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Let’s get moving on AI-discovered treatments

By STEVEN ZECOLA

Recursion Pharmaceuticals announced results today for one its AI-discovered treatments. I was pleased to see the large, sustained reduction in polyps attributable to its treatment for Familial Adenomatous Polyposis.  Recursions’ oral medication will be viewed by the traditional scientific and regulatory community as “promising”.

On the other hand, I was disappointed not to see/hear any reference to the savings of the cost to society from this treatment and a vague reference to working with the FDA in 1H2026.  Quite frankly, the urgency seemed to be lacking.

Currently, treating FAP is an expensive, lifelong endeavor for the 50,000+ survivors. Early detection strategies cost $10k+ and late detection $37k+. The cost to treating metastatic colorectal cancer (for which FAP predisposes) can be extremely high, up to $300,000.  Overall, the cost to society from FAP easily exceeds $1 billion per year, or more than $15 billion on a present value basis.

This medication should not be subject to any further regulatory delay.  There is enough information now on efficacy and safety to have Recursion more forward with a broad application of this treatment, while continuing test dosage levels and stratifying the patient population.  The alternative is more needless cost and suffering.

Steve Zecola sold his web application and hosting business when he was diagnosed with Parkinson’s disease twenty three years ago.  Since then, he has run a consulting practice, taught in graduate business school, and exercised extensively

Health Insurance Cancel Culture

By MATTHEW HOLT

Strap in for a dramatic tale in which our hero battles bureaucracy and logic to try to get his health insurance back.

About 20 years ago lots of Americans, especially Californians who bought health insurance from Blue Shield of California, found that their coverage was cancelled without them knowing about it. That practice called “recission” got lots of attention during the run up to the ACA, and was banned by it. Now if you want to buy insurance and you pay for it, the insurance company has to sell it to you and can’t cancel it after the fact.

Or so I thought.

Post ACA most people who don’t get their insurance through an employer, or Medicare or Medicaid, now buy it via a very regulated “individual market” on a state-based or Federal exchange. Generally, the insurance they buy is heavily standardized (with bronze, silver or gold levels) and what they pay for insurance is heavily subsidized based on income. It’s those subsidies that were increased in the pandemic and extended in the Inflation Reduction Act (IRA) during the Biden administration. The subsidies were the topic–still unresolved–of the latest government shutdown. (Yes, yes, I know the shutdown is over—for now).

It’s pretty much impossible to buy individual insurance outside the exchange, although if you have Scott Galloway levels of wealth you can avoid buying insurance altogether and pay cash and you might be better off, or you can join some quasi-religious health share organization and take your chance. But for most people you are way better off buying on the exchange because that’s the only way you can get those subsidies.

I live in California and remain an under-employed blogger, and a few times in my recent life I have not been married to someone with health insurance provided by their employer. It happened in 2016-17 and again two years ago. No, not what you’re thinking. I didn’t get kicked to the curb by my wife, but in 2022 she got laid off by her employer and decided not to get another job. For the first year of that period (2023) we did not buy via the exchange, but used COBRA. That means we bought into her previous company’s insurance using our own money because it was cheaper than buying on the exchange. Two reasons for this. First, she got a severance package that made our combined incomes too high to get a subsidy and secondly, the ACA plans charge by age, whereas employers pay a flat fee for all employees. That made the exchange plan more expensive than the employer plan. (No prizes for guessing who in our family is old and expensive!)

But COBRA only lasts a year, and then it was time to head back to Covered California.

This starts a process where you try to figure out which plan offered is the cheapest, yet includes your and your family’s doctors, and which one has the lowest associated fees for the stuff you use the most (usually pediatric visits in our case). Turns out that in our case is the Blue Shield Trio 73 HMO. My inability to understand why it’s called Trio 73 reveals why no one calls me a marketing genius.

The other thing you have to figure out is what level of subsidy you get. As mentioned, the IRA passed in 2022 extended the pandemic emergency increase in subsidies for people with higher incomes. But then again, you have to figure out what your income will be when you sign up. Like the audience laughing at an obvious punch line a comedian hasn’t gotten to yet, those of you running ahead of me will have worked out a slight problem here.

I was signing up for a 2024 health plan in 2023. But I had to guess what my 2024 taxable income would be. Like many self-employed people with extremely variable income I had no idea what that final income would be until I filed my 2024 taxes in October 2025 (given I take the IRS extension). In other words, almost two years after I chose the plan. It turns out that in California, the people who track your income are not your health plan, nor the exchange but instead your local county health department. So in November 2023 I guessed my 2024 income and had to tell the local county what that guess is via some affidavit. The county health department actually called me to check that my estimate was correct. Or at least was what I told them it was.  Remember this for later.

Meanwhile I sign up on what I regard to be a very complex web site run by Covered California, and select the aforementioned Blue Shield HMO. It covers One Medical and UCSF theoretically via the Brown & Toland IPA, and leads to lots of fun and games in terms generating much content for me on this blog and Linkedin.

As it turns out, I was sent for an echocardiogram by my primary care doctor this past summer to check if I had a heart. While many of you were surprised at the answer (yes, I do), apparently it’s got a congenital disorder that needs a little help.

This gets us to November 2025 (last month!) with your brave hero going back onto the Covered California exchange trying to figure out whether the cardiologist recommended by my primary care doc is covered by the 2026 version of the Blue Shield plan I am on, or whether I need to switch. I could now digress and tell you the late Ian Morrison’s formula for choosing a health plan but I will hold that for the next telenovela article as of course that process is a fricking mess too!

In order to try to do that I login to the Covered California site and see I have a notice that I am not eligible for health insurance. I am confused.

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Why Patients – And Many Innovative Doctors – Are Pursuing Health Outside the System

By DAVID SHAYWITZ

Our current system of delivering care is awful from the perspective of seemingly every stakeholder. It frustrates, enrages, saddens, and depletes patients and physicians alike. No one designed it this way. It evolved through a series of choices and contingencies that perhaps made sense at the time but now seem to have led us down an evolutionary dead end.

While there’s no shortage of examples, I was especially struck by an anecdote I heard in Dr. Lisa Rosenbaum’s brilliant “Not Otherwise Specified” podcast series for the NEJM. Her focus this season is primary care, and in one episode she speaks with a Denver family physician named Larry Green.

“I practiced in the oldest family practice in Denver, for years,” Green explains. “I was the chair of that department, I directed that residency, and I’m now a patient in that practice. I cannot call it. It’s impossible. Because when I call the practice, I get diverted to a call center…”

From the perspective of what he calls the “medical-industrial complex,” he says, longitudinal relationships are “totally unimportant in healthcare.”

Yet these relationships – developed with care over time – tend to be what many patients crave and what effective doctoring typically requires.

Green’s experience won’t surprise anyone who has tried to get care lately. In November 2023, Mass General Brigham announced it would not be accepting new primary care patients. At hospitals everywhere, it’s not unusual for patients to spend hours on gurneys in emergency-department hallways, waiting for an inpatient bed.

I don’t know many physicians who haven’t struggled to get care for themselves or a loved one – often at the very institutions where they trained and to which they’ve devoted years of their lives. If even insiders can’t reliably access timely, compassionate care, what chance does anyone else have?

The miserableness of the system has been well documented, and physician burnout has sadly become a dog-bites-man story.

Applicants Are Still Flocking to Medical Schools

What’s perhaps more surprising is how many people are still desperate to enter the system and become physicians, fueling an application process that, as Drs. Rochelle and Loren Walensky have documented in The New England Journal of Medicine (NEJM), has become increasingly competitive, expensive, and time-consuming. Premed students routinely take an extra year (or more) to tick all the expected boxes and jump through the hoops that are perceived as mandatory.

This highlights something that’s easy to forget: the ideal of medicine remains deeply attractive. I wrote about this almost thirty years ago in a New York Times op-ed, and it’s still true today.

The notion of doctoring – of being trusted at the intersection of science and human stories – retains a powerful hold on young people. If only the actual experience could live up to the hope of these applicants, the well-worn quotes from Osler and Peabody, the promise of the profession, and the expectations of patients.

Searching For A Better Alternative

The idea that there must be a better alternative is at once familiar and evergreen.

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If You Could read My Mind – Wait, You Can?

By KIM BELLARD

Over the years, one area of tech/health tech I have avoided writing about are brain-computer interfaces (B.C.I.). In part, it was because I thought they were kind of creepy, and, in larger part, because I was increasing finding Elon Musk, whose Neuralink is one of the leaders in the field, even more creepy. But an article in The New York Times Magazine by Linda Kinstler rang alarm bells in my head – and I sure hope no one is listening to them.

Her article, Big Tech Wants Direct Access to Our Brains, doesn’t just discuss some of the technological advances in the field, which are, admittedly, quite impressive. No, what caught my attention was her larger point that it’s time – it’s past time – that we started taking the issue of the privacy of what goes on inside our heads very seriously.

Because we are at the point, or fast approaching it, when those private thoughts of ours are no longer private.

The ostensible purpose of B.C.I.s has usually been as for assistance to people with disabilities, such as people who are paralyzed. Being able to move a cursor or even a limb could change their lives. It might even allow some to speak or even see. All are great use cases, with some track record of successes.

B.C.I.s have tended to go down one of two paths. One uses external signals, such as through electroencephalography (EEG) and electrooculography (EOG), to try to decipher what your brain is doing. The other, as Neuralink uses, is an implant directly in your brain to sense and interrupt activity. The latter approach has the advantage of more specific readings, but has the obvious drawback of requiring surgery and wires in your brain.

There’s a competition held every four years called Cybathlon, sponsored by ETH Zurich, that “acts as a platform that challenges teams from all over the world to develop assistive technologies suitable for everyday use with and for people with disabilities.” A profile of it in NYT quoted the second place finisher, who uses the external signals approach but lost to a team using implants: “We weren’t in the same league as the Pittsburgh people. They’re playing chess and we’re playing checkers.”  He’s now considering implants.  

Fine, you say. I can protect my mental privacy simply by not getting implants, right?  Not so fast.

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Katie D’Amico, Carequest–Integrating Oral Health into Medical Care

Katie D‘Amico is the VP of Innovation at Carequest, a non-profit that supports oral health–she’s a big proponent on its integration with medical care. At HLTH in October 2025 she took me on a brief tour of innovation in dental care and oral health. We had a quick look at the ability to test collagen breakdown and how to use the dental office to refer to lab tests. I also had a brief chat with Dr Ashley Lerman from Firstgrin, which is helping kids take care of their teeth, and distributing her kits and apps via health plans and hospitals–Matthew Holt

Nabla — It’s been a rocketship

I met the Nabla management team two years ago. Two years later they have ridden the wave of AI scribing to be one of the leaders in the field. At HLTH this year, I caught up with CEO Alex Lebrun and COO Delphine Groll to check in on their growth (150 customers and 100K users) what the next little bit of ambient AI scribing will look like (more specialties, more integration) and whether they’re scared of Epic (no!).–Matthew Holt

When Your Cloud Provider Doesn’t Understand HIPAA: A Cautionary Tale

By JACOB REIDER & JODI DANIEL

Jacob: I recently needed to sign a Business Associate Agreement (BAA) with one of the large hosting providers for a new health IT project. What should have been straightforward turned into a multi-week educational exercise about basic HIPAA compliance. And when I say “basic,” I mean really basic, like the definitions in the statute itself.

Here’s what happened and why you need to watch out for this if you’re building health care technology.

I’m building a system that automates clinical data extraction for research studies. Like any responsible health care tech company, I need HIPAA-compliant infrastructure. The company (I’ll call them Hosting Company or HC) is good technically, and they’re hosting our development environment, so I signed up for their enhanced support plan (which they require before they’ll even consider a BAA) and requested their standard agreement.

The Problem

HC’s BAA assumes every customer is a “Covered Entity.” That means a health plan, a health care clearinghouse, or a health care provider that transmits health information electronically.

But that’s not me. I’m not a Covered Entity. I’m a Business Associate (BA). I handle protected health information on behalf of Covered Entities. When I need cloud infrastructure, I need my vendors to sign subcontractor BAAs with me.

The Back and Forth

When I told HC that I couldn’t sign their BAA as written, they escalated to their legal department. Days later, a team lead came back with this response:

“To HC, even if you are a subcontracted or a down the line subcontracted association. It would still be an agreement between the covered entity within the agreement and HC… So even being a business associate, it would still be considered a covered entity since it is your business that is being covered.”

I had to read it twice. This is simply wrong.

Jodi: Let me chime in here with the legal perspective, because this confusion is more common than it should be.

The terms “Covered Entity” and “Business Associate” aren’t interchangeable marketing terms. They have specific legal definitions in 45 CFR § 160.103. You can’t just redefine them because it’s administratively convenient. Generally… covered entities are (most) health care providers, health plans, and health care clearinghouses; business associates are those entities that have access to protected health information to perform services on behalf of covered entities; and subcontractors are persons to whom a business associate delegates a function, activity, or service.

Here’s what the regulations actually say:

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Sachin Jain–How do we do better?

What are the practices that we have normalized that future generations will criticize us for? Sachin Jain, CEO of SCAN Health Plan, is perhaps the leading truth teller in health care who also runs a real health care organization. I had a really fun but serious interview with Sachin about what health care people are doing, what are the bad things that happen. How are good people letting this happen? How we should be changing what we are doing?–Matthew Holt

Kai Romero, Evidently

Kai Romero is Head of Clinical Success at Evidently. The company is one of many that are using AI to dive into the EMR and extract data to deliver it to clinicians. It works to get really great information from the EMR to various flavors of clinicians in a fast and innovative way. Kai leads me on a detailed exploration of how the technology gets used as a layer over the EMR. And Kai shows me the new version that allows and LLM to deliver immediate answers from the data. This is a demo you really need to see to understand how AI is changing, and improving, that clinical experience. Meanwhile Kai is fascinating. She was an ER doc who became a specialist in hospice. We didn’t get into that too much, but you can tell about her input into Evidently’s design — Matthew Holt

Life Is Geometry

By KIM BELLARD

In 2025, we’ve got DNA all figured out, right?  It’s been over fifty years since Crick and Watson (and Franklin) discovered the double helix structure. We know that permutations of just four chemical bases (A, C, T, and G) allow the vast genetic complexity and diversity in the world. We’ve done the Humam Genome Project. We can edit DNA using CRISPR. Heck, we’re even working on synthetic DNA. We’re busy finding other uses for DNA, like computing, storage, or robots. Yep, we’re on top of DNA.

Not so fast. Researchers at Northwestern University say we’ve been missing something: a geometric code embedded in genomes that helps cells store and process information. It’s not just combinations of chemical bases that make DNA work; there is also a “geometric language” going on, one that we weren’t hearing.

Wait, what?

The research – Geometrically Encoded Positioning of Introns, Intergenic Segments, and Exons in the Human Genome – was led by Professor Vadim Backman, Sachs Family Professor of Biomedical Engineering and Medicine at Northwestern’s McCormick School of Engineering, and director of its Center for Physical Genomics and Engineering. The new research indicates, he says, that: “Rather than a predetermined script based on fixed genetic instruction sets, we humans are living, breathing computational systems that have been evolving in complexity and power for millions of years.”

The Northwestern press release elaborates:

The geometric code is the blueprint for how DNA forms nanoscale packing domains that create physical “memory nodes” — functional units that store and stabilize transcriptional states. In essence, it allows the genome to operate as a living computational system, adapting gene usage based on cellular history. These memory nodes are not random; geometry appears to have been selected over millions of years to optimize enzyme access, embedding biological computation directly into physical structure.

Somehow I don’t think Crick and Watson saw that coming, much less either Euclid or John von Neumann.

Coauthor Igal Szleifer, Christina Enroth-Cugell Professor of Biomedical Engineering at the McCormick School of Engineering, adds: “We are learning to read and write the language of cellular memories. These ‘memory nodes’ are living physical objects resembling microprocessors. They have precise rules based on their physical, chemical, and biological properties that encode cell behavior.”

“Living, breathing computational systems”? “Microprocessors”? This is DNA computing at a new level.

The study suggests that evolution came about not just by finding new combinations of DNA but also from new ways to fold it, using those physical structures to store genetic information. Indeed, one of the researchers’ hypothesis is that development of the geometric code helped lead to the explosion of body types witnessed in the Cambrian Explosion, when life went from simple single and multicellular organisms to a vast array of life forms.

Coauthor Kyle MacQuarrie, assistant professor of pediatrics at the Feinberg School of Medicine, points out that we shouldn’t be surprised it took this long to realize the geometric code: “We’ve spent 70 years learning to read the genetic code. Understanding this new geometric code became possible only through recent advances in globally-unique imaging, modeling, and computational science—developed right here at Northwestern.” (Nice extra plug there for Northwestern, Dr. MacQuarrie.)

Coauthor Luay Almassalha, also from the Feinberg School of Medicine, notes: “While the genetic code is much like the words in a dictionary, the newly discovered ‘geometric code’ turns words into a living language that all our cells speak. Pairing the words (genetic code) and the language (geometric code) may enable the ability to finally read and write cellular memory.”

I love the distinction between the words and the actual language. We’ve been using a dictionary and not realizing we need a phrase book.   

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