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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. 

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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.”

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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:

  1. CO2 enrichment increased T. radicans photosynthesis by 77%
  2. Increased the efficiency of plant water usage by 51%
  3. Stimulated the growth of poison ivy during the five growing seasons ambient plants
  4. Annual growth increase of 149% in elevated CO2 compared to ambient plants.
  5. 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.

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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.

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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. 

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Shiv Rao, CEO demos Abridge

Abridge has been trying to document the clinical encounter automatically since 2018. There’s been quit a lot of fuss about them in recent weeks. They announced becoming the first “Pal” on the Epic “Partners& Pals” program, and also that their AI based encounter capture technology was now being used at several hospitals. And they showed up in a NY Times article about tech being used for clinical documentation. But of course they’re not the only company trying to turn the messy speech in a clinician/patient encounter into a buttoned-up clinical note. Suki, Augmedix & Robin all come to mind, while the elephant is Nuance, which has itself been swallowed by the whale that is Microsoft.

But having used their consumer version a few years back and been a little disappointed, I wanted to see what all the fuss was about. CEO Shiv Rao was a real sport and took me through a clinical example with him as the doc and me as a (slightly) fictionalized patient. He also patiently explained where the company was coming from and what their road map was. But they are all in on AI–no off shore typists trying to correct in close to real time here.

And you’ll for sure want to see the demo. (If you want to skip the chat it’s about 8.00 to 16.50). And I think you’ll be very impressed indeed. I know I was. I can’t imagine a doctor not wanting this, and I suspect those armies of scribes will soon be able to go back to real work! — Matthew Holt

Beyond the Scale: How organizations should evaluate the success of obesity management solutions

By CAITLYN EDWARDS

Obesity treatment is often framed as a race to the bottom — how much weight can someone lose? Five percent? Ten percent? And with recent scientific advancements in anti-obesity medications such as GLP-1s, what about even 15-20%?

Obesity treatment, though, isn’t just about the number on the scale. It’s about moving the needle on biomarkers that really matter to overall health. Seven out of the top ten leading causes of death and disability in the United States today are chronic diseases that have links to overweight and obesity. The metabolic benefits of just 5% weight loss can be life-changing for many people with obesity-related comorbidities. This means that for organizations looking to treat their chronic conditions, obesity care shouldn’t be all about striving for the lowest possible weight.

Indeed, consensus and practice statements from groups including the American Heart Association, the American College of Cardiology, the American Diabetes Association, and The Obesity Society, support weight loss programs that achieve clinically significant weight loss outcomes, defined as greater than or equal to 5% of an individual’s baseline body weight. This number is derived from decades of research demonstrating that even modest weight loss has impacts on physiological health including type 2 diabetes, dyslipidemia, hypertension, and many kinds of cancer.

People who attain just 5% weight loss see the following health improvements:

  • Reductions in systolic and diastolic blood pressure
  • Risk reductions of developing type 2 diabetes by almost 60%
  • Reductions in HbA1c and fasting blood glucose levels
  • Greater insulin sensitivity
  • Decreased need for newly prescribed diabetes, hypertension, and lipid-lowering medications

Understanding that obesity outcomes include more than just the number on the scale, how can benefit managers and health plan leaders measure success? Here are some things organizations should look for when evaluating an obesity management solution:

N-size of outcomes

While a high weight loss average may sound impressive, it doesn’t tell the whole story. A better measure might be the number of people in a program able to achieve greater than 5% weight loss. The fact is that weight loss averages are easily skewed by outliers.  An exceptionally high average may not be representative of what is actually taking place at the individual level. What matters is that a large percentage of people in the program are able to see clinically significant results.

Emphasis on behavior change

Another way to measure the success of an obesity management solution is by the sustainability of its outcomes — primarily through adopting healthier behaviors. Intensive behavioral therapy is crucial to obesity treatment and can reduce the risk of type 2 diabetes. Support from expert dietitians and coaches can help promote a healthy relationship with food for optimal weight loss.

Through medical nutrition therapy, dietitians create personalized calorie and macronutrient goals to foster weight loss in a healthy, sustainable way. Also, self-directed cognitive behavioral therapy can help people become more aware of underlying thoughts and behavior patterns around food.

Step therapy approach to treatment

Some obesity management solutions avoid medications entirely while others rely solely on expensive GLP-1s. But both of those methods fall short of providing the best care to the most people at the lowest cost possible.

The best obesity management solutions take a clinically rigorous step-therapy approach to treatment. This way, they carefully manage access to expensive anti-obesity medications while achieving meaningful outcomes. Many of their members will achieve clinically significant weight loss through behavior change alone. Some may need a boost from lower-intensity, lower-cost anti-obesity medications to reach their goals. Others, with severe obesity or multiple cardio-metabolic conditions, may require higher-intensity anti-obesity medications like GLP-1s. Treatment levels can be safely tried in succession with needs and costs in mind.

It’s likely only 5-10% of a given population would end up using GLP-1s with this step-therapy approach, while the majority of people would still get clinically meaningful results without such intensive treatment.

Address SDOH to personalize care

One-size-fits-all solutions — like those that insist on a highly restrictive diet — miss the mark on health equity. Not everyone can afford expensive meat-heavy diets and they don’t always line up with people’s cultural preferences. Similarly, a program that simply doles out GLP-1s without helping people manage side effects doesn’t work and will only drain budgets.

The key to unlock improved outcomes is by helping people address SDOH challenges like food insecurity, language barriers, cultural factors, physical environment, and more. A good obesity solution should expand access to bilingual registered dietitians who are trained in dietary considerations and eating patterns for many different cultures and ethnic groups. They can help folks plan meals around limited budgets and specific dietary needs.

Conclusion

Organizations have much to consider when evaluating obesity solutions for their population. It’s easy to be swayed by simple metrics that seem indisputable. But, in the end, outcomes like 5% weight loss and reductions in HbA1c for the majority of an eligible population are what counts. Sustainable outcomes rely on real behavior change, a careful step-therapy approach to medication, and personalized care when it comes to social determinants of health.

Caitlyn Edwards, PhD, RDN, is a Senior Clinical Research Specialist at Vida Health

Smells like AI Spirit

By KIM BELLARD

There are so many exciting developments in artificial intelligence (AI) these days that one almost becomes numb to them. Then along comes something that makes me think, hmm, I didn’t see that coming.

For example, AI can now smell.

Strictly speaking, that’s not quite true, at least not in the way humans and other creatures smell.  There’s no olfactory organ, like our nose or a snake’s tongue. What AI has been trained to do is to look at a molecular structure and predict what it would smell like.

If you’re wondering (as I certainly did when I heard AI could smell), AI has also started to crack taste as well, with food and beverage companies already using AI to help develop new flavors, among other things. AI can even reportedly “taste wine” with 95% accuracy. It seems human senses really aren’t as human-only as we’d thought.

The new research comes from the Monell Chemical Senses Center and Osmo, a Google spin-off. It’s a logical pairing since Monell’s mission is “to improve health and well-being by advancing the scientific understanding of taste, smell, and related senses,” and Osmo seeks to give “computers a sense of smell.” More importantly, Osmo’s goal in doing that is: “Digitizing smell to give everyone a goal at a better life.”

Osmo CEO Alex Wiltschko, PhD says: “Computers have been able to digitize vision and hearing, but not smell – our deepest and oldest sense.” It’s easy to understand how vision and hearing can be translated into electrical and, ultimately, digital signals; we’ve been doing that for some time. Smell (and taste) seem somehow different; they seem chemical, not electrical, much less digital. But the Osmo team believes: “In this new era, computers will generate smells like we generate images and sounds today.”

I’m not sure I can yet imagine what that would be like.

The research team used an industry dataset of 5,000 known odorants, and matched molecular structures to perceived scents, creating what Osmo calls the Principle Odor Map (POM). This model was then used to train the AI. Once trained, the AI outperformed humans in identifying new odors. 

The model depends on the correlation between the molecules and the smells perceived by the study’s panelists, who were trained to recognize 55 odors. “Our confidence in this model can only be as good as our confidence in the data we used to test it,” said co-first author Emily Mayhew, PhD. Senior co-author Joel Mainland, PhD. admitted: “The tricky thing about talking about how the model is doing is we have no objective truth.” 

The study resulted in a different way to think about smell. The Montell Center says:

The team surmises that the model map may be organized based on metabolism, which would be a fundamental shift in how scientists think about odors. In other words, odors that are close to each other on the map, or perceptually similar, are also more likely to be metabolically related. Sensory scientists currently organize molecules the way a chemist would, for example, asking does it have an ester or an aromatic ring?

“Our brains don’t organize odors in this way,” said Dr. Mainland. “Instead, this map suggests that our brains may organize odors according to the nutrients from which they derive.”

“This paper is a milestone in predicting scent from chemical structure of odorants,” Michael Schmuker, a professor of neural computation at the University of Hertfordshire who was not involved in the study, told IEEE Spectrum.  It might, he says, lead to possibilities like sharing smells over the Internet. 

Think about that. 

“We hope this map will be useful to researchers in chemistry, olfactory neuroscience, and psychophysics as a new tool for investigating the nature of olfactory sensation,” said Dr. Mainland. He further noted: “The most surprising result, however, is that the model succeeded at olfactory tasks it was not trained to do. The eye-opener was that we never trained it to learn odor strength, but it could nonetheless make accurate predictions.”

Next up on the team’s agenda is to see if the AI can learn to recognize mixtures of odors, which exponentially increases the number of resulting smells. Osmo also wants to see if AI can predict smells from chemical sensor readings, rather than from molecular structures that have already been digitized. And, “can we digitize a scent in one place and time, and then faithfully replicate it in another?”

That’s a very ambitious agenda.

Dr. Wiltschko claims: “Our model performs over 3x better than the standard scent ingredient discovery process used by major fragrance houses, and is fully automated.” One can imagine how this would be useful to those houses. Osmo wants to work with the fragrance industry to create safer products: “If we can make the fragrances we use every day safer and more potent (so we use less of them), we’ll help the health of everyone, and also the environment.”

When I first read about the study, I immediately thought of how dogs can detect cancers by smell, and how exciting it might be if AI could improve on that. Frankly, I’m not much interesting in designing better fragrances; if we’re going to spend money on training AI to recognize molecules, I’d rather it be spent on designing new drugs than new fragrances.

Fortunately, Osmo has much the same idea. Dr. Wiltschko writes:

If we can build on our insights to develop systems capable of replicating what our nose, or what a dog’s nose can do (smell diseases!), we can spot disease early, prevent food waste, capture powerful memories, and more. If computers could do these kinds of things, people would live longer lives – full stop. Digitizing scent could catalyze the transformation of scent from something people see as ephemeral to enduring.   

Now, that’s the kind of innovation that I’m hoping for.

Skeptics will say, well, AI isn’t really smelling anything, it’s just acting as though it does. E.g., there’s no perception, just prediction. One would make the same argument about AI taste, or vision, or hearing, not to mention thinking itself. But at some point, as the saying goes, if it looks like a duck, swims like a duck, and quacks like a duck, it’s probably a duck.  At some point in the not-so-distant future, AI is going to have senses similar to and perhaps much better than our own.

As Dr. Wilkschko hopes: “If computers could do these kinds of things, people would live longer lives – full stop.” 

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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