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AI is Bright, But Can Also Be Dark

BY KIM BELLARD

If you’ve been following artificial intelligence (AI) lately – and you should be – then you may have started thinking about how it’s going to change the world. In terms of its potential impact on society, it’s been compared to the introduction of the Internet, the invention of the printing press, even the first use of the wheel. Maybe you’ve played with it, maybe you know enough to worry about what it might mean for your job, but one thing you shouldn’t ignore: like any technology, it can be used for both good and bad.  

If you thought cyberattacks/cybercrimes were bad when done by humans or simple bots, just wait to see what AI can do.  And, as Ryan Health wrote in Axios, “AI can also weaponize modern medicine against the same people it sets out to cure.”

We may need DarkBERT, and the Dark Web, to help protect us.

A new study showed how AI can create much more effective, cheaper spear phishing campaigns, and the author notes that the campaigns can also use “convincing voice clones of individuals.”  He notes: “By engaging in natural language dialog with targets, AI agents can lull victims into a false sense of trust and familiarity prior to launching attacks.”  

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Asking Bard And ChatGPT To Find The Best Medical Care, I Got Truth And Truthiness

BY MICHAEL MILLENSON

If you ask ChatGPT how many procedures a certain surgeon does or a specific hospital’s infection rate, the OpenAI and Microsoft chatbot inevitably replies with some version of, “I don’t do that.”

But depending upon how you ask, Google’s Bard provides a very different response, even recommending a “consultation” with particular clinicians.

Bard told me how many knee replacement surgeries were performed by major Chicago hospitals in 2021, their infection rates and the national average. It even told me which Chicago surgeon does the most knee surgeries and his infection rate. When I asked about heart bypass surgery, Bard provided both the mortality rate for some local hospitals and the national average for comparison. While sometimes Bard cited itself as the information source, beginning its response with, “According to my knowledge,” other times it referenced well-known and respected organizations.

There was just one problem. As Google itself warns, “Bard is experimental…so double-check information in Bard’s responses.” When I followed that advice, truth began to blend indistinguishably with “truthiness” – comedian Stephen Colbert’s memorable term to describe information that’s seen as true not because of supporting facts, but because it “feels” true.

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The Disease Killing Healthcare and Causing Physician Burnout

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BY SCOTT MACDIARMID

We have a healthcare crisis . . . and the crisis is now. Costs are soaring out of control, threatening the financial health of individuals and our nation. Quality of care is deteriorating, in spite of “world class care” signs seemingly on every corner. And physicians are checking out and burning out. I believe it’s one of the greatest societal issues of our day.

So, you may be wondering: How in the heck did we get ourselves into such a mess? In the greatest country in the world who spends the most on healthcare and is regularly bragging on how great it is, what happened? 

Experts and pundits alike tout a litany of reasons. Increasing life expectancy, our reliance on sophisticated and expensive diagnostic tests and treatments, the costs of big pharma, duplication of care, fraud and abuse—the list goes on. Although these are all important contributors, none of them points to the underlying disease that’s killing healthcare.

The healthcare system in some respects is like the human body. It has seven systems, and the health and survival of each is largely dependent on the health of the others, much like the inter-dependent relationship of the organs of the human body. For example, if your liver or kidneys fail, your body’s health is severely impacted, even if your heart and lungs are functioning normally. 

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Healthcare: Make Better Mistakes

BY KIM BELLARD

I saw an expression the other day that I quite liked. I’m not sure who first said it, and there are several versions of it, but it goes something like this: let’s make better mistakes tomorrow.

Boy howdy, if that’s not the perfect motto for healthcare, I don’t know what is.

Health is a tricky business.  It’s a delicate balancing act between – to name a few — your genes, your environment, your habits, your nutrition, your stress, the health and composition of your microbiome, the impact of whatever new microbes are floating around, and, yes, the health care you happen to receive. 

Health care is also a tricky business. We’ve made much progress in medicine, developed deeper insights into how our bodies work (or fail), and have a multitude of treatment options for a multitude of health problems. But there’s a lot we still don’t know, there’s a lot we know but aren’t actually using, and there’s an awful lot we still don’t know. 

It’s very much a human activity. Different people experience and/or report the same condition differently, and respond to the same treatments differently. Everyone has unique comorbidities, the impact of which upon treatments is still little understood. And, of course, until/unless AI takes over, the people responsible for diagnosing, treating, and caring for patients are very much human, each with their own backgrounds, training, preferences, intelligence, and memory – any of which can impact their actions. 

All of which is to say: mistakes are made. Every day. By everyone. 

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The ERA – An Amendment Who’s Time Has Come

BY MIKE MAGEE

Believe it or not, The Equal Rights Amendment (ERA) was first introduced 100 years ago in 1923. But it was only adopted by Congress by a 2/3 majority vote 49 years later in 1972. That was simply step 1 in the world’s most complex and difficult national constitutional amendment process.

Step 2, approval by 3/4 of the states, seemed off to a running start with 28 of the required 38 states signing up that first year. But 1972 was also the year that Phyllis Schafly, an outspoken supporter of patriarchy and stay-at-home motherhood, began echoing her anti-ERA message on Chicago News Radio WBBM. The following year, she went national with a CBS Morning News contract, followed by a gig with CNN from 1980 to 1983.

Corny, but effective and dogged in pursuit culture war issues, she was a gifted publicist who leveraged the role of “housewife” for all it was worth. One of her gambits was to deliver homemade bread, jam and apple pies to state legislators with the message ”Preserve us from a congressional jam; Vote against the ERA sham” and “I am for Mom and apple pie.”   

The irony that she had been largely “not at home” as an active conservative political warrior since signing on as a young researcher at the American Enterprise Institute in 1946, and (by now) had waged a battle for three decades to preserve “traditional American values” as a lawyer, editor, and national speaker apparently never registered with her wildly enthusiastic fanhood. 

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In an Ideal World, How Much Would We Spend on Health Care?

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BY BEN WHEATLEY

We have heard it said before, and it is no longer shocking to say, that in 2021 the United States spent $4.3 trillion on health care. To put this gaudy number in some perspective, we measure it as a share of our economy and report that health care comprised 18.3% of our gross domestic product. CMS projects that health care will approach 20% of GDP in coming years—one-fifth of everything we buy and sell in this country. 

In a recent report, the Health Affairs Council on Health Care Spending and Value said that “it is unclear what percentage of GDP would represent the ideal level to devote to health care. Nevertheless, the council believes that the current expenditure and rate of growth are higher than they should be….” The council observed that the dollars devoted to health care seem “disproportionate to the health they produce” and noted that the spending places a “significant burden on families, employers, employees, and government.”

We spend approximately $12,900 per person per year on health care. By comparison, the average cost of health care per person in other wealthy countries is only about half as much.

These metrics seem to indicate that the United States is spending too much on health care, but nevertheless we struggle to identify the “right” amount. However, if someone were to ask me: “In an ideal world, how much would we spend on health care?” I would propose a very simple answer: zero. This is because, clearly, in an ideal world, no one would be sick.

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Burden of Pain

BY JAY JOSHI

We’re seeing a trend of late, where matters in healthcare once deemed to be civil in nature are turning criminal. We see it for nearly every polarizing health issue, from abortion to opioids. And it’s affecting vulnerable patients the most.

We have two separate systems in place, civil and criminal, because we have different standards of behavior. Civil laws determine whether undue harm was caused by one party to another. Criminal laws determine whether someone committed a crime. The threshold is distinctly different. If someone is caught driving ten miles over the designated speed limit, that person committed a civil infraction of traffic laws. But if someone is caught speeding well in excess, say thirty or forty miles over the speed limit, while driving recklessly, that person committed a crime. The extent of the violation determines the applicable law. That’s why traffic laws have distinct civil and criminal laws.

The same logic applies to healthcare. We have civil penalties for undue harm or malpractice and we have criminal penalties for crimes that transpire in the clinical context. The difference between the two, for something to go from civil to criminal, is mens rea, or a requirement of criminal intent.

Criminal intent implies certain violations were committed deliberately – literally as an act of crime. Normal civil violations, such as malpractice claims, offer physicians protection against liability. That protection doesn’t apply for criminal violations. And that’s the point. It explains why the sudden push by regulators, prosecutor offices, and federal agents to investigate otherwise civil matters as criminal is so pernicious.

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Bluesky Ahead

BY KIM BELLARD

I’ve been thinking about writing about Bluesky ever since I heard about the Jack Dorsey-backed Twitter alternative, and decided it is finally time, for two reasons. The first is that I’ve been seeing so many other people writing about it, so I’m getting FOMO.  The second is that I checked out Nostr, another Jack Dorsey-backed Twitter alternative, and there’s no way I’m trying to write about that (case in point: Jack’s Nostr username is: npub1sg6plzptd64u62a878hep2kev88swjh3tw00gjsfl8f237lmu63q0uf63m.  Seriously).

It’s not that I’ve come to hate Twitter, although Elon Musk is making it harder to like it, as it is that our general dissatisfaction with existing social media platforms makes it a good time to look at alternatives.  I’ve written about Mastodon and BeReal, for example, but Bluesky has some features that may make sense in the Web3 world that we may be moving into. 

And, of course, I’m looking for any lessons for healthcare.

Bluesky describes itself as a “social internet.”  It started as a Twitter project in December 2019, with the aim “to develop an open and decentralized standard for social media.”   At the time, the ostensible goal was that Twitter would be a client of the standard, but events happened, Jack Dorsey left Twitter, Elon Musk bought it, and Bluesky became an independent LLC.  It rolled out an invite-only, “private beta” for iOS (Apple) users in March 2023, followed by an Android version in mid-April (again, invite-only).  People can sign up to be on the waitlist.  There are supposedly over 40,000 current users, with some million people reportedly on the waitlist.

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Worms Aren’t So Dumb

BY KIM BELLARD

Chances are, you’ve read about AI lately.  Maybe you’ve actually even tried DALL-E or ChatGPT, maybe even GPT-4.  Perhaps you can use the term Large Language Model (LLM) with some degree of confidence.  But chances are also good that you haven’t heard of “liquid neural networks,” and don’t get the worm reference above.   

That’s the thing about artificial intelligence: it’s evolving faster than we are. Whatever you think you know is already probably out-of-date.

Liquid neural networks were first introduced in 2020.  The authors wrote: “We introduce a new class of time-continuous recurrent neural network models.” They based the networks on the brain of a tiny roundworm, Caenorhabditis elegans.  The goal was networks that were more adaptable, that could change “on the fly” and would adapt to unfamiliar circumstances. 

Researchers at MIT’s CSAIL have shown some significant progress.  A new paper in Science Robotics discussed how they created “robust flight navigation agents” using liquid neural networks to autonomously pilot drones. They claim that these networks are “causal and adapt to changing conditions,” and that their “experiments showed that this level of robustness in decision-making is exclusive to liquid networks.”  

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Two Cases of a Cool Skin Condition (Erythrocyanosis, Pernio or Chilblains, Anyone?)

BY HANS DUVEFELT

A month ago an oncologist called and asked me to see one of my heart failure patients whose chronically swollen legs seemed unusually blue but not cold.

Before I could get him in to see me, he ended up seeing a colleague, who called me up and said the man’s legs were cool and there was no Doppler in that office to check for pedal pulses. The man was sent for an urgent CT angiogram with runoff.

The test was perfectly normal. He had clean arteries.

When I saw him, the legs were less blue than they must have been and they felt OK but he had what looked like a shingles rash around his right elbow. There was some surrounding swelling and redness, so I prescribed an antiviral, an antibiotic and prednisone and arranged to see him back.

My diagnosis was erythrocyanosis. I have never seen a case but my instinct when I saw him was that this was a peripheral thermal regulation problem. So, a little bit of searching on the Internet gave me the diagnosis.

In follow up, the legs looked fine and the elbow rash was drying up nicely.

None of my research suggested a reasonable treatment option for his condition. But he was getting better so I didn’t have to worry about it at that moment.

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