It’s possible that I shall make an ass of myself. But in that case one can always get out of it with a little dialectic. I have, of course, so worded my proposition as to be right either way (K.Marx, Letter to F.Engels on the Indian Mutiny)
Friday, June 13, 2025
Characteristics of primary care physicians providing low-value care in japan
Tsukuba, Japan—Low-value care refers to health care services that have little or no net clinical benefit to the patient. Reducing such care is essential for avoiding unnecessary examinations and treatments, reducing healthcare costs, and reallocating limited medical resources--both financial and human--to more effective services. Despite the significance of this issue, the characteristics of the physicians who are provide such care more frequently have not been thoroughly investigated.
Using records of approximately 2.5 million patients from a large-scale clinic claim database, the researchers analyzed the provision of 10 types of low-value care service provided in primary care. They found that approximately 1 in 10 patients received at least one low-value care instance annually, with an overall rate of 17.2 episodes per 100 patients per year.
Further, nearly half of all low-value care services were provided by 10% of the physicians, where older physicians, physicians who were not board certified, and physicians having higher patient volumes being more likely to provide low-value care. Regional variation was also observed, where rates were higher in western Japan. These findings suggest that policy interventions that target a small number of certain types of physicians providing large quantities of low-value care may be more effective and efficient than interventions targeting all physicians uniformly.
Reducing the frequency of low-value and ineffective medical interventions is important to ensure the sustainability of healthcare systems while maintaining patient safety and the quality of care. The insights that are gained from this study can help inform future policy and improvements in clinical practice to optimize healthcare delivery.
### This study was supported by grants from the Health Care Science Institute (to Dr Miyawaki), the Japan Society for the Promotion of Science (grant 24K02701 to Dr Miyawaki), and Gregory Annenberg Weingarten GRoW @ Annenberg (to Dr Tsugawa).
Original Paper
Title of original paper: Primary Care Physician Characteristics and Low-Value Care Provision in Japan
While strawberry production runs from November through April in Florida, digital twin technology lets scientists simulate the growth of the fruit year-round, allowing research to proceed year-round.
A few years ago, Choi’s team built a digital twin of a strawberry field that copies every row, leaf and berry at life-size. Within that virtual field, scientists let the robot drive around and take thousands of photos of a simulated commercial farm in Hillsborough County.
Newly published research shows that AI trained exclusively in a digital twin environment using simulated strawberry fields achieved 92% accuracy in detecting fruit, without relying on real-world training data.
“Because the computer-simulated field never goes out of season, new berry-spotting tools can be prototyped even in the summer – speeding innovation,” Choi said. “The findings also mean lower development costs. Companies can test robotic pickers or smart sprayer designs in the digital twin, first, ironing out bugs before real-life trials. That ultimately lowers the price of new technology.”
The robot trained entirely on synthetic images also estimated real-world fruit diameter with only 1.2 millimeters of error – “good enough for commercial grading, using only synthetic, simulated data,” said Choi, a UF/IFAS assistant professor of agricultural and biological engineering.
This demonstrates the potential of AI models trained in virtual environments to support commercial decision-making tasks, such as classifying fruit based on characteristics like size or quality.
If growers know precise fruit size and volume, they can predict their yields and know when to harvest.
“The study shows that a realistic digital twin can jump-start AI tool development for strawberry farms, enabling faster, more cost-effective robotics innovation,” said Choi, a faculty member at the UF/IFAS Gulf Coast Research and Education Center.
“Normally, we’d have to take thousands of photos in real fields, label each one and wait for the right season,” she said. “That takes a lot of time and money. But with a digital twin, we can create and label these photos instantly.”
Furthermore, training in the virtual world eliminates the need to handle or label real images, saving weeks of field work.
Why does all this matter? It takes less money and time to build and improve new tools because scientists can test and fix them in a virtual setting before trying them in real life.
The digital twin platform could also support operator training and rapid prototyping of autonomous machinery, helping move agricultural technology from concept to field faster and more cost-effectively.
From left to right: Odile Rauzy, Dean of Toulouse III – Paul Sabatier University; Pierre Cordelier, Director of the Toulouse Cancer Research Center (CRCT); Marco Antonio Zago, President of FAPESP; Vahan Agopyan, Secretary of Science, Technology, and Innovation of São Paulo; and Marie-Hélène Baroux, President of the Higher Institute of Aeronautics and Space (ISAE-SUPAERO)
Scientific collaboration between researchers from France and the state of São Paulo in various fields has intensified and expanded in recent years, contributing to the increased impact of research in both regions.
This assessment was made by participants in the opening session of FAPESP Week France, which takes place from June 10th to 12th in Toulouse, the capital of the Occitanie region in southern France.
“France, along with the United States, the United Kingdom, and Germany, is one of the most important long-term partners of the scientific community in São Paulo. Scientific and technological cooperation between the two regions has been strong and growing. Over the past six years, researchers from France and São Paulo have published 9,800 scientific articles together, representing 52% of all articles published in international collaborations during this period,” said Marco Antonio Zago, President of FAPESP.
According to data presented by the Foundation’s director, the average citation impact of all articles published by French scientists who do not collaborate with São Paulo colleagues is 1.37. The average for São Paulo researchers is 1.02, which is above the world average. However, articles published last year by researchers from both regions in partnership had an average impact of 5.2.
“Collaboration is very good for both regions. That’s why we’re here today – to expand and strengthen this collaboration, which can take many different forms,” he emphasized.
The FAPESP Week France program features lectures by researchers affiliated with universities and research institutions, as well as science and technology-based companies and startups in the fields of health and aeronautics from the state of São Paulo and France.
The aeronautics session will take place at the Higher Institute of Aeronautics and Space (ISAE-SUPAERO). The health session will take place simultaneously with the aeronautics session at the Hôtel-Dieu Saint-Jacques. It was organized in partnership with the Cancer Research Center of the French National Institute of Health and Medical Research (INSERM), the National Center for Scientific Research (CNRS), and the University of Toulouse.
The scientific relationship between French and Brazilian researchers began in the mid-19th century, recalled Vahan Agopyan, Secretary of Science, Technology, and Innovation for the State of São Paulo.
“We have a very long relationship, which was strengthened during the 1930s and resumed with greater force at the beginning of this century,” he said.
The secretary emphasized that events such as FAPESP Weeks are crucial for fostering these historical relationships and promoting the globalization of research in São Paulo. “This type of activity not only provides an opportunity for São Paulo researchers to interact with colleagues from other countries but also helps train better scientists and exposes them to an international research environment,” he said.
Opportunities for collaboration
According to Marie-Hélène Baroux, President of ISAE-SUPAERO, one of the areas with great potential for expanding scientific collaboration between Brazil and France is aeronautics.
“France and São Paulo have common interests in strategic sectors such as aviation, which include topics such as artificial intelligence, drone development, and sustainability in aviation. On both sides of the Atlantic, we’re united by the common goal of making aviation more sustainable by reducing greenhouse gas emissions in this sector by 2030,” she said.
“This meeting between the two regions at FAPESP Week France is important and natural because the state of São Paulo has the highest concentration of aerospace activities in Brazil, and Toulouse is the European capital of aeronautics and space, where more than 100,000 people work in the sector,” she emphasized.
During the opening of the event, the institution renewed its cooperation agreements with the Technological Institute of Aeronautics (ITA) and the São Carlos School of Engineering at the University of São Paulo (EESC-USP).
“FAPESP Week gives us an opportunity to renew cooperation agreements with these institutions, building on the existing collaboration with USP and UNICAMP [State University of Campinas]. And the vitality of our knowledge exchange with the state of São Paulo certainly paves the way for new opportunities for collaboration in the future,” said Baroux.
The opening ceremony was also attended by the President of Toulouse III – Paul Sabatier University, Odile Rauzy.
“This meeting in Toulouse seeks excellence in research and higher education to address social and environmental challenges. Together, moving in the same direction, we’ll be stronger at a crucial moment for science,” she said.
Father-led program shows lasting dietary improvements in Mexican-heritage families
New research published in the Journal of Nutrition Education and Behavior highlights lasting health impacts of culturally tailored programs for Latino fathers
Lead author Annika Vahk, PhD, showcases the results of a father-focused nutrition and physical activity program that significantly improved long-term healthy dietary behaviors among Mexican-heritage fathers living in rural US communities. This 6-week program called ¡Haz Espacio para Papi! (Make Room for Daddy!) led to sustained increases in fruit and vegetable intake and healthy behaviors up to 2.5 years after completion. Findings point to the importance of culturally relevant, family-centered interventions, particularly those that prioritize familism and build skills together as a unit.
Credit: Journal of Nutrition Education and Behavior
Philadelphia, June 11, 2025 –A recent study in the Journal of Nutrition Education and Behavior, published by Elsevier, shows that a father-focused nutrition and physical activity program significantly improved long-term healthy dietary behaviors among Mexican-heritage fathers living in rural US communities. The 6-week program led to sustained increases in fruit and vegetable intake and healthy behaviors up to 2.5 years after completion.
The program, called ¡Haz Espacio para Papi! (Make Room for Daddy!), was delivered by promotoras (trained community health workers) in Texas border communities. It engaged 59 families with children aged 9–11 and included in-person group sessions, home-based activities, and interactive nutrition education. Fathers were assessed at baseline, after the program, 3–4 months later, and again 2.0–2.5 years later to measure dietary changes and behavior maintenance.
Results showed that participants increased their weekly fruit and vegetable consumption and improved overall dietary behavior scores over time. Fathers with lower education levels saw the greatest gains in vegetable intake, while older fathers tended to consume fewer vegetables than their younger peers.
Lead author of the study Annika Vahk, PhD, Eastern Washington University, Spokane, WA, said, “This study provides important evidence that culturally grounded programs centered on fathers can drive lasting dietary behavior change. Fathers play a vital role in modeling and supporting healthy behaviors in Latino families, and programs like HEPP can help activate that influence.”
The findings point to the importance of culturally relevant, family-centered interventions, particularly those that prioritize familism and build skills together as a unit. Future research should explore expanding the model to include a wider range of family structures and communities.
June 11, 2025—The next time your doctor suggests that you take a genetic test before prescribing a drug, you can thank a group of Black inmates imprisoned outside Chicago 75 years ago. The story starts with malaria research using prisoners but has long been told as if no Black participants were involved at all. That tale is now being rewritten.
Much attention has been paid to malaria research conducted on inmates at Illinois’ Stateville Penitentiary and the fraught ethical issues that the carceral studies raised. Stateville inmates were infected with the potentially fatal mosquito-borne disease from 1945 to 1974 to test the efficacy of various antimalarial treatments—part of a U.S. military-funded effort to protect American troops serving overseas.
The standard version of this history is that African-American prisoners were intentionally excluded from the infamous studies, based on the myth that Black people were immune to malaria.
University of Utah medical ethicists, led by philosophy professor James Tabery, are now shining a light on a buried part of the Stateville story in hopes of revealing how the prison experiments advanced medical science that benefits patients today, and which would not have happened were it not for the participation of Black inmates. The Utah research was funded by the National Institutes of Health and appears June 11 in JAMA (Journal of the American Medical Association).
The genetic basis of adverse drug reactions
Black inmates at Stateville were eventually brought into the malaria research in 1950—not to test antimalarials, but rather to figure out why the antimalarial drugs, such as primaquine, triggered dangerous adverse reactions in some people. This aspect of the Stateville research, in which at least 80 primaquine-sensitive inmates were studied, helped set the foundation for pharmacogenetics and “precision medicine,” the modern practice of tailoring medical treatment to individuals’ genetic profiles, according to former Utah graduate student Hannah Allen, first author on the study and now an assistant professor of philosophy at the University of Texas, Rio Grande Valley.
This study explores the history of research funded by the U.S. Army and led by Alf Alving, a nephrologist with the University of Chicago. The toxicity studies overloaded the prisoners with primaquine and then documented what happened to their physical health. The Stateville researchers discovered up to 10% of the African American subjects experienced an acute hemolytic reaction.
“This is where the drug is essentially destroying the body’s red blood cells at a faster rate than they are being produced,” Allen said. “This occurs due to an enzymatic deficiency that makes metabolizing the drug difficult. It's incredibly painful. You have a decrease in oxygenation to your limbs and organs, so it causes cyanosis, nausea, fatigue. Some people's spleens failed, or kidneys started to fail, the urine becomes really dark.”
The Stateville researchers shifted their focus to unearthing the basis for this primaquine sensitivity.
“That was the genuine mystery,” said Tabery, a member of University of Utah’s Center for Health Ethics, Arts & Humanities. “Why is it the case that certain people have this really awful reaction to these drugs and nobody else does? Trying to answer that question is what sets the stage for modern pharmacogenetics.”
In 1956, Alving’s team discovered the genetic basis of primaquine sensitivity boiled down to an inability to sufficiently produce an enzyme, known as glucose-6-phosphate dehydrogenase (G6PD), leaving the patient unable to combat oxidative stress triggered by exposure to the drug. The discovery was important because it told a clear genetic story behind a vexing health phenomenon and helped set the stage for avoiding dangerous drug reactions by testing people first to determine who might be sensitive.
Doctors now routinely administer genetic tests to their patients before prescribing certain drugs to decrease the risks of adverse reaction—a cardiologist who checks her patient’s genetic profile before prescribing a blood thinner, or an infectious disease specialist who ensures their patient with HIV will tolerate abacavir. These preventive measures are direct pharmacogenetic descendants of what was learned from Black research participants at Stateville.
A proper acknowledgment of the prisoners
Setting up that pharmacogenetic revolution came at a cost to the Black prisoners involved, according to Allen and Tabery’s research. In addition to the debilitating experience of the hemolytic anemia, the inmates’ identifiable information was regularly reported in publications, family members were even recruited into the controversial studies, and they were paid less than the white prisoners.
“There was a clear difference between what the white prisoners and Black prisoners experienced in the research conducted at Stateville,” they said.
Medical research involving prisoners—at Stateville and across the nation—was suspended in 1974 over ethical concerns centered on informed consent and coercion. The Stateville Penitentiary itself has been shuttered; the last inmates were moved out this year, and old cellblocks are planned for demolition.
Stateville was built in 1925 as a maximum-security prison with state-of-the-art panopticon structures where every cell could be observed from a central guard station. Its iconic roundhouse cellblocks became famous as sets in TV shows and major films, such as “Natural Born Killers” and “Bad Boys,” and the prison was the subject of the 1961 documentary, “Life at Stateville: The Wasted Years.”
Because prisoner records are sealed for 75 years under Illinois state law, historians today are not able to identify the participants after 1950 except through contemporaneous press accounts, Tabery said. Those accounts focused largely on the white prisoners who were tested for drug effectiveness. Accordingly, the Black participants’ identities remain obscured.
Still, Allen and Tabery are exploring other ways to properly acknowledge the role played by Black men in this transformational medical research—spotlighting the role of Black prisoners in museum exhibits about the history, and with science educators to develop lessons about pharmacogenetics oriented around the prisoner participants. As the JAMA publication concludes, “The medical community still has much to learn from what occurred at Stateville, and it is essential to recognize the participants—the people—who were at the center of it.”
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The study was published in JAMA on June 11 under title “The Black Prisoners of Stateville: Race, Research, and Reckoning at the Dawn of Precision Medicine.” The research formed part of Hannah Allen’s dissertation. The research was supported by a grant from the National Human Genome Research Institute (RM1HG009037). Content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Interior of the Stateville F Block as it appears today.
Credit
James Tabery, University of Utah
Journal
JAMA
Method of Research
Literature review
Subject of Research
Not applicable
Article Title
The Black Prisoners of Stateville: Race, Research, and Reckoning at the Dawn of Precision Medicine
