AI and Medicine: A Brief History and Where We Are in 2024

Posted on | December 10, 2024 | Comments Off on AI and Medicine: A Brief History and Where We Are in 2024

Mike Magee

The history of Medicine has always involved a clash between the human need for compassion, understanding, and partnership, and the rigors of scientific discovery and advancing technology. At the interface of these two forces are human societies that struggle to remain forward looking and hopeful while managing complex human relations.

The question has been “How can science and technology improve health without undermining humans’ freedom of choice and rights to self-determination.” The rapid rise of Artificial Intelligence (AI) feels especially destabilizing because it promises, on the one hand, great promise, and on the other, great risk.

The human imagination runs wild, conjuring up images of robots taking over the world and forcing humankind into submission. Yet it is important to take a deep breath and place science’s technologic progress in perspective. (Read on . . . )

Category: Uncategorized
Tags: AI > ama > ChatGPT > Gemini > Google > Meatverse > Medicine > Microsoft > STAT

Ten Wizards Who Shaped Our Health Care System.

Posted on | December 2, 2024 | Comments Off on Ten Wizards Who Shaped Our Health Care System.

Mike Magee

The incoming Trump Administration nominees for positions in Health and Human Services (like RFK Jr. to direct the department and Mehmet Oz to head Medicare and Medicaid Services) are names you know and apparently many trust? In this week’s New York Times, Dr. Ashish Jha, President Biden’s Covid lead, thinks he knows why. He said, “You have a large swath of the population facing a health crisis, and they feel like medicine and public health isn’t delivering…They’re much more open to people saying, ‘The whole system is corrupt and we have to blow the whole thing up.’” As Ashish knows better than most, we didn’t arrive here out of the blue. Over the years, many of the players who had the greatest impact on America’s health care system as we know it, remain hidden behind an historic screen. Here (in no particular order) are 10 of the least known but most influential figures who shaped U.S. health policy in our lifetime.

Sam Massengill

In spring 1937, the head of sales for S.E. Massengill Company in Bristol, Tennessee, went to the company head, Samuel Evans Massengill, with an idea generated by customer feedback. Massengill salesmen were passing along reports from doctors that there was demand among parents of young children suffering from strep throat for a liquid version of their new sulfa drug.

Massengill, charged the company’s chief chemist, Harold Cole Watkins, to find an effective solvent in which powdered sulfanilamide could be dissolved. His choice was diethylene glycol, which smoothly dissolved sulfanilamide powder and led to a concoction that was 10 percent sulfanilamide, 72 percent diethylene glycol, and 16 percent water. Flavored with raspberry extract, saccharine, and caramel, it passed the taste and smell tests, but in keeping with then current federal regulations—or lack thereof—there was no test for safety.

In fact, no one did even a rudimentary check of the literature on diethylene glycol, which would have quickly revealed that it was a highly toxic component of brake fluid, wallpaper stripper, and antifreeze that had caused a fatality in 1930.

Instead, perhaps sensing that its competition would be right behind, Massengill rushed its “Elixir Sulfanilamide” into production, then shipped 240 gallons of the red liquid to 31 states through a network of small distributors in early September 1937.

Within two weeks, children began to die. In all, more than 100 children died, but only after going through 7 to 21 days of wrenchingly painful illness including “stoppage of urine, severe abdominal pain, nausea, vomiting, stupor, and convulsions.”

The whole disaster was vigorously reported in the press, and drug safety soon inched its way up the list of New Deal priorities. By June 11, 1938, bills from the Senate and House of Representatives had been reconciled, and on June 25, 1938, President Roosevelt signed into law the 1938 Federal Food, Drug, and Cosmetic Act.

Samuel Massengill belatedly issued a statement on behalf of his company: “My chemists and I deeply regret the fatal results, but there was no error in the manufacture of the product. . . . I do not feel there was any responsibility on our part.” Unfortunately, Massengill’s morally blind position reflected the letter of the law at that time. In short, the absence of effective legal sanctions meant that a company or an individual could indeed sell a deadly medication and get away with it.

Mary Lasker

Born in 1900, Mary Lasker was the daughter of Frank Elwin Woodard, the head of the local bank in Watertown, Wisconsin, and a shrewd businessman with Chicago connections. By her own account, she was a campaigner almost from birth, and she traced her interest in promoting medical research back to an event she experienced at the age of three or four. Her mother, a local community supporter and civic activist, took Mary to see their ailing servant, a Mrs. Belter, who had undergone a double mastectomy as treatment for breast cancer. “I thought, this shouldn’t happen to anybody,” Mary Lasker later wrote.

As a young adult, she began to focus on health policy issues and became a devotee to Margaret Sanger. Mary sought out financial support for the organization, turning to a dynamic advertising man, Albert Lasker, who had launched some of America’s most recognizable consumer brands, including Lucky Strike cigarettes. Known as the “father of modern advertising,” Lasker is credited for suggesting that the Control Federation of America be renamed the Planned Parenthood Federation.

When Albert asked Mary what she wanted to accomplish, she listed reforms in health insurance, cancer research, and research against tuberculosis. Albert responded, “Well, for that you don’t need my kind of money. You need federal money, and I will show you how to get it.”

When Mary and Albert married in 1940, the world was preparing for war.

Beginning in 1942, the Laskers began to cultivate science luminaries who shared their commitment to maximizing government funding of applied research. The Laskers realized early that they would need a credible health-related national organization to anchor and launch their campaign and set their sights on the American Society for the Control of Cancer, an organization created in 1913 by 10 physicians meeting at the Harvard Club in New York City. The leadership was more than happy to grant the Laskers easy entry to their Board of Trustees in return for financial support. By 1944, the Laskers had seized control of the Board, largely dumped the doctors, and renamed the group the American Cancer Society (ACS). Its leadership was now composed of name-brand corporate heads, entertainment giants, and advertising executives.

To add further glory to the idea of Big Science, Mary and Albert created the annual Lasker Awards, with the somewhat self-serving tagline “Sometimes called ‘America’s Nobels.’” She then began to collect academic researchers, promote their careers, injecting publicity and special placement on government bodies. Over a decade she was at the center of creating seventeen specialty Institutes within the new NIH, most built around her favored scientists.

Mary Lasker died in 1994, a controversial figure. In the assessment of author and political journalist Elizabeth Drew, “Mrs. Lasker has been considered an able woman who has done good things but is too covetous of power, too insistent on her pursuits, too confident of her own expertise in the minutiae of medicine.”

William Menninger

During the first major WW II battle in North Africa, a startling number of soldiers were incapacitated with “Shell Shock.” One neurologist in North Africa, Frederick R. Hanson, discovered that a bit of kindness in the form of a hot shower and a warm meal, combined with sedation-induced rest, was remarkably successful in rehabilitating the majority of the “mentally incapacitated” men under his care.

Hanson’s success did not go unnoticed by the Army’s chief of the division of neuropsychiatry in the Office of the Surgeon General, William C. Menninger. After studying his results, he decided that if psychiatric casualties in a standard unit exceeded one mental casualty for every four wounded in action, this was a harbinger of broader problems—like a breakdown in morale, leadership issues, prolonged combat fatigue, or a policy breakdown in the evacuation scheme.

Other observations included the fact that new units with limited combat experience had a higher percentage of mental casualties then seasoned units did, and that the medical officers in these units were more inclined to ship out those with “normal fear reactions.” On the other end of the spectrum, troops that exceeded 12 months of combat exposure began to experience a higher percentage of mental casualties.

The experience in North Africa had clarified for Army Chief of Staff, General George Marshall, that the plan for handling neuropsychiatric casualties in the field was seriously broken. At his request, Menninger came up with a plan that included psychiatric support close to the battlefield, reinforced by the heavy and liberal use of barbiturates and ether anesthesia if necessary for initial sedation of hysterical soldiers. In the most severe cases, other experimental treatments would be used, such as intravenous sodium pentothal, a.k.a. truth serum, to draw out (and ideally remove) the troubling traumatic memories of war.

Menninger immediately realized there were not nearly enough psychiatrists to execute the plan, so he came up with the idea to train a portion of the medical officers in what he called “forward psychiatry.” These officers were subjected to a 30-day immersion course to master Menninger’s system and make them comfortable with the liberal use of barbiturates. They were thereafter labeled “30-day wonders.”

Menninger’s plans were encoded in a diagnostic manual, Medical 203 (which was the basis of the Diagnostic and Statistical Manual of Mental Disorders, or DSM, released shortly after the war). Today, the bible of mental health, and now in its fifth edition, the DSM-5 is a structured approach to the diagnosis and treatment of mental illnesses, including the use of those wartime barbiturates and the many chemical children they spawned.

The pharmaceutical industry responded to all these developments with an aggressive search for “blockbusters” to capture the expanding market. Some of these new medicines were designed to treat very real ailments; in other cases, the drug came first, after which the drug company’s newly energized marketing teams developed a problem for it to solve. By 1960, one out of every six American adults was being treated with pharmaceuticals for anxiety.

Hans Selye

In the early 1950s, Reader’s Digest published a ground breaking article titled “Cancer By The Carton”, informing the public that cigarettes caused lung cancer. As part of the fallout, the AMA eliminated cigarette advertising from their medical journals.

To continue selling cigarettes in the face of devastating scientific evidence of tobacco’s link to lung cancer was challenging enough, but newer evidence was beginning to reveal that the habit also led to deaths from heart attacks. The companies had to come up with an alternate explanation for the rise in cardiac deaths that clearly tracked the rise of cigarette sales.

Their savior was a Hungarian-born endocrinologist named Hans Selye, a man nominated multiple times for the Nobel Prize. Selye was famous for his formulation of the concept of stress as the source of microscopic injuries to the cell. But he was also known for his ability to attract research funding, which was enhanced by his willingness to tailor the evidence to suit the highest bidder.

In numerous court cases during the 1960s and 1970s, the Tobacco Industry Research Council relied on Selye as an expert witness to make the argument that smoking, rather than being a health hazard, might actually provide a measurable benefit in the form of stress relief. Meanwhile, Dr. Selye was turning to the tobacco industry for major grants to support his growing research enterprise and to enrich himself.

Years later, as part of document disclosure during litigation by state attorneys general against the tobacco industry, communications between Selye and industry representatives proved that he had conspired to hold back supportive testimony and publications suggesting a link between tobacco use and stress reduction until he received his cash.

When Hans Selye died in 1982, he was regarded as a venerable scientist, but the tobacco industry’s funding of his work, and Selye’s willingness to recruit additional scientists to present tobacco’s messages in meetings and publications, was later cited by the US Department of Justice as a clear example of racketeering.

Lemuel Boulware

When the AMA began to look for someone to help fight the scourge of socialized medicine in 1960 Ronald Reagan was the ideal public opinion operative. His training as a politician and public communicator lasted 10 years and was directed by Lemuel Boulware, who had served as Roosevelt’s operations vice chairman of the War Productions Board, and then moved on to one of the military’s largest suppliers, General Electric.

At GE Boulware had a philosophy of “going over the heads” of union leaders. Instead of confrontation, he employed comprehensive, ongoing communications and economic education directed not only at workers at all levels in his organization but also at their spouses and families. He fostered newsletters, symposia, book clubs, and courses that included a heavy dose of basic conservative economics, but they also touched on entrepreneurship, management philosophy, investment, retirement, health, and family education.

The new medium of television was becoming a factor in American life, so Boulware decided to launch a new TV show called General Electric Theater. He turned to Ronald Reagan to host the weekly dramatic series. Over the next eight years, Reagan visited and addressed more than 250,000 GE employees and customers at 139 different GE sites, perfecting what came to be known as “The Speech.”. The AMA hired Reagan on GE’s recommendation. Reagan’s speech and its’ views on Medicare aligned with those of the AMA, but they came out of GE, thanks to his mentor, Lemuel Boulware.

Edward Annis

On May 20, at Madison Square Garden in New York City, President Kennedy delivered a major address on health care to a full house of 20,000 senior citizens. The speech was broadcast without advertising by all three major networks as a “news event,” and it reached an estimated viewership of 20 million. He directly challenged the AMA and its health care lobbyists, who were flooding the hallways and mailrooms of Congress.

The AMA was livid. It demanded equal time from the networks to give a formal response to what they saw as a Democratic Party political address, but it was refused. Undaunted, the AMA board gave the go-ahead to rent Madison Square Garden and pay to televise their rebuttal.

As their voice, they chose a Tallahassee surgeon, Dr. Edward Annis, who had been a debater in high school and college. Part of the AMA speakers’ bureau, Annis, like Ronald Reagan, had been put on the road the year before to develop his own version of Reagan’s “ speech.” He had delivered it dozens of times over the past five months and along the way had publicly debated UAW officials and Senator Hubert Humphrey.

When he got to Madison Square Garden on May 22 to deliver a very personal rebuke to the president, Annis had two advantages. President Kennedy’s earlier address, as his staff would later admit, was not his best. The AMA also had Kennedy’s speech on film and was able to build a point-by-point reply.

Dr. Annis, in 30 minutes, mined the weaknesses of Kennedy’s address, referencing filmed portions of the president’s speech, and challenged the absent president directly as he went along. At the end of the speech, Annis admonished Kennedy: “The people have a right to remind their first servant that his election, even his present popularity, does not authorize him to change fundamental institutions that have proved a lasting value through the generations…There are few such things that touch so close to God. And the relationship between a doctor and his patient is one of them…To the millions of Americans who may have a doubt, who may want to take a moment to hear the views of one they know and trust, I implore you, ‘Ask your doctor. Ask your doctor.’”

And ask they did, in droves. The AMA’s paid televised address on the same networks Kennedy had accessed two days earlier was said to have reached 30 million viewers. On July 17, 1962, the health care bill went down in defeat in the Senate by a vote of 52–48.

Ed Pratt

In the 1980’s Pfizer CEO Ed Pratt was ideally positioned to lead the global charge on intellectual property (IP) protections. Pratt was chairman of the powerful US Business Roundtable and also the formal adviser to Reagan’s US trade representative, Bill Brock.

Pratt’s first move was to form a task force on intellectual property with his chief ally, IBM CEO John Opel. Their recommendation to Brock that a position be created within the Office of the US Trade Representative for a director of international investment and intellectual property sailed through.

Pratt also directed the creation of the Intellectual Property Committee (IPC) of the powerful US Council on Business. This provided a platform for the next step in organizing a global effort. In 1983, Pratt and Opel approached the leaders of 10 other large US-based multinationals, including General Electric, General Motors, DuPont, Johnson & Johnson, and Monsanto, requesting their participation on the Intellectual Property Committee and creating a united front across industries.

At Bill Brock’s request, Pratt, built a multi-sector global coalition of major corporations to engage the United Nations and World Trade Organization. Domestically, he worked the chambers of commerce, business councils, business committees, and trade associations. Pfizer executives, who occupied key positions in strategic business organizations, were directed to engage with their cross-sector colleagues in every industry.

Pratt persisted for over a decade until he won. As a direct result of his IP wins, pharmaceutical companies in the U.S. gained up to 20 years of patent protection for new drugs approved by the FDA. In addition, the integrated internal public affairs team he created inside Pfizer for the project became the prototype for PhRMA’s subsequent “government relations on steroids” and the under-pinning for the integrated and strategic cross-sector 21^st century Medical Industrial Complex.

Louis Lasagna

In 1970, Lou Lasagna MD became chairman of the Department of Pharmacology and Toxicology at the University of Rochester’s School of Medicine where he founded the Center for the Study of Drug Development (CSDD), a common meeting ground for free market–minded academics, government, and corporate leaders. By 1976, he had moved his center to Boston’s Tufts University. He was now a renegade scholar, a successful entrepreneur, and a lightning rod for controversy.

From the start, Lasagna’s CSDD was a multifaceted and highly productive platform, providing professional development courses in clinical pharmacology, drug development, research processes, and pharmaceutical regulations. It generated influential white papers and reports on everything from clinical research design to the growing trend of outsourcing work to contract (or clinical) research organizations (CROs). It also provided customized reports helping individual clients design their government-relations strategies in pursuit of favorable policies.

He laid the statistical groundwork to “prove” that the pharmaceutical industry was “high risk/high gain.” Lou pegged the cost of bringing a new drug to market at $800 million and the losses associated with a one-month delay in a product review by the FDA at $10 million for the sponsoring company. Multiplied by the average approval time required for a new drug application—31 months—that added up to real money.

Lasagna labeled the problem as America’s “drug lag” and positioned himself and his fellow physicians as friends of the industry. For individual drugs, Britain in 1980 beat the US to the market for new drugs, on average, by two years. At the time, the country was in a stubborn recession. Lasagna argued that the cost of drug innovation was way too high, and that part of the problem was government ownership of any discoveries that had been funded with NIH grants.

As a brilliant strategist, Lasagna could see a number of these issues breaking his way. The stubborn recession combined with the escalating cost of employer-based health benefits was beginning to fuel the demand for innovative solutions. Lasagna was skilled at converting concern about cost into demands for efficiency and less regulation of industry. He successfully led the charge to release government patents back to medical scientists and their institutions. A decade latter, the HIV/AIDS epidemic would push massive liberalization of drug approval over the line, and Lasagna would be the director of the government’s expert committee with a young researcher, Anthony Fauci as his NIH ally.

Paul Weyrich

in 1970, a Nixon-era journalist named Paul Michael Weyrich arrived on the political scene. A staffer at the Milwaukee Sentinel who served as a weekend anchor at the local ABC affiliate WISN-TV, Weyrich went on to serve as press secretary to Colorado senator Gordon Allott. From there it was a short walk to the offices of conservative beer mogul Joseph Coors, who was funding the creation of a new right-wing think tank called the Heritage Foundation. Weyrich became its first director, and he summed up his mission this way: “The New Right is looking for issues that people care about. Social issues, at the present, fit the bill.”

Over the next decade, working with televangelists Jerry Falwell and Pat Robertson, they together fashioned Christian white nationalists into a political body, “The Christian Right”, and helped elect Jimmy Carter. When Carter was unwilling to oppose Roe v. Wade and homosexuality, they mobilized in support of Reagan and what they now termed “The Moral Majority.” Four decades latter, with the Dobbs decision, their dream came true.

Linda Robinson

In 1997, at the age of 44, Linda Robinson was already a legend in the field of Crisis Communications on Wall Street. Well known for her role in the leveraged buyout of RJR Nabisco, the story at the center of the book and film “Barbarians at the Gate”, she had been featured in a 10-page cover story in Vanity Fair. This piece described her as “the most powerful public relations broker in the country.”

Her husband, James D. Robinson III, was the chairman of American Express, and she was on first-name terms with most of the major players in media and politics in New York City. Her father, Freeman Gosden, had been a radio personality (Amos of Amos ’n’ Andy) and a longtime Hollywood fixture close to many political figures, including Ronald Reagan. When Reagan entered the 1980 presidential race, Linda became assistant to the campaign’s press secretary. After Reagan’s victory, she became press secretary to the secretary of transportation just as America’s air traffic controllers went on strike, and the showdown between them and President Reagan became one of the lead stories of the year.

In the mid-1990s, Pfizer CEO Bill Steere was ramping up to support a product that he already knew would become infamous, Viagra. He knew it would unleash a huge public debate, and he was focused on identifying every possible issue or public challenge that might arise. In short, he wanted to be prepared and avoid a crisis. So he quite naturally turned to Linda Robinson to head up Pfizer’s secret, internal Viagra Advisory Board filled with ethicists, theologians, sex therapists, scientists and representatives of four of the largest public relations firms in New York, including her own company: Robinson Lerer & Montgomery. This was a full 18 months before the drug was slatted to be approved.

Robinson imbedded her own staff at Pfizer headquarters at 42^nd and 2^nd Avenue, and ran the Viagra “War Room” for the first 12 months after approval until the product’s success was assured. Rather than dismantle the team, it was then repurposed as Robinson and her people helped direct the successful “hostile takeover” of Warner Lambert. The prize? Lipitor, the statin drug, which by 2010 was the first drug ever to exceed $10 billion in annual sales.

___________________________________________________________________

These stories and more in CODE BLUE: Inside America’s Medical Industrial Complex (Grove/2020)

Category: Uncategorized
Tags: Ashish Jha > Ed Pratt > Edward Annis > Hans Selye > Lemuel Boulware > Linda Robinson > Louis Lasagna > mary lasker > Mehmet Oz > Paul Weyrich > RFK Jr. > Sam Massengill > william menninger

What is the Value of our Humanity?

Posted on | November 25, 2024 | 4 Comments

Mike Magee

The image of William Westmoreland, speaking direct to the camera in the 1974 documentary “Hearts and Minds”, is stark and unapologetic. He addresses the interviewer’s question about extensive loss of civilian lives during the Vietnam War this way: “Well, the Oriental doesn’t put the same high price on life as the Westerner. And as the philosophy of the Orient expresses it, life is not important.”

Thinking of him and those years again, which in many ways I’d sooner forget, and realizing that to some extent, we have managed to repeat our mistakes, and embrace the same types of biases, well, you can understand why I sighed a bit for the human race last evening.

And yet, out of the same era, from another clearly morally compromised President, Richard M. Nixon, came the historic 1970 Clean Air Act. It passed the Senate 73-0, before gaining the President’s signature, and created the Cabinet level Environmental Protection Agency (EPA) that, if some had their way, would be on the chopping block come January 20th.

And yet, history has shown that clean air and water are pretty popular on Main Street and in the halls of Congress. In 1990, another Republican president, George H.W. Bush, signed legislation that further strengthened the law after 89 senators, including Mitch McConnell supported the changes. Of this action, the then new incoming Majority Leader, who later decried actions of the EPA as attempts to destroy “Big Coal”, stated, “I had to choose between cleaner air and the status quo. I chose cleaner air.” President Bush’s action allowed the EPA to first begin to measure levels of ozone and mercury in our air.

The EPA has been up (Obama and Biden) and down (Trump/2016) since then. It drew a 28 page chapter in the Project 2025 playbook. Trump’s 2016 director of the EPA, Mandy Gunaswkara (originally a staffer on the Senate Environment and Public Works Committee under the late Oklahoma Sen. James Inhofe) says she’s good to go again. As she put it, “The biggest difference is we have a plan from Day One, we’re going to start implementing it, and we won’t be as susceptible to process problems that really sunk a couple of those final regulatory proposals and actions we took at the tail end of the administration.”

Heritage Foundation’s Trustee, Kevin D. Roberts, is all in. As he recently wrote, “…economic freedom is not something Americans should apologize for, but harness, spur, and give free rein—for our own sake, and everyone else’s, too.” Their opinions on governmental guardrails and regulation are similarly strong, but in reverse. “America is over regulated. Every facet of daily life, from what cars we drive to what food we eat is subject to government’s regulatory reach.”

According to the Heritage Foundation, AI has arrived in the nick of time. To listen in on their planning, there is still time to register for the December 4, 2024 conference, “Digital Tools for Modernizing the Federal Permitting Process.” As they describe it, “The report tackles the obstacles created by the lack of transparency in the federal permitting process which needlessly increases the risk to investors while obscuring accountability in the democratic process.”

The Pew Research Center covered the same territory a few years back. Alexander Cho, a digital media anthropologist, was not surprised by the Heritage Foundations current focus on AI. He says that “‘digital’ acts as a magnifier, accelerator and exacerbator of historical conduits of power that may have not been as obvious to folks before.” What we are experiencing in the wake of this election cycle are “social and civic conversations that are not new but that have been catalyzed through digital media.”

Chair of Environmental Studies and Science at Pace University, Melanie DuPuis, on the same Pew centered platform, recalled David Blight’s biography of Frederick Douglas, and left open the possibility of a painfully long policy winter. In her words, technology back then was an accelerator as well. “Of course, it was technology that made Douglass’s words visible to a civic public: newspaper and, interestingly, train travel…I don’t think he would have guessed that the darkness would continue so long. I think American darkness will continue but that civil society will eventually reemerge, as it has in democratic countries over the last two centuries.”

Another participant added this, “Individuals will have to reevaluate their lives and their prospects. Whether the responses to change are successful or not depends on multiple factors, such as the current sophistication of societies, the perceived place of a shared morality and the level of education and awareness. The risk is the emergence of a disposed and disenchanted digital ‘proletariat’ whose response to change will be violent rather than reasoned.”

Others predict a backlash. One said, “The reign of Trump and other nay-sayers will lead to a countermovement that will bring about sweeping changes in the digital world. We will see a privacy set of laws similar to Europe. We’ll see the breakup of monopolies like Google that will generate new innovations.”

Where’s the common ground? All agree the debate has been engaged, and AI assisted information technology will likely fan the flames. What remains to be determined is what sprigs of new life will emerge from these ashes. We shall see what is the value of our humanity.

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Tags: Alexander Cho > Frederick Douglas > heritage foundation > humanity > Mandy GunaswkaraKevin Robert > Pew Reseach Center > Pew Research > trump

Thomas E. Kurtz and “A Few Good Men”

Posted on | November 21, 2024 | Comments Off on Thomas E. Kurtz and “A Few Good Men”

Mike Magee

This has been a challenging week for me, but not for the reasons you might think. Compartmentalization skills have allowed me to push the 2024 Presidential election into the back reaches of my mind as I worked to complete teaching a course on “AI and Medicine” at the Presidents College at the University of Hartford.

Along with my students, we confronted a future filled with competing visions. Promise and dread lurked side by side at every turn. In one of the final slides of the final lecture I included an image from the 1992 Alan Sorkin legal drama, “A Few Good Men.” The face of an enraged Jack Nicholson (relentlessly baited by Tom Cruise) filled the screen under the headline “You can’t handle the truth!”

This device was employed to spotlight the fact that genAI, trained on de-identified population health data, will soon reveal numerous uncomfortable “truths” about our health care system – like its’ inefficiency, inequity, and spotty outcomes; or its wastefulness, fraud, and permissive attitude toward DTC marketing designed to drive demand.

AI’s capacity to uncover the strengths and faults of our system has already been highlighted in a January 24, 2024 JAMA article titled “Scalable Privilege” – How AI Could Turn Data From the Best Medical Systems Into Better Care For All.”

If we want to emphasize the positive, we do well to stop for a moment and acknowledge with gratitude the passing this week of 94 year old Thomas E. Kurtz. You may not have heard of him, but you likely recall his seminal invention, the first computer programming language for the masses – BASIC (Beginners’ All-purpose Symbolic Instruction Code). As Bill Gates himself reflected this week, “The approachability of BASIC and time-sharing began what the PC and the internet took to a whole new level.”

Bill would know. His high school had a teletype connection to the original time-sharing main frame computer at Dartmouth. But Gates was not alone or first in line. As Kurtz remembered, “I once estimated that even before Bill Gates got into the action at all, five million people in the world knew how to write programs in BASIC. There was something like 80 time-sharing systems in the U.S. that offered BASIC as one of their languages. And it was all over the world. I even got a letter from somebody in Siberia.”

It wasn’t until1978 that Gates teamed up with Microsoft founder, Paul Allen, and received permission to install BASIC in the first customizable personal microcomputer, the MITS Altair 8800.

Kurtz was the son of German immigrants, and displayed high aptitude in mathematics early in life. He graduated from a local college in Illinois in 1950, and by 1956 had earned a PhD in statistics at Princeton. He was recruited to Dartmouth that same year by the chairman of Mathematics, John Kemeny, who had previously been a research assistant at Princeton himself under none other than Albert Einstein. Kurtz launched a new field at Dartmouth that year – computer science.

He was starting at ground level – or more accurately, below ground level since the solitary computer the university possessed was housed in the basement of College Hall where it filled an entire room. Training students in computer science required hands on engagement. As Kurtz explained some years later, “Lecturing about computing doesn’t make any sense, any more than lecturing on how to drive a car makes sense.”

In later interviews, Kurtz make it clear that his idea didn’t meet with applause at the outset. He admitted, “The target (in computing) was research, whereas here at Dartmouth we had the crazy idea that our undergraduate students who are not going to be technically employed later on should learn how to use the computer. Completely nutty idea.”

Two barriers at the time were computer language and computer time. The main frame on campus ran on complex FORTRAN and COBOL which only a few experts had mastered. And if you wanted access, you had to wait in line.

But eight years after he had arrived on campus, on May 1, 1964, at 4 a.m., he put his new language, BASIC, to the test with the typed command “RUN” and it worked. He modestly remembered that “The whole point of this was to make computing easy for Dartmouth students, Dartmouth faculty, Dartmouth staff, and even Dartmouth janitors.”

One of Kurtz’s famous quotes was “always choose simplicity over efficiency.” It took only a one hour seminar to learn the system. At around the same time, he addressed the second problem – time. Developing what has been called “a clever workaround,” his new system permitted multiple users at remote terminals to access the computer simultaneously.

As with C.Everett Koop, who also died at age 96, he chose to live out the last few years of his life in near view of the Dartmouth green. And the world he left behind, one hurtling forward at breakneck speed, offers near unlimited computing access, and little time or delay between thought and action. Mistakes therefore run the risk of self-amplifying and potentially hurtling out of human control.

Mark Minevich, a well-respected AI Master Strategist focused on “human-centric digital transformation” understands the risks and benefits as well as anyone. He recently laid out pillars for governmental management of AI. They include risk assessment, enhanced safeguards, pragmatic governance, and public/private partnerships. Channeling Kurtz, he said, “There are no shortcuts to developing systems that earn enduring trust…transparency, accountability, and justice (must) govern exploration…as we forge tools to serve all people.”

The Dartmouth flags were lowered in Kurtz’s honor on Wednesday, Nov. 20, and Thursday, Nov. 21.

Category: Uncategorized
Tags: A Few Good Men > BASIC > Bill Gates > Dartmouth > John Kemeny > Koop > Paul Allen > Princeton > Thomas E. Kurtz

A Post-Election Resource

Posted on | November 13, 2024 | Comments Off on A Post-Election Resource

Access Online

Hard Copy

We are in the grip of change and our American Democracy is at risk. Change is one of the few human experiences that supports two dramatically opposed human emotions. On the one hand, change is fear, and on the other, change is exploration. And while you can support both emotions simultaneously, you can only do so for a short period of time before the tension created between the two forces you to choose one or the other.

At times like these, leadership really matters. Negative leaders embrace fear, using it as a currency to mobilize and organize populations to cement minority rules. In contrast, positive leaders are explorers who use a compelling value-centered vision as currency. Through role modeling and the strength of new ideas, they draw people in as they work through the challenges and shape an environment consistent with the majority’s long-term vision.

Negative leaders retrench and divide; positive leaders connect across the divide. Negative leaders segregate; positive leaders aggregate. Negative leaders build walls. Positive leaders build “islands of common stewardship.”

In our lifetime, we have witnessed the emergence of Intternet and HIV, of globalization and overnight delivery, of bubbles and bursts in our stock market, of the genomic revolution, and artificial intelligence. We have witnessed our health care system creak under the weight of a pandemic, and borne witness to an ongoing attempt to overthrow our democratic form of government. We are heavily armed, are always prepared for war, but show little desire for peace.

People are basically good, but they are not perfect.

People are basically kind, but when afraid can act unpredictably.

People are basically loving, but when misled can respond with hatred.

People are people.

Positive leaders are value driven role models and highly effective leaders worth emulating. They are also defenders and practitioners of Democracy.

What this book offers is one person’s stories, 10 cornerstone themes, and 52 personal challenges which are the distillation of values and lessons drawn from one life. They are no more valid than those of the reader.

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Tags: Mike Magee MD > positive leadership

Will Trump (with RFK as Intern) Play Doctor Again?

Posted on | November 12, 2024 | 4 Comments

Mike Magee

It has been a collision of past, present and future this week in the wake of Trump’s victory on November 5, 2024. The country, both for and against, has been unusually quiet. It is unclear whether this is in recognition of political exhaustion, or the desire of victors to be “good winners” and no longer “poor losers.”

Who exactly are “the enemy within” remains to be seen. But Trump is fast at work in defining his cabinet and top agency officials. In his first term as President, Trump famously placed himself at the front of the line of scientific experts sowing confusion and chaos in the early Covid response.

His 2024 campaign alliance with Robert F. Kennedy Jr. suggests health policy remains a strong interest. As his spokesperson suggested, his up-front leadership led to a resounding victory “because they trust his judgement and support his policies, including his promise to Make America Healthy Again alongside well-respected leaders like RFK Jr.”

For those with a memory of Trump’s checkered, and disruptive management of the Covid crisis, it is useful to remind ourselves of those days not long ago, and consider if throwing Bobby Kennedy Jr. in the mix back then would have been helpful.

I have been revisiting the Covid pandemic as I have prepared for a 3-session course on “AI and Medicine” at the University of Hartford’s Presidents College. The course includes a number of case studies, notably the multi-prong role of AI in addressing the Covid pandemic as it spun out of control in 2020.

The early Covid timeline reads like this:

December 1, 2019: A 70 year old man is admitted to the hospital in Wuhan, China with respiratory distress.

Mid-December, 2019: Multiple citizens in Wuhan, China are now gravely ill.

December 24, 2019: A post-mortem lung sample of a Wuhan patient yields a partial genetic sequence of the infectious viral agent. It is similar to the SARS virus that triggered an epidemic in 2003.

December 30, 2019: Word leaks out and reaches U.S. epidemiologist Marjorie Pollack, head of Promed, which alerts their 80,000 subscribers, including officials at the WHO, of a pending epidemic.

December 31, 2019: China’s National Health Commission directs the Wuhan health officers to formally announce the outbreak.

January 1,2020: Wuhan police threaten several local doctors for speaking out, labelling them as “rumormongers.”

January 3, 2020: Chinese government lets WHO know they are managing 44 confirmed cases.

January 5, 2020: A full genetic sequence of the virus is released. Chinese officials initially attempt to suppress the information.

January 13, 2020: German scientists release a test for the virus.

mid-January, 2020: Hundreds are now ill in Wuhan, and people are beginning to die from respiratory failure.

January 23,2020: There are now outbreaks in other parts of China. 571 cases are reported.

A Wuhan Central Hospital worker reports at the time: “It erupted too fast, and then there were just too many people infected, Without ventilators, without specific drugs, even without enough manpower, how were we going to save people? If you’re unarmed on the battlefield, how can you kill the enemy?”

February 15, 2020: Moderna release a “clinical-grade, human safe manufacturing, batch (of mRNA) shipped to health clinics for testing” just 45 days after the genetic sequencing had been revealed.

What normally would take years, took a few weeks. As Moderna’s chief data and AI officer, Dave Johnson PhD said later, “We were building that early preclinical engine of a company, which is, how can we target a bunch of different ideas at once, run some experiments, learn really fast and do it again… if you wanna run a lot of experiments, you have to have a lot of mRNA. So we built out this massively parallel (AI aided) robotic processing of mRNA… as things evolved as you capture data in these systems, that’s where AI starts to show up. You know, instead of just capturing, you know, here’s what happened in an experiment, now you’re saying let’s use that data to make some predictions.”

What AI did was direct the re-engineering, through purposeful mRNA mediated mutations of the virus’s genetic code, helping to generate the first batch of mRNA Covid vaccine.

December 18, 2020: Moderna receives “emergency use authorization” from the FDA Vaccine Advisory Committee.” Not a moment too soon, most would say. The death toll in the U.S. had already reached over 800,000, and projections of monthly fatalities ahead had reached 62,000.

It is now believed that rapid AI-aided development of the mRNA vaccine for Covid saved 15 to 20 million lives worldwide. The rapidity was the result AI driven hyper-accelerated mRNA generation. Prior to the integration of AI, Moderna was generating 30 samples of mRNA a month. By optimizing with AI, the yield exploded to more than 1000 per month. AI was then used again to predict how best to structure the vaccine to maximize a protein production response in the body…or as the company says, “more bang for the biological buck.”

Dave Johnson is quick to note that Moderna was fast at work with AI applications years before Chat-GPT became a household term. His background was software engineering and data science, and his PhD was in information physics. So it is not surprising that he’s comfortable forming non-human relationships. As he says, “We always think about it in terms of this human-machine collaboration, because they’re good at different things. Humans are really good at creativity and flexibility and insight, whereas machines are really good at precision and giving the exact same result every single time and doing it at scale and speed.”

As for a civilian like RFK Jr. playing doctor, that never seems to end well. Tommy Thompson tried managing the Anthrax crisis in 2001 and had to be rescued by Tony Fauci, MD. Fauci was there again in April of 2020 to clean up Trump’s bleach for Covid comments. Add to this a series of disastrous outcomes in red states where zealot bureaucrats have deemed themselves qualified to manage obstetrical emergences.

Will history repeat? We’ll know soon enough.