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How Did the AI “Claude” Get Its Name?

By MIKE MAGEE

Let me be the first to introduce you to Claude Elwood Shannon. If you have never heard of him but consider yourself informed and engaged, including at the interface of AI and Medicine, don’t be embarrassed. I taught a semester of “AI and Medicine” in 2024 and only recently was introduced to “Claude.”

Let’s begin with the fact that the product, Claude, is not the same as the person, Claude. The person died a quarter century ago and except for those deep in the field of AI has largely been forgotten – until now.

Among those in the know, Claude Elwood Shannon is often referred to as the “father of information theory.” He graduated from the University of Michigan in 1936 where he majored in electrical engineering and mathematics. At 21, as a Master’s student at MIT, he wrote a Master’s Thesis titled “A Symbolic Analysis Relay and Switching Circuits” which those in the know claim was “the birth certificate of the digital revolution,” earning him the Alfred Noble Prize in 1939 (No, not that Nobel Prize).

None of this was particularly obvious in those early years. A University of Michigan biopic claims, “If you were looking for world changers in the U-M class of 1936, you probably would not have singled out Claude Shannon. The shy, stick-thin young man from Gaylord, Michigan, had a studious air and, at times, a playful smirk—but none of the obvious aspects of greatness. In the Michiganensian yearbook, Shannon is one more face in the crowd, his tie tightly knotted and his hair neatly parted for his senior photo.”

But that was one of the historic misreads of all time, according to his alma mater. “That unassuming senior would go on to take his place among the most influential Michigan alumni of all time—and among the towering scientific geniuses of the 20th century…It was Shannon who created the “bit,” the first objective measurement of the information content of any message—but that statement minimizes his contributions. It would be more accurate to say that Claude Shannon invented the modern concept of information. Scientific American called his groundbreaking 1948 paper, “A Mathematical Theory of Communication,” the “Magna Carta of the Information Age.”

I was introduced to “Claude” just 5 days ago by Washington Post Technology Columnist, Geoffrey Fowler – Claude the product, not the person. His article, titled “5 AI bots took our tough reading test. One was smartest — and it wasn’t ChatGPT,” caught my eye. As he explained, “We challenged AI helpers to decode legal contracts, simplify medical research, speed-read a novel and make sense of Trump speeches.”

Judging the results of the medical research test was Scripps Research Translational Institute luminary, Eric Topol.  The 5 AI products were asked 115 questions on the content of two scientific research papers : Three-year outcomes of post-acute sequelae of COVID-19 and Retinal Optical Coherence Tomography Features Associated With Incident and Prevalent Parkinson Disease.

Not to bury the lead, Claude – the product – won decisively, not only in science but also overall against four name brand competitors I was familiar with – Google’s Gemini, Open AI’s ChatGPT, Microsoft Copilot, and MetaAI. Which left me a bit embarrassed. How had I never heard of Claude the product?

For the answer, let’s retrace a bit of AI history.

Continue reading…

What AI and Grief-bots Can Teach Us About Supporting Grieving People

By MELISSA LUNARDINI

The Rise of Digital Grief Support

We’re witnessing a shift in how we process one of humanity’s most universal experiences: grief. Several companies have emerged in recent years to develop grief-related technology, where users can interact with AI versions of deceased loved ones or turn to general AI platforms for grief support.

This isn’t just curiosity, it’s a response to a genuine lack of human connection and support. The rise of grief-focused AI reveals something uncomfortable about our society: people are turning to machines because they’re not getting what they need from the humans around them.

Why People Are Choosing  Digital Over Human Support

The grief tech industry is ramping up, with MIT Technology Review reporting that “at least half a dozen companies” in China are offering AI services for interacting with deceased loved ones. Companies like Character.AI, Nomi, Replika, StoryFile, and HereAfter AI offer users the ability to create and engage with the “likeness” of deceased persons, while many other users use AI as a way to quickly normalize and seek answers for their grief. This digital migration isn’t happening in a vacuum. It’s a direct response to the failures of our current support systems:

  • Social Discomfort: Our grief-illiterate society struggles with how to respond to loss. Friends and family often disappear within weeks, leaving mourners isolated when they need support, especially months later.
  • Professional Barriers: Traditional grief counseling is expensive, with long wait times. Many therapists lack proper grief training, with some reporting no grief-related education in their programs. This leaves people without accessible, qualified support when they need it most.
  • Fear of Judgment: People often feel safer sharing intimate grief experiences with AI than with humans who might judge, offer unwanted advice, or grow uncomfortable with the intensity of their grief.

The ELIZA Effect

To understand why grief-focused AI is succeeding, we must look back to 1966, when the first AI-companion program called ELIZA was developed. Created by MIT’s Joseph Weizenbaum, ELIZA simulated conversation using simple pattern matching, specifically mimicking a Rogerian psychotherapist using person-centered therapy. 

Rogerian therapy was perfect for this experiment because it relies heavily on mirroring what the person says. The AI companion’s role was simple: reflect back what the person said with questions like “How does that make you feel?” or “Tell me more about that.” Weizenbaum was surprised that people formed deep emotional connections with this simple program, confiding their most intimate thoughts and feelings. This phenomenon became known as the “ELIZA effect”.

ELIZA worked not because it was sophisticated but because it embodied the core principles of effective emotional support, something we as a society can learn from (or in some cases relearn).

What AI and Grief-bots Get Right

Modern grief-focused AI succeeds for the same reasons ELIZA did, but with enhanced capabilities. Here’s what AI is doing right:

  • Non-Judgmental Presence: AI doesn’t recoil from grief’s intensity. It won’t tell you to “move on,” suggest you should be “over it by now,” or change the subject when your pain becomes uncomfortable. It simply witnesses and reflects.
  • Unconditional Availability: Grief doesn’t follow business hours. It strikes at 3 AM on a Tuesday, during family gatherings, while you’re at work, or on a grocery run. AI works 24/7, providing instant support by quickly normalizing common grief experiences like “I just saw someone who looked like my mom in the grocery store, am I going mad?” AI’s response demonstrates effective validation: “You’re not going mad at all. This is actually a very common experience when grieving someone close to you. Your brain is wired to recognize familiar patterns, especially faces of people who were important to you… This is completely normal. Your mind is still processing your loss, and these moments of recognition show just how deeply your mom is still with you in your memories and awareness.” Simple, on-demand validation helps grievers instantly feel normal and understood.
  • Pure Focus on the Griever: AI doesn’t hijack your story to share its own experiences. It doesn’t offer unsolicited advice about what you “should” do or grow weary of hearing the same story repeatedly. Its attention is entirely yours.
  • Validation Without Agenda: Unlike humans, who may rush to make you feel better (often for their own comfort), AI validates emotions without trying to fix or change them. It normalizes grief without pathologizing it.
  • Privacy and Safety: AI holds space for the “good, bad, and ugly” parts of grief confidentially. There’s no fear of social judgment, no worry about burdening someone, no concern about saying the “wrong” thing.
  • No Strings Attached: AI doesn’t need emotional reciprocity. It won’t eventually need comforting, grow tired of your grief, or abandon you if your healing takes longer than expected.

AI Can Do It, But Humans Can Do It Better. Much Better.

According to a 2025 article in Harvard Business Review, the #1 use of AI so far in 2025 is therapy and companionship.

Continue reading…

Now is the Time to Modernize Communication in the Medicaid Program

By ABNER MASON

What do television shows 60 Minutes, Roseanne, Designing Women, and Murder, She Wrote all have in common? They were top 10 prime time shows in the 1991 – 92 season according to Nielson Media research. Obviously, what Americans want to watch has changed in 34 years. The decline in market share the major networks – ABC, CBS, and NBC – have experienced, and the dramatic growth of streaming services proves the point. It makes sense to let people watch what they want to watch on the device of their choice, and use new technologies like streaming services to access the shows they want to watch.  It would be foolish for us to insist that Americans watch only shows from the legacy networks on traditional TVs. But this is basically what we are doing now when we force Medicaid Managed Care Plans (Plans) to comply with a 1991 Federal Law when they communicate with Medicaid recipients.

Here’s the problem. Federal legislation called the Telephone Consumer Protection Act (TCPA), enacted in 1991, makes it very difficult for States and Plans to use text messaging to communicate with their members, even though texting is the primary, and preferred mode of communication for all Americans including Medicaid recipients. TCPA requires a State or Plan sending a text to have permission from the person receiving the text before the text is sent. Violations of TCPA result in significant financial penalties for each infraction, and penalties are tripled if the sender knowingly sent the text without consent.

Medicaid recipients are typically assigned to Plans, they do not choose their Plan, and as a result, in light of TCPA, and potentially enormous financial penalties being assessed, plans have taken the position that they do not have consent from recipients to text them. And that is the problem.

Texting is the way most Americans communicate today. Other modalities like US mail (called snail mail for a reason), phone calls (who answers calls anymore?), and email (likely to go without a response for days or weeks) are dramatically less effective. Because they are low income, many Medicaid recipients often do not have a landline, or a laptop. They rely on their mobile phone for all their communication, including healthcare related communication. Texting is their preferred, and often only way of communicating.

As Founder and CEO for SameSky Health, I spent over a decade working with Plans to help them engage their members and navigate them into healthcare at the right time and the right place. Again and again, we found when we could maneuver around the outdated restrictions TCPA placed on Plans, we got higher engagement which translated into more well child visits, more breast cancer screenings, more diabetes (a1c) screenings, and so on. Using modern tools of communication is a way of meeting people where they are. It builds trust and leads to better health outcomes. But sadly, because of TCPA, we were not able to text members in most instances.

What has been a significant problem will be made exponentially worse when Federal Work Requirements are implemented as now seems likely. A Federal Medicaid Work requirement will dramatically increase the need to modernize how States and Plans communicate with Medicaid recipients. Compliance with TCPA is standing in the way of this modernization. And if it is not fixed, many, many people will lose their Medicaid benefits for purely procedural reasons.

To improve health outcomes, allow efficient communication to verify work status,  and provide twice yearly redetermination information, States and Plans must be exempted from the outdated provisions of TCPA. Senate action on, and final passage of the Reconciliation legislation offers the best opportunity to get an exemption from TCPA passed and signed into law.

The time to act is now.

So lets focus on (1) getting the exemption language in the Senate version of the Reconciliation legislation, (2) working with HHS and CMS to ensure post legislation guidance directs States and Plans to include texting as a best practice when implementing work requirement programs and communicating with recipients more generally, and (3) implementing a media strategy to build support for using modern technology to create easier more efficient ways for Medicaid recipients to comply with the new work requirements.

We have two months – June and July – to get action on an exemption in the Senate, and the remainder of the year to influence Administration guidance on work requirement programs.

Medicaid beneficiaries will be the biggest winners if we succeed because an exemption is a key strategy to reduce unnecessary loss of Medicaid benefits.

What can you do? Call your Senator and ask them to support modernizing how States and Plans communicate with Medicaid recipients. And please share this blog post with your network.

Abner Mason is Chief Strategy and Transformation Officer for GroundGame Health. He serves on the Board for Manifest MedEx, California’s largest health information exchange, is Vice-Chair of the Board for the California Black Health Network, and is a member of the National Commission on Climate and Workforce Health. Here are are just some of articles and interviews he has published over the past 10 years pushing for States and Plans to be able to text Medicaid recipients. 

Personal and Professional Choices in PSA Testing: A Teaching Moment

By KELLI DEETER  

I was intrigued by Daniel Stone’s piece on THCB in May titled “Biden’s cancer diagnosis as a teaching moment”. In my practice as a board-certified nurse practitioner, I am frequently asked about prostate specific antigen (PSA) testing by my male patients.  

Nursing practice and medical practice often get blurred or lumped together. In the state of Colorado, nurse practitioners practice under their own license, and can independently diagnose and treat patients. In some settings where I have worked, I found myself frequently correcting patients who refer to me as ‘doctor’. “I am not a medical  doctor, I am a nurse practitioner,” is repeated by me multiples of times per day. In this discussion of PSA testing, I want to share my decisions to order or not to order PSA testing for individuals, based on my nursing training.  

It is important to refer to the guidelines for PSA testing recommended by the US Preventive Services Task Force (USPSTF), and published by the Journal of the American Medical Association (JAMA). The last updates made to the guidelines were in 2018. It is key to remember that these are guidelines, and that medical doctors, physician assistants, and  nurse practitioners use these guidelines in their consideration of the patient. In nursing, a holistic and team approach with the patient’s preferences, history, cultural considerations, and desired outcome are all weighted in decision making for assessment, testing, referral, and treatment. Guidelines are just that, a GUIDE, not an absolute.  

Guidelines state that for patients aged 55-69: Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction… Clinicians should not screen men who do not express a preference for screening. And for patients  aged 70 and older: The USPSTF recommends against PSA-based screening for prostate cancer. This does not mean that we as providers should not test men younger than 55 or older than 70. We need to look at each patient case independently of one another and not  lump everyone together. 

Additionally, patients may not know how to “express a preference for  screening”. It is imperative that providers have the allotted time to explore their family history of prostate and other cancers, explain to them the benefits and risks of testing, listen to and discuss their signs and symptoms, perform a digital rectal exam (DRE) if appropriate and agreed on by the patient, take into consideration their medication regimen and their age, as well as if they would want treatment or not. Certainly, if they are symptomatic, and a new medication for their symptoms is being prescribed, or if they are symptomatic and a DRE is obtained that is abnormal, a PSA should be obtained with the  patient’s approval to establish a baseline, and a follow-up appointment made with repeat  labs or referral, if desired by the patient. If there is a family history of prostate cancer, an  early PSA screening test to establish a baseline might be preferable. Again, patient  preferences must be taken into account.  

People have very different feelings about western medicine and about what they want for  themselves and their bodies. We must realize that just because someone has an ever increasing PSA with or without symptoms, they may not agree to a DRE or to referral to  urology, surgery, or oncology. As a provider, we should obtain a refusal of recommended care. It is ok to not want testing, follow-up, or treatment, no matter one’s age. In Biden’s  case, there had been no PSA testing since 2014, during his vice presidency. The fact that no reason was given is irrelevant, in 2014 he was 72 years old. Guidelines are not to test  starting at age 70. The PSA level if drawn may not have aƯected his health outcome or  treatment, but it may have affected the outcome of his nomination for the presidency, thus politicizing nursing and medical practice. Pointing fingers now at the past changes nothing. I agree with Stone, that this is a teaching moment: advocate for yourself as a patient, advocate for your patient as a provider, and consider that so much of one’s health is a personal choice and that it should be honored and protected.  

I agree with Peter Attia’s contention in his May 24, 2024, A timely though tragic lesson on  prostate cancer screening, that the PSA screening guidelines are out of date; the last revision was in 2018. Attia indicates many men remain healthy and live well past the age of  80, and aggressive cancers if caught early and treated, will better benefit the patient’s quality of life and length of life. I would also argue this is true of screening earlier in life, at age 50. Access to health care is an issue for many in our society. Marginalized populations such as  the indigent, homeless, geriatric, mentally ill, and incarcerated experience greater  disparities, and have a higher risk of missing any PSA testing at all. In my work as a nurse  practitioner in the correctional system, for individuals entering jails and prisons this is  often the first time they have ever seen a healthcare provider. These individuals often have  a history of indigence, homelessness, and/or mental illness. Additionally, new cancer diagnoses are increasing and for men; 29% of new cancer types are prostate. 

Age 50 is a  milestone for most individuals, and they know they are supposed to get screening for colorectal cancer at this age as well as other screening tests. Consolidating care by capturing a PSA at this same time would establish an early baseline; there is never a guarantee that a patient with healthcare access issues will ever return for another appointment, due to finances, transportation, fear, or other factors. Another consideration for revising the PSA screening guidelines is lowering the threshold for PSA levels based on patient age that drive referral to urology for imaging, and putting simple language into the guidelines to look at a two-fold increase in PSA over 6-12 weeks as likely urgent referral to  urology. Initiating early watchful waiting with PSA screening has the potential for saving  more lives and maintaining desired qualities of life.

Kelli Deeter is a board-certified family nurse practitioner with 12 years of experience in geriatrics, rehabilitation, correction, women’s health, mental health, and complex chronic care.

Waste, Fraud and Abuse – Oh, My!

By KIM BELLARD

So the House has passed their “big, beautiful bill,” by the narrowest of margins. Crucial to the bill are large savings from Medicaid, which in past years Republicans would have taken some glee from but now they are careful to explain away as just cutting “waste, fraud and abuse,” having finally realized that many MAGA voters depend on Medicaid.

Much of those savings come from proposed work requirements for Medicaid recipients, long a favored Republican tactic that the Biden Administration kept rejecting. Speaker Mike Johnson is very vocal about their importance. The people impacted by the work requirements, he insisted on Face the Nation:

If you are able to work and you refuse to do so, you are defrauding the system. You’re cheating the system. And no one in the country believes that that’s right. So there’s a moral component to what we’re doing. And when you make young men work, it’s good for them, it’s good for their dignity, it’s good for their self-worth, and it’s good for the community that they live in.  

He’s convinced that, instead of working, too many of them – especially young men – “playing video games all day.” He and other Republicans want to return Medicaid to what they see as its original purpose: “It’s intended for young, you know, single, pregnant women and the disabled and the elderly,” Speaker Johnsom said. “But what’s happening right now is you have a lot of people, for example, young men, able-bodied workers, who are on Medicaid. They’re not working when they can.”

He’s generally right that, for most of its existence, Medicaid was not truly a program for the poor so much as for certain kinds of poor people, especially low income pregnant women and children, and the medically impoverished. It took Obamacare to widen coverage to all people under the poverty line, although the Supreme Court allowed states to decide if they wanted to do so, and ten states still have not.

It is, indeed, a moral question, just not the kind that Speaker Johnson likes, about whether there is a moral imperative to give more people, especially poor people, health coverage.  

The issue of these non-working Medicaid recipients is something of a shibboleth. Kaiser Family Foundation, for example, found “that 92% of Medicaid adults are either working (64%) or have circumstances that may qualify them for an exemption.” A 2023 CBO analysis cast doubt that such work requirements wouldn’t have much impact on the number of Medicaid recipients working. Work requirements are a solution in search of a problem.

Continue reading…

The Crawfish Chronicles: An NIH Fixed Cost Cap Parable

By GREGORY HOPSON

T-Maître Pierre’s Family Restaurant was a Louisiana institution. The kind of place where generations gathered over steaming mountains of boiled crawfish, spicy corn, and seasoned potatoes. A place where Clifton Chenier’s Louisiana Blues & Zydeco played in the background and the waitstaff wore starched white shirts with bright-colored bow ties. The walls were plastered with faded photos of people smiling. Nobody knew who they were anymore, but they felt like family.

Pierre Thibodeaux, the founder, made sure every customer was treated as if they were indeed family. So it was a bit ironic that when he passed away, he had no heirs. 

Within the week, the restaurant was acquired by multi-million-dollar developer O. B. Noxious, who addressed reporters beneath a banner that read:

MAKE CRAWFISH AMAZING AGAIN
“They call these little lobsters crawfish. Very smart. I like that. We’re keeping that name. Everything else? Outdated. Inefficient. Sad. We’re going to take this failing shack and turn it into the greatest restaurant the world has ever seen. People will come from everywhere and say, ‘Wow! I’ve never had crawfish this good. It’s the best anyone has ever tasted.’”

To oversee the transformation, Noxious brought in Otto Maladore, a consultant known for running billion-dollar companies and doing math in his head (where he also did all of his research).

Maladore spent thirty minutes walking the property, leaning over this, pressing on that, and stepping back from things while shaking his head. It wasn’t long before he issued his report to the press:

  • Excess Labor: “Wait staff, custodian, dishwasher? None of them cook so we’re wasting money on them. Eliminate all of those positions.”
  • Menu Simplification: “Boiled crawfish outsells everything. Eliminate everything else. Eliminate the menu itself. Menus are nothing more than administrative bloat.”
  • Décor: “We will have the best of everything. Those photos are faded and were low quality when they were new. Remove them.”
  • IT Modernization: “Found an IBM 5150 still running their books. This fascinates me-and concerns me-on so many different levels.”
  • Fixed Costs: “This place is hemorrhaging due to indirect costs. Forty percent of revenue on facilities and administration? That’s insane. Ten percent is more than enough for a place like this! But we’re far more generous and much more compassionate than people give us credit for. So we’re not going to cap it at 10%. We’re going to bump it all the way up to 15%!”

The changes happened quickly-literally overnight.

The next day when customers showed up, they found no music. No waiters. No ambiance. Just folding chairs, a beat-up old card table, and flickering fluorescent lights (they were told the remodeling would be done later). The walls were bare except for a sign that read:

T-MAÎTRE PIERRE’S CRAWFISH

READ CAREFULLY!!!!!!

  1. Proceed to the back parking lot and sign in.
    You will be assigned a ten-minute time slot for boiling.
  2. You will receive:
    a. Live crawfish
    b. Unshucked corn
    c. Potatoes (with high-quality dirt: pH between 6 and 6.5)
  3. Boiling pot pre-heated to exactly 212°F.
    DO NOT ADD OR REMOVE WATER!!!!!!
  4. Spice levels are pre-set.
  5. Extra napkins: $0.25 each
  6. IMPROPER DISPOSAL OF CORN HUSKS: 10% surcharge
  7. Failure to remove crawfish on time results in meal forfeiture.
    NO EXCEPTIONS, NO REFUNDS!!!!!

A middle-aged man in a Ragin’ Cajuns hat read the instructions aloud. Then he looked around at the solemn-looking patrons waiting in line behind him. The place was quiet except for a few muffled noises from the kitchen. He removed his cap, looked heavenward, paused, and muttered:

“Mais, ça, c’est pas bon.” (Man, this is no good.)

By the end of the week, two of the three chefs had had enough of renting pots and pans and arguing over burner rights. They moved to California, where a Chinese restaurant offered a fully equipped kitchen and covered indirect costs. Within weeks, they’d introduced Admiral Pierre’s Crawfish, featuring crawfish imported from China-descendants of Louisiana crawfish accidentally introduced there in the 1930s.

Back in Louisiana, the rain was coming down harder and the lone remaining chef was standing ankle-deep in a puddle, scolding a water-logged customer for being thirty seconds late getting his crawfish into the pot.

The Moral

This is what happens when outsiders impose arbitrary cost caps in the name of “efficiency.”

T-Maître Pierre’s didn’t fail because of bad crawfish. It failed because it lost the infrastructure that made the meal possible-pots, burners, tongs, and the people. The chef, once celebrated for his recipes and skill, now stands in the rain, powerless to cook without the tools he depended on. The recipes remain, but customers must now struggle to bridge the gaps themselves, leaving behind the joy and ease of a shared meal.

NIH’s Facilities and Administrative (F&A) cap is no different. It slashes funding for the very essentials that enable research to thrive: lab space, equipment, compliance staff, and the humans who know how to maintain complex machinery like autoclaves. Researchers, once empowered by infrastructure and expertise, are left to watch their innovations stall as benefactors scramble to piece together what’s missing.

At T-Maître Pierre’s, you’re stranded in the rain, struggling to figure out how to get crawfish boiled properly. And when you ask for help, the chef responds:

“Je suis l’uniq qui reste, pis ça c’est tout ce que j’ai.”
(I’m the only one left and this is all there is.)

Under NIH’s 15% cap, your research institution is trying to fund an autoclave by tearing its couch apart to find any loose change that may have fallen out of visitors’ pockets. And even that source is drying up-since PayPal and Venmo don’t have loose change.

Gregory Hopson works remotely from Baton Rouge, Louisiana as a Business Intelligence Developer for Emory Healthcare in Atlanta, Ga.

Owen Tripp, Included Health

Owen Tripp is CEO of Included Health. It started way back in the 2010s as a second opinion service but now has added telehealth, continuous primary care, behavioral health and guidance for its populations. He’s taken to calling what they do all in one personalized healthcare. Underlying all this is a data integration and analytics platform that’s now being used by some of the biggest employers including Walmart, Comcast, CALPers and more. Essentially Included Health is building the new multi-specialty medical group. Owen & I really got into the details and had a great conversation about how we develop a “3rd way” between the payers and providers–Matthew Holt

I’m Sensing Some Future

By KIM BELLARD

One of my frequent laments is that here we are, a quarter of the way into the 21st century, yet too much of our health care system still looks like the 20th century, and not enough like the 22nd century. It’s too slow, too reactive, too imprecise, and uses too much brute force. I want a health care system that seems more futuristic, that does things more elegantly.

So here are three examples of the kinds of things that give me hope, in rough order of when they might be ready for prime time:

Floss sensor: You know you’re supposed to floss every day, right? And you know that your oral health is connected to your overall health, in a number of ways, right? So some smart people at Tufts University thought, hmm, perhaps we can help connect those dots.

 “It started in a collaboration with several departments across Tufts, examining how stress and other cognitive states affect problem solving and learning,” said Sameer Sonkusale, professor of electrical and computer engineering. “We didn’t want measurement to create an additional source of stress, so we thought, can we make a sensing device that becomes part of your day-to-day routine? Cortisol is a stress marker found in saliva, so flossing seemed like a natural fit to take a daily sample.”

The result: “a saliva-sensing dental floss looks just like a common floss pick, with the string stretched across two prongs extending from a flat plastic handle, all about the size of your index finger.”

It uses a technology called electropolymerized molecularly imprinted polymers (eMIPs) to detect the cortisol. “The eMIP approach is a game changer,” said Professor Sonkusale. “Biosensors have typically been developed using antibodies or other receptors that pick up the molecule of interest. Once a marker is found, a lot of work has to go into bioengineering the receiving molecule attached to the sensor. eMIP does not rely on a lot of investment in making antibodies or receptors. If you discover a new marker for stress or any other disease or condition, you can just create a polymer cast in a very short period of time.”

The sensor is designed to track rather to diagnose, but the scientists are optimistic that the approach can be used to track other conditions, such as oestrogen for fertility tracking, glucose for diabetes monitoring, or markers for cancer. They also hope to have a sensor that can track multiple conditions, “for more accurate monitoring of stress, cardiovascular disease, cancer, and other conditions.” 

They believe that their sensor has comparable accuracy to the best performing sensors currently available, and are working on a start-up to commercialize their approach.

Nano-scale biosensor: Flossing is all well and good, but many of us are not as diligent about it as we should be, so, hey, what about sensors inside us that do the tracking without us having to do anything? That’s what a team at Stanford are suggesting in A biochemical sensor with continuous extended stability in vivo, published in Nature.

The researchers say:

The development of biosensors that can detect specific analytes continuously, in vivo, in real time has proven difficult due to biofouling, probe degradation and signal drift that often occur in vivo. By drawing inspiration from intestinal mucosa that can protect host cell receptors in the presence of the gut microbiome, we develop a synthetic biosensor that can continuously detect specific target molecules in vivo.

“We needed a material system that could sense the target while protecting the molecular switches, and that’s when I thought, wait, how does biology solve this problem?” said Yihang Chen, the first author of the paper. Their modular biosensor, called the Stable Electrochemical Nanostructured Sensor for Blood In situ Tracking (SENSBIT) system, can survive more than a week in live rats and a month in human serum.

Continue reading…

Biden’s cancer diagnosis should be a teaching moment

By DANIEL STONE

Joe Biden’s metastatic cancer diagnosis brings together two controversial issues: PSA testing for prostate cancer and presidential politics. To understand what is at stake Americans need basic information about PSA testing, and a frank discussion of the reasoning behind the prostate cancer screening decisions in the former president’s case. The dribble of information we’ve gotten only creates more uncomfortable questions for Biden and his family. The absence of adequate explanation also fails to contribute to public appreciation of these important medical issues.

The prostate, a walnut-shaped gland at the base of the bladder, produces “prostate specific antigen,” or PSA. Chemically classed as a glycoprotein, a sugar/protein aggregate, it leaks from the prostate into the blood, where its level can be measured with routine blood testing.

As men age, the prostate enlarges, increasing PSA levels. Screening tests take advantage of the fact that prostate cancer usually leaks more PSA than normal prostate tissue. And in the case of prostate cancer, the PSA typically rises relatively fast.

Beyond these basic facts, the PSA story becomes hazy. Although an elevated PSA may signal cancer, most men with an elevated PSA have benign prostate enlargement, not prostate cancer. Worse yet for screening, many men with prostate cancer have a mild and slow-moving disease that requires no treatment. They coexist with their disease rather than dying of it. This fact leads to the old adage that prostate cancer is the disease of long-lived popes and Supreme Court justices.

Medical advisory panels view PSA screening with skepticism partly due to the challenges of distinguishing benign PSA elevations from those related to cancer. Confirming a suspected cancer diagnosis requires prostate biopsies that can be painful and can produce side effects. Additionally, once a diagnosis is made, patients who might have coexisted with their disease may needlessly be subject to the harms of treatment, such as radiation and surgery. Finally, the benefits of early treatment of prostate cancer have been difficult to prove in clinical studies.

For all these reasons medical advisory panels have discouraged widespread testing or recommend a nuanced approach with careful discussion of risk and benefits between patients and their

Despite these concerns, the pendulum has swung toward more PSA testing in recent years. One reason is that improvements in radiographic imaging, such as MRI, allow for “active surveillance” that can track early lesions for signs of spread, allowing doctors to distinguish between relatively benign cases of prostate cancer and those likely to progress. Interventions can then be directed more specifically to those at high risk.

In my medical practice, I have generally been an advocate for prostate cancer screening despite the controversy surrounding the clinical benefits. My experience leads me to believe that early diagnosis improves prognosis. But even without improved medical outcomes, patients and their families still benefit from early diagnosis for the purposes of planning. No one wants to be sideswiped by a late-stage symptomatic disease that limits both clinical and life choices.

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High-Profile Start-Ups Inato And Prenosis Show AI ‘Best Practice’

By MICHAEL MILLENSON

Treating artificial intelligence as just one ingredient in a business success recipe was a prominent theme at the MedCity INVEST 2025 conference, with this AI “best practice” advice epitomized by high-profile start-ups Inato and Prenosis.

“You need to build a business model that makes sense, then use AI,” cautioned Raffi Boyajian, principal at CIGNA Ventures and a panelist at the MedCity INVEST 2025 conference in Chicago.

That sentiment was echoed and emphasized by fellow investors Aman Shah, vice president of new ventures at VNS Health, and Dipa Mehta, managing partner of Valeo Ventures. Both emphasized the necessity in a tough economic environment to find a “burning platform” that could immediately boost a customer’s bottom line.

In a separate panel, high-profile start-ups Inato and Prenosis accentuated that AI approach.

Innovation Customers Need

Inato was named by Fast Company magazine as one of the Most Innovative Companies of 2024, and that same year chosen by Fierce Healthcare as one of its Fierce 15. The Paris-based company connects drugmakers with otherwise hard-to-enroll patients for clinical trials by means of an AI-based platform that has attracted more than 3,000 community research sites in over 70 countries. By making clinical trials “more accessible, inclusive, and efficient,” in the company’s words, breaking a shocking pattern where 96% of trials do not include a representative population, Inato has established partnerships with more than a third of the top 30 pharmaceutical firms.

In describing its technology, Inato says it “assembled an AI agent to de-identify patient records, quickly determine which trials are relevant to each patient and evaluate patients against inclusion and exclusion criteria to assess eligibility” accurately and at scale. However, that phrase, “assembled an AI agent,” obscures a subtler process.

Liz Beatty, Inato’s co-founder and chief strategy officer, described using “off-the-shelf” large language models like ChatGPT and Claude and then optimizing them for a particular process with algorithms attuned to each model. As new models appear, the company adjusts accordingly. Although Beatty did not offer an analogy, there seemed an obvious parallel to a chef choosing among the right ingredients in the right proportions to ensure a recipe’s success.

Said Beatty, “I hear, ‘Let’s apply AI to everything.’ That’s not the right answer.” Investors are convinced enough that Inato does have the right answer that they’ve poured in $38.2 million, according to Pitchbook.

AI has also been central to the success of Prenosis. The company’s Sepsis ImmunoScore was the first Food and Drug Administration-approved tool using AI to predict the imminent onset of an often-deadly condition known as sepsis. Integrated into the clinical workflow, it was hailed by Time magazine as one of “the best inventions of 2024,” while Bobby Reddy Jr., Prenosis co-founder and chief executive officer, was subsequently named to the Time100 Health List recognizing influential individuals in global health.

Chicago-based Prenosis describes itself as an artificial intelligence company tailoring therapy to individual patient biology as part of “a new era of precision medicine.” As with Inato, though, the AI headline hides a more complex reality.

Sepsis is a heterogenous syndrome with close to 200 different symptoms possibly at play. “AI brings it together so we can understand the process of deterioration,” Reddy said. The company used machine learning to develop and validate a sophisticated algorithm, according to a New England Journal of Medicine study.

But the right AI was only one product ingredient. Prenosis also assembled a database of thousands of patients and set up a “wet lab” to find sepsis biomarkers – and to use for other conditions as the company expands its offerings – based on what is now 120,000 blood samples. Adding biomarkers to EHR data enabled the company to position itself as a more accurate, real-time complement to the sepsis tool Epic provides free to hospitals using its EHR.

“That’s our competitive advantage,” Reddy said.

Focused AI

Just as Inato focused on AI for its specific purposes, Prenosis also focused on a crucial goal. The AI was used “first and foremost to fit the FDA model for approval,” said Reddy.

Sepsis is caused by an overactive immune response to infection. It costs the U.S. health care system billions of dollars annually while claiming the lives of at least 350,000 people – more than all cancers combined, according to the Prenosis website. The World Health Organization has labeled sepsis a threat to global health, and the economic impact of just this one condition amounts to an average 2.7% of a nation’s health care costs, according to a 2022 study.

Unmentioned by Reddy at the INVEST conference was that a U.S. hospital’s performance in preventing and effectively treating sepsis is a factor in value-based payment by Medicare and in the hospital patient safety score published by the Leapfrog Group. A “burning platform,” indeed.

For Prenosis and Inato alike, AI best practice is based on practicality. As Reddy put it, AI is “just a tool” in product development.

Michael L. Millenson is president of Health Quality Advisors & a regular THCB Contributor. This first appeared in his column at Forbes