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China Goes “Democratic” on Artificial General Intelligence

By MIKE MAGEE

Last week, following a visit to the White House, Jensen Huang instigated a wholesale reversal of policy from Trump who was blocking Nvidia sales of its H20 chip to China. What did Jensen say?

We can only guess of course. But he likely shared the results of a proprietary report from noted AI researchers at Digital Science that suggested an immediate policy course correction was critical. Beyond the fact that over 50% of all AI researchers are currently based in China, their study documented that “In 2000, China-based scholars produced just 671 AI papers, but in 2024 their 23,695 AI-related publications topped the combined output of the United States (6378), the United Kingdom (2747), and the European Union (10,055).”

David Hook, CEO of Digital Science was declarative in the opening of the report, stating “U.S. influence in AI research is declining, with China now dominating.”

China now supports about 30,000 AI researchers compared to only 10,000 in the US. And that number is shrinking thanks to US tariff and visa shenanigans, and overt attacks by the administration on our premier academic institutions.

Economics professors David Autor (MIT) and Gordon Hanson (Harvard), known for “their research into how globalization, and especially the rise of China, reshaped the American labor market,” famously described the elements of “China Shock 1.0.” in 2013. It was “a singular process—China’s late-1970s transition from Maoist central planning to a market economy, which rapidly moved the country’s labor and capital from collective rural farms to capitalist urban factories.”

As a result, a quarter of all US manufacturing jobs disappeared between 1999 and 2007. Today China’s manufacturing work force tops 100 million, dwarfing the US manufacturing job count of 13 million. Those numbers peaked a decade ago when China’s supply of low cost labor peaked. But these days China is clearly looking forward while this administration and its advisers are being left behind in the rear view mirror.

Welcome to “China Shock 2.0” wrote Autor and Hanson in a recent New York Times editorial. But this time, their leaders are focusing on “key technologies of the 21st century…(and it) will last for as long as China has the resources, patience and discipline to compete fiercely.”

The highly respected Australian Strategic Policy Institute, funded by their Defense Department, has been tracking the volume of published innovative technology research in the US and China for over a quarter century. They see this as a measure of experts opinion where the greatest innovations are originating. In 2007, we led China in the prior four years in 60 of 64 “frontier technologies.”

Two decades later, the table has flipped, with China well ahead of the US in 57 of 64 categories measured.

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Healthcare AI: What’s in your chatbot?

By OWEN TRIPP

So much of the early energy around generative AI in healthcare has been geared toward speed and efficiency: freeing doctors from admin tasks, automating patient intake, streamlining paperwork-heavy pain points. This is all necessary and helpful, but much of it boils down to established players optimizing the existing system to suit their own needs. As consumers flock to AI for healthcare, their questions and needs highlight the limits of off-the-shelf bots — and the pent-up demand for no judgment, all-in-one, personalized help.

Transforming healthcare so that it actually works for patients and consumers — ahem, people — requires more than incumbent-led efficiency. Generative AI will be game-changing, no doubt, but only when it’s embedded and embraced as a trusted guide that steers people toward high-quality care and empowers them to make better decisions.

Upgrading Dr. Google

From my vantage point, virtual agents and assistants are the most important frontier in healthcare AI right now — and in people-centered healthcare, period. Tens of millions of people (especially younger generations) are already leaning into AI for help with health and wellness, testing the waters of off-the-shelf apps and tools like ChatGPT.

You see, people realize that AI isn’t just for polishing emails and vacation itineraries. One-fifth of adults consult AI chatbots with health questions at least once a month (and given AI’s unprecedented adoption curve, we can assume that number is rising by the day). For most, AI serves as a souped-up, user-friendly alternative to search engines. It offers people a more engaging way to research symptoms, explore potential treatments, and determine if they actually need to see a doctor or head to urgent care.

But people are going a lot deeper with chatbots than they ever did with Dr. Google or WebMD. Beyond the usual self-triage, the numbers tell us that up to 40% of ChatGPT users have consulted AI after a doctor’s appointment. They were looking to verify and validate what they’d heard. Even more surprising, after conferring with ChatGPT, a similar percentage then re-engaged with their doctor — to request referrals or tests, changes to medications, or schedule a follow-up.

These trends highlight AI’s enormous potential as an engagement tool, and they also suggest that people are defaulting to AI because the healthcare system is (still) too difficult and frustrating to navigate. Why are people asking ChatGPT how to manage symptoms? Because accessing primary and preventive care is a challenge. Why are they second-guessing advice and prescriptions? Sadly, they don’t fully trust their doctor, are embarrassed to speak up, or don’t have enough time to talk through their questions and concerns during appointments.

Chatbots have all the time in the world, and they’re responsive, supportive, knowledgeable, and nonjudgmental. This is the essence of the healthcare experience people want, need, and deserve, but that experience can’t be built with chatbots alone. AI has a critical role to play, to be sure, but to fulfill its potential it has to evolve well beyond off-the-shelf chatbot competence.

Chatbots 2.0

When it comes to their healthcare, the people currently flocking to mass-market apps like ChatGPT will inevitably realize diminishing returns. Though the current experience feels personal, the advice and information is ultimately very generic, built on the same foundation of publicly available data, medical journals, websites, and countless other sources. Even the purpose-built healthcare chatbots in the market today are overwhelmingly relying on public data and outsourced AI models.

Generic responses and transactional experiences have inherent shortcomings. As we’ve seen with other health-tech advances, including 1.0 telehealth and navigation platforms, impersonal, one-off services driven primarily by in-the-moment-need, efficiency, or convenience don’t equate to long-term value.

For chatbots to avoid the 1.0 trap, they need to do more than put the world’s medical knowledge at our fingertips.

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Dominique Wells, Conduit Health Partners

Dominique Wells is COO of Conduit Health Partners which is a spin off from the (now) Bon Secours Mercy Health system. Their role is to provide back up for nursing staff for health systems in very specific areas, notably patient transfer operations, nurse triage and patient communications. Dominique and her team showed me a brief demo of how the transfer operation works. We also got into the conversation about the role of AI in nursing, and how nursing has changed since the pandemic. An interesting discussion about how the most vital role in health care is changing and how new services are being developed to adapt to it—Matthew Holt

Watching Where and How You’re Walking

By MIKE MAGEE

In a speech to the American Philosophical Society in January, 1946, J. Robert Oppenheimer said, “We have made a thing …that has altered abruptly and profoundly the nature of the world…We have raised again the question of whether science is good for man, of whether it is good to learn about the world, to try to understand it, to try to control it, to help give to the world of men increased insight, increased power.”

Eight decades later, those words reverberate, and we once again are at a seminal crossroads. This past week, Jensen Huang, the CEO of Nvidia, was everywhere, a remarkably skilled communicator celebrating the fact that his company was now the first publicly traded company to exceed a $4 trillion valuation.

As he explained, “We’ve essentially created a new industry for the first time in three hundred years. the last time there was an industry like this, it was a power generation industry…Now we have a new industry that generates intelligence…you can use it to discover new drugs, to accelerate diagnosis of disease…everybody’s jobs will be different going forward.”

Jensen, as I observed him perform on that morning show, seemed just a bit overwhelmed, awed, and perhaps even slightly frightened by the pace of recent change. “We reinvented computing for the first time since the 60’s, since IBM introduced the modern computer architecture… its able to accelerate applications from computer graphics to physics simulations for science to digital biology to artificial intelligence. . . . in the last year, the technology has advanced incredibly fast. . . AI is now able to reason, it’s able to think… Before it was able to understand, it was able to generate content, but now it can reason, it can do research, it can learn about the latest information before it answers a question.”

Of course, this is hardly the first time technology has triggered flashing ethical warning lights. I recently summarized the case of Facial Recognition Technology (FRT). The US has the largest number of closed circuit cameras at 15.28 per capita, in the world. On average, every American is caught on a closed circuit camera 238 times a week, but experts say that’s nothing compared to where our “surveillance” society will be in a few years.

The field of FRT is on fire. 

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Why Multi-morbidity Requires Two Health Systems, not One

By JEREMY SHANE

What’s behind the coming health care reckoning? Most industry leaders have their preferred list of culprits: not us! Left-leaning critics blame large insurers, drug companies, and private equity firms. Take the profit and self-dealing out of health care. Those on the right blame excessive regulation, poorly-designed insurance markets, or limits on individuals’ ability to pick their own coverage. Debates yo-yo between these views in a political stalemate. While the views are diametrically opposed on solutions, they share a belief that financial issues are the root cause of systemic dysfunction. That manipulating how clinicians are paid or insurance is structured can improve health outcomes. 

A half century into efforts to fix health care, it is clear that both views are wrong. Americans’ healthspans are shrinking while costs spiral upwards thanks to chronic disease. Progressively worsening illness throughout adulthood eventually explodes in multimorbidity, driving cancer and dementia, and protracted hospitalizations. Clinicians know this, with their well-worn chorus of “if only” laments. If only we could reward prevention instead of treatment. If only we intervened earlier before advanced pathology takes hold. If only clinical care was not fragmented. If only people had a direct stake in their longer-term health. Yet the debate in Washington DC, even shaken up by the MAHA movement’s focus on chronic issues, regresses into an interminable blame game, and conflicting ideas about how Congress or CMS could end the madness. 

It is time to break the cycle and say clearly what we know to be scientific fact. It’s impossible to use a system built to solve acute issues to also solve multi-decade, highly variable disease threats. Yet this presumption, that one system can do it all, addressing everything from colds to car crashes to cardiovascular issues to cancer, is so deeply ingrained in our thinking as to escape scrutiny. 

It is folly to continue. We need two systems, not one — the first for routine, emergency, and elective treatments and the second to confront long-term, complex challenges. Absent this change it will take far longer than it should, and cost far more, to decipher chronic issues or create economic arrangements that can bring forward the ultimate value of preventing disease.  

Resetting Assumptions

It’s illuminating to focus on the scientific drivers of disease rather than the financial after effects. It becomes clear why Medicare Advantage is imploding, and no, it’s not because CMS changed payment rates. Since 2000, the percent of Americans entering Medicare with multimorbidity has jumped by two-thirds, from a quarter of new entrants to over 40%. Software may be eating the world but multimorbidity is eating Medicare, Medicaid, and private insurance, and with it, most Americans’ healthspans. 

Most Americans now live a decade more than their grandparents, only to spend all the additional years, and then some, in poorer health.

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Towards a Tricoder

By MIKE MAGEE

On March 9, 1967, the Star Trek classic episode, “The Devil in the Dark” first aired. The Enterprise had received an urgent distress call from miners on the planet Janus VI. They are literally melting after, Horta, a wounded inhabitant has targeted them with liquifying acid rays.

A sympathetic Spock hears the call, and in an effort to disclose cause and motivation, “mind-melts” with the creature. Turns out, all she’s trying to do is protect her babies from a perceived threat. Kirk agrees, and with Spock, calls in Dr. McCoy to access the patient’s condition.

What McCoy encounters is a “rocky-skinned patient.” With the aid of his tricoder, a handheld diagnostic sensor, “Bones” (McCoy’s nickname referencing the historical 19th century American slang “Sawbones” referring to surgeons) uncovers a serious and deep gaping wound that requires immediate attention.

Kirk manages to “beam down” a hundred pounds of thermoconcrete, and McCoy expertly applies it to the wound. All of which is a set-up for his shipmates to wonder if this will work, which generates the iconic most-repeated line in the series storied history. McCoy (clearly irritated) utters – “How do I know? I’m a doctor, not a bricklayer.”

Similarly challenged modern day doctors have been voicing their own frustrations for more than a few decades. But the AMA has been scientifically tracking their discontent only since 2011. The levels of burnout are somewhat down in 2025 compared to peaked pique in 2021. But among the irritants, integration of new technology remain near the top of the list.

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We’re Gonna Need a Bigger Boat

By KIM BELLARD

My friends, we are like explorers of yore standing at the edge of a known continent, looking out at the vast ocean in hopes of finding new, unspoiled, better lands across it. True, we may have despoiled the continent behind us, but certainly things will be better in the new lands.

In the metaphor I’m thinking of, the known continent is our shambles of a healthcare system. For all the protestations about the U.S. having the best health care in the world, that’s manifestly untrue. We don’t live as long, we have more chronic diseases, we kill each other and ourselves at alarming rates, we pay way more, we have too many people that can’t afford care and/or can’t obtain care, we have too much care that is ineffective, inappropriate, or even harmful, and we spend much too much on administration.

We don’t trust the healthcare system, we don’t think its quality of care is good, we have an unfavorable opinion of it, we think it fails us. The vast majority of us think it should be fundamentally changed or completely rebuilt. That’s what we want to flee, and it’s no wonder why.

Across that metaphorical ocean, in the distance, over the horizon, lies the 22nd century healthcare system. It will, we hope, be like magic. It will be more equitable, more effective, more efficient, more proactive, less invasive, more affordable. We don’t know exactly what it will look like or how it will work, but we’ve seen what we have, and we know it can be better – much better. We just need to get there.

This leads me to the next part of the metaphor. I recently read a great quote from the late nature writer Barry Lopez, from his posthumous book of essays Embrace Fearlessly the Burning World. Mr. Lopez laments: “We are searching for the boats we never built.”

The boats aren’t coming to save us, to transport us to that idealized 22nd century healthcare system. Because we never built them. Because we still don’t have the courage to build them.

We’ve never built a system to ensure universal coverage. We rely on a hodgepodge of coverage mechanisms, each of which is struggling with its own problems and still leaving some 25 million people without insurance – and that’s before the 10-20 million who are predicted to lose coverage due to the “Big, Beautiful Bill” – plus the tens of millions who are “underinsured.

We’ve never built a system that was remotely equitable, just as we never did for housing, education, or employment. Money matters, ethnicity matters, geography matters. Discrepancies in availability of care and in outcomes show up clearly for each of those, and more.

We’ve never built a system that prizes patients above all. We deferred to doctors and hospitals, not calling them out when they gave us substandard care or when they charged us too much. Now health care has gone from a “noble calling” to a jobs and wealth creator. A recent New York Times analysis found (among other things):

  • Health care is the nation’s largest employer;
  • In 1990, health care wasn’t the largest employer in any state; now it is in 38 states;
  • We spend more on health care than on groceries or housing.

Pick your favorite target: private equity firms buying up health care entities, for-profit companies extracting profits from our care (or nominal “non-profits” doing the same), the steady corporatization of health care. Throw in favorite boogeymen like health insurers, PBMs, or Big Pharma. One way or another, it’s about the money, not us.

The adage about Big Tech comes to mind: we’re not the customer, we’re the product (or, as I’ve written before, we’re simply the NPCs.).

We’ve never built the systems to make administration easier. So many codes, so many rules, so many types of insurance, so many silos, so many administrators. By now you’ve no doubt seen the chart of the growth of administrators versus clinicians in our health care system, and are aware that around a quarter of our healthcare dollar goes to administration. It doesn’t have to be this way, it shouldn’t be this way, but administrative bloat is getting worse, not better.  

We’ve never built the systems to properly track our health or risks to it.

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Matthew tries Reperio’s at home health screening

We are entering an age of at home testing and the team at Reperio just raised $14m to make weight, blood pressure and cholesterol/blood sugar testing available at home. But this is a relatively complex series of tests, intended to get people who haven’t been to a primary care doctor back into the system. How is the experience and can we expect people to do it? And does the result correlate with standard lab testing? They sent me the box for me to find out. I totally screwed it up the first time (apparently only 4% of people do), but they gave me another chance. So come along with me to find out how it works. Would you do this, or just go to Labcorp?! — Matthew Holt

BTW since I did this Reperio released an early customer study that said 23% of those who used the kit found a problem they weren’t aware of. Which is I guess the point!

Water, Water, Everywhere . . . but Not a Drop to Drink

By MIKE MAGEE

In the wake of last week’s human tragedy in Texas, it would be easy (and appropriate) to focus on the role played by Trump’s reckless recent dismantling of FEMA and related federal agencies. But to do so would be to accept that the event was an anomaly, or as Trump labeled it on Sunday on his way to a round of golf at Bedminster, “a hundred year catastrophe.”

In reality, tragedies like this are the direct result of global warming, and last week’s suffering and loss are destined to be followed by who knows how many others here and in communities around the world.

In 2009 President Obama joined global leaders in New York City for the Opening Session of the UN. One of the transboundary issues discussed was Global Warming. All agreed that the Kyoto Protocol had failed. It failed because the target to decrease emissions by some 5% was too low. It failed because large transitional nations like India and China were excluded. And it failed because US leadership opted out.

The global community today has a deeper hole out of which it must dig. In doing so we would do well to focus on health and safety as outcome measures, and define strategies to manage the obvious consequences of this ongoing crisis.

Two decades ago, the warnings were clear. Left unattended, we would soon not only need to plan mitigation, but also need to prepare and resource intervention to deal with inevitable human injury and disease fall-out. Of course, back then, we could not have predicted that wise disease interventions in climate ravaged hot spots around the globe, like expansion of USAID funding in the Bush and Obama administrations, would be X’d out under Trump/Musk. Who could have imagined such reckless and ultimately self-destructive moves?

And yet, here we are:

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