Patients are NPCs

I found a new way to think about patients in an opinion piece by Ezra Klein: they’re NPCs. For those of you unfamiliar with gaming, NPCs are those characters in video games that aren’t controlled by live players; they’re part of the game, serving as background for the actions the actual players take.

When it comes to healthcare, we are, alas, just NPCs

Not a very flattering metaphor.

Mr. Klein’s article is neither about healthcare nor gaming, but about politics: The Republican Party’s NPC Problem — and Ours. Conservatives, Mr. Klein explains, accused liberals of being NPCs -- passive, conformists, deferential – whereas they were the live players, willing to take chances and make things happen. He goes on to explain why this is not at all accurate, especially in the Congress, but this paragraph is what really struck me:

It’s a genuine failure of Democrats that they didn’t put more energy into making the government faster and better when they were in charge. How did the Biden administration pass $42 billion for broadband in 2021 and have basically nothing to show for it by November of 2024? How did it get $7.5 billion for electric vehicle chargers but build only a few hundred chargers by the end of the term?

I.e., Democrats had some good ideas, took action to try to make them happen, but failed in the delivery. Good intentions matter, but are necessary, not sufficient.

Marc J. Dunkelman makes a similar argument in The Atlantic: How Progressives Broke the Government (an adoption of his new book Why Nothing Works: Who Killed Progress--And How to Bring It Back). Here are a couple of the relevant passages, aimed at the Progressive movement:

Progressives are so fearful of establishment abuse that reformers tend to prefer to tighten rather than loosen their grip on authority. The movement discounts whatever good the government might do in service of ensuring that it won’t do bad. And that’s driven well-intentioned reformers to insert so many checks into the system that government has been rendered incompetent.

At present, progressives are too inclined to cut public authority off at the knees. And that’s why they so often feel like they can’t win for losing. Their cultural aversion to power renders government incompetent, and incompetent government undermines progressivism’s political appeal.

America can’t build housing. We can’t deploy high-speed rail. We’re struggling to harness the promise of clean energy. And because government has failed in all these realms—because confidence in public authority has waned through the years—progressives have found it difficult to make a case for themselves.

What does any of this have to do with healthcare, much less NPCs? It’s this: we talk a good game about health care, especially Democrats, but we consistently fail to deliver. Pick your poll: Americans are critical of the healthcare system in general, of the quality of care, and especially its costs.  Americans hate Big Pharma, we hate health insurers, and our trust in doctors and hospitals has plummeted, especially since COVID.

U.S. researchers develop innovative, life-saving treatments, but we often can’t get them to the people who need them most. U.S. produces miraculous prescription drugs, but we pay far more for them than anywhere in the world. Healthcare professionals and institutions urge us to get preventive care, to seek care when needed, and to go to the ER in a crisis, but put us in a queue when we try to do any of those. “Complicated” is perhaps the kindest description one could use for our healthcare system.

Every healthcare organization claims to “put patients first.”  It’s all about the patients. Except, of course, it isn’t. Healthcare has been invaded by private equity, which offers no pretenses about its priorities. If your health care or health insurance is delivered by a publicly traded company, it can say all it wants about patients but its mission is to deliver for its shareholders. Even supposed non-profit healthcare institutions are increasingly acting like for profits, and if you don’t believe that, ask your local hospital how many patients it has sued for nonpayment.

Democrats tout Obamacare as evidence of improving the healthcare system, and it is a great improvement over what it was before, but no one believes it “fixed” anything. Tell that to the residents of the ten states that have still not expanded Medicaid, or to the twenty million who would lose Medicaid coverage under proposed House Medicaid cuts. Tell that to the millions of Americans whose bankruptcy is directly tied to their medical debt.

Who would put up with all this? NPCs, of course.

The “live” players in the healthcare system are the ones making money; patients are the means to that end. We may be the ones suffering, but that suffering makes other parties’ money. The game isn’t about our health; the game is about returns on investment. If you don’t believe that, you probably still believe Facebook is all about connecting the world and Google is all about making the world’s information accessible. We’re the product; we’re in NPCs in their game.

We need a healthcare system that works for patients, one that treats us like individuals with unique challenges, not like nameless NPCs.

Our healthcare system is not sustainable as is. Credit: Harvard Health

Our government – at the state, local, and federal level – is not delivering. Our major institutions are not delivering. And our healthcare system is most definitely not delivering. I have to modify all that; if you are in the 1%, things are pretty good. Otherwise, though, you’re just an NPC in their world.

We need leaders who won’t just talk a good game but play it well. Last year Democrats campaigned as though health care meant abortion access, transgender care, and capping prescription costs (e.g., transferring them to the insurer, and into premiums). Not bad goals, but not getting at root problems either.

Mr. Dunkleman argues:

Populism takes hold not when democracy works well, but rather when it doesn’t deliver. No amount of righteous sanctimony can substitute for the political benefits of making public authority serve the public interest. That should be the progressive movement’s north star.

Similarly, conservative Bret Stevens, in the most recent The Conversation with liberal Gail Collins, asserts: “A better motto for Democrats, I think, is “Effective government,” which is primarily about delivering the services people need or expect and not just about saving money, which seems to be the central criterion of “efficiency.””

That needs to be more than a motto, and not just for Democrats.  Healthcare would be a great place to start.

The World Is a Little Off-Center

I’m not going to write about the NIH cuts, devasting though they will be (to researchers, universities, and all of America). I’m not even going to touch on healthcare, or even technology per se, as I usually do. Instead, I want to write about some really cool Science, emphasis on the capital “S.”

Earth’s inner core, it seems, is not always the same shape.

The inner core was previously considered to be solid. (USC Graphic/Edward Sotelo)

Now, in case you forget your high school geology, we live on the Earth’s surface, which rests on the crust, followed by the mantle (which accounts for 84% of the earth), and then, some three thousand miles down, is the core. Think about that carefully: three thousand miles down. By comparison, Mt. Everest is less than 30,000 feet high. The deepest point in the ocean is 36,000 feet down. The deepest hole we’ve ever bored into the earth is 40,000 feet.  Three thousand miles is a looong way down. So, no, we’re never going to get to the core (despite what movies you might have seen). We may get to Mars or even the stars, but not the core.

And it’s big. It’s about 70% of the size of the moon. As one expert put it, “it’s like a planet within a planet.” It is about a third of the Earth’s mass, since it is primarily made of metals (mostly iron and nickel). It’s incredibly hot, close to 10,000 degrees Fahrenheit at its surface, which is about the temperature of the surface of the sun. There’s the inner core, which is basically solid, and the outer core, which is molten. The inner core is only solid, despite the temperature, due to the high pressure it is under.

Now researchers from USC are telling us that the inner core is not quite as solid as we’d thought; it changes shape. John Vidale, Dean’s Professor of Earth Sciences at the USC Dornsife College of Letters, Arts and Sciences and principal investigator of the study, says: “What we ended up discovering is evidence that the near surface of Earth’s inner core undergoes structural change.”

Scientists studying the core had previously found that the core didn’t spin at the same speed or even in the same direction as the rest of the earth, both of which are mind-blowing in themselves. (It’s that spinning, by the way, that generates the magnetic fields which prevents life on earth from being scorched by radiation.) Pretty cool stuff, but the researchers now state: “Previous research has proposed that the inner core has undergone either rotational or shape changes through time, but not both simultaneously.”

If you’re wondering how we can possibly know anything about the core, researchers analyze seismic waves, using them kind of like a form of radar. In this case, USC researchers analyzed what are called “earthquake pairs” – earthquakes that happen in the same place and at about the same magnitude but at different times. “But as I was analyzing multiple decades’ worth of seismograms, one dataset of seismic waves curiously stood out from the rest,” Professor Vidale said. “Later on, I’d realize I was staring at evidence the inner core is not solid.”

“Basically, the wiggles are different,” Dr. Vidale told The New York Times.

“This is kind of the first time we’ve seen the evidence for this kind of motion,” he told The Washington Post. “The surface of the inner core is moving around in ways we hadn’t detected and still don’t understand very well.”

The hypothesis is that, though it may be solid, the edge of the inner core isn’t solid enough to withstand the gravitation pressures from the outer core and the mantle. “Even though that inner core part is really solid, [this boundary] is really soft,” Guanning Pang, a co-author and geophysicist at Cornell University, explained to WaPo. “Maybe as soft as jelly.”

They call these changes “viscous deformation.” Dr. Vidale told Live Science: "We sort of expect that the motion could be on the order of hundreds of meters, maybe a kilometer or two, and we don't know how broad. It could be hundreds of kilometers across."

Wow.

No everyone is convinced. “The offered interpretation is sound,” Hrvoje Tkalcic, a professor of geophysics at the Australian National University who was not involved with the research, told The New York Times, “although it is not the only possible explanation, as the authors acknowledge.” Dr. Vidale acknowledged that the paper is not the final word: “We’re pretty sure we were right, but this isn’t a bulletproof paper. How sure? I sort of put it at 90 percent.”

Bruce Buffett, a geoscientist at the University of California, Berkeley, who was not involved in the work, told Live Science: "Maybe everyone's a little bit right."

That’s how science words; theories are only as good as the next set of facts.

"We'll need to keep accumulating the data and keep searching for the inner core behaviors," Xiaodong Song, a geophysicist at Peking University who coauthored important earlier work on the inner core, told Live Science. "I won't be surprised by future surprises about the inner core behaviors as we keep searching." Dr. Tkalcic believes we should build “seismological infrastructure in remote areas of the planet, including the ocean floor” to help accumulate such data.

In case you’re wondering, the results don’t offer any immediate practical benefits.  The researchers think they may help improve our understanding of Earth’s thermal and magnetic fields, but we’re a long way off from being able to do anything with that understanding. Again, that’s how science works. History suggests that this kind of knowledge will end up being useful someday.

I think it’s great. A part of the Earth that is crucial to our existence yet can’t be directly experienced can be indirectly measured, detecting what are relatively minuscule variations. We still don’t fully understand it, but we understand it better today than we did yesterday.

Gotta love scientists!

DEI Is Now a Four Letter Word

I’d love to be writing about something fun. Something that makes us think about things in a new way, or something exciting that will take us into the future. There are lots of such things happening, but there’s too many Orwellian actions happening that I can’t be silent about.

Diversity, we’re told, is actually a pretext for racism – against white people. Equity is foolhardy at best and pernicious at worst. Inclusion only matters if you are the “right” kind of person. “Meritocracy” is the new buzzword; we want only the “best and brightest,” with none of the lowering of standards that we’re being told comes with trying to ensure that everyone has a fair chance to prove their merits.

The Trump Administration has declared war on DEI. It has fired scores of workers whose jobs involve DEI, has asked other workers to inform on people they think may be involved in DEI, and is searching out even workers who attended diversity training (mandated or not). All that would be horrifying enough but it isn’t ending there.

Federal websites are being cleansed of any references to anything that might be construed as DEI. Pages are being edited, or taken down entirely. The NIH has ground to a halt until the appropriate authorities can ensure that no grants are being even to anything that might possibly be related to DEI. The CDC has been forced to pull papers from its researchers that are up for publication for similar review.

The Atlantic reports: “the government was, as of yesterday evening, intending to target and replace, at a minimum, several “suggested keywords”—including “pregnant people, transgender, binary, non-binary, gender, assigned at birth, binary [sic], non-binary [sic], cisgender, queer, gender identity, gender minority, anything with pronouns”—in CDC content.”

Thousands of pages of data from the CDC and Census Bureau have “disappeared,” and the same from other agencies. Health data is prominent among the missing. Angela Rasmussen, a virologist at the University of Saskatchewan, told Science: ““I knew it was going to be bad, but I didn’t know it was going to be this bad. It’s like a data apocalypse.”

Just one example

Elon Musk, who has no official power yet seems to have control over government IT and the data it contains, is shutting down U.S.A.I.D., who provides almost $40b annually in health services, disaster relief, anti-poverty, and other social mission programs. Previously the Administration had shutdown, then reinstated, PEPFAR, a vital international HIV program that has been credited with saving millions of lives.

The President and his team even tried to blame last week’s Washington D.C. plane-helicopter collision on DEI.  That’s just “common sense, ok,” according to President Trump.

As if all that wasn’t enough, The Washington Post reported:

Late Friday, newly confirmed Defense Secretary Pete Hegseth ordered the agency to stop commemorating cultural celebrations such as Black History Month. The message to staff was headlined: “Identity Months Dead at DoD.”

On Thursday, the FBI directed janitorial staff at Quantico to paint over a multicolored mural that once featured the words “FAIRNESS,” “LEADERSHIP,” “INTEGRITY,” “COMPASSION” and “DIVERSITY.”

I can’t even…

The breadth and depth of the changes caught many off guard, but people are starting to respond. Stat reports that CDC’s advisory board has demanded to be told why information has gone missing from CDC websites, and when it will be restored. “Silence is not an option right now,” said one advisory board member, Daniel Dawes. “I try to use the term unprecedented sparingly, but I believe this is an unprecedented moment. There will be dire consequences if they do not restore this information and it may not come back if we do not speak out.”  

The Guardian reports that a union representing 5,000 NIH researchers filed a legally binding demand to bargain over the sweeping changes. Marjorie Levinstein, a postdoctoral fellow at the National Institute on Drug Abuse and a union bargaining committee member, told The Guardian: “We cannot do our research effectively, and this is putting into question delaying research on cancer and diabetes, on drug addiction, on heart disease. And this is going to delay medical breakthroughs that the American people deserve.”

Alexander Jordan Lara, a postbaccalaureate fellow at the National Institute of Dental and Craniofacial Research and also a member of the union’s bargaining committee, added: “We were anticipating changes, and that it would be a new relationship we would have to manage but I don’t think anyone expected this firehose.”

We should have expected it.

Let’s be clear what all this is. “His attacks on diversity, equity and inclusion aren’t about a particular program or some acronym — they’re just a sanitized substitute for the racist comments that can no longer be spoken openly,” Margaret Huang, the Southern Poverty Law Center’s president and chief executive said.

When I heard “meritocracy,” I think of an exchange in the TV adaption of Celeste Ng’s Little Fires Everywhere. When the rich employer criticizes her minority employee about her life choices, the latter responds: “You didn’t make good choices. You had good choices. Options that being rich, and white, and entitled gave you.”

Somehow the meritocracy never see that.

And let’s be clear where this is all going.  As George Orwell’s 1984 said:

Now I will tell you the answer to my question. It is this. The Party seeks power entirely for its own sake. We are not interested in the good of others; we are interested solely in power, pure power. What pure power means you will understand presently. We are different from the oligarchies of the past in that we know what we are doing. All the others, even those who resembled ourselves, were cowards and hypocrites. The German Nazis and the Russian Communists came very close to us in their methods, but they never had the courage to recognize their own motives. They pretended, perhaps they even believed, that they had seized power unwillingly and for a limited time, and that just around the corner there lay a paradise where human beings would be free and equal. We are not like that. We know that no one ever seizes power with the intention of relinquishing it. Power is not a means; it is an end. One does not establish a dictatorship in order to safeguard a revolution; one makes the revolution in order to establish the dictatorship. The object of persecution is persecution. The object of torture is torture. The object of power is power. Now you begin to understand me.

Sadly, we’re only beginning to understand.

As Professor Dawes said, silence is not an option now. Make yourself heard.

Expect the Unexpected

Most people probably know about Alexander Fleming “discovering” penicillin by accident, thus inventing the field of antibiotics. Others may know that Viagra was originally developed to combat hypertension and angina pectoris. You may think of Botox for its cosmetic purposes, but it was originally intended to treat strabismus (cross eyes), and has a host of other medical purposes as well. All of those, and countless other examples, speak to the importance of serendipity in science.

Science often surprises. Credit: Microsoft Designer

A new study, by Aslan et. al., attempts to quantify how common such serendipity is. Bottom line: it is way more common than you think.

The team analyzed over 1.2 million publications, which had resulted from 90,000 NIH grants between 2008 and 2016. They used the NIH's Research, Condition, and Disease Categorization (RCDC) to categorize what the researchers said they were looking for in their grant application versus what their findings were when published.

The results:

We found that 70 % of the publications have at least one RCDC category not in its grant, which we termed ‘unexpected’ categories. On average, 40 % of categories assigned to a publication were unexpected. After adjusting for similarity across some of the RCDC categories by empirically clustering the categories, we found 58 % of the publications had at least one unexpected category and, on average, 33 % of publication categories were unexpected.

Larger grants tend to result in more unexpected results, as do results published longer after the grant was issued.

Fig. 1. Proportion of publications with (A) one or more unexpected categories or (B) one or more unexpected categories (clustered); distribution of (C) unexpected category proportions and (D) unexpected category proportions (clustered).

“The bottom line is that ‘unexpectedness’ is not rare — this came through loud and clear,” said Ohid Yaqub, a biochemist and social scientist at the University of Sussex in Brighton, UK, who led the work. According to Nature, this research is “part of a wider project to understand the role in research of serendipity, of which unexpectedness is just one aspect.”

The researchers do caution: “what we are calling “unexpected” on the basis of text in the grants and publications may not in fact be unexpected for the investigators, or others in the field. Future research could make progress on these issues by using interviews and surveys to validate text-based measures of unexpected spillovers.” Professor Yaqub admits: “What we’ve looked at is only just scratching the surface.”

Telmo Pievani, a philosopher of biological sciences at the University of Padua in Italy, told Nature that the results go “beyond the anecdotal view of serendipity in science” and “for the first time verifies it on a quantitative and statistical level.” It is, indeed, part and parcel of how science works.

Somewhat surprisingly, the researchers also found:

Our results suggest that disease-orientation and clinical research were less likely to be associated with spillovers. Grants resulting from targeted requests for applications were more likely to result in publications with unexpected categories, though the magnitude of the differences was relatively small.

E.g., one would think those targeted requested would result in more targeted results, but that was not the case.

Samatha Copeland, a philosopher at Delft University of Technology in the Netherlands, told Nature that she worries that funding pressures may inhibit such serendipitous findings: “What’s happening right now is, scientists have actually been working around funding processes in order to make room for unexpected discoveries,” with Ph.D. students in particular likely to feel “oppressed by the scientific method and model of producing exactly the results you said you would produce.” Getting unexpected results may not be good for tenure or for Ph.D. thesis approval.

The key is being open to the unexpected results. Professor Pievani believes: “It is okay to fund both basic research and applied research, as long as both are open to unexpected results and do not eliminate anomalies too hastily.” Indeed, in his recent book Serendipity: The Unexpected in Science, he writes: “The common thread is chance and observational sagacity: a mixture of skill, clairvoyance, an incisive and fortunate mind, and the ability to discover connections.”

As the saying goes (oft attributed to Louis Pasteur), chance favors the prepared mind.

Still, Professor Pievani worries: “In the dictatorship of an instantaneous, emotional, and overwhelming present, you can always look for something specific with a quick google and find it for sure. Serendipity instead blossoms in the bends and meanders, the dull moments and wanderings.” Scientists struggling to stay within their funding or to attract new funding may be more reluctant to follow those bends and meanders, wherever they might lead.

Innovation expert John Nosta, founder of Nostalab, believes that AI can serve as “serendipity engines” by using AI’s so-called hallucinations. “What if these hallucinations could be harnessed to create a serendipity engine?” he writes. “An AI that doesn’t merely predict the next word but facilitates unexpected connections, delightful surprises, and groundbreaking insights?”

If you doubt that, note that a 2024 Wharton study found that AI was more creative than Wharton students (which may say more about Wharton students than AI): “There was a significantly higher preference for the ideas created by AI than by the Wharton students…Of the 400 ideas generated, only five human-created ideas were among the 40 most desirable products in this experiment.” The researchers say: “ChatGPT-4 can generate ideas much faster and cheaper than students, the ideas are on average of higher quality (as measured by purchase-intent surveys) and exhibit higher variance in quality. More important, the vast majority of the best ideas in the pooled sample are generated by ChatGPT and not by the students.”

The authors of that study, Christian Terwiesch and Karl Ulrich, wrote in The Wall Street Journal:  “First, generative AI has brought a new source of ideas to the world. Not using this source would be a sin…Second, the bottleneck for the early phases of the innovation process in organizations now shifts from generating ideas to evaluating ideas.”

The question is whether organizations are open to unexpected results when evaluating those new ideas.

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In an era of Big Science, with expensive projects staffed by dozens or hundreds of researchers, is there flexibility to pursue unexpected results? In an era of corporate innovation centers, can those workers really follow the “bends and meanders,” or are they constrained by budget and corporate goals? I.e., is there room for serendipity?

Science and innovation do not show linear progress. They take unexpected turns, they run into dead ends, and they take leaps no one could have predicted. If we’re not open to serendipity, if we’re not encouraging it and on the lookout for it, we’re going to miss those leaps.     

Take Note of RedNote

Admit it: until a week or so ago, you’d never heard of the Chinese app RedNote.

RedNote logo. Yes, it's in Mandarin. Credit:  Xingin Information Technology

Its actual name is Xiaohongshu, which I’m told means “little red book” in Mandarin. That may or may not be an allusion to Chairman Mao’s little Red Book; it may simply be a play on “red” as a term for “popular” in Chinese. It has over 300 million users, but until recently almost all of them were in China, especially among young women.

Now is has been one of the leading downloads in the U.S. Why the surge? It’s all about TikTok, of course.

Not that long ago, TikTok was seen as a threat to U.S. national security. Since it was owned by a Chinese company (ByteDance), there were fears that the Chinese government had access to the data on the 170 million Americans on it, and could use TikTok’s algorithms to push out all kinds of propaganda to impressionable youth. Despite ByteDance’s protestations of its independence, and its ultimate agreeing to store data in the U.S., Congress banned it last April, giving it until January 19, 2025 to be sold to a U.S. company. The Supreme Court affirmed the ban last Friday.

So TikTok went dark yesterday…for part of the day.

TikTok on January 19. This didn't last long.

Many TikTok users weren’t going to stick around for the drama, and somehow landed on RedNote. There have been hundreds of millions of posts with the phrase “TikTok refugee” in the past week. Although such refugees are just a fraction of TikTok users, the growth rate has been incredible.

Never mind that RedNote is also owned by a Chinese company (Xingin Information Technology). Never mind that its servers, and thus all its data, are all in China. Never mind that its terms and conditions are in Mandarin, just in case you are the kind of person to want to read such things. And never mind that it is openly subject to Chinese government censorship and oversight.

Talk about jumping from the frying pan into the fire.

TikTok creator Manimatana Lee posted on TikTok: “How funny would it be if they ban TikTok and we all just move over to this Chinese app.” She told The New York Times: “I don’t really care if I’m using a Chinese app at all. It’s like a place for me to escape reality. And if it’s making me feel good, I’m here for it.”

Oh, and I’d be remiss if I didn’t note that another leading App store download this past week is Lemon8, which is not only another Chinese app but is also owned by ByteDance.

Ivy Yang, a China tech analyst and founder of consulting firm Wavelet Strategy, commented to CNN about the migration: “Users are finding creative ways to transcend language barriers, navigate cultural differences, and co-exist in fascinating ways. This community building happening in real time could have lasting impact, and I’m cautiously optimistic.”

RedNote preview in the Apple App Store. Credit: Apple

The Chinese government is barely disguising its glee. In a briefing last week, Chinese Foreign Ministry spokesperson Guo Jiakun said: “As a matter of principle, China has always supported and encouraged strengthening people-to-people exchanges and the promotion of people-to-people bonds with all countries.” Similarly, a commentary in People’s Daily opined: “Moving to RedNote can be seen as an act of defiance against the U.S. government’s narrative that Chinese apps are security threats. By embracing RedNote, users challenge the assumption that Chinese platforms are inherently dangerous.”

Users may not want to get too complacent. The law that banned TikTok wasn’t TikTok-specific. "This appears to be the kind of app that the statute would apply to and could face the same restrictions as TikTok if it's not divested," a U.S. official told CBS News. Daria Impiombato, China analyst at the Australian Strategic Policy Institute, told The Washington Post: “We’ve probably spent too much energy worrying about the single app. Once you have the capacity to build those algorithms and those apps, it doesn’t take very long to create a TikTok or something different.” 

TikTok isn’t quite dead yet, of course. Last spring then former President Trump did a 180 degree shift in his opinion about TikTok, from demanding a ban in his first Administration to his 2024 campaign heavily using TikTok to reach young voters. Once he jumped onboard, all the other critics seemed to melt away; even President Biden said he wouldn’t enforce the ban. TikTok went dark for part of January 19, until President Trump indicated that he would give the platform additional time to comply with the law.

He may want ByteDance to sell TikTok to Elon Musk. Seriously.

It’s important to note that, although TikTok is a huge international success, there is a separate ByteDance app (Douyin) for Chinese citizens. Most of Chinese internet companies do almost all their business within China (which, granted, has a huge population). Li Yuan writes in The New York Times:

As the Chinese Communist Party tightens its grip on the country’s private sector, it’s increasingly difficult for the world to entrust their citizens’ personal data to Chinese companies, which ultimately answer to Beijing.

There are good reasons that the outside world, including the U.S. government, doesn’t trust these companies. In a country where the government owns much of everything and wields power randomly and often ruthlessly, the private sector has been on its toes. The internet companies are heavily censored and must self censor to survive. All the big ones, with no exception, have had their apps removed from app stores or been fined or disciplined by regulators in recent years.

RedNote and Lemon8 are noteworthy because the Chinese version is available outside of China as well. All that access to personal data, all that censorship, all that government control – apparently many Americans just don’t care. "Did the U.S. government forget our founding principles? We are a nation built on spite," user @thesleepydm posted on TikTok. "We're giving our information directly to the Chinese government now. The communists just have our information directly because of … what you did."

As Amanda Hess writes in The New York Times: “As if American-owned social media companies like Meta have never sought to mine and exploit sensitive data. As if American-owned platforms like X would never juice their algorithms to reward certain political ideas.”

I don’t think RedNote is going to supplant TikTok, but, then again, I don’t think TikTok is going away. A face-saving deal will be made, as long as President Trump finds TikTok useful. But, hey, since X and Meta are basically abandoning content moderation, I can see the appeal of a RedNote.

Maybe AI Doesn't Read Blueprints

Gosh, who knew that today would be an AI day, with at least three major announcements about “blueprints” for its development going forward? Of course, these days every day is an AI day; trying to take in all AI-related news can be overwhelming. But before some other AI news drowns them out, I wanted to at least outline today’s announcements.

The Biden Administration thinks it has an AI blueprint. Credit: AI.gov

The three I’m referring to are the Biden Administration’s Interim Final Rule on Artificial Intelligence Diffusion, OpenAI’s Economic Blueprint, and the UK’s AI-driven Plan for Change.  

The Biden Administration’s rules aim to preserve America’s lead in AI, stating: “it is essential that we do not offshore this critical technology and that the world’s AI runs on American rails.” It establishes who advanced chips can be sold to and how they can be used in other countries, with no restrictions on 18 key allies and partners.

It also sets limits on model weights for AI models, seeking to constrain non-preferred entities’ ability to train advanced AI models.

“The U.S. leads the world in AI now, both AI development and AI chip design, and it’s critical that we keep it that way,” Commerce Secretary Gina Raimondo said in a briefing with reporters ahead of Monday’s announcement

Not everyone is happy. The Information Technology & Innovation Foundation blasted the rule, claiming it would hamper America’s competitiveness.  Vice President Daniel Castro warned: “By pressuring other nations to choose between the United States and China, the administration risks alienating key partners and inadvertently strengthening China’s position in the global AI ecosystem.”

Similarly, Nvidia, which makes most of those advanced AI chips, expressed its opposition in a statement from Ned Finkle, vice president of government affairs, claiming the rule “threatens to derail innovation and economic growth worldwide.”  He explicitly contrasts how the first Trump Administration (and, one assumes, the next Trump Administration) sought to foster “an environment where U.S. industry could compete and win on merit without compromising national security.”  

Not to be outdone, Ken Glueck, Executive Vice President, Oracle, says the rule “will go down as one of the most destructive to ever hit the U.S. technology industry,” and “we are likely handing most of the global AI and GPU market to our Chinese competitors.”

It will be interesting to see what the Trump Administration does with the Rule.

Meanwhile, OpenAI’s economic blueprint believes “America needs to act now to maximize the technology’s possibilities while minimizing its harms…to ensure that AI’s benefits are shared responsibly and equitably.” Its goals are to:

• Continue the country’s global leadership in innovation while protecting national security
• Make sure we get it right in AI access and benefits from the start
• Maximize the economic opportunity of AI for communities across the country.

It sees “infrastructure as destiny,” with investment in AI infrastructure “an unmissable opportunity to catalyze a reindustrialization of the US.” It wants to ensure that “an estimated $175 billion sitting in global funds awaiting investment in AI projects” get invested here rather than in China.

OpenAI does want “common-sense rules” that promote “free and fair competition” while allowing “developers and users to work with and direct our tools as they see fit” under those rules. And, of course, all this while “Preventing government use of AI tools to amass power and control their citizens, or to threaten or coerce other states.” It particularly wants to avoid a “patchwork of state-by-state regulations”

The company is planning an event in Washington D.C. on January 30 with CEO Sam Altman “to preview the state of AI advancement and how it can drive economic growth.”  I’ll bet Mr. Altman is hoping he gets plenty of Trump Administration officials, although probably not Elon Musk.

Credit: OpenAI

Last but not least, UK Prime Minister Keir Starmer has endorsed an ambitious set of AI recommendations, wanting to turbocharge the economy by turning the UK into an AI superpower. Mr. Starmer vowed:

But the AI industry needs a government that is on their side, one that won’t sit back and let opportunities slip through its fingers. And in a world of fierce competition, we cannot stand by. We must move fast and take action to win the global race.

Our plan will make Britain the world leader. It will give the industry the foundation it needs and will turbocharge the Plan for Change. That means more jobs and investment in the UK, more money in people’s pockets, and transformed public services.

There are three key elements:

First, “laying the foundations for AI to flourish in the UK,” including AI Economic Growth Zones and  a new supercomputer.

Second, “boosting adoption across public and private sectors,” such as through a new digital government center that “will revolutionise how AI is used in the public sector to improve citizens lives and make government more efficient.”

Third, “keeping us ahead of the pack,” with a new team that “will use the heft of the state to make the UK the best place for business.”

It will do so while also charting its own course on regulation. "I know there are different approaches (to AI regulation) around the world but we are now in control of our regulatory regime so we will go our own way on this," the PM said. "We will test and understand AI before we regulate it to make sure that when we do it, it's proportionate and grounded."

Credit: Gov.UK

Chris Lehane, Chief Global Affairs Officer at OpenAI, praised the plan: “The government’s AI action plan - led by the Prime Minister and Secretary Peter Kyle - recognises where AI development is headed and sets the UK on the right path to benefit from its growth:”

All nice words, but lots left unsaid. As Gaia Marcus of the Ada Lovelace Institute pointed out: "Just as the government is investing heavily in realising the opportunities presented by AI, it must also invest in responding to AI’s negative impacts now and in the future."

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These things are true: AI is going to play a major role in the world economy, and to be a superpower, a country will have to be an AI superpower. To be an AI superpower, a country has to have the best AI infrastructure, including chips and data centers. AI is equally capable of positive impacts as well as negative impacts, and some regulation is needed to mitigate the latter. Lastly, regulation is going to lag innovation -- and AI will drive innovation at rates we haven’t seen before.

I envy the people working on AI innovation, but I don’t envy those trying to figure out how to best regulate it.

Program Me Some Cells, Please

Tempted though I might be to write about Nvidia’s new platform for “physical AI” – aka, robots – I figured plenty of others will do that. What’s another trillion in market cap for Nvidia, anyway?  On the other hand, I don’t see enough excitement about some recent research at Rice University on “smart cells.”

If you want to program cells, Xiaoyu Yang is your man. Credit: Jeff Fitlow/Rice University

The research, published in Science with the matter-of-fact title Engineering synthetic phosphorylation signaling networks in human cells (by contrast, Nvidia’s marketers named their foundation models for humanoid robots “GRooT Blueprint” -- now, that’s catchy), was about how to program human cells to detect and respond to signals in the body. Between synthetic biology and robots. I’ll pick synthetic biology everyday (unless the robots are nanobots, of course).  

“Imagine tiny processors inside cells made of proteins that can ‘decide’ how to respond to specific signals like inflammation, tumor growth markers or blood sugar levels,” said Xiaoyu Yang, a graduate student in the Systems, Synthetic and Physical Biology Ph.D. program at Rice who is the lead author on the study. “This work brings us a whole lot closer to being able to build ‘smart cells’ that can detect signs of disease and immediately release customizable treatments in response.”   

Imagine, indeed.

It turns out that there is a natural process called phosphorylation, which cells use to respond to their environment. As the Rice press release explains: “Phosphorylation is involved in a wide range of cellular functions, including the conversion of extracellular signals into intracellular responses — e.g., moving, secreting a substance, reacting to a pathogen or expressing a gene.”

It goes on to elaborate:

Phosphorylation is a sequential process that unfolds as a series of interconnected cycles leading from cellular input (i.e. something the cell encounters or senses in its environment) to output (what the cell does in response). What the research team realized — and set out to prove — was that each cycle in a cascade can be treated as an elementary unit, and these units can be linked together in new ways to construct entirely novel pathways that link cellular inputs and outputs.

“This opens up the signaling circuit design space dramatically,” said Caleb Bashor, an assistant professor of bioengineering and biosciences and corresponding author on the study. “It turns out, phosphorylation cycles are not just interconnected but interconnectable — this is something that we were not sure could be done with this level of sophistication before. Our design strategy enabled us to engineer synthetic phosphorylation circuits that are not only highly tunable but that can also function in parallel with cells’ own processes without impacting their viability or growth rate.”

The “sense-and-respond” cellular circuit design occurs rapidly – seconds or minutes – which allows it to be used for processes that occur on similar timescales, unlike other previous efforts. For example, the researchers tested it to detect and respond to inflammatory factors, which they believe could be used to control autoimmune flare-ups and reduce immunotherapy-associated toxicity.

Soon-to-be Dr. Yang added: “We didn’t necessarily expect that our synthetic signaling circuits, which are composed entirely of engineered protein parts, would perform with a similar speed and efficiency as natural signaling pathways found in human cells. Needless to say, we were pleasantly surprised to find that to be the case. It took a lot of effort and collaboration to pull it off.”

Professor Bashor concluded: “Our research proves that it is possible to build programmable circuits in human cells that respond to signals quickly and accurately, and it is the first report of a construction kit for engineering synthetic phosphorylation circuits.”

A “construction kit” for “programmable circuits” in human cells.  Tell me that’s not exciting stuff.

Caroline Ajo-Franklin, director of the Rice Synthetic Biology Institute, added: “If in the last 20 years synthetic biologists have learned how to manipulate the way bacteria gradually respond to environmental cues, the Bashor lab’s work vaults us forward to a new frontier — controlling mammalian cells’ immediate response to change.” 

“This is like embedding tiny processors in cells, made entirely of proteins, that can ‘decide’ how to respond to specific signals such as inflammation, tumor growth, or high blood sugar,” Dr. Yang explained to SynBioBeta. “Our work moves us significantly closer to constructing ‘smart cells’ that can detect disease indicators and instantly produce tailor-made treatments.”

You had me at “smart cells.”

I would be remiss if I didn’t mention a couple of other developments that offer to make this kind of advance even more powerful. Last month researchers at University of California San Diego announced a new software package they call SMART: Spatial Modeling Algorithms for Reactions and Transport. “SMART provides a significant advancement in modeling cellular processes,” said Emmet Francis, PhD, lead author of the study and a postdoctoral fellow at UC San Diego

They believe it can realistically simulate cell-signaling networks; it “takes in high-level user specifications about cell signaling networks and then assembles and solves the associated mathematical systems.” This “could help accelerate research in fields across the life sciences, such as systems biology, pharmacology and biomedical engineering.”

If you are not a fan of geometry, much less computational geometries, SMART is not for you, but if you are a biologist it opens up lots of possibilities. Someone such as Blaise Manga Enuh, a Postdoctoral Research Associate in Microbial Genomics and Systems Biology at University of Wisconsin-Madison. He writes in The Conversation about genome-scale metabolic models, or GEMs, which can be used to virtually carry out experiments that would have taken painstaking, time-consuming experiments in the lab.

“With GEMs,” Dr. Enuh says, “researchers cannot only explore the complex network of metabolic pathways that allow living organisms to function, but also tweak, test and predict how microbes would behave in different environments, including on other planets.”

Moreover:

Synthetic biologists can use GEMs to design entirely new organisms or metabolic pathways from scratch. This field could advance biomanufacturing by enabling the creation of organisms that efficiently produce new materials, drugs or even food.

I have a feeling Dr. Yang, Dr. Francis, and Dr. Enuh would have a lot to talk about.

So with GEMs or SMART, you could model out what you want to happen at a cellular level, then use the Rice technique to program cells to accomplish that. That’s 22^nd century medicine – and we’re lucky enough to be catching glimpses of it in 2025.