AI Outperforms Doctors at ER Triage, Shingrix and Immune Reconstitution Syndrome, ADHD Subtypes and Hookworms for Asthma Treatment

About this episode

Broadcast from KSQD, Santa Cruz on 5-21-2026:

• This is the second show featuring Mira Achilles, a UCSC graduate working on her masters in epidemiology. Dr. Dawn and Mira open with a Harvard study showing OpenAI's o1 reasoning model reached correct diagnoses 67% of the time versus 50-55% for physicians, and scored 89% versus 34% on treatment plans. The AI advantage shrinks when doctors get more data and time, suggesting its greatest value is in fast-moving triage. Dr. Dawn cautions that over-reliance on AI during residency could undermine the clinical reasoning neurologic pathways doctors must develop, and emphasizes the "zebra paradox"— rare diseases remain rare even when symptoms match the textbook.
• Dr. Dawn shares a personal case of a patient with throat shingles, leading her to use a medical AI (OpenEvidence) to investigate Shingrix risks. An Australian study found an elevenfold increase in shingles within 21 days of the first Shingrix dose in adults over 65, though dose two reduced overall risk by 73%. She explains this could be one of several things such as immune reconstitution inflammatory syndrome (IRIS), or that the AS01B vaccine adjuvant's strong activation may transiently reactivate latent virus, and recommends valacyclovir prophylaxis for high-risk patients for their first Shringrex shot..
• Mira discusses AI in education, noting the shift from professors threatening plagiarism charges to teaching students how to critique AI output, emphasizing taking summaries "with a grain of salt."
• Dr. Dawn describes Chinese research scanning 1,154 children that identified a third ADHD subtype—severe emotional dysregulation—showing 45 abnormal brain regions versus 26 in the inattentive and hyperactive-impulsive types, with standard stimulants working poorly for this group. She connects this to traditional psychiatric personality disorder classifications and
• A discussion of vagus nerve stimulation's emerging applications for autoimmune conditions.
• Dr. Dawn and Mira discuss menstruation and bodily autonomy, then describe the Somedays period pain simulator that uses electrical impulses to let men experience menstrual cramps, highlighting differing pain thresholds.
• An emailer references a Radiolab episode about deliberate hookworm infection to treat asthma and allergies. Dr. Dawn explains parasites release immunosuppressants to survive, including anti-inflammatory protein-2 (AIP) now in drug development, which stimulates T-regulatory cells and IL-10 while "alarmins" inhibit lung inflammation—though this increases vulnerability to new infections.
• A caller with H. pylori and frequent viral infections asks whether S. boulardii and reuteri probiotics are safe given her low immunity. Dr. Dawn explains immunosuppression warnings target transplant-level drug suppression, not a tendency toward viruses like hers. Dr. Dawn thinks that her near-zero natural killer cells explain frequent infections, and suggests that the H. pylori test given her absence of symptoms, may be an incidental bystander rather than the cause of her low ferritin, which suggests bleeding.
• In medical news of the weird, Dr. Dawn describes Baby Cassian, diagnosed in utero with congenital high airway obstruction syndrome (CHAOS), who was partially removed from the womb at 25 weeks for airway surgery, returned, and born again at 31 weeks—leading to a discussion of microsurgery and how specialties partition by the physical scale of the surgery rather the location or type of structure.