Robert Kirchoff, MD, FACP, FASAM

Thanks!

It looks like it’s same feed name, does anything additional need to be done?

🍄 ➡️ 🚭 ? The future of addiction medicine is so much more than just receptor blockade and suppression of cravings…but rather attention to disruption of rigid neural loops, increasing neuroplasticity, and reprocessing of trauma and behavior in a therapeutic setting #addictionmed #medsky #psychedelics

Xzibit smiling

LLM-assisted systematic review of large language models in clinical medicine - Nature Medicine A large language model (LLM)-powered systematic review of over 1,000 studies revealed that, despite the growth of medical research involving LLMs, a majority of studies do not involve real-world clini...

“Yo dawg, I heard you liked large language models…” insert <xzibit.gif> #medsky #research #meme

A quick read from @thelancet.com.

Hi @notwes.bsky.social 👋

This is worth talking about. Great study and a potential game changer. #cdiff #IDsky #medsky

@tipperofcows.bsky.social truth.

My favorite podcast host speaking the truth yet again. I treat patients from Minneapolis every day. I hear their traumas, I hear their stories. I stand with you. This affects all of us.

Do use.

🚨 New on REBEL EM!
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#EMIMCC #FOAMed #MedSky

A few of us were just talking about effecting change in this current climate where nothing matters and everything is what is fed to you. some things were brought to my attention that I didn’t know.It changed my behavior.Does that make @tipperofcows.bsky.social an INFLUENCIAL HERO? I think it does.

I believe it usually laziness or apathy. The belief system that “my individual contribution makes no difference, so it’s just won’t do anything because it’s inconvenient.” The juice isn’t worth the squeeze. We have this debate often in our core group of friends. Wild stuff. Wild.

Also credit to @jennschiffer.com for the original skeet, of course

Reskeeting this so that friends in my slack group will see it twice. Some of the most important content @notwes.bsky.social has posted. As my drill sergeants always said to us: “It’s too damn easy to do the right thing”

Cannabis Hyperemesis Syndrome: Pharmacological and Toxicological Perspectives Cannabis hyperemesis syndrome (CHS) is a disorder of gut-brain interaction with symptoms of nausea, severe episodic vomiting, and abdominal pain. The …

Check out our team’s latest article in Current Opinion in Toxicology here! 🌿 🔬 💊 👨‍⚕️

Romero, PM, Heard, KJ, Oblizajek, NR, Qadeer, A, Kirchoff, RW, and Leung, MCK. (2026). Cannabis Hyperemesis Syndrome: Pharmacological and Toxicological Perspectives. (In press)

Breaking Up with Nicotine: How to Kick a Nicotine Dependency YouTube video by Mayo Clinic

🎙️ It was a pleasure to be a guest on the Mayo Clinic Health Matters podcast discussing nicotine dependence.

We covered addiction neurobiology, withdrawal physiology, and evidence-based pharmacologic and behavioral strategies that improve cessation outcomes.

▶️ youtu.be/r_o0f8F70ag

Multi-model assurance analysis showing large language models are highly vulnerable to adversarial hallucination attacks during clinical decision support - Communications Medicine Omar et al. test six leading large language models with 300 doctor-designed clinical vignettes containing a single fake lab value, sign or disease. They show that the models repeat or elaborate on the...

www.nature.com/articles/s43... Nothing reassures you about the future of medicine quite like an AI that hallucinates citations, misses obvious contraindications, and still gets marketed as “clinical decision support.” This is fine.

This is life support, by the way. Those medications are keeping the patient alive and if stopped for only a moment would likely result in death. The nurse manages all of that.

No one is going to save you. Certainly not 911. It’s over. The saddest days are ahead. 😕

Assigning a npm package to global.fetch is a hack. How it thata an architectural solution lol. I get its tongue in cheek she didn't actually quit It just all feels whatever. This isn't my field but just wanted to say hi.

That’s not a glitch or whatever if the runtime doesn’t support native fetch, the reasonble response is to pin a compatible node version, upgrade the platform, or scope the polyfill locally.

False-Certainty Probability Formula
P_h = α × (T_c / D_c)
Where:
P_h = hallucination probability
T_c = tone confidence
D_c = domain correctness
α = corpus bias constant
When T_c ↑ but D_c ↓ → P_h spikes.

AI will not replace physicians. Relax.

Two interesting formulas to consider:
P(disease | symptom) ∝ P(symptom | disease) × P(disease)
P(drug | disease) ∝ P(drug | review) × P(review | rating)

Wishing everyone a very anti-MAGA thanksgiving. May your holidays be filled with tolerance, peace, and a complete absence of xenophobia.

Covid-era rules for addiction medication, Ritalin are extended again For a fourth time, the government avoids making permanent policy on telehealth prescriptions of controlled medications for addiction and ADHD.

Encouraging news: COVID-era telehealth rules for addiction meds are likely extended again. Not yet official, but reassuring that these vital services will remain in place for those who need them most. Barriers to treatment are steep—telehealth bridges the gap.

Important work

This one took a while to get accepted, but we are excited to take this off the project dashboard. Congrats all! #pocus #research #academicmedicine

It’s almost as though non-scientists /cognitively deficient conspiracy theorists shouldn’t be making decisions that impact public health. 🤷🏽 #medsky