This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of October 2023
The show gives you a quick insight into the latest news, twists, turns, and debacles going on in healthcare with my friend and co-host Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners, and myself, where every diagnosis comes with a side of humor. We hope you stay curious, stay engaged, and keep seeking the truth in healthcare in a world that thrives on information.
Buckle up as we dive into the ER of excitement, the ICU of irrationality, and the waiting room of wacky wisdom in this month’s show that features a review of:
- Recent moves adds, and changes in the employees at Open AI
- Using other AI and Generative Pre-trained Transformers
- Consumers versus Patients
- Weight Loss Drugs and Direct-to-Consumer Advertising
The unexpected firing of Sam Altman, the former CEO of OpenAI was the main topic of discussion and while we were both surprised at the move had differing views on the underlying causes and potential outcomes. While Microsoft was quick to jump in and say they would be happy to hire the two individuals that may not extend to the 700 or so employees who all openly expressed support for their former CEO and why a return for Sam Altman to Open AI may not be in the best interests of the company. The AI alignment required of the board structure and the fear of FOOM (Fast Onset of Overwhelming Mastery – something we all at one time or another think we have personally 🙂)
We discuss the use of the term consumers versus patients and what that might mean and while both of us see the value of ‘consumerization’ and acknowledge the benefits of a consumer-centric approach perhaps the term “patient” remains the preferred for many doctors at least.
Listen in to hear our take on the weight loss drugs that have been in the news a lot recently and our caution against jumping to conclusions and emphasize the need for further research to establish a clear cause-and-effect relationship as we discussed when we talked about the Parachute study.
We hope you enjoy our take on the latest news and developments in healthcare and want to help you keep untangling the web of information, dodging the sensational pitfalls, and emerging victorious, albeit a little dizzy, on the other side. In the end, the stories we uncover, and the discussions we ignite, all shape the narrative of our shared future. We want to hear from you especially if you have topics covered or questions you’d like answered. You can reach out directly via the contact form on my website, or send a message on LinkedIn to Craig or me.
Until next week keep solving healthcare’s mysteries before they become your emergencies
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
So how can we not talk about the recent? I’m going to call it the firing, because that’s what it seemed like of Sam Altman from open AI. That was just I think it caught everybody by surprise. And of course, lots of people are waiting. Well, I could see this coming. And oh, you know, here’s all the fantastic insights. What what do you think, Craig? Are you? Were you surprised?
Craig Joseph
I was as surprised as anyone. Sam Altman, who is the was the CEO of open AI. Oh, hold
Nick van Terheyden
on, we record this. He could be now right?
Craig Joseph
He could be the new and then he could be fired again. Yes, we can bounce back and forth here.
Nick van Terheyden
And that is all in the last day, right.
Craig Joseph
Up until recently, he’s been the face of of open AI, the creator of chat GPT, and doll II and a bunch of other things. And he’s been everywhere around the world around the country talking about the, you know, AI and the work that he’s done and the work that this company is doing and and then all of a sudden, he was informed by an a Zoom meeting that he no longer works.
Nick van Terheyden
They didn’t hear that, Jen. So this was a zoom dismissal. Wow, actually, now that I think elevation from tactics this
Craig Joseph
I miss I misspoke. It was it was actually worse than that. It was a Google meet. Whoa, whoa, whoa, that
Nick van Terheyden
is so low.
Craig Joseph
That is worse, because which a lot of people may not know that open AI is, is heavily supported, and works very closely with a company in Seattle. I forgot their name. Oh, wait, Microsoft, Microsoft. So the even do it on TV. They couldn’t do it on teams. They did. Yeah. So that was the big thing. That was taking the the social media by by storm was that the it all came from a Google meeting request.
Nick van Terheyden
It was such a goldmine of useful, highly relevant information relative to the scientists got.
Craig Joseph
It’s amazing. It’s amazing. The irony. I mean, there’s just 1819 Different levels of irony there.
Nick van Terheyden
So what do you think do you think? Because I mean, since then, and you know, what do we know at this point in time, so that happened, and, you know, the internet exploded with all sorts of commentators, everybody that knew that didn’t know that had, you know, insights and whatever. I saw somebody sort of post something about Satya Nadella, CEO of Microsoft. And he said, Oh, well taken. And you know, he’s got a job. Oh, and by the way, he has an open checkbook is I also read, that’s my understanding. And you know, there was some commentary about that. Wow, that’s a really clever, cool move. I’m just wondering about the billions that they invested in what they thought about that, because if they exit all the staff does their 13 billion or however much it was that they invested, does that go to zero? Or how does that work?
Craig Joseph
You know, another meme that was going around the internet was this comparison of how much companies have paid to acquire other companies. For instance, Facebook paid $1 billion for its own weight. Am I gonna mess this up? I think it was for Instagram.
Nick van Terheyden
Yeah. Instagram. Good. Yeah, well, WhatsApp. I think they probably those were the or WhatsApp.
Craig Joseph
Yeah, they, you know, they paid seemed like a lot of money. But in hindsight, what a bargain. And so the meme goes through, and it says, you know, this company paid X dollars for this, and this one for that. And then it said, Microsoft paid for open ai $0. Meaning that they were about to acquire, as you noted, everything is in flux. And we don’t really know where it’s gonna go. But Sam Altman was fired. And then the very next day, Microsoft said we’ll hire him. And then a bunch of other people. A significant chunk of the of the workforce has has potential signed
Nick van Terheyden
a letter Ay, ay, ay, good idea. What if you were though, was that what you would do? Or would you be part of the 70? That didn’t sign that didn’t see the letter when it was left in the Yeah,
Craig Joseph
well, let’s, let’s just be clear. Again, this is all from reporting that we’re seeing now. But that, that, you know, the reporting that I’m seeing now is that there are about 770 employees at open AI, of which about 700 report reportedly signed a letter saying, hey, board, we’re going to leave and if you don’t, you know, fix all of this and go back to the way it was and Fire yourselves, and, you know, bring back our fearless leader. Now, if that’s all true, it’s really hard to understand how the company moves forward without 700 without, you know, 90% of their of their employees, including all of their leadership. I, you know, I don’t get how you how you move forward with that? Was it a good idea? I don’t I don’t know. I apparently they like Sam. According to the reporting, they really like Sam. And I’m
Nick van Terheyden
just wondering is that 700 new employees at Microsoft with a new microsoft.com email address? Suddenly? Yeah, well, I don’t know that they can stand that kind of influx of numbers. Well,
Craig Joseph
it’s, it’d be a small drip. In terms of the numbers. I think the salary though requirements would be out the roof, but it Yeah, it’s, it’s, it’s kind of crazy. You and I both depend on the software that they create, right? We
Nick van Terheyden
do. And we don’t depend on it. We just maybe use it occasionally. All
Craig Joseph
right, oh, you’re right. I mean, I probably over spoke there, I use their software on a regular basis, you know, I pay the $20 a month to open AI to have access to the latest and greatest and, and all of that jazz, and I find it, you know, amazing, I still find it magical. And the idea that it wouldn’t be there or and many, many others, you know, it’s behind the scenes from Bing and other other tools, it’s built into all kinds of stuff that people don’t even might not even realize that they use, you know, for suggestions and, you know, other aspects, it’s just the behind the scenes thing. So the concept that open AI would go away, is odd. I mean, we’re in we’re talking about healthcare, specifically, a lot of electronic health records are using specifically open AI software, to try to summarize the chart or to predict, in the case of one big vendor, they’re predicting, when you send a message to your doctor, your doctor might actually get a message when when they open up your message saying, Hey, here’s a, here’s a good response to this patient with it already kind of written out. And so that’s all from open AI, or at least a lot of those vendors are using open AI. So I don’t know, there’s essentially
Nick van Terheyden
you’ve got this company, they’ve created quite the wave of interest, I would say that, you know, if I was talking about AI, you, you would be hard pressed to talk about it without chat GPT, which is, you know, now in general use, and suddenly this misbehavior, or, you know, firing of a CEO with no forewarning. And, again, I’ve seen lots of commentary and, you know, potentially going back. But one of the things that I think is really interesting, and you know, still to unfold, but it’s, I don’t think it’s quite as simple as well, that’s terrible, they shouldn’t have been allowed to do it. Because in the creation of this company, it’s got a really unusual corporate structure. And I am not to be clear and expert in this space. But based on what I understand, it’s not the sort of traditional holding company that you know, owns all of this open ai ai, it actually has this open AI nonprofit, it’s a 501 C, that is a public charity. And that is the owning entity for the organization, which has a board of directors that controls that is separated from the financial streams, and was deliberately done to prevent the misuse of what is deemed to be an extraordinarily powerful technology. And I think I don’t know if everybody agrees with this, but it feels like this is a true inflection point in society, that artificial intelligence using that as the broadest term, could potentially be some of the most significant developments in our world. And, you know, what, what’s contained within all of that? Well, it’s the challenge of what’s called AI alignment. And the only way I can describe this or to sort of talk about AI alignment is to reference something they call Foom. I’m going to challenge you here, do you know what Foom is? Are you familiar with the term Foom?
Craig Joseph
I would rather not respond.
Nick van Terheyden
Oh, thank goodness, fast onset of overwhelming mastery, which is essentially the machine teaching itself to do and we saw that with go if you remember, go it taught itself to win and beat go that was just in a small subset. But when you extend this to the potential future, it’s essentially a life preserving activity. And, you know, in that instance, what are we Talking about Well, I mean, for those that know, you know, what are we talking about? I’ll be back. Right? It’s Terminator right there, isn’t it? I mean, isn’t that what you think about or potentially 2001 Space Odyssey. And if you know it Ex Machina, I mean, the list goes on, we have all of this, you know, movies that are sort of painted the picture. And they designed the board so that the board could prevent that from happening. There was, as I understand it, some fear that that was the direction that they were going. So they executed on this, it wasn’t an easy task, because they had founders, there were two sort of independent board directors. And they’ve essentially made this decision done it. And now there’s this huge reversal. So I’m getting out my popcorn. And I’m gonna watch this space, because I’m, you know, a small fry in this very, very big ocean. But it’s extraordinarily interesting. And I think, probably the most important thing that we’re watching, and it’s right around Thanksgiving. Wow.
Craig Joseph
Yeah, gift. Yeah. It’s a lot of fun if you’re not involved, right. And let me be clear, Dr. Nick, I do not want computers to take over.
Nick van Terheyden
So you don’t feel that you want the Terminator helping you drive because he helps me when I have him on Waze when they have it available, because I love him as my guide. I really do.
Craig Joseph
No, I have not been advised. I am. I’ve seen these movies. And I’m not a big fan of that outcome. So yeah, if firing Sam Altman is what it takes to not have Arnold Schwarzenegger come back, you know, naked in killing people, then I’m in favor of that.
Nick van Terheyden
Well, let me just pull one other movie for the positive side of this. You remember this one transcendence. That was where he dumped his whole persona, you know, his essence into the computer that he then chased around the world. I was, you know, that there’s some positive sides to this, but it sure as hell gets really dark pretty quickly. And, you know, let’s be clear Terminator was that was a movie from the 80s. So it’s been a long time. But yeah, it’s it’s been covered, it feels like it’s a bit closer. So before we close out on AI, let’s just very briefly mentioned, we talked about chat GPT. And if it does disappear, which, you know, apparently, Craig thinks that’s a possibility. And it would be terrible, since he pays for that. There are some others out there. And I am going to call out specifically the clawed AI tool from anthropic, which you can register for the same way that is extremely good at summarizing long documents. So if you have long documents, you can throw them in there. I’ve just found some really interesting use cases. And, you know, I recognize I’m going to be overtaken by AI at some point. But in the meantime, I’m using it because I think it’s really valuable. So any closing thoughts?
Craig Joseph
No, I look forward to you being taken over by AI.
Nick van Terheyden
How do you know that hasn’t already happened? I don’t I just my personality has changed.
Craig Joseph
I’m just waiting for it to happen. And I’m hopeful that it’s you first. So I can watch. I suspect I’ll only get a minute or two. And then it’ll be it won’t
Nick van Terheyden
be that long. I’m telling you, you’re going to be a fast second. If it goes, if it goes for me. I’m coming for you. Um, yeah, I
Craig Joseph
guess. So. I want to I want to All
Nick van Terheyden
right, so trying to cover a few other items of news before we have to finish. Consumer versus patient. I think this has been a trending topic for a while people are saying you should be a consumer, you’re not a patient. You know, you I there was some reference to this, and actually some pushback from this sort of consumerization of healthcare. What are your thoughts?
Craig Joseph
You know, my thoughts are that I see the benefits of thinking about patients as, as consumers and clients right, adding this experience so that they are not so that they I say be they like we’re all not patients. I don’t like to feel like cattle. And if that’s something if changing the way you think about me as a as a as a patient, and changing the name to customer makes me feel less like cattle than I’m on board. However, you’re referencing an editorial that was in modern healthcare from two leaders at Stanford University and, and it resonated with me and I absolutely responded to it on on LinkedIn and Twitter and wherever else I am, and said, like, yeah, I prefer to be called a patient. And I prefer to think of the people that we take care of as patients. Because I think that’s different than than being a customer or a consumer. And if I’m, if I’m your customer, it kind of doesn’t imply that there’s a lifelong, hopefully, ideally, a lifelong relationship and, and you know, if I’m your customer, I’m expecting you to sell me things. And if I’m your patient, I’m expecting the opposite, quite frankly. And so, you know, where does the where does the response? Where does the duty lie if I’m physicians are treating and dealing with customers instead of with patients and I think there’s I totally get people who might be rolling their eyes and it really doesn’t matter what you call me, you know, like, I have a headache, I want you to help me get rid of that headache. And
Nick van Terheyden
I do since you’ve been droning on but anyway, go. No,
Craig Joseph
I. I acknowledged this, but I do think that words matter, and they have power. And I I’m in favor of being called a patient and calling the people that we take care of patients and not thinking of them solely as, as, as consumers or customers. That said, I still think it’s very important to try to leverage what we know from retail and other aspects of taking care of customers. That those are things that we can do, we can go quite far, there’s a lot of whitespace there in the US healthcare system to make things easier and make me want to work with you. But at the bottom, at the end of the day, I’m still I’m still rooting for me to be called a patient.
Nick van Terheyden
Yeah, I, I’ve certainly been one for pushing the consumerization. I think, you know, we desire that kind of service level in some respects. I agree with you words do matter. I think what I heard, and I wish I could, quote the individual, but I would go one step further and say, it’s not just words matter, it’s the way that we use them. And you know, the appropriate context in this particular instance. And you’re right, I mean, it’s a very privileged circumstance, you can’t get away from that as a clinician, the trust and bond. And I’m pretty sure if I was doing that, and calling somebody, the consumer in that interaction, it would change dramatically. So I think fair comment. So weight loss drugs, there seems to be a big push and saying, Wow, they’re doing all of these amazing things. Let’s pick one, improving cardiac outcomes, less myocardial infarction, cardiovascular disease as a result of massive weight loss. I’m just going to use two words, correlation causation, in my view, feels like we’re jumping the gun a bit. I mean, great drugs. But is that really the case? I think we have to take a slightly deeper look, right?
Craig Joseph
Well, this is an initial study. And of course, you’re talking about, you know, what, what, what causes what, right? So certainly, these these drugs started off for patients with diabetes, and and so as to lower their their blood sugar and decrease the complications that come from high blood sugar, of which cardiology problems are what they are. So it’s hard to kind of tease out like, hey, is this medicine, helping your heart problems directly? Or instead is it well, it’s doing what it’s supposed to, which is lowering your glucose, making it easier for you to lose weight? We know if you lower your glucose to normal levels and lose weight, your risk of having heart related problems is much less and so you know, is it the chicken or the egg? i We don’t know. I don’t think we’re going to know for sure
Nick van Terheyden
we did have that wonderful yesterday with with skydivers and jumping out of an airplane, didn’t we? We
Craig Joseph
did. And that was amazing. We’re gonna need some more evidence to you.
Nick van Terheyden
I think we should do some more studies like that right to prove the point. Heck,
Craig Joseph
I you know, I want to go on some of these meds. I if you’re watching TV, the commercials are pretty awesome. And so I base all of my medical decisions on commercials that I see on TV, as I assume you do to Dr. Nick. So
Nick van Terheyden
yeah, let’s cover that point. Very briefly, since you brought it up. This is one of only two countries in the whole world that allows DTC direct to consumer advertising of drugs. That can possibly be right. Just, I can you justify this at all in any way?
Craig Joseph
Well, we didn’t know now, I think the only justification for direct to consumer for prescription drugs it because in the past, in the not too distant past. I remember when, if it was a prescription drug, it could only be advertised towards prescribers, aka physicians. Oh, so
Nick van Terheyden
that was the case before? I didn’t know that. So though, yeah. Oh, so it changed?
Craig Joseph
Oh, yes. I don’t in the 80s, late 80s 90s, early 90s. Sometime it changed. Yeah. And I don’t. So the the one argument that you could make in favor of this is that, hey, there were patients who had a problem that they didn’t even know there were medications for. And when they learned that they do go and have a different conversation with their physician, like, Hey, I wasn’t gonna bring this up. But I have been having, you know, trouble sleeping and I have I might have sleep apnea, or maybe that’s a bad example. But yeah, those kinds of things and so they make patients aware. Stop rolling your eyes. That that is what you asked me. Could you defend direct to consumer advertising? That’s how I would do it.
Nick van Terheyden
Well, we find ourselves at the end of another episode exploring health care’s mysteries before they become your emergencies. Until next time, I’m Dr. Nick.
Craig Joseph
And I’m Dr. Craig.
