would give me less confidence, especially if it's quoting an article from 1990, but it's better than nothing. I ask unusual cases and it will give me at least a source that I could work with.
Larry Bernstein:
Let's take a more basic question. Let's say you have a healthy 25-year-old and she has a cough that won't go away. And what should the patient do?
Dr. Ari Ciment:
That's a very common pulmonary consult that we have. I'll put it into the Open Evidence and see if it is any different. We would check allergies, possibly do pulmonary function tests, possibly do a chest x-ray, look for reflux. It says most likely diagnoses for healthy 25-year-old with persistent cough. Most common are post-viral, post-infectious cough, upper airway cough syndrome like post-nasal-drip cough variant, asthma, reflux, environmental exposure. It says don't forget to ask about ACE inhibitors, which is a medicine. We see quite a bit of cough and chronic sinusitis.
Post-viral cough is common after upper respiratory infection typically resolves within three to eight weeks.
This could certainly replace a lot of the pulmonologists out there eventually. Some of these answers are very good, but then what I like about it in this type of basic question, it will say most important not to misdiagnosis. It'll say Pulmonary TB should be excluded if you have risk factors and then it will ask you to ask other key additional history and follow-up like how long has the cough been going on?
Larry Bernstein:
Let's say the cough has been going on for a year. It is been enough time; it should have gone away.
Dr. Ari Ciment:
Now one year, it says further evaluation with chest imaging, spirometry, which is the breathing test and going to see a pulmonologist.
Larry Bernstein:
How do you think this is going to change how doctors practice medicine?
Dr. Ari Ciment:
It's changing already. This is an avenue to help hospitals and doctors avoid some malpractice cases.
Larry Bernstein:
Can I take the other side? Open Evidence says to do X, doctor says Y…
Dr. Ari Ciment:
It could even make it worse. You're right.
Larry Bernstein:
Zoom medicine where we were no longer at the doctor's office, we'd have a chat and then we'd come to a conclusion either with a nurse practitioner or with a physician. I saw the world going in that direction, but I could imagine a world where I'm just going to look it up on Open Evidence myself if this were made available to the public. I'm not going to bother talking to the nurse practitioner.
Can you imagine where this would change the nature of how the public interacts with medical professionals?
Dr. Ari Ciment:
We're probably two to five years away where your first visit is going to be with an AI plugging in your history and then going to Quest Laboratory.
Larry Bernstein:
I assume what you meant by that was Open Evidence says the next step is to get a blood test, then the patient without the physician runs over to Quest and gets the test. I do not know how the insurance company interacts with all this, but you get the test even without the doctor suggestion and then you now go to the doctor with evidence for that meeting. Is that how you imagine it works?
Dr. Ari Ciment:
This is going to be powered by evidence-based guidelines. It could eventually work with the government that tells you, here's your prescription for your colonoscopy hand this to your GI doctor. We should be up-to-date in our screening, whether it be mammograms or colonoscopy.
Those are the two most important current screening protocols that we have and we're not doing a great job of doing this. It could prevent a lot of unnecessary deaths. AI is going to help people get screening faster.
What we're seeing especially in South Florida is concierge medicine. I think AI medicine will eventually have concierge services too. You pay an extra premium, it's going to be on your phone asking you, “how was your run today? What's your blood pressure?” And it will be hooked up with a smart physician and it will generate prescriptions. That's what I see in the next three to five years.
Larry Bernstein:
Do you see more tests? Do you see more medication? Fewer visits?
Dr. Ari Ciment:
I see less medication overall. If you screen for colon cancer and you catch it at stage one and you're cured, you're going to be better off in the future. It's going to help us find diseases earlier and you could treat it more effectively.
Larry Bernstein:
How will this change your learning experience with medicine?
Dr. Ari Ciment:
It will make specialists want to continue learning. Somebody like me, pulmonary critical care trained, I'm seeing pulmonary nodules, cough, COPD, asthma, lung cancer, but I'm not seeing gout, I'm not seeing rashes, I'm not seeing kidney stones, but guess what, Larry Bernstein, God forbid, calls me with the pain that looks like a kidney stone. I'm going to go to Open Evidence and I'm going to read it and I'm going to be reminded and I'm going to take ownership. That's another great advantage of something like this.
Larry Bernstein:
What are you excited about Open Evidence.
Dr. Ari Ciment:
This audience should be thrilled because the Mayo Clinic, New England Journal of Medicine, JAMA, they bought into this great idea evidence-based answers for medical questions. They did an overall amazing job and it's like it's talking to you.
Larry Bernstein:
Do you think there might be a bias, like it'll say, use Claritin or use this brand?
Dr. Ari Ciment:
If you go on the actual website, there are ads. There's definitely some inherent bias, so you have to be aware of that. Just the fact of who's paying for it. The overall benefits outweigh the risks and just as long as you can't just only be about the AI. You have to use it but don't only rely on it.
Larry Bernstein:
Thanks to Ari for joining us.
If you missed the last podcast, the topic was It’s What Every White Boy Off the Lake Wants. This was a Tom Cruise Retrospective.
Our speaker was Darren Schwartz who is the What Happens Next Culture Critic. The two of us went to the movie theater together to watch Mission Impossible -- The Final Reckoning. We reviewed the action film and how it fits into Tom Cruise’s body of work. We also discussed three of his other films including Collateral, A Few Good Men, and Risky Business.
I would like to make a plug for next week’s show. Our speaker is Eli Beer who is the founder and President of United Hatzalah. This is an organization led by volunteers who provide fast and free emergency medical first response throughout Israel.
You can find our previous episodes and transcripts on our website
whathappensnextin6minutes.com. Please follow us on Apple Podcasts or Spotify. Thank you for joining us today, goodbye.
Check out our previous episode, It’s What Every White Boy Off the Lake Wants, here.
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