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Inventors (and Innovators) Wanted

By KIM BELLARD

I thought about writing about the election, but I’m too anxious – and a little terrified – about it, so I’ll take a pass. I was intrigued by Oracle Health’s promise of an AI-driven, “next-generation” EHR, or the news that OpenAI was introducing ChatGPT search, but I felt that each was inevitable and yet that both would prove underwhelming in the short term.

So I decided to write about invention.

The November issue of IEEE Spectrum magazine is all about invention, starting with the tantalizing overview Why the Art of Invention Is Always Being Reinvented. “Invention doesn’t come from some innate genius, it’s not something that only really special people get to do,” says Stephanie Couch, executive director of the Lemelson MIT Program. 

Still, authors Eliza Strickland and Peter B. Meyer warn, “…the limits of what an individual can achieve have become starker over time. To tackle some of the biggest problems facing humanity today, inventors need a deep-pocketed government sponsor or corporate largess to muster the equipment and collective human brainpower required.”

Tell that to UTEP student Tayia Oddonetto. While an undergraduate, she had an epiphany. “During class, the professor said that if someone discovered how to turn brine, water with a high salt concentration, into something of value, it’d be revolutionary for the planet. At that moment, I told myself I was going to be the one who found the solution for brine, and that thought has never left me.”

And she did it. Instead of the more common reverse osmosis (RO) method of desalination, which at best converts 85% of salt water into fresh water and leaves a problematic 15% of concentrated brine, Ms. Oddonetto used something called salt-free, electrodialysis metathesis. As the press release describes it: “Salt-free electrodialysis metathesis treats brine by passing it through ion exchange membranes, thin sheets or films, and electrical currents that work to separate salt from water at the molecular level.”

Her approach produced over 90% fresh water, and generated higher levels of valuable metals and minerals that can be repurposed across several industries including technology, health and food.

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Patty Hayward, Talkdesk

Patty Hayward is GM of Healthcare and Life Sciences at Talkdesk. Talkdesk runs the technology for contact centers that helps companies across health care connect and manage their consumers. You’ve probably unknowingly used their technology when you call (or now text or email) your health plan, your provider system or call into one of those numbers on the drug adverts. Patty told me about the business of technology for contact centers, and how the transition is happening between voice to text and for that matter from on-prem to cloud. They’re also deeply integrated with Epic. Pretty interesting view into a not-often-thought-about part of the puzzle.–Matthew Holt

The Penn State College of Medicine Oath vs. “Doomscrolling.”

By MIKE MAGEE

Two years ago, prior to the 2022 election, mental health experts alerted the medical world to their version of an assessment scale for yet another new condition – “doomscrolling.”

As defined in the article, “Constant exposure to negative news on social media and news feeds could take the form of ‘doomscrolling’ which is commonly defined as a habit of scrolling through social media and news feeds where users obsessively seek for depressing and negative information.”

As the distressing recent MSG Rally well broadcast, there apparently are no guard rails remaining in Trump-led “doom making.” But that does not mean that the majorities that oppose him have to fall victim as well.

Optimism is a choice and an effective political message. No one can deny a range of legitimate concerns. Faced with continued background noise from residual effects of the pandemic, we’ve been forced to absorb global warming induced weather disasters, renegade AI, sectional warfare around the globe, and the fact that (inexplicably) most elected Republican leaders have chosen to compromise all values and decency to preserve their jobs.

With real challenges like these, our troubled world needs to stay focused on values and resilience. This means aligning our humanity with our approach to self-governance. John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.”

We live under a constitutional and representative democracy, as do two-thirds of our fellow citizens in over 100 nations around the world. The health of these democracies varies widely. The case for democracy emphasizes its capacity to enhance dignity and self-worth, promote well-being, advance equal opportunity, protect equal rights, advance economic productivity, promote peace and order, resolve conflicts peacefully, hold rulers accountable, and achieve legitimacy through community based action.

One of the challenges of democracy is to find the right balance in pursuing “the common good” which has dual (and often competing) arms. One  arm is communitarian well-being and the other, individual well-being.  Blending personal and public interests is complex.

Both nursing and medicine have worked to bridge this gap through “professionalism,” and launched new graduates by voicing “oaths” or promises to themselves, their colleagues, and our society as a whole.

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Andrea Ippolito, CEO, Simplifed

Andrea Ippolito has combined her personal experience as a mum struggling with breast feeding, and her professional career as an entrepreneur and engineer at Athenahealth building integrations with EMRs. She’s now the CEO of Simplifed which has built a network of lactation consultants, and much more, and has placed it in the workflow of that most important part of health care — pre and post partum. How did she do it and what’s it like? She told and showed Matthew Holt.

THCB Gang Episode 142, Thursday October 31

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 31 at 1pm PST 4pm EST are patient advocate Robin Farmanfarmaian (@Robinff3); health economist Jane Sarasohn-Kahn (@healthythinker); futurist Jeff Goldsmith: and digital health guru Fard Johnmar (@fardj). Yes, it’s the pre-election special on Halloween!

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

By the way the photo below was THCBGang Halloween 2020. When we all dressed up and Zoya Khan came as me!

Engineers: Heal Thyselves (and Health Care)

By KIM BELLARD

The article I can’t get out of my head is one by Greg Ip in The Wall Street Journal: Crises at Boeing and Intel Area National Emergency.

I’m old enough that I remember when the Boeing 707 took airline passenger travel from the prop age to the jet age. I’m old enough that I remember that we all wanted PCs with Intel chips when companies starting giving office workers their first PCs. I’ve read enough history to know the storied engineering background and achievements of both. I mean, those B-52s that have been the backbone of the U.S. Air Force bomber command for the past 70+ years: those are Boeing planes.

To younger people, though, Being is the company whose doors pop out mid-flight, or which abandons astronauts in space. When they think of Intel – oh, I’m just kidding; when younger people think about chip companies, it’s NVIDIA or TSMC. Intel’s stock is doing so badly it may get kicked out of the Dow Jones Industrial Average.

So, as Mr. Ip says: “A generation ago, any list of America’s most admired manufacturers would have had Intel and Boeing near the top. Today, both are on the ropes.”

He goes on to add:

The U.S. still designs the world’s most innovative products, but is losing the knack for making them.

At the end of 1999, four of the 10 most valuable U.S. companies were manufacturers. Today, none are. The lone rising star: Tesla, which ranked 11th.

Intel and Boeing were once the gold standard in manufacturing groundbreaking products to demanding specifications with consistently high quality. Not any longer. 

What is most frustrating, Mr. Ip points out, is: “Neither fell prey to cheap foreign competition, but to their own mistakes. Their culture evolved to prioritize financial performance over engineering excellence.”

As an example, in a Blockbuster-could-have-bought-Netflix parallel, The New York Times reports that Intel could have bought NVIDIA in 2005, but the reported $20b price was considered too expensive. NVIDIA is now worth $3.5 trillion. Whoops.

Boeing’s new CEO, Kelly Ortberg, admits: “The trust in our company has eroded,” and that Boeing needs “a fundamental change in culture.” It doesn’t help that its machinists have been on strike almost 2 months, with the union rejecting Boeing’s latest offer last week. Boeing is slashing some 17,000 jobs, considering selling off its Starliner business, and trying to raise as much as $25b. 

Intel has also cut jobs, is trying to beef up its manufacturing through a revitalized foundry business (which some believe Intel should spin off), and has seen its stock crater (down 52% YTD), but CEO Pat Gelsinger vows: “We see the finish line in sight.”

Intel is still waiting for some $8.5b in CHIPS Act funding, “There’s been renegotiations on both sides,” Mr. Gelsinger told The New York Times. “My simple message is, ‘Let’s get it finished.’” But, as former Commerce Department official Caitlin Legacki noted: [There is fear that] Intel is going to take chips money, build an empty shell of a factory and then never actually open it, because they don’t have customers.”  Its much-hyped plants in Arizona and Ohio have both faced setbacks. 

Meanwhile, the vultures are circling: there are rumors that Samsung and Apple may want to acquire Intel.

The trouble is, which is Mr. Ip’s point, neither has any real domestic competition; if either would fail, it would throw even more of our economy to the mercy of foreign manufacturers (or, in its space business, make the U.S. even more dependent on Elon Musk’s SpaceX). That’s the national emergence he is warning about.

My point with all this is not so much to add another lament about the decline of U.S. manufacturing as to emphasize the decline of the role of engineers. Earlier this year Jerry Useem, writing in The Atlantic,  argued: “When the wave of Japanese competition finally crashed on corporate America, those best equipped to understand it—the engineers—were no longer in charge. American boardrooms had been handed over to the finance people.”   

 Mr. Useem points out that a revitalized GE “is belatedly yielding to the reality that workers on the gemba [Japanese term for the shop floor, where value is actually created] are far better at figuring out more efficient ways of making things than remote bureaucrats with spreadsheet abstractions.” That sounds a lot like what Mr. Ortberg is saying: “We need to be on the factory floors, in the back shops and in our engineering labs.”

So what, you might ask, does this have to do with healthcare? 

It turns out that there is something called a healthcare engineer.

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My Father and Arnold Palmer – Embodying Honesty and Respect

By MIKE MAGEE

My father and Arnold Palmer had a great deal in common – and none of it involved golf. They were both men of faith and lived into their 80’s. My father was Catholic, and Arnold Palmer was Presbyterian. But on the day that Palmer died (September 25, 2016), Benedictine Archabbot Douglas R. Nowicki of St. Vincent’s Archabbey in Latrobe, Pennsylvania, was at his bedside.

Nowicki and Palmer’s friendship dated back a half century. He and his wife would often attend 7:30 a.m. Sunday Mass at the abbey.

At the time of Palmer’s death, the Benedictine monk said, “Arnie sort of appealed to everyone. There were no barriers, race, color, creed — those were things that never entered into his mind. He was welcoming to everybody and treated everyone with tremendous warmth and respect.”

But eight years and one month after his death, Palmer’s daughter, Peg Palmer Wears felt compelled to rise up and defend her father’s honor. In the Latrobe Airport, named after him, Donald Trump (according to FOX News) “discussed the golf legend’s manhood and how other players would react to Palmer in the showers.” Specifically, in an effort to relate to the local audience, Trump said, “He was all man. This man was so strong and tough, and I refused to say it, but when he took showers with the other pros, they came out of there; they said, ‘Oh my God, that’s unbelievable.’”

The reaction from his daughter, a registered Independent from North Carolina, was swift. She labeled his words, “disrespectful” and “inappropriate”… “appropriating someone he admires to bolster his own image, people deserve better.” Her words in defense of her father, who was no longer there to speak for himself, called to mind my sister Sue’s Eulogy to our father. It focused on the values and qualities in him that she admired – honesty, hard work, compassion, integrity, humility, kindness, and love for others.

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Health Care’s Endless Loops

By KIM BELLARD

Last week the Federal Trade Commission (FTC) issued its final “click-to-cancel” rule, making it easier for consumers to cancel various kinds of subscriptions, such as gym memberships or streaming services. It will require enrollments to be as easy to cancel as they were to enroll.

“Too often, businesses make people jump through endless hoops just to cancel a subscription,” said Commission Chair Lina M. Khan. “The FTC’s rule will end these tricks and traps, saving Americans time and money. Nobody should be stuck paying for a service they no longer want.”

Oh, boy, Chairperson Khan: if you want to talk about jumping through endless loops, let’s talk about health care.

The FTC rule was part of its effort to modernize its 1973 Negative Option Rule. It had issued a preliminary rule in March 2023, which drew some 16,000 comments. Laura Brett, vice president of the National Advertising Division of BBB National Programs, explained the need for the rule to CNN: “(Consumers) had to jump through hoops online to find out where to cancel. Other times they might’ve been able to sign up online, but in order to cancel they had to call and talk to a representative. Other kinds of memberships required them to actually show up in person to cancel their subscription,”

The new rule is also part of a broader Biden Administration Time Is Money initiative, “a new governmentwide effort to crack down on all the ways that corporations—through excessive paperwork, hold times, and general aggravation—add unnecessary headaches and hassles to people’s days and degrade their quality of life.”

Predictably, not everyone agrees. The U.S. Chamber of Commerce called the whole Time is Money initiative a heavy-handed effort to micromanage business practices and pricing, and warned it would lead to “fewer choices, higher prices, and more headaches.”

But of course they do; I mean, if you asked an AI to create a Chamber of Commerce response to virtually any regulation, it would probably sound much like that.

Critics see politics behind the rule. In her dissent, Melissa Holyoak, one of the FTC’s two Republican commissioners, wrote: “Why the rush? There is a simple explanation. Less than a month from election day, the Chair is hurrying to finish a rule that follows through on a campaign pledge made by the Chair’s favored presidential candidate.” The same could be said of the Biden Administration’s new proposed rules to make over-the-counter birth control to be covered by insurers at no cost to patients.

Be that as it may, we all have more subscriptions than we probably really want, the gym membership scam has been going on so long that there was a Friends episode about it almost 30 years ago, and who among us hasn’t gotten caught in endless loops with supposed customer service representatives – if you can ever reach a live person – about some problem with a company?

Which leads me to health care.

Providing health care has always been complex, as physicians like to remind us, but just trying to receive health care has grown more and more complex over the past several decades (while growing drastically more expensive). Time is Money, the Biden Administration tells us, but in health care, the only people whose time is valued are the people billing us. We are, after all, patients, so we are supposed to be patient.

The FTC, and the Biden Administration more generally, has this right: Time is Money, and that’s our time and our money. The initiative specifically included healthcare – “…the unnecessary complications of dealing with health insurance companies…” – but I don’t think that goes far enough, fast enough.

I like the precept that things should be as easy to get out of as they were to get into, although I want to use that more as a parameter than a restriction in expanding the discussion to healthcare.

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THCB Gang — DiME Special Episode 141, Thursday October 24

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 24 at 1pm PST 4pm EST are Digital Medicine Society CEO Jennifer Goldsack, (@GoldsackJen) , the VA’s Cole Zanetti (@ColeZanetti); and the Chief Commercial Officer at Curai Health Nicole Bell (@bellnicolee). There’ll likely be chatter about #HLTH2024 but also a lot of focus on the new announcement about the DiME Seal. Which is not about a those lovable animals that you see basking on rocks or ice flows, I understand…

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.

“Accelerationalism”: Is Your Money on Altman or Musk?

By MIKE MAGEE

Has America turned into an “Island of Musk?” He seems to be everywhere and nowhere at the same time. As Trump’s new best friend, he’s opened up the gates of Twitter-hell, morphed into a steady stream of crypto-cash, and demonstrated his dance moves alongside Trump at featured venues.

He’s also launched “a robot for every citizen” as part of a cover for sagging expectations for the Tesla Cybertruck, and issued a new round of hollow promises on his Robotaxi scheme. In short, Musk’s ADHD aside, he seems a bit more unhinged than usual.

In contrast, his arch foe, 38-year old OpenAI CEO, Sam Altman, is (if you’re to believe him) almost professorial. In his own words, “Technology brought us from the Stone Age to the Agricultural Age and then to the Industrial Age. From here, the path to the Intelligence Age is paved with compute, energy, and human will.”

Part of the clash revolves around a single word, accelerationalism. Destined to become the 2025 “word of the year,” this label is increasingly assigned to thought leaders in AI who have convinced themselves that AI will soon rule the world, our politics, and the battle field, and therefore “faster is better” is now the mantra when it comes to world-dominating generative AI.

This was not always the case. Back in 2015, when Elon Musk and a young Sam Altman teamed up to launch a non-profit called OpenAI “to benefit humanity,” they both realized that the leased offices were not big enough for two alpha males. But in launching their decade long battle for dominance, they agreed that slow, transparent, and deliberative was better than fast and reckless. Altman wrote at the time, “In an ideal world, regulation would slow down the bad guys and speed up the good guys.”

Back then, Musk famously warned, “Mark my words, AI is far more dangerous than nukes. I am really quite close to the cutting edge in AI, and it scares the hell out of me.” Where Musk was ”in your face,” Altman was “extremely nice and accommodating” which masked a startlingly aggressive underbelly according to those who knew him well. As his former partner in the 2011 start-up “Y combinator”, Paul Graham said, “You could parachute him into an island full of cannibals and come back in five years and he’d be the king.” Sam was 23 at the time.

In February, 2018, Musk jumped ship, apparently disagreeing on strategy with Altman. And then Altman’s board, in an all-out coup, fired him on November 17, 2023. Twelve days later, they were forced to rehire him when major stakeholder, Microsoft, threatened to pull their considerable support. Altman, for his part, displayed a conciliatory tone on Musk’s own X-platform, tweeting on his return “For my part, it is incredibly important to learn from this experience and apply those learnings as we move forward as a company. I welcome the board’s independent review of all recent events.”

On June 7, 2023,  38-year old Sam told his Congressional questioners that money wasn’t his motivator. Rather “I’m doing this because I love it.” Sen Richard Blumenthal swooned, “It’s so refreshing. He was willing, able, and eager.” Altman, playing to the cameras, said, “We think that regulatory intervention by governments will be critical to mitigate the risks of increasingly powerful models.”

Just 9 months later, his Senate supporters were no doubt confused to open the Wall Street Journal and discover the headline, “Sam Altman Seeks Trillions of Dollars to Reshape Business of Chips and AI. Open AI chief pursues investors including the U.A.E for a project requiring up to $7 trillion.”

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