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The Silicon Curtain Descends on SB 1047

By MIKE MAGEE

Whether you’re talking health, environment, technology or politics, the common denominator these days appears to be information.  And the injection of AI, not surprisingly, has managed to reinforce our worst fears about information overload and misinformation. As the “godfather of AI”, Geoffrey Hinton, confessed as he left Google after a decade of leading their AI effort, “It is hard to see how you can prevent the bad actors from using AI for bad things.”

Hinton is a 75-year-old British expatriate who has been around the world. In 1972 he began to work with neural networks that are today the foundation of AI. Back then he was a graduate student at the University of Edinburgh. Mathematics and computer science were his life. but they co-existed alongside a well evolved social conscience, which caused him to abandon a 1980’s post at Carnegie Mellon rather that accept Pentagon funding with a possible endpoint that included “robotic soldiers.” 

Four years later in 2013, he was comfortably resettled at the University of Toronto where he managed to create a computer neural network able to teach itself image identification by analyzing data over and over again. That caught Google’s eye and made Hinton $44 million dollars richer overnight. It also won Hinton the Turing Award, the “Nobel Prize of Computing” in 2018. But on May 1 2023, he unceremoniously quit over a range of safety concerns.

He didn’t go quietly. At the time, Hinton took the lead in signing on to a public statement by scientists that read, “We believe that the most powerful AI models may soon pose severe risks, such as expanded access to biological weapons and cyberattacks on critical infrastructure.” This was part of an effort to encourage Governor Newsom of California to sign SB 1047 which the California Legislature passed to codify regulations that the industry had already pledged to pursue voluntarily. They failed, but more on that in a moment.

At the time of his resignation from Google, Hinton didn’t mix words. In an interview with the BBC, he described the generative AI as “quite scary…This is just a kind of worst-case scenario, kind of a nightmare scenario.”

Hinton has a knack for explaining complex mathematical and computer concepts in simple terms.

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Red Alert about Red Buttons

By KIM BELLARD

In a week where, say, the iconic brand Tupperware declared bankruptcy and University of Michigan researchers unveiled a squid-inspired screen that doesn’t use electronics, the most startling stories have been about, of all things, pagers and walkie-talkies.

Now, most of us don’t think much about either pagers or walkie-talkies these days, and when we do, we definitely don’t think about them exploding. But that’s what happened in Lebanon this week, in ones carried by members of Hezbollah. Scores of people were killed and thousands injured, many of them innocent bystanders. The suspicion, not officially confirmed, is that Israel engineered the explosions.

I don’t want to get into a discussion about the Middle East quagmire, and I condemn the killing of innocent civilians on either side, but what I can’t get my mind around is the tradecraft of the whole thing. This was not a casual weekend cyberattack by some guys sitting in their basements; this was a years-in-the-making, deeply embedded, carefully planned move.

A former Israeli intelligence official told WaPo that, first, intelligence agencies had to determine “what Hezbollah needs, what are its gaps, which shell companies it works with, where they are, who are the contacts,” then “you need to create an infrastructure of companies, in which one sells to another who sells to another.”  It’s not clear, for example, if Israel someone planted the devices during the manufacturing process or during the shipping, or, indeed, if its shell companies actually were the manufacturer or shipping company. 

Either way, this is some James Bond kind of shit.

The Washington Post reports that this is what Israeli officials call a “red-button” capability, “meaning a potentially devastating penetration of an adversary that can remain dormant for months if not years before being activated.” One has to wonder what other red buttons are out there.

Many have attributed the attacks to Israel’s Unit 8200, which is roughly equivalent to the NSA.  An article in Reuters described the unit as “famous for a work culture that emphasizes out-of-the-box thinking to tackle issues previously not encountered or imagined.”  Making pagers explode upon command certainly falls in that category.

If you’re thinking, well, I don’t carry either a pager or a walkie-talkie, and, in any event, I’m not a member of Hezbollah, don’t be so quick to think you are off the hook. If you use a device that is connected to the internet – be it a phone, a TV, a car, even a toaster – you might want to be wondering if it comes with a red button. And who might be in control of that button.

Just today, for example, the Biden Administration proposed a ban on Chinese software used in cars.

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THCB Gang Special! Women Healthcare Leaders for Progress talk about health care & the election

THCB Gang is back! (I know you’ve all missed it) and we started with a bang. I met with five powerhouse women leaders in health care who’ve just issued a public statement signed by another 500+ women leaders in support of the Harris/Walz campaign.

On the Gang are Missy Krasner, digital health veteran most recently at Amazon and Redesign Health but wayback on the founder team at ONC; Molly Coye, who ran Medicaid in NJ and CA and has had every role in health innovation know to womankind; Miriam Paramore, investor board member and operator at many, many health tech companies; (Lori Evans Bernstein, founder of Caraway, Health Reveal & many more but also at ONC back in the day, who actually couldn’t make the call); Laurie McGraw, EVP at Transcarent, formerly at AMA, Allscripts, etc; and Audrey Mann Cronin, communication advisor to CEOs and Founder, Say it Media.

Despite my obvious political leanings, this wasn’t be a push over. Do we need this group? What does Harris want to do about health care? What can she do? I am on record as saying “not much”. This was great discussion, and I was (virtually) ducking alot! — Matthew Holt

Streamlining Public Benefits Access is a Must to Address Poverty

By ALISTER MARTIN and TARA MENON

If a friend were to ask you which state, Massachusetts or Texas, has a more streamlined federal benefits enrollment program, what would your guess be?

Having screened over 17,000 families and helped them obtain more than $1.8M in federal and state aid through our work in both Massachusetts and Texas, our experiences doing federal benefit enrollment have led us to a surprising conclusion: Texas is leading the way. While Massachusetts has room for improvement, this issue extends beyond a single state—many other states face similar challenges with complex and fragmented benefits systems.

At Link Health, where our work spans the bustling neighborhoods of Boston and Houston, this revelation has been both a surprise and a call to action. In many underserved communities, through partnerships with Federally Qualified Health Centers, our organization seeks to assist eligible people in the navigation and enrollment in benefit programs that address crucial needs like access to affordable internet, food access, healthcare support, and housing resources.

One of the main obstacles we’ve encountered is that people are often unaware of the benefits they qualify for or find the process overwhelming. In states like Massachusetts, separate applications are required for each benefit program, making it harder for families to get the help they need. Programs such as LIHEAP, which offers heating subsidies, Lifeline, which provides internet access for telehealth, and SNAP, which helps with food assistance, all come with different paperwork and requirements. This fragmentation creates unnecessary barriers.

This is not unique to Massachusetts. Across the U.S., many states have similarly disjointed systems, leaving millions of dollars in federal aid unclaimed. It’s estimated that around $140 billion in federal aid goes unclaimed each year due to these inefficiencies.

In contrast, we have found that Texas’s “Your Texas Benefits” platform is efficient and user-friendly. This centralized, comprehensive application process covers a wide range of state benefit programs, including SNAP, TANF, Medicaid, and CHIP, as well as other services like WIC, family violence support, adult education, and substance abuse prevention programs. This unified system allows users to apply for multiple programs through a single portal, streamlining the process considerably. Plus, this common application system allows groups like ours to efficiently connect patients with the help they need without the usual bureaucratic entanglements — it benefits us both.

Although Massachusetts made some progress with its limited common application for MassHealth and SNAP in 2021, it still doesn’t offer a fully unified system for all its programs. This means that many residents must continue navigating multiple applications and processes. During the recent Medicaid “unwinding,” people across the U.S. lost coverage because they couldn’t manage the renewal process. It’s estimated that between 8 million and 24 million people are at risk of losing Medicaid benefits nationwide(Center For Children and Families), not because they no longer qualify, but because of these application challenges.

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David Dyke demos Relatient scheduling

David Dyke is the Chief Product Officer of Relatient, which is one of the biggest players in the up and coming area of direct patient scheduling. As anyone who has been stuck in a phone tree or tried to reach a live human just to get an appointment at a doctor’s office knows, scheduling in health care is way behind the eight ball compared to booking a restaurant, massage, or basically anything else online. Why is it so hard? David explained that and then demos how Relatient allows provider organizations to let both new and returning patients self-schedule. There is a ton of complexity behind this including what David says is an average of infinity minus one API calls to the practice management system and EMR of all of its clients. But speaking as someone who has literally left a message and hoped that someone called me back “within 4 business days” for my last specialty appointment, I’m glad to see one company at least is taking on this challenge–Matthew Holt

Software Living in an Enterprise World: Why Digital Behavioral Health Can’t Gain Traction

By TREVOR VAN MIERLO

Let’s face it: for the past 25 years, digital behavioral health has struggled. Yet, we keep reinventing (and funding) the same models over and over again.

How It All Started

In the beginning (mid-1990s), a handful of developers, researchers, and investors envisioned high reach, lower-cost, highly tailored, anonymous interventions reaching millions of people with limited healthcare access.

The initial focus was never healthcare providers and insurers. These organizations were seen as too slow to adopt new technologies, and there was a general distrust of integrated care and insurers. Many digital health companies feared these organizations (and pharma) would leverage their power to learn from smaller companies, and then redevelop interventions internally.

Instead, the focus was on partnerships and B2C sales. Funding was easier to obtain from granting agencies, and there was ample development support flowing from sources like the tobacco Master Settlement Agreement (MSA). The primary concern was 1) whether the population could access these revolutionary tools and, 2) who would pay for them.

The Digital Divide

Back then, funders were often short-sightedly obsessed with the digital divide – the gap between people who had access to digital technology (mostly educated, higher-income earners in large cities) and everyone else. The argument was, “Why should we fund digital tools that will only benefit those who already have access to healthcare?”

Data was available, so academics armed themselves with ANOVA and relentlessly examined variables such as hardware costs, processing speed, age, gender, race, ethnicity, geography, income, and education. If you check Google Scholar, you can see the prevailing sentiment was that it would take decades for the digital divide to narrow, and new policy was desperately required to fix the problem (see: here, here, here, and here).

No More Excuses

Fast forward to 2024. According to a recent article in Forbes, there are 5.4 billion internet users worldwide (66% of the global population). In the U.S., 94.6% of Americans have internet access. Most US households have multiple devices, and according to Pew Research Center Research, 97% own a cellphone, of which 90% are smartphones.

As a Gen X’er who used a typewriter in college before upgrading to a Compaq Deskpro 286 from Future Shop (for about $400), my adult life has been a witness to the rapid progression of digital. Now, my 9-year-old daughter is teaching me how to play Fortnite (Epic Games), my 11-year-old is the only kid on his hockey team without a smartphone (this won’t last), and STARLINK allows me to chat face-to-face with my parents in rural Northern Ontario.

All aspects of technology are pervasive and accessible – but if you search Google or Bing for immediate, evidence-based behavioral help, you can’t get it. If you can find access it’s behind a paywall: through your employer (contact HR), health plan (call to see if you’re covered), or subscription ($19.99 per month).

That’s not meeting the original vision – and we have the technology. So, what’s the problem?

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Moving the bar(rier) forward: the benefits of de-risking cytokine release syndrome

By SAMANTHA McCLENAHAN

Every breakthrough in cancer treatment brings hope, but it also comes with a staggering price, raising a critical question: how do we balance groundbreaking advances with the financial reality that could limit access for many patients? 

Developing new cancer medications involves extensive research, clinical trials, and regulatory approvals; a lengthy process that requires substantial financial investment. Within clinical trials, this includes maintaining stringent safety protocols and managing a variety of adverse events, from mild reactions requiring little to no care to extremely severe events with hefty hospital stays and life-saving medical intervention. Take Cytokine Release Syndrome (CRS), for example. CRS is a common adverse event associated with chimeric antigen receptor (CAR) T cell therapy and other immunotherapies that presents across this spectrum with flu-like symptoms in mild cases of CRS to organ damage, and even death, in severe cases. The median cost of treating CRS following cancer-target immunotherapy is over half a million dollars in the United States. Tackling that large price tag – in addition to another $500,000 for CAR-T cell therapies – and reducing associated risks are necessary to break down barriers to care for many patients – especially those who are uninsured or with limited resources hindering the ability to travel, miss work, or secure a caregiver.

Unlocking Cost Efficiency in Clinical Trials with Digital Health Technologies

Integration of digital health technologies (DHTs) including telehealth, wearables such as smart watches, remote patient monitoring, and mobile applications in oncology care and clinical trials has shown immense value in improving patient outcomes, despite the slow uptake within the field. General benefits during clinical trials are captured through: 

  1. Reducing clinical visits and shortening trial length – Remote patient monitoring and virtual consultations minimize the need for physical visits, accelerating trial timelines. 
  2. Enhancing recruitment, diversity, and participant completion – Targeted outreach supported by big data analytics and machine learning algorithms helps to effectively identify and engage with eligible candidates, leading to faster recruitment and lower dropout rates. Digital technologies also overcome traditional barriers to participation, such as location, transportation, language barriers, and information access.  for a broader representation of patient demographics and more generalized findings and improved healthcare equity. 
  3. Increasing availability of evidentiary and safety requirements – Continuous data collection and monitoring in the setting most comfortable to patients – extending beyond clinical walls. This provides a pool of data to support clinical endpoints and enhances patient safety by enabling early detection of adverse events. 

While the exact cost of these digital interventions varies by study, there is significant evidence that cost-saving measures are emerging.

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Everything you ever want to know about birth control and much more — Sophia Yen, Pandia Health

Dr. Sophia Yen is the Chief Medical Officer (and Founder) of Pandia Health. She is about as expert as it comes on the topics contraception, emergency contraception, medication abortion, menopause and lots more. Her PR peeps asked if I’d interview her about Pandia Health, which is a fantastic online clinic & pharmacy for women at basically all ages. But I couldn’t have her on THCB without having her tell all about the world of contraception, menopause and of course reproductive health. I promise you that if you are a woman or somone who knows a woman, this is a fascinating interview. You will learn a lot, and there are lots of suggestions for how to manage many aspects of your health–Matthew Holt

The Fantastic Fungi — Biohybrid Bots Are Mushrooming

By KIM BELLARD

I hadn’t expected to write about a biology-related topic anytime soon after doing so last week, but, gosh darn it, then I saw a press release from Cornell about biohybrid robots – powered by mushrooms (aka fungi)! They had me at “biohybrid.”  

The release talks about a new paper — Sensorimotor Control of Robots Mediated by Electrophysiological Measurements of Fungal Mycelia – from the Cornell’s Organic Robotics Lab, led by Professor Rob Shepherd. As the release describes the work:

By harnessing mycelia’s innate electrical signals, the researchers discovered a new way of controlling “biohybrid” robots that can potentially react to their environment better than their purely synthetic counterparts.  

Or, in the researchers’ own words:

The paper highlights two key innovations: first, a vibration- and electromagnetic interference–shielded mycelium electrical interface that allows for stable, long-term electrophysiological bioelectric recordings during untethered, mobile operation; second, a control architecture for robots inspired by neural central pattern generators, incorporating rhythmic patterns of positive and negative spikes from the living mycelia.

Let’s simplify that: “This paper is the first of many that will use the fungal kingdom to provide environmental sensing and command signals to robots to improve their levels of autonomy,” Professor Shepherd said. “By growing mycelium into the electronics of a robot, we were able to allow the biohybrid machine to sense and respond to the environment.”

Lead author Anand Mishra, a research associate in the lab, explained: “If you think about a synthetic system – let’s say, any passive sensor – we just use it for one purpose. But living systems respond to touch, they respond to light, they respond to heat, they respond to even some unknowns, like signals. That’s why we think, OK, if you wanted to build future robots, how can they work in an unexpected environment? We can leverage these living systems, and any unknown input comes in, the robot will respond to that.”

The team build two robots: a soft one shaped like a spider, and a wheeled one. The researchers first used the natural spike in the mycelia to make them walk and roll, respectively, using the natural signals from the mycelia. Then researchers exposed them to ultraviolet light, which caused the mycelia to react and changed the robots’ gaits. Finally, the researchers were able to override the mycelia signals entirely.

“This kind of project is not just about controlling a robot,” Dr. Mishra said. “It is also about creating a true connection with the living system. Because once you hear the signal, you also understand what’s going on. Maybe that signal is coming from some kind of stresses. So you’re seeing the physical response, because those signals we can’t visualize, but the robot is making a visualization.”

Dr. Shepherd believes that instead of using light as the signal, they will use chemical signals. For example: “The potential for future robots could be to sense soil chemistry in row crops and decide when to add more fertilizer, for example, perhaps mitigating downstream effects of agriculture like harmful algal blooms.”

It turns out that biohybrid robots in general and fungal computing in particular are a thing. In last week’s article I quoted Professor Andrew Adamatzky, of the University of the West of England about his preference for fungal computing. He not only is the Professor in Unconventional Computing there, and is the founder and Editor-in-Chief of the International Journal for Unconventional Computing, but also literally wrote the book about fungal computing.  He’s been working on fungal computing since 2018 (and before that on slime mold computing).

Professor Adamatzky notes that fungi have a wide array of sensory inputs: “They sense light, chemicals, gases, gravity, and electric fields,” which opens the door to a wide variety of inputs (and outputs). Accordingly, Ugnius Bajarunas, a member of Professor Adamatzy’s team, told an audience last year: “Our goal is real-time dialog between natural and artificial systems.”

With fungal computing, TechHQ predicts: “The future of computing could turn out to be one where we care for our devices in a way that’s closer to looking after a houseplant than it is to plugging in and switching on a laptop.”

But how would we reboot them?

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Biology to the Rescue?

By KIM BELLARD

I feel much about synthetic biology as I do AI: I don’t really understand it from a technical point of view, but I sure am excited about its potential. Sometimes they even overlap, as I’ll discuss later. But I’ll start with some recent developments with bioplastics, a topic I have somehow never really covered.

Let’s start with some work at Washington University (St. Louis) involving, of all things, purple bacteria. In case you didn’t know it – I certainly didn’t – purple bacteria “are a special group of aquatic microbes renowned for their adaptability and ability to create useful compounds from simple ingredients,” according to the press release. The researchers are turning the bacteria into bioplastic factories.

One study, led by graduate student Eric Connors, showed that two “obscure” species of purple bacteria can produce polyhydroxyalkanoates (PHAs), a natural polymer that can be purified to make plastics.  Another study, led by research lab supervisor Tahina Ranaivoarisoa, took another “well studied but notoriously stubborn” species of purple bacteria to dramatically ramp up its production of PHAs, by inserting a gene that helped turn them into “relative PHA powerhouses.” The researchers are optimistic they could use other bacteria to produce even higher levels of bioplastics.

The work was done in the lab of associate professor Aripta Bose, who said: “There’s a huge global demand for bioplastics. They can be produced without adding CO2 to the atmosphere and are completely biodegradable. These two studies show the importance of taking multiple approaches to finding new ways to produce this valuable material.”

“It’s worth taking a look at bacteria that we haven’t looked at before,” Mr. Conners said. “We haven’t come close to realizing their potential.” Professor Bose agrees: “We hope these bioplastics will produce real solutions down the road.”

Meanwhile, researchers at Korea Advanced Institute of Science and Technology, led by Sang Yup Lee, have manipulated bacteria to produce polymers that contain “ring-like structures,” which apparently make the plastics more rigid and thermally stable.  Normally those structures would be toxic to the bacteria, but the researchers managed to enable E. coli bacteria to both tolerate and produce them.  The researchers believe that the polymer would be especially useful in biomedical applications, such as drug delivery.

As with the Washington University work, this research is not producing output at scale, but the researchers have good confidence that it can. “If we put more effort into increasing the yield, then this method might be able to be commercialized at a larger scale,” says Professor Lee. “We’re working to improve the efficiency of our production process as well as the recovery process, so that we can economically purify the polymers we produce.”

Because the polymer is produced using biological instead of chemical processes, and is biodegradable, the researchers believe it can be important for the environment. “I think biomanufacturing will be a key to the success of mitigating climate change and the global plastic crisis,” says Professor Lee. “We need to collaborate internationally to promote bio-based manufacturing so that we can ensure a better environment for our future.”

Environmental impact is also very much on the minds of researchers at the University of Virginia. They are working on creating biodegradable bioplastics from food waste. “By creating cost-effective bioplastics that naturally decompose, we can reduce plastic pollution on land and in oceans and address significant issues such as greenhouse gas emissions and economic losses associated with food waste,” said lead researcher Zhiwu “Drew” Wang.

The team is developing microorganisms that convert food waste into fats, which are then processed into bioplastics. Those bioplastics then should easily be composed. “Our first step is to make single-layer film to see if it can be utilized as an actual product,” said Chenxi Cao, a senior in packaging and system design. “If it has good oxygen and water vapor barriers and other properties, we can move to the next step. We aim to replace traditional coated paper products with PHA. Current paper products are often coated with polyethylene or polyactic acid, which are not fully degradable. PHA is fully biodegradable in nature, even in a backyard environment.”

The approach is currently still in the pilot project stage.

If all that isn’t cool enough, our own bodies may become biofactories, such as to deliver drugs or vaccines. Earlier this year researchers at UT Southwestern reported on “in situ production and secretion of proteins,” which in this case targeted psoriasis and two types of cancer.

The researchers say: “Through this engineering approach, the body can be utilized as a bioreactor to produce and systemically secrete virtually any encodable protein that would otherwise be confined to the intracellular space of the transfected cell, thus opening up new therapeutic opportunities.”

“Instead of going to the hospital or outpatient clinic frequently for infusions, this technology may someday allow a patient to receive a treatment at a pharmacy or even at home once a month, which would be a significant boost to their quality of life,” said study leader Daniel Siegwart, Ph.D. Professor Siegwart believes this type of in situ production could eventually improve health and quality of life for patients with inflammatory diseases, cancers, clotting disorders, diabetes, and a range of genetic disorders.  

I promised I’d touch on an example of synthetic biology and AI overlapping. Last year I wrote about how “organoid intelligence” was a new approach to biocomputing and AI. Earlier this year Swiss firm FinalSpark launched its Neuroplatform, which uses 16 human brain organoids as the computing platform, claiming it was: “The next evolutionary leap for AI.”   

“Our principal goal is artificial intelligence for 100,000 times less energy,” FinalSpark co-founder Fred Jordan says. 

Now FinalSpark is renting its biocomputers to AI researchers at several top universities…for only $500 a month. “As far as I know, we are the only ones in the world doing this” on a publicly rentable platform, Dr. Jordan told Scientific American. Reportedly, around 34 universities requested access, but FinalSpark so far has limited use to 9 institutions, including the University of Michigan, the Free University of Berlin, and the Lancaster University in Germany.

Scientific America reports related work at Spain’s National Center for Biotechnology, using cellular computing, and at the University of the West of England, using – I’m serious! – fungal networks. “Fungal computing offers several advantages over brain-organoid-based computing,” Andrew Adamatzky says, “particularly in terms of ethical simplicity, ease of cultivation, environmental resilience, cost-effectiveness and integration with existing technologies.”

Bioplastics, biofactories, biocomputing — pretty cool stuff all around. I’ll admit I don’t know where all of this is leading, but I can’t wait to see where it leads.   

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