Week of January 8, 2024
Twenty years ago this year, I started subspecialty training in nephrology. While the fundamentals of caring for patients haven't changed, medical technology, data tools, and our collective healthcare knowledge have evolved rapidly in 1/5 of a century. And yet, all the wisdom and innovations feel less impactful than preventing illness early. And, for now, the skills of convincing patients to act proactively (building trust, coaching, and cajoling) are still analog and interpersonal. While I am confident A.I. coaching and counseling will be a thing, I am curious when my patients (especially my vaccine deniers and conspiracy believers) will embrace an ever-present "doctor Alexa" or "nurse Siri." Of course, in another 20 years, they may not have a choice.
I am confident in the usefulness of fleshy doctors through at least 2025: https://www.healthcareitnews.com/news/ai-2024-welcome-new-normal-healthcare
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By wastewater RNA concentrations, at the moment, coronavirus is more prevalent than at any time other than the Delta-variant surge in 2021-2022. However, hospitalizations, while high and rising, are not proportional. I have seen numerous hypotheses:
1) JN.1 (the current variant) is more transmissible but causes less severe illness (or is this an artifact of #3 below?).
2) JN.1 seems to infect the G.I. system more robustly than the respiratory system (thus causing disproportionately elevated wastewater concentrations).
3) Vaccination + previous infection has offered broader protection against severe illness (but not infection).
I suspect all of these ideas contribute to the data we see.
The N.Y. Times COVID Tracker reflects only CDC-gathered hospital data. Hospitalization data are a (lagging) indicator.
https://www.nytimes.com/interactive/2023/us/covid-cases.html
Wastewater monitoring is more of a LEADING indicator.
Currently, on average, 1 out of 25 Americans is infected.
See:
https://twitter.com/michael_hoerger/status/1743364329636761603
and
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COVID articles
I have seen several new articles on the physiologic mechanisms of long COVID. As I have written before, the prevalence of COVID is unprecedented. The scientific and medical community's ability to analyze population-level coronavirus impact is an enormous opportunity to learn more about the interplay of viruses, the immune system, and long-term illness. To be sure, coronavirus is not the only virus that is linked to or associated with chronic disease. However, given how difficult it is to longitudinally follow patients infected with other viruses (such as Epstein Barr in ALS or cytomegalovirus in depression), the data are often retrospective, and the causal association is far more tenuous.
For context, an organization dedicated to patients with Chronic Fatigue Syndrome offers a well-referenced and balanced review of the evidence between various infections and some common diseases. (N.B. - I am not endorsing CFS or any of these data, but it is a good list of diseases and possible associated viruses and bacteria.)
https://me-pedia.org/wiki/List_of_chronic_diseases_linked_to_infectious_pathogens
Here are some of the data I have been finding about coronavirus:
Pediatrician Dr. Vipin Vashishtha's overview of long covid physiology:
https://x.com/vipintukur/status/1743694538873716888
Viral pathogens and dementia, including COVID's possible relationship to dementia
https://x.com/DaniBeckman/status/1742602437330874556
and
Early data hinting at a relationship between an altered microbiome in long COVID patients:
I still recommend getting COVID as infrequently as you can (masking and vaccines!)
Medical Trends and Technology
Researchers from Kenya published data on using smartphones to collect the sounds of known tuberculosis patients and patients with other pulmonary diseases to create a phone-based "cough classifier." It is a great concept and hints at the power of off-the-shelf technology and AI, even in poorer countries.
https://www.science.org/doi/10.1126/sciadv.adi0282
and
https://twitter.com/EricTopol/status/1742651677063381108
Infographics
In 1999, Frank Zappa's autobiography included the quote, "You can't be a Real Country unless you have A BEER and an airline—it helps if you have some kind of a football team or some nuclear weapons, but at the very least you need A BEER." Someone on Reddit updated the Frank Zappa world map to "real" countries.
More: https://quoteinvestigator.com/2014/09/16/beer-airline/
Zappa died in 1993. If you haven't explored his music or were too young to see him debate politics on CNN in the late 80s and early 1990s, it is worth catching up on some Zappa history. He is fascinating.
https://newrepublic.com/article/160383/weird-frank-zappa-documentary-review
Things I learned this week
Thanks to a loyal reader's book recommendation, I learned that in 2019, The Royal Society of Chemistry calculated the cost of chemical elements to build a live replica of Benedict Cumberbatch would cost about $151,578.46 (excluding labor and the necessary tools to transform elements into a living being, of course).
I was surprised that I had never thought about how elephants are anesthetized and put on breathing machines (ventilators) for surgical procedures. Thanks to a Tweet from Dr. Nick Mark (a pulmonologist and ICU doctor), I learned about large animal veterinary ventilators.
https://x.com/nickmmark/status/1743804068139794624?s=42&t=cHtDhpWgAdi0UhIayqsoag
and
https://vetlandmedical.com/large-animal-anesthesia-machine/
And in some strange harmonic convergence of my childhood, I learned that Kurt Cobain's daughter married Tony Hawk's son in October, with REM's Michael Stipe officiating. Any resulting children will undoubtedly be born preloaded with angst, wearing flannel and Vans.
Living with A.I.
OpenAI is launching its App Store this week. It won't be long for some interesting tools to emerge.
https://www.theverge.com/2024/1/4/24025610/openai-gpt-store-ai-agent-delay
Several loyal readers have sent me videos and articles about the emerging integration of AI into robotics. A great example is Trossen Robotics' ALOHA project, which uses low-cost hardware, optics, and predictive modeling to build robots with fine-grained, bimanual manipulation skills. Videos of this robot preparing meals and cleaning offer a Jetson-like view of the future. Or, our robot overlords will rule us by creating a Wall-E-like incompetence of humans no longer able to wash dishes and cook.
https://www.trossenrobotics.com/aloha.aspx
and
A.I. "art and more" of the week
I asked ChatGPT to help me with a patent application for a multi-armed robot that can simultaneously cook and act as a large animal veterinarian. Not only did DALL-E draw the schematic, but the LLM built me a name and business plan. See below and let me know if you know of any animal shelters with attached cafes.
Patent Schematic:
https://drive.google.com/file/d/13lq24mWOCnrUwFH7ik2qfGZLI2ro7wdC/view?usp=sharing
Suggested names:
- ChefVet Bot
- GastroVetron (<- my favorite)
- BistroBeast Machine
- MediMeal Mech
- Gastronimal Helper
- Culinary CritterBot
Suggested Business Plan:
- Market Research and Target Audience Identification:
- Conduct thorough market research to understand potential customers, such as restaurants, veterinary clinics, and other commercial entities.
- Identify niche markets that could benefit from a multifunctional robot, like animal shelters with attached cafés.
- Conduct thorough market research to understand potential customers, such as restaurants, veterinary clinics, and other commercial entities.
- Unique Value Proposition and Branding:
- Develop a clear value proposition highlighting the robot's unique ability to cook and perform veterinary tasks.
- Develop a clear value proposition highlighting the robot's unique ability to cook and perform veterinary tasks.
- Product Development and Beta Testing:
- Finalize the product design, incorporating feedback from potential users. Conduct beta testing in real-world environments to gather data and testimonials.
- Finalize the product design, incorporating feedback from potential users. Conduct beta testing in real-world environments to gather data and testimonials.
- Strategic Partnerships:
- Partner with culinary and veterinary institutions for endorsements.
- Partner with culinary and veterinary institutions for endorsements.
- Marketing and Advertising Campaign:
- Launch a multi-channel marketing campaign utilizing digital marketing, social media, and industry-specific platforms, including video demonstrations, testimonials, and case studies.
- Launch a multi-channel marketing campaign utilizing digital marketing, social media, and industry-specific platforms, including video demonstrations, testimonials, and case studies.
- Sales Strategy:
- Implement a direct sales approach for B2B clients and consider online sales; Offer flexible pricing models, including leasing options for budget-conscious customers.
- Implement a direct sales approach for B2B clients and consider online sales; Offer flexible pricing models, including leasing options for budget-conscious customers.
- Online Presence and E-Commerce:
- Create an engaging, informative website with e-commerce capabilities.
- Create an engaging, informative website with e-commerce capabilities.
- Customer Service and Support:
- Establish a robust customer service system, including training, maintenance, and troubleshooting support.
- Establish a robust customer service system, including training, maintenance, and troubleshooting support.
- Sustainability and Corporate Social Responsibility:
- Emphasize the robot's contribution to sustainability, such as reducing kitchen food waste.
- Corporate social responsibility initiatives include donating units to non-profit animal rescues or educational institutes.
- Emphasize the robot's contribution to sustainability, such as reducing kitchen food waste.
Clean hands and sharp minds, team
Adam
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