Above the Fold

2024 Prediction: Society Will Arrive at an Inflection Point in AI Advancement


For my parents, March, 1965 was a banner month. First, that was the month that NASA launched the Gemini program, unleashing “transformative capabilities and cutting-edge technologies that paved the way for not only Apollo, but the achievements of the space shuttle, building the International Space Station and setting the stage for human exploration of Mars.” It also was the last month that either of them took a puff of their favored cigarette brand – L&M’s.

They are long gone, but the words “Gemini” and the L’s and the M’s have taken on new meaning and relevance now six decades later.

The name Gemini reemerged with great fanfare on December 6, 2023, when Google chair, Sundar Pichai, introduced “Gemini: our largest and most capable AI model.” Embedded in the announcement were the L’s and the M’s as we see here: “From natural image, audio and video understanding to mathematical reasoning, Gemini’s performance exceeds current state-of-the-art results on 30 of the 32 widely-used academic benchmarks used in large language model (LLM) research and development.

Google’s announcement also offered a head to head comparison with GPT-4 (Generative Pretrained Transformer-4.) It is the product of a non-profit initiative, and was released on March 14, 2023. Microsoft’s helpful AI search engine, Bing, helpfully informs that, “OpenAI is a research organization that aims to create artificial general intelligence (AGI) that can benefit all of humanity…They have created models such as Generative Pretrained Transformers (GPT) which can understand and generate text or code, and DALL-E, which can generate and edit images given a text description.”

While “Bing” goes all the way back to a Steve Ballmer announcement on May 28, 2009, it was 14 years into the future, on February 7, 2023, that the company announced a major overhaul that, 1 month later, would allow Microsoft to broadcast that Bing (by leveraging an agreement with OpenAI) now had more than 100 million users.

Which brings us back to the other LLM (large language model) – GPT-4, which the Gemini announcement explores in a head-to-head comparison with its’ new offering. Google embraces text, image, video, and audio comparisons, and declares Gemini superior to GPT-4.

Mark Minevich, a “highly regarded and trusted Digital Cognitive Strategist,” writing this month in Forbes, seems to agree with this, writing, “Google rocked the technology world with the unveiling of Gemini – an artificial intelligence system representing their most significant leap in AI capabilities. Hailed as a potential game-changer across industries, Gemini combines data types like never before to unlock new possibilities in machine learning… Its multimodal nature builds on yet goes far beyond predecessors like GPT-3.5 and GPT-4 in its ability to understand our complex world dynamically.”

Expect to hear the word “multimodality” repeatedly in 2024 and with emphasis.

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A Speech For The Ages – 83 Years Ago This Christmas


On the evening of December 29, 1940, with election to his 3rd term as President secured, FDR delivered these words as part of his sixteenth “Fireside Chat”: “There can be no appeasement with ruthlessness…No man can tame a tiger into a kitten by stroking it.”

Millions of Americans, and millions of Britains were tuned in that evening, as President Roosevelt made clear where he stood while carefully avoiding over-stepping his authority in a nation still in the grips of a combative and isolationist opposition party.

That very evening, the Germans Luftwaffe, launched their largest yet raid on the financial district of London. Their “fire starter” group, KGr 100, initiated the attack with incendiary bombs that triggered fifteen hundred fires that began a conflagration ending in what some labeled the The Second Great Fire of London. Less than a year later, on the eve of another Christmas, we would be drawn into the war with the bombing of Pearl Harbor.

Now, 83 Christmases later, with warnings of “poisoning the blood of our people,” we find ourselves contending with our own Hitler here at home.  Trump is busy igniting white supremacist fires utilizing the same vocabulary and challenging the boundaries of decency, safety and civility. What has the rest of the civilized world learned in the meantime?

First, appeasement does not work. It expands the vulnerability of a majority suffering the “tyranny of the minority.”

Second, the radicalized minority will utilize any weapon available, without constraint, to maintain and expand their power.

Third, the battle to save and preserve democracy in these modern times is never fully won. We remain in the early years of this deadly serious conflict, awakened from a self-induced slumber on January 6, 2020.

Hitler was no more an “evil genius” than is Trump. But both advantaged historic and cultural biases and grievances, leveraging them and magnifying them with deliberate lies and media manipulation. Cultures made sick by racism, systemic inequality, hopelessness, patriarchy, and violence, clearly can be harnessed for great harm. But it doesn’t take a “genius.” Churchill never called Hitler a “genius.” Most often he only referred to him as “that bad man.”

The spectacle and emergence of Kevin McCarthy, followed by Mike Johnson, as Speaker of the House, and the contrasting address by House Minority Leader Hakeem Jeffries as he handed over the gavel, represent just one more skirmish in this “War for Democracy.” 

If our goal is a “healthier” America – one marked by compassion, understanding and partnership; one where fear and worry are counter-acted by touch and comfort; one where linkages between individuals, families, communities and societies are constructed to last – all signals confirm that the time is now to fight with vigor.

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A Place to Call Home


Congratulations, America. We have another new record, albeit a dismal one. According to the Department of Housing and Urban Development (HUD), there are now 653,000 homeless people, up 12% from the prior year. As one can imagine, compiling such a number is problematic at best, and no doubt misses a non-trivial number of such unfortunate people.

“Homelessness is solvable and should not exist in the United States,” said HUD Secretary Marcia L. Fudge. Well, yeah, like kids without enough food, pregnant women without access to adequate prenatal care, or people without health insurance, yet here we are.

HUD says that the increase was driven by people who became for the first time, up some 25%. It attributes this to “a combination of factors, including but not limited to, the recent changes in the rental housing market and the winding down of pandemic protections and programs focused on preventing evictions and housing loss.” As with the recent increase in child poverty, the lessons that we should have learn from our COVID response didn’t survive our willingness to put the pandemic behind us.

Jeff Olivet, executive director of the U.S. Interagency Council on Homelessness, told AP: “The most significant causes are the shortage of affordable homes and the high cost of housing that have left many Americans living paycheck to paycheck and one crisis away from homelessness.” The National Low Income Housing Coalition estimates we’re missing some 7 million affordable housing units, so I suppose we should be relived there are “only” 653,000 homeless people.

“For those on the frontlines of this crisis, it’s not surprising,” Ann Oliva, CEO of the National Alliance to End Homelessness, also told AP. Indeed, we’ve all seen news accounts of homeless encampments spreading seemingly out of control, many of us have spotted homeless people as we go about our daily lives, and yet most of us don’t want either homeless people or low income housing units in our neighborhoods.

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AI Could Have “Unimaginable Consequences” For Democratic Societies, Says Expert.


His biography states, “He speaks to philosophical questions about the fears and possibilities of new technology and how we can be empowered to shape our future. His work to bridge cultures spans artificial intelligence, cognition, language, music, creativity, ethics, society, and policy.”

He embraces the title “cross-disciplinary,” and yet his PhD thesis at UC Berkeley in 1980 “was one of the first to spur the paradigm shift toward machine learning based natural language processing technologies.” Credited with inventing and building “the world’s first global-scale online language translator that spawned Google Translate, Yahoo Translate, and Microsoft Bing Translator,” he is clearly a “connector” in a world currently consumed by “dividers.” In 2019, Google named De Kai as “one of eight inaugural members of its AI Ethics Council.”

The all encompassing challenge of our day, as he sees it, is relating to each other. As he says, “The biggest fear is fear itself – the way AI amplifies human fear exponentially…turning us upon ourselves through AI powered social media driving misinformation, divisiveness, polarization, hatred and paranoia.” The value system he embraces “stems from a liberal arts perspective emphasizing creativity in both technical and humanistic dimensions.”

Dr. De Kai is feeling especially urgent these days, which is a bit out of character.

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From Xenobots to Anthrobots


There were many things I could have written bout this week – e.g., in A.I., in quantum computing, even “transparent wood” — but when I saw some news about biological robots, I knew I had my topic.

The news comes from researchers at Tufts University and Harvard’s Wyss Institute. Their paper appeared in Advanced Science, introducing “a spheroid-shaped multicellular biological robot (biobot) platform” that they fondly dubbed “Anthrobots.” Importantly, the Anthrobots are made from human cells.

Let’s back up. In 2020, senior researcher Michael Levin, Ph.D., who holds positions at both Tufts and Harvard, worked with Josh Bongard, Ph.D. of the University of Vermont to create biological robots made from frog embryo cells, which they called Xenobots.  They were pretty impressive, capable of navigating passageways, collecting material, recording information, healing themselves from injury, and even replicating for a few cycles on their own, but the researchers wanted to find out if they could create biological robots from other types of cells – especially human cells.

Well, the new research showed that they could. They started with cells from adult trachea, and without genetic modification were able to demonstrate capabilities beyond those Xenobots had demonstrated. Lead author Gizem Gumuskaya, a PhD. student said: “We wanted to probe what cells can do besides create default features in the body. By reprogramming interactions between cells, new multicellular structures can be created, analogous to the way stone and brick can be arranged into different structural elements like walls, archways or columns.”   

The Anthrobots come in different shapes and sizes, and are capable of different motions. Ms. Gumuskaya is quite excited about their capabilities:

The cells can form layers, fold, make spheres, sort and separate themselves by type, fuse together, or even move. Two important differences from inanimate bricks are that cells can communicate with each other and create these structures dynamically, and each cell is programmed with many functions, like movement, secretion of molecules, detection of signals and more. We are just figuring out how to combine these elements to create new biological body plans and functions—different than those found in nature.

Even better, Ms. Gumuskaya pointed out: “Anthrobots self-assemble in the lab dish. Unlike Xenobots, they don’t require tweezers or scalpels to give them shape, and we can use adult cells – even cells from elderly patients – instead of embryonic cells. It’s fully scalable—we can produce swarms of these bots in parallel, which is a good start for developing a therapeutic tool.”

They tested Anthrobots’ healing capabilities by scratching a layer of neurons, then exposed the gap to a cluster of Anthrobots called a “superbot.”  That triggered neuron growth only in that area. The researchers noted: “Most remarkably, we found that Anthrobots induce efficient healing of defects in live human neural monolayers in vitro, causing neurites to grow into the gap and join the opposite sides of the injury.”

“The cellular assemblies we construct in the lab can have capabilities that go beyond what they do in the body,” said Dr. Levin. “It is fascinating and completely unexpected that normal patient tracheal cells, without modifying their DNA, can move on their own and encourage neuron growth across a region of damage.”

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The Courage of Corporate America is Needed to End America’s Opioid Crisis


A Kaiser Family Foundation tracking poll published in July found that three in ten U.S. adults (29%) said they had someone in their family who struggled with opioid dependence. Also surprising, and encouraging, was the statistic that 90% support increasing access to opioid use disorder treatment programs in their communities.

As a person in recovery from opioid use disorder and advocate, my read on this data set is that the public support is there. Now more than ever, we need leaders in healthcare, public policy, and corporate America to have the courage to advance effective treatment options. The most inspiring example of the kind of courage we need was the recent news that one of the nation’s largest retail grocery and pharmacy chains, Albertsons, made the financial investment to train their pharmacy staff to administer buprenorphine injections (known as Sublocade) on site.

To someone who is not in the weeds on the issue of opioid use disorder (OUD) treatment programs, this may just sound like a solid business decision. But go a layer deeper and the courage is evident: Albertsons decided to invest in an underutilized treatment option (despite buprenorphine being the gold-standard in OUD treatment) that serves a highly stigmatized patient population who is often shunned at pharmacy counters nationwide. Albertsons chose to put treatment centers for an underserved and highly stigmatized patient population in the middle of their family-friendly, neighborhood grocery pharmacy chain. 

The company rightly recognized that OUD impacts every family and community in this country—including the lives of its patrons. Albertsons pushed through stigma, not leaving the overdose crisis for someone else to address, because it had the ability to provide widespread access through its pharmacies and locations across the nation.

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Lead Pipe Cinch


The term “lead pipe cinch” means something that is very easy or certain. Here’s two things that are lead pipe cinches: first, that ingesting lead, such as from the water or the air, is bad for us. It’s especially bad for children, whose cognitive abilities can be impaired. Second, that the Biden Administration’s latest proposal to reduce the lead in our drinking water is not going to accomplish that.

The new proposed rules would require that lead service lines be replaced within ten years; there are estimated to still be some 9.2 million such lines in the U.S. The trouble is, no one really knows how many there are or where exactly they are, making replacement difficult. So step two of the rules is for an initial inventory by next October. The “acceptable” parts per billion would drop from 15 to 10. Utilities would also have to improve tap sampling and consumer outreach.

“This is the strongest lead rule that the nation has ever seen,” Radhika Fox, the E.P.A.’s assistant administrator for water, told The New York Times. “This is historic progress.”

Erik Olson, an expert with the Natural Resources Defense Council is also hopeful, telling NPR: “We now know that having literally tens of millions of people being exposed to low levels of lead from things like their drinking water has a big impact on the population. We’re hoping this new rule will have a big impact.”

The EPA estimates the replacement will cost $20b to $30b over the next decade; the 2021 Infrastructure Act allocated $15b, along with $11.7b available from the Drinking Water State Revolving Fund. Of course, the cost will be much higher.

Chicago alone claims it will cost $10b to replace its estimated 400,000 lead pipes. The Wall Street Journal reports: “David LaFrance, CEO of the American Water Works Association, a trade group, said the total cost could “easily exceed” $90 billion. He said the average cost to replace a single lead service line is more than $10,000, nearly double the EPA’s estimate.”

If the federal funds aren’t enough, Ms. Fox says: “We strongly, strongly encourage water utilities to pay for it,” but you should probably expect customers will end up paying – or that some of those pipes won’t be getting replaced.

It’s not like any of this is catching us by surprise. You probably remember the 2014 scandal with the Flint (MI) water crisis, with all those people lining up for bottled water. You may not remember similar crises in Washington D.C., Newark (NJ), or Benton Harbor (MI). “The Washington, D.C., lead-in-water crisis was far more severe than Flint in every respect,” Yanna Lambrinidou, a medical anthropologist at Virginia Tech and co-founder of the Campaign for Lead Free Water, told AP.

The EPA issued a set of rules around lead pipes in 1991, but those rules were watered down, and little progress has been made since. Ronnie Levin, an EPA researcher at the times, also told AP: “But, you know, we’ve been diddling around for 30 years.”

Because, you know, that’s what we do, especially when fixing a problem costs too much money.

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Where is AI in Medicine Going? Ask The Onion.


One of the top ten headlines of all time created by the satirical geniuses at The Onion was published 25 years ago this December. It read, “God Answers Prayers Of Paralyzed Little Boy. ‘No,’ Says God.”

The first paragraph of that column introduced us to Timmy Yu, an optimistic 7-year old, who despite the failures of the health system had held on to his “precious dream.” As the article explained, “From the bottom of his heart, he has hoped against hope that God would someday hear his prayer to walk again. Though many thought Timmy’s heavenly plea would never be answered, his dream finally came true Monday, when the Lord personally responded to the wheelchair-bound boy’s prayer with a resounding no.”

But with a faith that rivals the chieftains of today’s American health care system who continue to insist this is “the best health care in the world,” this Timmy remained undeterred. As The Onion recorded the imagined conversation, “‘I knew that if I just prayed hard enough, God would hear me,’ said the joyful Timmy,., as he sat in the wheelchair to which he will be confined for the rest of his life. ‘And now my prayer has been answered. I haven’t been this happy since before the accident, when I could walk and play with the other children like a normal boy.’”

According to the article, the child did mildly protest the decision, but God held the line, suggesting other alternatives. “God strongly suggested that Timmy consider praying to one of the other intercessionary agents of Divine power, like Jesus, Mary or maybe even a top saint,” Timmy’s personal physician, Dr. William Luttrell, said. ‘The Lord stressed to Timmy that it was a long shot, but He said he might have better luck with one of them.’”

It didn’t take a wild leap of faith to be thrust back into the present this week. Transported by a headline to Rochester, Minnesota, the banner read, “Mayo Clinic to spend $5 billion on tech-heavy redesign of its Minnesota campus.” The “reinvention” is intended to “to present a 21st-century vision of clinical care” robust enough to fill 2.4 million square feet of space.

The Mayo Clinic’s faith in this vision is apparently as strong as little “Timmy’s”, and their “God” goes by the initials AI.

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Patients are Not “Consumers”: My Cancer Story 


On Christmas Eve 2014, I received a present of some profoundly unwelcome news: a 64 slice CT scan confirming not only the presence of a malignant tumor in my neck, but also a fluid filled mass the size of a man’s finger in my chest cavity outside the lungs. Two days earlier, my ENT surgeon in Charlottesville, Paige Powers, had performed a fine needle aspiration of a suspicious almond-shaped enlarged lymph node, and the lab returned a verdict of “metastatic squamous cell carcinoma of the head and neck with an occult primary tumor”. 

I had worked in healthcare for nearly forty years when cancer struck, and considered myself an “expert” in how the health system worked. My experience fundamentally changed my view of how health care is delivered, from the patient’s point of view. Many have compared their fight against cancer as a “battle”. Mine didn’t feel like a battle so much as a chess match where the deadly opponent had begun playing many months before I was aware that he was my adversary. The remarkable image from Ingmar Bergman’s Seventh Seal sums up how this felt to me.

The CT scan was the second step in determining how many moves he had made, and in narrowing the uncertainty about my possible counter moves. The scan’s results were the darkest moment: if the mysterious fluid filled mass was the primary tumor, my options had already dangerously narrowed. Owing to holiday imaging schedules, it was not until New Years’ Eve, seven interminable days later, that a PET/CT scan dismissed the chest mass as a benign fluid-filled cyst. I would require an endoscopy to locate the still hidden primary tumor somewhere in my throat.  

I decided to seek a second opinion at my alma mater, the University of Chicago, where I did my doctoral work and subsequently worked in medical center administration.

The University of Chicago had a superb head and neck cancer team headed by Dr. Everett Vokes, Chair of Medicine, whose aggressive chemotherapy saved the life and career of Chicago’s brilliant young chef, Grant Achatz of Alinea, in 2007.

If surgery was not possible, Chicago’s cancer team had a rich and powerful repertoire of non-surgical therapies. I was very impressed both with their young team, and how collaborative their approach was to my problem. Vokes’ initial instinct that mine was a surgical case proved accurate.

The young ENT surgeon I saw there in an initial consultation, Dr. Alex Langerman performed a quick endoscopy and thought he spotted a potential primary tumor nestled up against my larynx. Alex asked me to come back for a full-blown exploration under general anaesthesia, which I did a week later. The possible threat to my voice, which could have ended my career, convinced me to return to Chicago for therapy. Alex’s endoscopy found a tumor the size of a chickpea at the base of my tongue. Surgery was scheduled a week later in the U of Chicago’s beautiful new hospital, the Center for Care and Discovery.

This surgery was performed on Feb 2, 2015, by a team of clinicians none of whom was over the age of forty. It was not minor surgery, requiring nearly six hours:  resections of both sides of my neck, including the dark almond and a host of neighboring lymph nodes. And then, there was robotic surgery that removed a nearly golf ball-sized piece of the base of my tongue and throat. The closure of this wound remodeled my throat.

I arrived in my hospital room late that day with the remarkable ability to converse in my normal voice.

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