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Medicine May Be an Art, but AI May Be Artists

By KIM BELLARD

Six hundred years ago, Swiss physician/scientist/philosopher Paracelsus disclaimed: “Medicine is not only a science; it is also an art.”  Medicine, most people in healthcare still believe, takes not just intelligence and fact-based decision-making, but also intuition, creativity, and empathy.  This duality is often cited as a reason artificial intelligence (A.I.) will never replace human physicians.

Perhaps those skeptics have not heard about Ai-Da. 

Now, I have to admit, “she” wasn’t on my radar either until recently, when she was imprisoned/impounded at customs by Egyptian authorities on her way to an art exhibit at the Great Pyramids of Giza, where she was scheduled to show her work.  Egyptian authorities first objected to her modem, then to the cameras in her eyes.  “I can ditch the modems, but I can’t really gouge her eyes out,” said her creator Aidan Meller.  After a 10 day stand-off, she was released late last week. 

Let me back up.  Named in honor of famed 19th century mathematician/programmer Ada Lovelace, Ai-Da is “the world’s first ultra-realistic humanoid robot artist.”  She was created in 2019, and uses AI algorithms to create art with her cameras/eyes and her bionic arms.  She can draw, paint, even sculpt, and had her first major exhibit – Ai-Da: Portrait of the Robot — this summer at London’s Design Museum.

The description of her exhibit says:

As humans increasingly merge with technology, the self-titled robotic artist, Ai-Da, leads us to ask whether artworks produced by machines can indeed be called ‘art’…Ai-Da can both draw and engage in lively discussion…These features, and the movements and gestures that Ai-Da is programmed to perform, raise questions about human identity in a digital age.

Her website elaborates:

…current thinking suggests we are edging away from humanism, into a time where machines and algorithms influence our behaviour to a point where our ‘agency’ isn’t just our own. It is starting to get outsourced to the decisions and suggestions of algorithms, and complete human autonomy starts to look less robust. Ai-Da creates art, because art no longer has to be restrained by the requirement of human agency alone.  

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You Need a Cyber Team

By KIM BELLARD

Maybe you, like me, are an Olympics fan (in my case: Summer Games, track & field).  Most Americans look forward eagerly to the Super Bowl, while the rest of the world (and, increasingly, many in the U.S.) are waiting for the World Cup.  But too few of us are aware that next summer will be the inaugural International Cyber Security Challenge, an esports event that pits teams from multiple countries against each other in cybersecurity skills.  The U.S. is sending a 25 person team.  

So what, you might say?  Well, if you work in healthcare (or any industry, for that matter), or use any kind of digital device, you should care.  Ransomware attacks on healthcare organizations continue to proliferate. The Colonial Pipeline cyberattack this past spring illustrated the weakness of other parts of our critical infrastructure, and we’ve all almost certainly had some of our personal data exposed in data breaches.    

We’re in a war, but it’s not clear that we have the right army, with the right weapons, ready to fight it. Thus the U.S. Cyber Games.

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THCB Gang Episode 67 – Thurs October 14

Joining Matthew Holt (@boltyboy) on THCBGang today were THCB regular writer Kim Bellard (@kimbbellard); patient safety expert and all around wit Michael Millenson (@MLMillenson); and privacy expert and entrepreneur Deven McGraw (@HealthPrivacy).

We heard a good bit from Deven about Ciitizen’s acquisition by genomic testing company Invitae, and got into it about the Texas abortion law, Walgreens moving into health care delivery in a big way–and whether the Giants can beat the Dodgers despite spending only 55% of their payroll! At least one of those questions will be answered tonight!

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Get Ready for Deepfakes

By KIM BELLARD

The Tom Cruise TikTok deepfakes last spring didn’t spur me into writing about deepfakes, not even when Justin Bieber fell so hard for them that he challenged the deepfake to a fight.  When 60 Minutes covered the topic last night though, I figured I’d best get to it before I missed this particular wave.

We’re already living in an era of unprecedented misinformation/disinformation, as we’ve seen repeatedly with COVID-19 (e.g., hydroxychloroquine, ivermectin, anti-vaxxers), but deepfakes should alert us that we haven’t seen anything yet.  

ICYMI, here’s the 60 Minutes story:

The trick behind deepfakes is a type of deep learning called “generative adversarial network” (GAN), which basically means neural networks compete on which can generate the most realistic media (e.g., audio or video).  They can be trying to replicate a real person, or creating entirely fictitious people.  The more they iterate, the most realistic the output gets.  

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You Want to 3D Print What

By KIM BELLARD

You know we’re living in the 21st century when people are 3D printing chicken and cooking it with lasers.  They had me at “3D printing chicken.”  

An article in NPJ Science of Food explains how scientists combined additive manufacturing (a.k.a, 3D printing) of food with “precision laser cooking,” which achieves a “higher degree of spatial and temporal control for food processing than conventional cooking methods.”  And, oh, by the way, the color of the laser matters (e.g., red is best for browning).   

Very nice, but wake me when they get to replicators…which they will.  Meanwhile, other people are 3D printing not just individual houses but entire communities.   It reminds me that we’ve still not quite realized how revolutionary 3D printing can and will be, including for healthcare. 

The New York Times profiled the creation of a village in Mexico using “an 11-foot-tall three-dimensional printer.”  The project, being built by New Story, a nonprofit organization focused on providing affordable housing solutions, Échale, a Mexican social housing production company, and Icon, a construction technology company, is building 500 homes.  Each home takes about 24 hours to build; 200 have already been built.

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THCB Gang Episode 65 – Thurs September 30

It has been WAY too long and for too many reasons (conferences, travel, a hurricane flooding out 4 East Coast guests) we haven’t got together but #THCBGang is back.

Joining Matthew Holt (@boltyboy) will be fierce patient activist Casey Quinlan (@MightyCasey);  THCB regular writer Kim Bellard (@kimbbellard); ; medical historian Mike Magee (@drmikemagee); and board-certified patient advocate Grace Cordovano (@GraceCordovano).

We opined a lot on the latest machinations in Congress, we talked about access to data (especially images) and we really enjoyed getting in touch with each other for a great hour!

You can see the video below & if you’d rather listen than watch, the audio is preserved as a weekly podcast available on our iTunes & Spotify channels.

Never Waste a (Design) Crisis

By KIM BELLARD

The Wall Street Journal reported that the American Dental Association (ADA) opposes expanding Medicare to include dental benefits.  My reaction was, well, of course they do. 

They apparently don’t care that at least half, and perhaps as many as two thirds, of seniors lack dental insurance, or that one in five seniors are missing all their teeth.  The ADA prefers a plan for low income Medicare beneficiaries only, although state Medicaid programs were already supposed to be that, with widely varying results between the states. 

The ADA is following blindly in the AMA’s opposition to enactment of Medicare, ignoring how fruitful Medicare has turned out to be for physicians’ incomes.  It’s all about the money, of course; the ADA thinks dentists can get more money from private insurance, or directly from patients, than they would from Medicare, and they’re probably right.    

As is typical for our healthcare system, good design is no match for interfering with the incomes of the people/organizations providing the care. 

By the same token, I suspect that the real opposition to “Medicare for All” is not from health insurers but from healthcare providers.  Health insurers, a least the larger ones, have done quite nicely with Medicare Advantage, and would probably welcome moving members from those balkanized, largely self-funded employer plans to Medicare Advantage plans. 

No, the bloodbath in Medicare for All would be the loss in revenue of health care professionals/organizations missing out on those lucrative private pay rates.  As Upton Sinclair once observed, “It is difficult to get a man to understand something when his salary depends upon his not understanding it.”  Or, as Guido tells Joel in Risky Business, “never, ever, fuck with another man’s livelihood.”

Very little about our healthcare system has been consciously designed.  It’s a patchwork of efforts – legislative/regulatory initiatives, tax provisions, entrepreneurial choices, independent design decisions — and many unintended consequences.   We should be less surprised at how poorly they all fit together than that some of them fit at all.   Find someone who is happy with our current healthcare system and I bet that person is either making lots of money from it, or not receiving any services from it. 

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Not Your Father’s Job Market

By KIM BELLARD

If you, like me, continue to think that TikTok is mostly about dumb stunts (case in point: vandalizing school property in the devious licks challenge; case in point: risking lives and limbs in the milk crate challenge), or, more charitably, as an unexpected platform for social activism (case in point: spamming the Texas abortion reporting site), you probably also missed that TikTok thinks it could take on LinkedIn.  

Welcome to #TikTokresumes.  Welcome to the Gen Z workplace.  If healthcare is having a hard time adapting to Gen Z patients – and it is — then dealing with Gen Z workers is even harder.  

TikTok actually announced the program in early July, but, as a baby boomer, I did not get the memo.  It was a pilot program, only active from July 7 to July 31, and only for a select number of employers, which included Chipotle and Target.  The announcement stated:

TikTok believes there’s an opportunity to bring more value to people’s experience with TikTok by enhancing the utility of the platform as a channel for recruitment. Short, creative videos, combined with TikTok’s easy-to-use, built-in creation tools have organically created new ways to discover talented candidates and career opportunities. 

Interested job-seekers were “encouraged to creatively and authentically showcase their skillsets and experiences.”  Nick Tran, TikTok’s Global Head of Marketing, noted: “#CareerTok is already a thriving subculture on the platform and we can’t wait to see how the community embraces TikTok Resumes and helps to reimagine recruiting and job discovery.”  

Marissa Andrada, chief diversity, inclusion and people officer at Chipotle, told SHRM: “Given the current hiring climate and our strong growth trajectory, it’s essential to find new platforms to directly engage in meaningful career conversations with Gen Z.  TikTok has been ingrained into Chipotle’s DNA for some time, and now we’re evolving our presence to help bring in top talent to our restaurants.”

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More Laughing, More Thinking

By KIM BELLARD

There was a lot going on this week, as there always is, including the 20th anniversary of 9/11 and the beginning of the NFL season, so you may have missed a big event: the announcement of the 31st First Annual Ig Nobel Awards (no, those are not typos).  

What’s that you say — you don’t know the Ig Nobel Awards?  These annual awards, organized by the magazine Annals of Improbable Research, seek to:

…honor achievements that make people LAUGH, then THINK. The prizes are intended to celebrate the unusual, honor the imaginative — and spur people’s interest in science, medicine, and technology.  

Some scientists seek the glory of the actual Nobel prizes, some want to change the world by coming up with an XPRIZE winning idea, but I’m pretty sure that if I was a scientist I’d be shooting to win an Ig Nobel Prize.  I mean, the point of the awards is “to help people discover things that are surprising— so surprising that those things make people LAUGH, then THINK.”   What’s better than that?

Healthcare could use more Ig.

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Selfish Much?

By KIM BELLARD

In a week where we’ve seen the bungled Afghan withdrawal, had Texas show us its contempt for all sorts of rights, watched wildfires ravage the west and Ida wreak havoc on a third of the country, and, of course, witnessed COVID-19 continue its resurgence, I managed to find an article that depressed me further.  Thank you, Aaron Carroll.

Dr. Carroll – pediatrician, long-time contributor to The New York Times, and now Chief Health Officer of I.U. Health — wrote a startling piece in The Atlantic: We’ve Never Protected the Vulnerable.  He looks at the resistance to public health measures like masking and wonders: why is anyone surprised? 

Some of his pithier observations:

  • “Much of the public is refusing. That’s not new, though. In America, it’s always been like this.”
  • “COVID-19 has exposed these gaps in our public solidarity, not caused them.”
  • “America has never cared enough. People just didn’t notice before.”

Wow.  What was that about Texas again? 

Some of Dr. Carroll’s examples include our normally lackadaisical approach to influenza, our failure to recognize the dangers we often pose to immunocompromised people, our paltry family and sick leave policies, and our vast unpaid care economy.  He could have just as well pointed to our (purposefully) broken unemployment system or the stubborn resistance to Medicaid expansion in 12 states (Texas again!), but you probably get the point. 

Everyone likes to complain about our healthcare system – and with good reason – but it is not an abyss we somehow stumbled into.  It’s a hole we’ve dug for ourselves, over time.  We may not like our healthcare system but it is the system we’ve created, or, perhaps, allowed. 

Health insurance was once largely community-rated, spreading the risk equally across everyone to protect the burden on the sickest, until some insurers (and some groups) figured out that premiums could be cheaper without it.  Use of preexisting conditions and medical underwriting also served to protect the less vulnerable, until ACA outlawed those practices. 

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