Raise the Line

“What's really exciting and scary in medical education right now is we're seeing large language models enter the scene,” says today’s Raise the Line guest Dr. Adam Rodman, who is well-placed to make such an assessment. As co-director of the Innovations in Media and Education Delivery Initiative (iMED) at the Beth Israel Deaconess Medical Center, Rodman is witnessing, and influencing, how new technologies are shaping both medical education and the future of healthcare.  In his view, AI can’t replace a doctor right now, but it can make remarkable insights into how humans think. “We need to start to grapple with what it means when a lot of these cognitive processes that medical education is designed to train for get offloaded to a machine,” he tells host Shiv Gaglani. He summarized his thoughts on AI, with co-author Dr. Avraham Cooper, in a piece for the August issue of the New England Journal of Medicineentitled “AI and Medical Education: A 21st-Century Pandora's Box” and invokes another concept rooted in ancient Greece as he describes AI as a ‘pharmakon.’ “There really is a way these technologies could dramatically improve what it means to be a patient -- and hopefully what it means to be a physician -- but the same technologies could be used to make things worse.” The ancient references are not surprising coming from Rodman, a medical historian who enjoys exploring the roots and evolution of the field on his long-running podcast Bedside Rounds. Don’t miss this richly informed conversation on how humans perform when interacting with AI, the advent of virtual tutors, and how AI might be used to improve student assessments and enhance the doctor-patient relationship.

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When Munjal Shah and his colleagues chose to use Hippocratic in the name of their new AI-based company, it wasn’t just about signaling their product was involved with healthcare, it was also intended to leverage the ‘do no harm’ philosophy associated with the term. After all, formerly fanciful fears of ‘robots’ replacing doctors have become more realistic since the advent of generative AI last year.  Shah addresses that issue up front in this revealing Raise the Line episode with host Shiv Gaglani. “We're going to be restricting the product when it comes out. It's not going to be able to do diagnoses.” Instead, the platform will focus on serving the needs of patients after their diagnosis, especially for those with chronic conditions.  Shah sees his healthcare-specific chatbots answering questions about symptoms, medications, post-op care and other routine matters as a vast, virtual and low-cost expansion of the healthcare workforce. “What would happen in the world if we could have 30 million nurses? How much would America's health improve? That's the vision we're after.” And he argues that healthcare expertise available in every home in every language, 24-7 would be a major factor in improving access. “We want to really solve health equity for everybody.” Tune in to find out how Hippocratic AI plans to establish itself as a trusted source of accurate healthcare information, how they intend to manage AI’s ‘hallucination’ problem and how his system could actually improve patient engagement.  

Mentioned in this episode: https://www.hippocraticai.com/

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

You’re going to hear something in this episode of Raise the Line that you most likely have never heard before: what DNA sounds like.  Our guests today all had an interest in musically representing DNA for different reasons, and have come together to pursue this theme as a way to raise awareness for rare diseases. Dr. Aditi Kantipuly had used the arts once before to achieve that goal by writing the children’s book The Zebra Alphabet. After coming across music based on genetic sequences composed by University of Chicago professor Stephen Taylor, a new idea formed. “Can we make a song for rare genetic conditions?” She expanded the possibilities by connecting with Casey McPherson, a Texas-based musician who had written a song based on his daughter Rose’s rare gene mutation. How do they do it?  “DNA consists of four letters -- A, T, C, and G -- and you can map those to anything,” explains Taylor. McPherson built melodies based on the amino acids involved in Rose’s condition. “Being a pop artist, I was looking for patterns. I was looking for motifs.” The aim is to engage people emotionally and intellectually in the fight against rare diseases. As McPherson puts it: “We have the technology to cure many of these diseases, we just don't have the structures to do it at scale. Music is a huge way of inspiring us to think differently.” Don’t miss this fascinating discussion with host Michael Carrese on a unique intersection of art and science.

Mentioned in this episode:

To Cure a Rose Foundation

http://stephenandrewtaylor.net/

https://thezebrabook.com/

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“I see health systems being systematically disintermediated by certain payers and some tech companies who are eager to take the easy stuff and leave health systems with really complex, sick and often very poor patients,” says veteran healthcare executive Dr. Marc Harrison. “I need a speedboat to change that.” He’s building that speedboat in partnership with venture capital firm General Catalyst, and will leverage his deep experience -- most recently as CEO of Intermountain Healthcare -- to set a new course for healthcare in the US. “Healthcare should be accessible, affordable, of high quality, consumer-centric and a combination of the digital and legacy world,” he tells host Shiv Gaglani.  “A ‘clicks & mortar’ future, as we like to say.” In this thoughtful episode of Raise the Line, Harrison also touches on his own health struggles and discusses his book Possibility Unleashed which examines how to create environments where people get to do their very best work. “How do they get to run hard, run fast, be collaborative and do more in that context than they could ever do on their own?” Don’t miss this wisdom drop from one of the country’s leading figures in healthcare reform.

Mentioned in this episode: Dr. Marc Harrison’s book, Possibility Unleashed.

 

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While it’s encouraging that efforts to provide culturally competent care have gained a foothold in the wake of COVID, today’s Raise the Line guest says it is time to expand the conversation to encompass the concepts of cultural safety - which involves awareness of historical power dynamics -- and cultural humility -- which requires an inward look. “Are you reflecting on your own values, beliefs, and background and what you're bringing to the table,” Dr. Raj Sundar explains to host Michael Carrese. Sundar tries to practice all of this himself with patients in his family medicine practice in Washington, but also works at a broader level as a community organizer with culturally diverse populations and reaches an even wider audience through his Health Care for Humans podcast aimed at educating clinicians on cultural safety in healthcare. He acknowledges up front how challenging this work can be, especially because well-intentioned efforts to connect culturally with patients can backfire unless they are well-informed, but it is more than worth the effort. “This work is messy and sometimes doesn't have a black or white answer, but it can provide moments of joy. When patients feel known, seen, and heard they feel like they can trust you.” Sundar is a thoughtful source of guidance in this enlightening look at what can be done at the individual and institutional level to facilitate cultural connection in healthcare. 

Mentioned in this episode: https://www.healthcareforhumans.org/

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Our focus on the renaissance in research into psychedelics continues on this episode of Raise the Line, but instead of looking at their potential therapeutic applications, we're going to hear about using them as a tool for learning how the brain works. “We don't have a great idea about the neural basis of self-conception, and psychedelics make us question so many of our fundamental assumptions about the nature of reality,” says Dr. Michael Silver, director of the UC Berkeley Center for the Science of Psychedelics. Dr. Silver, who is also a professor of Optometry, has the advantage of using the extensive knowledge we already have of how visual activity works in the brain as a predicate for his research. “We have the ability to do human neuroimaging and objectively define many areas in the visual cortex, while it’s still unclear how some higher order areas of the brain are defined,” he tells host Shiv Gaglani. The Center was established in 2020 in part to fill a need for credible information about psychedelics and its work is informed by a wide range of disciplines including molecular and cell biology, psychology, neuroscience and journalism. In fact, one of the Center’s founding members is journalist Michael Pollan, author of the bestselling books How to Change Your Mind and This is Your Mind on Plants. This is a truly fascinating conversation on the nature of visual perception, standards for training psychedelic facilitators and the possible recategorization of mental health disorders, among other implications of psychedelic research. 

Mentioned in this episode:
UC Berkeley Center for the Study of Psychedelics

UC Berkeley Online Course: Psychedelics and the Mind

Sam Harris Podcast

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“I'm betting it's going to be more good than bad, but I have some big concerns about where things are headed,” warns Dr. Matthew Johnson of Johns Hopkins University when prognosticating about what impact the use of psychedelics in mental health treatment will have on society at large. As he tells host Shiv Gaglani, once these compounds are more widely available, there is real potential for unscrupulous actors to take advantage of people and cults to form. “One of the critiques is about this “new religion” component. I've been really concerned about that because I see even within the deepest layers of science, it’s very difficult to trust people with the magnitude of effect psychedelics have in people.” It's perhaps surprising for one of the scientists responsible for the renaissance in psychedelic research to articulate those concerns, but Dr. Johnson notes there is a long history, going back centuries, of psychedelics waxing and waning due to social and political factors. For now, he is focused on the efficacy of psychedelics in combating nicotine addiction, an area he pioneered starting a decade ago. Preliminary results of a study building on his early work indicate psychedelic-assisted therapy may be twice as effective as the leading nicotine replacement therapy. Up next is a multi-site trial on nicotine, plus studies on using LSD to treat chronic pain and psylocibin to deal with opioid addiction and PTSD. Don’t miss this thoughtful, nuanced and super informative discussion on one of the most interesting areas in medical science today. 

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For our 400th episode we’re happy to be diving into one of our favorite topics -- direct-to-consumer healthcare -- with a leading force in the space, Dr. Kapil Parakh. In his role as senior medical lead at Google, Dr. Parakh has led projects to expand access to health information and help people achieve their fitness goals using Fitbit and other means. He’s also helped launch products that reach a billion people and pioneered partnerships with a range of organizations, including the World Health Organization and the American Heart Association. “I've found my passion around innovation and digital health, and the intersection of consumers and health,” he tells host Shiv Gaglani. Tune in to gain from Parakh’s broad insight into how AI and digital tools are making a difference in the science of health, and the opportunities for wearables and other digital tools to help doctors and patients work together to improve health. “You can take these consumer-grade tools and intelligently use them in many different clinical and population health settings. You just have to understand what that data means and how to use it.”

Mentioned in this episode: https://www.google.com/fit/

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