I got up super early on a Sunday (in Vegas no less!) to meet Delphine Groll, COO and Alexandre Lebrun, CEO of Nabla. I have heard directly from doctors a lot about their CoPilot product being adopted as a less expensive version than Nuance or Abridge, and wanted to see what the fuss was about. They gave me a demo of their ambient AI medical note taker and it is very impressive–you’ll see a little bit of my demo and the resulting note in the interview. They were a little shy on Sunday to tell me about their relationship with the Permanente group but between Jay Parkinson and Fierce Healthcare, the beans are well and truly spilled now, and they are apparently soon to be available in every Permanente region. I suspect because of that the integration with Epic that Alexandre mentioned will be full speed ahead!–Matthew Holt
matthew holt
Interview with Sonia Milsom, CEO Oxeon
Sonia Milsom is the relatively new CEO at Oxeon, which became the dominant executive search (headhunter) firm in digital health over the past decade or so. The company was built by Trevor Price and team. Sonia discussed the transition, the other things Oxeon does (venture studio, relationship to TownHall Ventures), and the state of the employment market in digital health. TL:DR on that, it’s slowed but they are doing a lot of work and still growing. Matthew Holt
The “Green Pope” Loves Science and Is Cautious of AI
By MIKE MAGEE
By all accounts, they were mutually supportive. He was three years older and the chief scientific adviser to the world’s most powerful religious leader. The Scientific American called him “the greatest scientist of all time,” and not because he won the Nobel Prize in Chemistry a decade earlier for explaining the nuts and bolts of ozone formation. It was his blunt truthfulness and ecological advocacy that earned the organization’s respect.
Paul Crutzan is no longer alive. He died on February 4, 2021 in Mainz, Germany at the age of 87. What attracted the 86 year old “Green Pope” to Paul were three factors that were lauded at his death in the Proceedings of the National Academy of Sciences (PNAS) – “the disruptive advancement of science, the inspiring communication of science, and the responsible operationalization of science.”
It didn’t hurt that Crutzan was pleasant – or as the The Royal Society in its obituary simply described him: “a warm hearted person and a brilliant scientist.”
In 2015, he was Pope Francis’s right arm when the Catholic leader, who had purposefully chosen the name of the Patron Saint of Ecology as his own, was briefed on the Anthropocene Epoch. Crutzen had christened the label five years earlier to brand a post-human planet that was not faring well.
Crutzen was one of 74 scientists from 27 nations and Taiwan who formed the elite Pontifical Academy of Sciences in 2015. Those selected were a Who’s Who of the world’s scientific All-Stars including 14 Nobel recipients, and notables like Microbiologist Werner Arber, physicist Michael Heller, geneticist Beatrice Mintz, biochemist Maxine Singer, and astronomer Martin Rees.
On May 24, 2015, they delivered their climate conclusions to the Pope, face to face. The Pope heard these words, “We have a collection of experts from around the world who are concerned about climate change. The changes are already happening and getting worse, and the worst consequences will be felt by the world’s 3 billion poor people.”
The next month, with his release of the encyclical on the environment, Laudato Si’, Pope Francis began by embracing science, with these words, “I am well aware that in the areas of politics and philosophy there are those who firmly reject the idea of a Creator, or consider it irrelevant, and consequently dismiss as irrational the rich contribution which religions can make towards an integral ecology and the full development of humanity. Others view religions simply as a subculture to be tolerated. Nonetheless, science and religion, with their distinctive approaches to understanding reality, can enter into an intense dialogue fruitful for both.”
Further along, he celebrates scientific progress with these remarks, “We are the beneficiaries of two centuries of enormous waves of change: steam engines, railways, the telegraph, electricity, automobiles, aeroplanes, chemical industries, modern medicine, information technology and, more recently, the digital revolution, robotics, biotechnologies and nanotechnologies. It is right to rejoice in these advances and to be excited by the immense possibilities which they continue to open up before us”
But then comes the hammer: “Any technical solution which science claims to offer will be powerless to solve the serious problems of our world if humanity loses its compass, if we lose sight of the great motivations which make it possible for us to live in harmony, to make sacrifices and to treat others well.”
Continue reading…Out of Control Health Costs or a Broken Society
Flawed Accounting for the US Health Spending Problem
By Jeff Goldsmith
Source: OECD, Our World in Data
Late last year, I saw this chart which made my heart sink. It compared US life expectancy to its health spending since 1970 vs. other countries. As you can see, the US began peeling off from the rest of the civilized world in the mid-1980’s. Then US life expectancy began falling around 2015, even as health spending continued to rise. We lost two more full years of life expectancy to COVID. By the end of 2022, the US had given up 26 years-worth of progress in life expectancy gains. Adding four more years to the chart below will make us look even worse.
Of course, this chart had a political/policy agenda: look what a terrible social investment US health spending has been! Look how much more we are spending than other countries vs. how long we live and you can almost taste the ashes of diminishing returns. This chart posits a model where you input health spending into the large black box that is the US economy and you get health out the other side.
The problem is that is not how things work. Consider another possible interpretation of this chart: look how much it costs to clean up the wreckage from a society that is killing off its citizens earlier and more aggressively than any other developed society. It is true that we lead the world in health spending. However, we also lead the world in a lot of other things health-related.
Exceptional Levels of Gun Violence
Americans are ten times more likely than citizens of most other comparable countries to die of gun violence. This is hardly surprising, since the US has the highest rate of gun ownership per capita in the world, far exceeding the ownership rates in failed states such as Yemen, Iraq and Afghanistan. The US has over 400 million guns in circulation, including 20 million military style semi-automatic weapons. Firearms are the leading cause of deaths of American young people under the age of 24. According to the Economist, in 2021, 38,307 Americans aged between 15 and 24 died vs. just 2185 in Britain and Wales. Of course, lots of young lives lost tilt societal life expectancies sharply downward.
A Worsening Mental Health Crisis
Of the 48 thousand deaths from firearms every year in the US, over 60% are suicides (overwhelmingly by handguns), a second area of dubious US leadership. The US has the highest suicide rate among major western nations. There is no question that the easy access to handguns has facilitated this high suicide rate.
About a quarter of US citizens self-report signs of mental distress, a rate second only to Sweden. We shut down most of our public mental hospitals a generation ago in a spasm of “de-institutionalization” driven by the arrival of new psychoactive drugs which have grossly disappointed patients and their families. As a result, the US has defaulted to its prison system and its acute care hospitals as “treatment sites”; costs to US society of managing mental health problems are, not surprisingly, much higher than other countries. Mental health status dramatically worsened during the COVID pandemic and has only partially recovered.
Drug Overdoses: The Parallel Pandemic
On top of these problems, the US has also experienced an explosive increase in drug overdoses, 110 thousand dead in 2022, attributable to a flood of deadly synthetic opiates like fentanyl. This casualty count is double that of the next highest group of countries, the Nordic countries, and is again the highest among the wealthy nations. If you add the number of suicides, drug overdoses and homicides together, we lost 178 thousand fellow Americans in 2021, in addition to the 500 thousand person COVID death toll. The hospital emergency department is the departure portal for most of these deaths.
Maternal Mortality Risks
The US also has the highest maternal mortality rate of any comparable nation, almost 33 maternal deaths per hundred thousand live births in 2021. This death rate is more than triple that of Britain, eight times that of Germany and almost ten times that of Japan. Black American women have a maternal mortality rate almost triple that of white American women, and 15X the rate of German women. Sketchy health insurance coverage certainly plays a role here, as does inconsistent prenatal care, systemic racial inequities, and a baseline level of poor health for many soon-to-be moms.
Obesity Accelerates
Then you have the obesity epidemic. Obesity rates began rising in the US in the late 1980’s right around when the US peeled away from the rest of the countries on the chart above. Some 42% of US adults are obese, a number that seemed to be levelling off in the late 2010’s, but then took another upward lurch in the past couple of years. Only the Pacific Island nations have higher obesity rates than the US does. And with obesity, conditions like diabetes flourish. Nearly 11% of US citizens suffer from diabetes, a sizable fraction of whom are undiagnosed (and therefore untreated). US diabetes prevalence is nearly double that of France, with its famously rich diets.
Continue reading…War — and Health Care — on the Cheap
By KIM BELLARD
Like many of you, I’m watching the war in Ukraine with great interest and much support. For all the fuss about expensive weapons — like F-16 fighters, Abrams tanks, Stryker and Bradley armored fighting vehicles, Patriot missile defense systems, Javelin anti-tank missiles, Himars long range missiles, and various types of high tech drones — what I’m most fascinated with is how Ukraine is using inexpensive, practically homemade drones as a key weapon.
It’s a new way of waging war. And when I say “waging war,” I can’t help but also think “providing health care.” It’s not so much that I think drones are going to revamp health care, but if very expensive weapons may, in fact, not be the future of warfare, maybe very expensive treatments aren’t necessarily the future of healthcare either.
Just within the last two weeks, for example, The New York Times headlined Budget Drones Prove Their Value in a Billion-Dollar War, AP said Using duct tape and bombs, Ukraine’s drone pilots wage war with low-cost, improvised weapons, ABC News reports: Inside Ukraine’s efforts to bring an ‘army of drones’ to war against Russia, and Defense News describes how Cardboard drone vendor retools software based on Ukraine war hacks.
This is not the U.S. military-industrial complex’s “shock-and-awe” kind of warfare; this is the guy-in-his-garage-building-his-own-weapons kind of warfare.
Ukraine’s minister for digital transformation, Mykhailo Federov, says the government is committed to building a state-of-the-art “army of drones.” He promises: “A new stage of the war will soon begin.”
NYT detailed:
Drones made of plastic foam or plastic are harder to find on radar, reconnaissance teams said. Ukraine buys them from commercial suppliers who also sell to aerial photographers or hobbyists around the world, along with parts such as radios, cameras, antennas and motors. The drone units mix and match parts until they find combinations that can fly past sophisticated Russian air defenses.
“The doctrine of war is changing,” one Ukrainian commander said. “Drones that cost hundreds of dollars are destroying machines costing millions of dollars.” The AP discusses how an elite drone unit – “a ragtag group of engineers, corporate managers and filmmakers” — “assembled with just $700,000, has destroyed $80 million worth of enemy equipment.”
Continue reading…The Carenostics Interview
In my other day job of advising companies, I was introduced to Carenostics by my friends at Bayer G4A. This is a super interesting company which is using AI to diagnose serious chronic diseases like kidney disease, asthma, and others much earlier. So far they are working with health systems like Hackensack in NJ and the VA, and have just raised a $5m round. Last week I spoke with father and son team, Kanishka Rao, COO & Bharat Rao, CEO. In particular look out for Bharat’s explanation of what has to go on behind the curtain to make AI become effective.
“PictureWhat” ??? Super-Human Poison Ivy. What’s Going On?
By MIKE MAGEE
Connecticut loves its’ trees. And no town in Connecticut loves its’ trees more than West Hartford, CT. The town borders include an elaborate interconnected reservoir system that does double duty as a focal point for a wide range of nature paths for walkers, runners and cyclists.
While walking one path yesterday, I came a tree with the healthiest upward advancing vine I had ever seen. My “PictureThis” app took no time to identify the plant. To my surprise, it was Toxicodendron radicans, known commonly as Poison Ivy.
The description didn’t pull punches. It read, “In pop culture, poison ivy is a symbol of an obnoxious weed because, despite its unthreatening looks, it gives a highly unpleasant contact rash to the unfortunate person who touches it.” And even that doesn’t quite capture the plants negative notoriety.
Its’ pain and itch inducing chemical oil covers every inch of the plant, and is toxic to 80% of humans. It was discovered by Japanese chemist Rikō Majima in the lacquer tree and named urushiol (Japanese for lacquer) in 1922. It is a derivative of catechol, an organic compound with the molecular formula C₆H₆O₂.
But the giant vine this week was nothing like the creeping little three leaf plant most children have be taught to avoid. This was a giant – a very different aggressor worth investigating. Its leaves were impossibly large and its vine straight and thick, and its vitality unhampered by a need to support elaborate roots or bark.
Others have noticed it too including “Pesky Pete” who has made a good living removing the invader from properties in Massachusetts and southern New Hampshire. And recently business has been booming. This is because the plant, which up to this year has never appeared in the region before May 10th, suddenly appeared this year on April 23rd.
This was no surprise to Bill Schlesinger, resident of Maine and Durham, NC. Officially, he is “William H. Schlesinger … one of the nation’s leading ecologists and earth scientists …a member of the National Academy of Sciences, …has served as dean of the Nicholas School of the Environment at Duke…”
Turns out Bill was in the lead on a six year project termed the “DukeUniversity Free-Air CO2 Enrichment Experiment” between 2000 and 2006 when the results were published. They had been following tree declines in the Duke Forest where predatory vines had played a major role. They decided to encircle and isolate six giant forest plots and pump them full of CO2, and then catalogue the effects.
Their 2006 publication revealed that:
- CO2 enrichment increased T. radicans photosynthesis by 77%
- Increased the efficiency of plant water usage by 51%
- Stimulated the growth of poison ivy during the five growing seasons ambient plants
- Annual growth increase of 149% in elevated CO2 compared to ambient plants.
- Notably larger than the 31% average increase in biomass observed for woody plants
Poison Ivy was the fastest grower of them all in the experimental CO2 forests. Bill’s collaborator, Jacqueline E. Mohan, carried the work further as head of the Harvard Forest project in Massachusetts. They reported out results, not on CO2 soil, but warmed soil. They heated the upper layer of soil by 9 degrees. Her response to the findings was surprisingly down-to-earth. She said, “My heavens to Betsy, it’s taking off. Poison ivy takes off more than any tree species, more than any shrub species.”
Mohan and coworkers made it clear at the time that this was not great news for 8 out of 10 Americans who are sensitive to poison ivy. Not only did global warming and carbon footprints accelerate growth in the plant by 70% in its leaf size and biomass, but additional experiments revealed that these environmental enablers increased the amount of urushiol in the plant
As Duke was building those first towers to isolate their experimental forests in 2000, the International Geosphere-Biosphere Program was holding its annual meeting in Mexico. A Working Group subsequently focused on defining planetary boundaries (PB) that would assure both planetary and human health.
Nine years later, the group published “A Safe Operating Space For Humanity” in Nature. In it they proposed nine “planetary boundaries” to gauge “the continued development of human societies and the maintenance of the Earth system(ES) in a resilient and accommodating state.” In their view, measuring and ongoing monitoring of these boundaries would provide “a science-based analysis of the risk of human perturbations” that might “destabilize the Earth’s Systems (ES) on a planetary scale.” The work was updated in 2015.
The first Planetary Boundary listed was Global Warming with two measures, atmospheric CO2 and air and water temperature. As for human perturbation, as the picture above well illustrates, you can add super-human poison ivy to the list of unintended consequences.
Mike Magee MD is a Medical Historian and regular THCB contributor. He is the author of CODE BLUE: Inside the Medical-Industrial Complex (Grove/2020)
DNA is Better at Math than You Are
By KIM BELLARD
I was tempted to write about the work being done at Wharton that suggests that AI may already be better at being entrepreneurial than most of us, and of course I’m always interested to see how nanoparticles are starting to change health care (e.g., breast cancer or cancer more generally), but when I saw what researchers at China’s Shanghai Jiao Tong University have done with DNA-based computers, well, I couldn’t pass that up.
If PCs helped change the image of computers from the big mainframes, and mobile phones further redefined what a computer is, then DNA computers may cause us to one day – in the lifetime of some of you — look back at our chip-based devices as primitive as we now view ENIAC.
It’s been almost 30 years since Leonard Adleman first suggested the idea of DNA computing, and there’s been a lot of excitement in the field since, but, really, not the kind of progress that would make a general purpose DNA computer seem feasible. That may have changed.
At the risk of introducing way too many acronyms, the Chinese researchers claim they have developed a general purpose DNA integrated circuit (DIC), using “multilayer DNA-based programmable gate arrays (DPGAs).” The DPGAs are the building blocks of the DIC and can be mixed and matched to create the desired circuits. They claim that each DPGA “can be programmed with wiring instructions to implement over 100 billion distinct circuits.”
They keep track of what is going on using fluorescence markers, which probably makes watching a computation fun to watch.
One experiment, involving 3 DPGAs and 500 DNA strands, made a circuit that could solve quadratic equations, and another could do square roots. Oh, and, by the way, another DPGA circuit could identify RNA molecules that are related to renal cancer. They believe their DPGAs offers the potential for “intelligent diagnostics of different kinds of diseases.”
DNA tracking DNA.
Continue reading…Poor Kids. Pitiful Us
By KIM BELLARD
Well, congratulations, America. The child poverty rate more than doubled from 2021 to 2022, jumping from 5.2% to 12.4%, according to new figures from the Census Bureau. Once again, we prove we sure have a funny way of showing that we love our kids.
The poverty rate is actually the Supplemental Poverty Measure (SPM), which takes into account government programs aimed at low income families but which are not counted in the official poverty rate. The official poverty rate stayed the same, at 11.5% while the overall SPM increased 4.6% (to 12.4%), the first time the SPM has increased since 2010. It’s bad enough that over 10% of our population lives in poverty, but that so many children live in poverty, and that their rate doubled from 2021 to 2022 — well, how does one think about that?
The increase was expected. In fact, the outlier number was the “low” 2021 rate. Poverty dropped due to COVID relief programs; in particular, the child tax credit (CTC). It had the remarkable (and intended) impact of lowering child poverty, but was allowed to expire at the end of 2021, which accounts for the large increase. We’re basically back to where we were pre-pandemic.
President Biden was quick to call out Congressional Republicans (although he might have chided Senator Joe Manchin just as well):
Today’s Census report shows the dire consequences of congressional Republicans’ refusal to extend the enhanced Child Tax Credit, even as they advance costly corporate tax cuts…The rise reported today in child poverty is no accident—it is the result of a deliberate policy choice congressional Republicans made to block help for families with children while advancing massive tax cuts for the wealthiest and largest corporations.
Many experts agree: child poverty, and poverty more generally, is a choice, a policy choice.
Continue reading…The Times They Are A-Changing….Fast
By KIM BELLARD
If you have been following my Twitter – oops, I mean “X” – feed lately, you may have noticed that I’ve been emphasizing The Coming Wave, the new book from Mustafa Suleyman (with Michael Bhaskar). If you have not yet read it, or at least ordered it, I urge you to do so, because, frankly, our lives are not going to be the same, at all. And we’re woefully unprepared.
One thing I especially appreciated is that, although he made his reputation in artificial intelligence, Mr. Suleyman doesn’t only focus on AI. He also discusses synthetic biology, quantum computing, robotics, and new energy technologies as ones that stand to radically change our lives. What they have in common is that they have hugely asymmetric impacts, they display hyper-evolution, they are often omni-use, and they increasingly demonstrate autonomy.
In other words, these technologies can do things we didn’t know they could do, have impacts we didn’t expect (and may not want), and may decide what to do on their own.
To build an AI, for the near future one needs a significant amount of computing power, using specialized chips and a large amount of data, but with synthetic biology, the technology is getting to the point where someone can set up a lab in their garage and experiment away. AI can spread rapidly, but it needs a connected device; engineered organisms can get anywhere there is air or water.
“A pandemic virus synthesized anywhere will spread everywhere,” MIT”s Kevin Esvelt told Axios.
I’ve been fascinated with synthetic biology for some time now, and yet I still think we’re not paying enough attention. “For me, the most exciting thing about synthetic biology is finding or seeing unique ways that living organisms can solve a problem,” David Riglar, Sir Henry Dale research fellow at Imperial College London, told The Scientist. “This offers us opportunities to do things that would otherwise be impossible with non-living alternatives.”
Jim Collins, Termeer professor of medical engineering and science at Massachusetts Institute of Technology (MIT), added: “By approaching biology as an engineering discipline, we are now beginning to create programmable medicines and diagnostic tools with the ability to sense and dynamically respond to information in our bodies.”
For example, researchers just reported on a smart pill — the size of a blueberry! — that can be used to automatically detect key biological molecules in the gut that suggest problems, and wirelessly transmit the information in real time.
Continue reading…
