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Go Ahead, AI—Surprise Us

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By KIM BELLARD

Last week I was on a fun podcast with a bunch of people who were, as usual, smarter than me, and, in particular, more knowledgeable about one of my favorite topics – artificial intelligence (A.I.), particularly for healthcare.  With the WHO releasing its “first global report” on A.I. — Ethics & Governance of Artificial Intelligence for Health – and with no shortage of other experts weighing in recently, it seemed like a good time to revisit the topic. 

My prediction: it’s not going to work out quite like we expect, and it probably shouldn’t. 

“Like all new technology, artificial intelligence holds enormous potential for improving the health of millions of people around the world, but like all technology it can also be misused and cause harm,” Dr Tedros Adhanom Ghebreyesus, WHO Director-General, said in a statement.  He’s right on both counts.

WHO’s proposed six principles are:

  • Protecting human autonomy
  • Promoting human well-being and safety and the public interest
  • Ensuring transparency, explainability and intelligibility 
  • Fostering responsibility and accountability
  • Ensuring inclusiveness and equity 
  • Promoting AI that is responsive and sustainable

All valid points, but, as we’re already learning, easier to propose than to ensure.  Just ask Timnit Gebru.  When it comes to using new technologies, we’re not so good about thinking through their implications, much less ensuring that everyone benefits.  We’re more of a “let the genie out of the bottle and see what happens” kind of species, and I hope our future AI overlords don’t laugh too much about that. 

As Stacey Higginbotham asks in IEEE Spectrum, “how do we know if a new technology is serving a greater good or policy goal, or merely boosting a company’s profit margins?…we have no idea how to make it work for society’s goals, rather than a company’s, or an individual’s.”   She further notes that “we haven’t even established what those benefits should be.”

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THCB Gang Episode 59 – Thurs June 24, 1pm PT – 4pm ET

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#THCBGang will feature special guest venture capitalist & massive over-achiever Justin Norden  (@JustinNordenMD) from GSR Ventures. Also joining Matthew Holt (@boltyboy) will be regulars, patient safety expert and all around wit Michael Millenson (@MLMillenson); WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa);  futurist Ian Morrison (@seccurve); & THCB regular writer Kim Bellard (@kimbbellard) 

Then video will be below at 1pm PT- 4pm ET. If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes  & Spotify channels.

Better Broadband for Better Health Care

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By KIM BELLARD

Here’s a question that we don’t often ask: which is the U.S. more likely to accomplish – getting everyone health insurance, or broadband?  Hint: it’s probably not what you think.

The health insurance part of it is often debated.  We passed ACA, but the number of uninsured stubbornly remains at nearly 30 million, almost 10% of the population.  Still, except for residents of those 12 states that have refused to pass Medicaid expansion, everyone in the country has at least access to public or private health insurance, with subsidies available to many. 

Broadband hasn’t been around as long a health insurance, but it has become an integral part of our society, as the pandemic proved (ever try remote work or learning without broadband, much less telehealth?).   Unfortunately, some 20 million households lack broadband; assuming an average household size of about 2.5, that’s some 50 million people, which is way more than the number of uninsured. 

Welcome to the digital divide.   

Everyone seems to agree increasing access to broadband is a good goal.  It’s part of President Biden’s proposed infrastructure plan, and even many Republicans support some funding towards the goal, as in a recent bipartisan proposal. 

We often think about the issue as being a rural problem, similar to the problem of electricity availability in rural areas before the Rural Electrification Act (1936).  It’s just hard, or at least expensive, to wire all those vast spaces, those farms and small communities that comprise much of America. 

The fact of the matter, though, is that of those 20 million households without broadband, some 15 million of them are urban households.  A higher percent of rural households may lack broadband, but, in terms of actual numbers of households lacking it, it is urban dwellers.  For the most part, broadband is available in their neighborhood; they just can’t afford it (or don’t see the need).  

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Twins For Everyone!

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By KIM BELLARD

I have lived my entire life as a twin, and, while it isn’t an unalloyed blessing, on balance I’d recommend it.  Most of you, though, probably aren’t twins and have missed the experience.  Don’t worry: you may still get a chance – with a digital twin. 

It could have profound implications for your health and for healthcare generally.

A digital twin, in case you are not familiar with the concept, is a virtual representation of a physical object.  It is created from data about that physical object, and is fed ongoing data (e.g., via IoT) about it to keep the model accurate. 

The concept is not new, often attributed to Michael Grieves at the Florida Institute of Technology in 2002.  Dr. Grieves saw the value of the concept for manufacturing; for example, GE’s Aircraft Engines has been using them to make their engines safer and more efficient.  Other applications include building maintenance, data centers, and even creating a digital twin of the whole planet.

People have seen the potential of digital twins for healthcare for years.  Back in 2016, GE’s Digital CEO Bill Ruh predicted:

I believe we will have a digital twin at birth, and it will take data off of the sensors everybody is running, and that digital twin will predict things for us about disease and cancer and other things. I believe we will end up with health care being the ultimate digital twin. Without it, I believe we will have data but with no outcome, or value.

We’re not there yet, not nearly, but it’s coming.

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THCB Gang Episode 57 – Thurs June 10

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Episode 57 of “The THCB Gang” will be live on Thursday, June 10, 1pm PT 4pm ET. Matthew Holt (@boltyboy) will joined by regulars: medical historian Mike Magee (@drmikemagee), THCB regular writer Kim Bellard (@kimbbellard) and futurist Ian Morrison (@seccurve). And we have a special guest, health care equity analyst at Hedgeye, Emily Evans (@HedgeyeEEvans)

You might guess that the latest meme stock Clover Health (CLOV) might make an appearance! But that won’t be all!

The video is below. If you’d rather listen, the audio is preserved as a weekly podcast available on Fridays on our iTunes  & Spotify channels

Hey, How About Starship Earth?

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By KIM BELLARD

I missed the job announcement on the company website.  I missed it again when the company posted the job on Linkedin.  I missed it when Eric Ralph tweeted that the posting was “probably the coolest job posting I’ve read in years.”  Fortunately, though, I follow Isaac Kohne (MD, PhD), and I did see his tweet:

Yes, I’m talking about SpaceX.  Yes, the job is for a “Starship Medical Engineer.”  Yes, it’s to help SpaceX’s mission to Mars, whenever that might be.  Who knows, the job might even entail going to Mars, although that’s not spelled out. 

I am not, of course, remotely qualified for such a job.  In fact, I don’t even know anyone who might be.  But I agree with Mr. Ralph that it’s probably the coolest job posting I’ve seen in years, maybe ever.  And I even more agree with Dr. Kohne: it could be an “opportunity to rethink a bigger broken system.”

Hint: I don’t think he’s talking about just the SpaceX mission. 

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Make Some Microbe Friends

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By KIM BELLARD

It’s the coolest story I’ve seen in the past few days: The New York Times reported how an Italian  museum cleaned its priceless Michelangelo sculptures with an army of bacteria.  As Jason Horowitz wrote, “restorers and scientists quietly unleashed microbes with good taste and an enormous appetite on the marbles, intentionally turning the chapel into a bacterial smorgasbord.”

And you just want to kill them all with your hand sanitizers and anti-bacterial soaps. 

The Medici Chapel in Florence had the good fortune to be blessed with an abundance of works by Michelangelo, but the bad fortune to have had centuries of various kinds of grime building up on them.  In particular, over time the corpse of one Medici “…seeped into Michelangelo’s marble, the chapel’s experts said, creating deep stains, button-shaped deformations…”

This is, I assume, why they tell you not to touch the art.

Scientists picked a bacteria — Serratia ficaria SH7, in case you’re taking notes – that ate the undesired grime without also eating the underlying marble.   It wasn’t hazardous to humans either and didn’t create spores that might go elsewhere.  “It’s better for our health,” one of the art restorers told NYT.  “For the environment, and the works of art.”

The technique was a success, allowing the sculptures to look like they did centuries ago. 

Using such bacteria to clean art has been around for at a decade, and not just for sculptures.  Perhaps more surprising is bacteria isn’t just cleaning art, it’s also creating it; the American Society for Microbiology hosts an annual Agar Art Contest. 

If you’re impressed by that, researchers are teaching bacteria to read, or at least to recognize letters.  That’s not all they might learn to do.  “For example, the framework and algorithm in our study can be used to facilitate the design of living therapeutics, such as targeted drug release systems based on engineered probiotic bacteria systems,” the researchers say.   

The thing is, we not only don’t know what microbes do, or could do, but we have only a vague understanding how they surround us.  That’s starting to change.  We’ve known for some time that each of us has a unique microbiome (including mycobiome!).  What we didn’t realize until recently was that each urban area has its own microbiome as well. 

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Holograms to the Rescue

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By KIM BELLARD

Google is getting much (deserved) publicity for its Project Starline, announced at last week’s I/O conference.  Project Starline is a new 3D video chat capability that promises to make your Zoom experience seem even more tedious.  That’s great, but I’m expecting much more from holograms – or even better technologies.  Fortunately, there are several such candidates.

For anyone who has been excited about advances in telehealth, you haven’t seen anything yet.

If you missed Google’s announcement, Project Starline was described thusly:

Imagine looking through a sort of magic window, and through that window, you see another person, life-size and in three dimensions. You can talk naturally, gesture and make eye contact.

Google says: “We believe this is where person-to-person communication technology can and should go,” because: “The effect is the feeling of a person sitting just across from you, like they are right there.” 

Sounds pretty cool.  The thing, though, is that you’re still looking at the images through a screen.  Google can call it a “magic window” if it wants, but there’s still a screen between you and what you’re seeing.

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Death, Taxes — and Paperwork

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By KIM BELLARD

Tuesday, in case you missed it, was the deadline for filing your 2020 federal taxes (it was postponed  from its usual April 15 date due to “the unusual circumstances related to the pandemic”).  Nothing, Benjamin Franklin famously said, is certain but death and taxes, but if you live in the United States, you might add the inevitability of paperwork involved with both (and with healthcare in general). 

The question is, does it have to be as bad as it is? 

A Washington Post op-ed by Helaine Olen argues that tax filing could, and should, be much simpler.  A March article in The Conversation by Beverly Moran, a tax expert at Vanderbilt, agrees.  Both make the point that, for most of us, the IRS could do the work for us. 

Ms. Olen asserts:

The thing is, filing taxes just doesn’t have to be this hard. In 36 countries, the nation’s tax agency sends eligible residents a pre-filled return, and asks them to sign if they agree with the amount that’s indicated is owed or should be credited to them. Japan does this. So do Sweden, the Netherlands, Spain and others.

Professor Moran has slightly different numbers, but makes the same point.  She adds that our tax system is 10 times more expensive than in other major economies.  This should not be a surprise; collectively, we spend close to $200b annually on IRS paperwork, taking some 6 billion hours of our time along the way. 

You’d think that all this time and money spent on tax filing would at least give us an efficient tax system, but the opposite is true.  The last time the IRS took a look, for tax years 2011-2013, the “tax gap” – the estimate between taxes owed and taxes paid – was $441b annually, some 16% of tax liability.  IRS Commissioner Charles Rettig told Congress last month that the number might actually be over $1 trillion annually now, due to new kinds of wealth creation and more sophisticated tax avoidance. 

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THCB Gang Episode 54, Thursday May 13

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Episode 54 of “The THCB Gang” was held on Thursday, May 13. Matthew Holt (@boltyboy) was joined by regulars: policy expert consultant/author Rosemarie Day (@Rosemarie_Day1); medical historian Mike Magee (@drmikemagee), THCB regular writer Kim Bellard (@kimbbellard) employer health expert Jennifer Benz (@jenbenz); and WTF Health host & Health IT girl Jessica DaMassa (@jessdamassa).

The topic ended up looking at the role of employers in dealing with inequality in health care, and whether the digitally enabled primary care navigation organizations could help. A great discussion!

Then video is below. If you’d rather listen, the audio is preserved as a weekly podcast available on our iTunes  & Spotify channels.

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