Bibliographic record
Abstract
Dr. Gerson raises timely issues: there may be alternative bases on which to support the provision of a given healthcare service, and people may differ in how they value different services. Certainly, enhanced patient satisfaction, among a wider set of criteria, could be used to support an expansion of healthcare services, such as anesthesiologist involvement in colonoscopy sedation, as he suggests.Although the demand for services is infinite, societal resources are finite, if not overstretched. Budgetary limitations in every country prompt difficult choices about which services to provide. Decisions principally reflect judgments about medical necessity, generally based on demonstrated benefit (e.g. , efficacy and effectiveness) and, increasingly, perceived value (i.e , cost effectiveness) in effecting population health. Dr. Gerson perhaps unwittingly acknowledges this critical point when he notes, “I think only those who pay for anesthesiologists' services [for colonoscopy sedation] might be less satisfied.”Underlying the urgency of U.S. healthcare reform is the need to increase value in our feast-and-famine healthcare system; although first in per-capita healthcare spending, we have mediocre comparative population health rankings that have declined over three decades1: one-sixth of our population without health insurance, and uncontrolled healthcare costs that are an important factor in personal, corporate, and governmental bankruptcies. The lack of association between anesthesiologist involvement in colonoscopy sedation in the Canadian province of Ontario and patient acuity in the study by Alharbi et al. 2indicates that the service is not a medical necessity and, thus, has low value. As we noted in our editorial,3fragmentary evidence suggests that the same phenomenon prevails in the United States. Hence, we remain confident that anesthesiologist involvement in colonoscopy sedation in the absence of medical indication (e.g. , severe comorbidity) is a low-value service that is ripe for pruning as healthcare reform progresses.*Yale University School of Medicine, New Haven, Connecticut. fred.orkin68@post.harvard.edu
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.031 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.005 | 0.006 |
| Scholarly communication | 0.004 | 0.011 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.012 | 0.024 |
| Insufficient payload (model declined to judge) | 0.026 | 0.010 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".