Searching for the Next Search

I didn’t write about ChatGPT when it was first introduced a month ago because, well, it seemed like everyone else was.  I didn’t play with it to see what it could do.  I didn’t want it to write any poems. I didn’t have any AP tests I wanted it to pass. And, for all you know, I’m not using it to write this.  But when The New York Times reports that Google sees ChatGPT as a “Code Red” for its search business, that got my attention.

Credit: 1littlecoder/YouTube

A few months ago I wrote about how Google saw TikTok as an existential threat to its business, estimating that 40% of young people used it for searches.  It was a different kind of search, mind you, with video results instead of links, but that’s what made it scary – because it didn’t just incrementally improve “traditional” search, as Google had done to Lycos or Altavista, it potentially changed what “search” was.    

TikTok may well still do that (although it is facing existential issues of its own), but ChatGPT could pose an even greater threat.  Why get a bunch of search results that you still have to investigate when you could just ask ChatGPT to tell you exactly what you want to know?

Look, I like Google as much as anyone, but the prospect that its massive dominance of the search engine market could, in the near future, suddenly come to an end gives me hope for healthcare.  If Google isn’t safe in search, no company is safe in any industry, healthcare included.

“No company is invincible; all are vulnerable,” said Margaret O’Mara, a professor at the University of Washington told NYT. “For companies that have become extraordinarily successful doing one market-defining thing, it is hard to have a second act with something entirely different.”  One Google executive described how Google responded to ChatGPT as “make or break” for the company.

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The problem with ChatGPT for search is two-fold.  The first is that, while it will give you a plausible sounding answer to almost anything you ask it. As Emily Peck of Axios noted, “ChatGPT has no idea whether anything it says is true.” 

At least with traditional search results, you can see results from several sources and evaluate their credibility.  With ChatGPT all that happens behind the scenes.  ChatGPT doesn’t care whether what it is telling you is true or not; it’s just interested in providing you a response.  That hopefully is something that will improve as ChatGPT “learns” to distinguish true from potentially true to unlikely to probably false and to demonstrably false.  Over time, it could probably do that as well as (most) users do. 

Umm, no -- Honduras. Credit: Mashabe/OpenAI screenshot

The second problem is even more dangerous, for Google: it doesn’t fit with the digital advertising model that delivers most of Google’s massive revenues.  “Google has a business model issue,” AI expert Amr Awadallah, told NYT. “If Google gives you the perfect answer to each query, you won’t click on any ads.”

And this threat is happening at a time when Google’s share of digital dollars is already declining.

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Forrester Research analyst Rowan Curran sees ChatGPT as a major turning point for AI, telling Venture Beat: “The only thing that I’ve been able to compare it to is the release of the iPhone.”  There were smartphones before the iPhone, just as there were AI chatbots before ChatGPT, but the iPhone raised expectations dramatically.  Mr. Curran feels ChatGPT is having a similar effect:

I think what is really unique here is we have a technology that is useful today, that is advancing very quickly, and that we are all learning about in real time — in terms of both how to use it and how to prevent it being used in negative ways.

Sridhar Ramaswamy, co-founder and CEO of ad-free search platform Neeva, is similarly excited, telling NYT: “Last year, I was despondent that it was so hard to dislodge the iron grip of Google. But technological moments like this create an opportunity for more competition.”

In addition to Neeva and Dr. Awadallah’s Ventura, there’s AI-driven search engine You.com, “the AI search engine you control.”  As with ChatGPT, users take their chances on the accuracy of results; the site warns: “This product is in beta and its accuracy may be limited," and  "You.com is not liable for content generated.” 

It's not as though Google has been ignoring AI.  Google helped develop what led to ChatGPT, and has a chatbot technology of its own – LaMDA (Language Model for Dialogue Applications) that is so powerful that some feared it was, in fact, sentient.  In addition, Google has a host of AI-based products and tools it is working on.  Given its market dominance and reputation, though, it has to be careful how it introduces any innovations.

Credit: Google

The very nature of what we expect “search” to be is changing.  Results might be a text conversation” with a chatbot. It might be curated videos.  It might be Dalle-E 2 or Stable Diffusion creating explanatory images, or it might be your favorite expert explaining it to you in a deepfake video.  That’s technology evolving.

The business model problem is far deeper.  If search has been, essentially, a way to serve up targeted ads, then a chatbot or other model that doesn’t easily accommodate ads is a problem for companies that have relied on them.  And companies that don’t rely on ads to generate revenue have to come up with other revenue sources, in an online world where users expect most things to be “free.”

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Healthcare has similar issues with AI.  As with search, the first is that it is going to enable new ways of delivering information and even care.  Initially it won’t do so with as much accuracy as humans, but it will learn quickly and at some point it will rival – or even exceed – human experts.  Healthcare can dig in its heels and stick to the human-driven model, but the AI-driven changes are coming.

Again, as with search, the business model challenge is even greater.  The healthcare business model is both exceeding expensive and insanely complicated. It isn’t built at all on what is best for people’s care, much less their health.  AI will enable models that are far cheaper, far faster, and potentially much simpler.  Healthcare will fight to maintain its sources of revenue, but the revolution is coming.

If I were Epic, the Cleveland Clinic, United Healthcare, Big Pharma, or any of healthcare’s other dominant entities, I’d be watching how Google responds to ChatGPT. 

Netflix for Drugs?

A relative – obviously overestimating my healthcare expertise -- asked my thoughts on The New York Times article Can a Federally Funded ‘Netflix Model’ Fix the Broken Market for Antibiotics?  I had previously skimmed the article and was vaguely aware of the Pasteur Act that it discusses, but, honestly, my immediate reaction to the article was, gosh, that may not be a great analogy: do people realize what a tough year Netflix has had? 

Courtesy iStock; Composite by Chris Hale/CQ Roll Call

I have to admit that I tend to stay away from writing about Big Pharma and prescription drugs, mainly because, in a US healthcare system that seems to pride itself on being opaque, frustrating, and yet outrageously expensive, the prescription drug industry takes the cake.  It’s too much of a mess.

But a “Netflix model” for drug development?  Consider me intrigued.

It's easy to understand why market forces might not do well with rare diseases that need an “orphan drug,” but the “subscription model” approach that the Pasteur Act seeks to address is something that most of us need: antibiotics.  Antibiotic resistance has made many of our front-line antibiotics less effective, but discovering new antibiotics is a slow, expensive process, and many pharmaceutical companies are reluctant to take the risk.  The Pasteur Act would essentially pay for their development in return for “free” use of subsequently invented drugs. 

There is widespread support for the bill (including, no surprise, PhRMA).  Carlos del Rio, president of the Infectious Diseases Society of America (among other roles) writes: “PASTEUR is a unique financing model that creates a reliable market for critically needed antimicrobials — and as a result, promises to ignite a desperately needed revitalization in antimicrobial development.”  That’s the hope.

Credit: Sevahn K. Vorperian/Stat News

It is worth noting that the U.K. has been testing such a model since 2020, but results so far are inconclusive.  Glover, et. alia argue:

…the current subscription funding does not convincingly reward innovative research into new chemical space, a field that many small and medium-sized enterprises are struggling to attract funding for….Rather than supporting a resilient, innovative, commercial antibiotic ecosystem, there seems to be a marked risk that the UK subscription model could fall prey to what is termed the folly of rewarding A when hoping for B.

 It wasn’t their intent, but I don’t think I’ve ever read a better description of the US healthcare system than “rewarding A when hoping for B.”

Critics of the Pasteur Act wrote a letter to Congress in November, warning: “Under the Pasteur Act, taxpayer dollars will be wasted as a blank check to pharmaceutical manufacturers for antimicrobials of limited benefit,”  One of the signators of that letter, Reshma Ramachandran, argues in The Hill:  “PASTEUR would instead signal to drug companies that they can continue the same lackluster antimicrobial development — paid for in large part by the public already — divorced from improving patients’ health.”

 Let’s see: the existing business model has led to huge profits for Pharma, high prices for consumers, and yet not enough antibiotics or rare disease drugs, so, no, I’m not keen on subsidizing that industry with guaranteed, upfront payments. 

The NYT article mentions other approaches that are being tried to incent antibiotic development.  Carb-X (Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) is a global partnership whose mission is: “Accelerate a diverse portfolio of innovative antibacterial products towards clinical development and regulatory approval with funding, expert support and cross-project initiatives.”  It announced its latest funding rounds, targeted at three product categories, in October.

Another NYT article discussed development not of antibiotics but for rare diseases, mentioning n-Lorem, a non-profit foundation that “is focused on creating individual treatments for patients in the United States with nano-rare diseases caused by genetic mutations that affect approximately <30 patients in the world.”  It relies on donations, and has been surprisingly successful in its fundraising to-date, but, as the NYT notes: “Some rare disease experts are skeptical that one nonprofit organization will be able to serve every patient who needs help.” 

Some researchers have proposed, instead of the Pasteur Act, setting up federally funded non-profits, staffed by microbiologists, medical chemists, and pharmacologists and overseen by a board of patient advocates, doctors, industry representatives, and others. Dr. Brad Spellberg, one of the authors of the proposal, told KHN: “They would not focus on one drug, per se. They would focus on discovering and developing new, impactful technologies.”

What I don’t want to see, and what I fear the Pasteur Act might do, is to lock in existing approaches with existing companies.  As I’m fond of saying, it’s the 21^st century; we need 21^st century approaches.  In particular, taking advantage of our microbiome and synthetic biology.

Just in the past few weeks, we’ve learned that the gut microbiome may drive our motivation to exercise, can be used to improve symptoms of autism and inflammatory bowel disease, and is connected to multiple sclerosis (MS) and depression, binge-eating, and heart-failure.  We’re just scratching the surface of the impact of our microbiome on our health, but we know that all those antibiotics we’re keen on wreak havoc on it.  Oh, and by-the-way, it is pretty good at developing antibiotics of its own.

We’ve been testing what I’ll call primitive efforts of using fecal transplants to boost the microbiome (the FDA just approved the first such treatment last month).  Kate Macbride, writing in Inverse, says: “This approval is likely only the start of a promising future for prescription poop” (otherwise referred to as referred to as fecal-microbial therapy, or FMT). 

Alison Halliday, PhD, goes a step further.  In Technology Networks, she writes: “Scientists are harnessing the power of synthetic biology to develop a variety of medical applications – from powerful drug production platforms to advanced therapeutics and novel diagnostics.”

Credit: Technology Networks

Jim Collins, Termeer professor of medical engineering and science at MIT, tell her: “By approaching biology as an engineering discipline, we are now beginning to create programmable medicines and diagnostic tools with the ability to sense and dynamically respond to information in our bodies.” He notes: “By applying synthetic biology, we have designed a living therapeutic that has the potential to help counter the potential negative effects of antibiotic use.”

Ms. Macbride points out: “Advances in synthetic biology are enabling researchers to create engineered probiotic bacteria that can sense, record and report on changes occurring inside the gut.”  That’s some 21^st century medicine.

So, don’t give me a “Netflix” for drugs that gives us reruns and spinoffs, from the same old companies that have been producing them.  Give me one that looks ahead to new approaches (like synthetic biology), new theories of medicine/health (like microbiome-based).     

And Now for Some Good News

I’m awfully tired of bad news.  The U.S. health care system is flooded, again, with sick people: this time not just COVID, but also flu and RSV.  Inflation remains high and we teeter on the edge of a recession.  We talk about renewable energy but remain heavily dependent on oil, coal, and natural gas; the war in Ukraine is proving how vulnerable that makes the world, as Europe is grimly finding out.  We pretend that we’re recycling plastics but, really, we’re not, and all that plastic ends up somewhere, especially as microplastics, which literally end up everywhere, including inside us. 

Well, sorry, I don’t have good news about all of those, but there is some good news about a couple of them, and these days I count that as a win.

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Let’s start with the plastics.  Plastics have been a huge boom to our lives and economy, but, as with most things, we failed to really understand the consequences until it was too late.  Thus all that plastic everywhere, seemingly forever.  But maybe not.  Interesting Engineering reported on the work of two companies, who “have found technologies that recycle all types of plastic.”  The companies are Plastonix and Elemental Recycling.   

Plastonix says its “technology comprises methods, systems, apparatuses, and a proprietary lipid agent to process up to 10 unique petroleum-derived material types together or separately in order to convert them into a usable chip or powdered material,”  which “can be further repurposed as a filler or parallel material for virgin plastic resins or converted to a composite material, paving material, or construction units such as block paving stones, tile beams, sheets, or boards.” 

Beats a landfill, or bits of microplastics in your lungs and bloodstream, right? 

This is not sustainable. Credit: Laura Sullivan/NPR

As if that wasn’t enough, Plastonix claims its technology is “energy efficient, low carbon, and uses an organic, non-toxic chemical – a green chemical – in its processes.”  Its patent is pending.

Elemental Recycling boasts “From Waste Plastics to Graphite and Beyond.”  Their process produces graphite and “High Purity Hydrogen” that can both be used in a number of industrial applications.  Even better, IE notes: “Both of these methods are carbon-neutral and provide green sources of materials…more importantly, it produces no emissions at all.” 

Elemental Recycling’s technology is already patented and is expected to be available for sale in 1Q 2023. 

And these aren’t the only players in the plastic recycling.  Researchers at the University of Colorado recently announced a method to break down a common but extremely durable polymer, called polycyanurate networks (PCNs) into simpler “monomers” that can be rebuilt into other PCNs. 

“We are thinking outside the box, about different ways of breaking chemical bonds,” said Wei Zhang, lead author of the study. “Our chemical methods can help create new technologies and new materials, as well as be utilized to help solve the existing plastic materials crisis.”

Professor Zhang wants plastics to be recycled as commonly as things in the natural world: “Why can’t we make our materials the same way?”

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As exciting as those are, and as big an impact as they could have, there’s an even more exciting development in nuclear fusion.  According to a scoop from Financial Times, and confirmed by numerous other outlets, on Tuesday The Department of Energy is expected to report that scientists have finally  produced a fusion reaction with a net energy gain.  I.e., it produced more energy than it took to create the fusion.  This has long been considered the “holy grail” of not just fusion research but of clean energy generally.

If you don’t remember your high school physics, fission is when we split atoms – like in an atomic bomb or a nuclear power plant – but fusion is when two atoms are fused.  Both produce vast amounts of power, but fusion is especially powerful.  The sun relies on fusion. 

The research was conducted at the National Ignition Facility at the Lawrence Livermore National Laboratory. 

Credit: Lawrence Livermore National Laboratory/AP

Now, we’re not going to have our own nuclear fusion generators anytime soon.  We’re not even going to have fusion power plants in the near future.  The research relies on big lasers focused on small pellets of hydrogen in targeted bursts, and require hours between the bursts. We’re still in the basic research stage, as we have been for the past fifty years.

Moreover, it didn’t produce all that much energy.  It used 2.1 megaJoule (MJ) of energy to produce 2.4 MJ.  “It’s about what it takes to boil 10 kettles of water,” Jeremy Chittenden, co-director of the Centre for Inertial Fusion Studies at London’s Imperial College told CNN. “In order to turn that into a power station, we need to make a larger gain in energy – we need it to be substantially more.”

He added:

To turn fusion into a power source we’ll need to boost the energy gain still further. We’ll also need to find a way to reproduce the same effect much more frequently and much more cheaply before we can realistically turn this into a power plant.

Still, many people are excited.  DOE previews tomorrow’s announcement as “a major scientific breakthrough.”  Dr Robbie Scott, of the Science and Technology Facilities Council’s (STFC) Central Laser Facility (CLF) Plasma Physics Group, who contributed to this research, told The Guardian:

Fusion has the potential to provide a near-limitless, safe, clean, source of carbon-free baseload energy.  This seminal result from the National Ignition Facility is the first laboratory demonstration of fusion ‘energy-gain’ – where more fusion energy is output than input by the laser beams.

Ultimately, fusion could produce energy that is cheap, has no carbon footprint, doesn’t leave radioactive waste, and is more reliable than solar or wind energy.  It’d be a different world – and a much healthier one.    

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Carbon-based energy and plastics (and, remember, plastics generally are made with petroleum products) helped make possible many of the 20^th century’s accomplishments.  The price for those accomplishments is only becoming clear in the 21^st century, and it is a price that is causing dangerous climate change and havoc with ecosystems, among other things. 

Science got us here, for better and for worse, but the recent achievements in recycling plastics and fusion show that science may yet help us survive the 21^st century.     

Give Kids a Healthy Itch

Someday I’ll probably write about Neuralink, but these days I don’t feel like giving Elon Musk any extra publicity.  I also had the notion to take OpenAI’s newly announced ChatGPT down a rabbit hole about U.S. healthcare, just to see where it would go, but Mr. Musk has his fingerprints on that organization too.  Then I saw something worth celebrating:  Scratch has hit 100 million users worldwide. 

Credit: Scratch Foundation

What’s that?  You’re not familiar with Scratch?  Well, me neither, until last week.  Now that I know a little about it, I kind of feel how I felt when I first discovered TikTok, found out about Roblox, or learned about Raspberry Pi.  In all cases, there were big ecosystems aimed at young people, getting them to view tech-related things (e.g., gaming, coding, even building computers) as something natural, something fun, something easy to do, and those ecosystems were largely invisible to most adults.

I’m still waiting for the ecosystem that makes health like that for young people.   

Scratch modestly describes itself as a “coding platform for children.”  It is a project from the MIT Media Lab, developed by the Lifelong Kindergarten group there in 2007.  That group:

develops technologies, activities, and communities to engage young people, from all backgrounds, in creative learning experiences, so they can develop their thinking, their voices, and their identities. We are deeply committed to bringing about change in the world and improving the lives of young people, especially those from communities that face systemic inequities and injustices.

Scratch now is “the world’s largest coding community for children and a coding language with a simple visual interface that allows young people to create digital stories, games, and animations,” and is available in 70 languages, in over 200 countries.  It is overseen by the Scratch Foundation, whose mission “is to ensure that Scratch and ScratchJr are available for free, for everyone, so that kids around the world can express their ideas through coding.”

It is aimed at ages 8 to 16, “but is used by people of all ages” (that “lifelong” in Lifelong Kindergarten really does have meaning, it turns out).   It gives users ideas about projects they could do, lets them explore projects others have done, and, of course, gives them tools to create their own projects, using “a coding language with a simple visual interface that allows young people to create digital stories, games, and animations.“  

All this, Scratch believes, “promotes computational thinking and problem solving skills; creative teaching and learning; self-expression and collaboration; and equity in computing.”  On the 15^th anniversary last year, Shawna Young, the Scratch Foundation executive director, said:

Kids just enjoy it, it is fun.  They are able to create these projects. It is based on this idea of yes, you are learning, developing computational skills, but at the heart of the work you are really having fun and creating something you care about.”

The kids may not realize they’re learning computational thinking and problem-solving skills; they think they’re having fun.  One hundred million users can’t all be wrong.  Mitch Resnick, Professor at the MIT Media Lab and the Founder of Scratch, believes: “We developed Scratch to provide young people with opportunities to imagine, create, share, and learn, and we continue to be amazed by what they create and how they support one another.”

That 100 million user Scratch community is bigger, by the way, than the Roblox or Raspberry Pi communities, although, unfortunately, well short of TikTok.  In a different world…

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Health care, on the other hand, is not fun.  Oh, navigating it requires, among other things, a lot of problem-solving skills, learning, and collaboration, but trying to teach those kinds of coping skills to young people doesn’t seem high on anyone’s list of things-to-do in our healthcare system.  Health care for most young people – oh, just say “people” generally – is a frustrating, confusing, slow, and largely opaque process. 

Even more broadly, learning how to live a healthy life is one of the most important life skills we should be imparting to young people, and we’re failing badly.  I’m not sure what health education curriculums in schools look like these days, but I doubt they have much to teach the Lifelong Kindergarten group. 

Kids have natural tendencies to be active, but modern life steers many away – too little time outside, too little time in free play, too much time on screens or sitting passively in classrooms.   Parents may try to teach kids to learn healthy eating habits, but those efforts are confounded at every turn: such food competes with processed food that has literally been engineered to maximize cravings, even addiction, and may be both harder to find and more expensive.    

Sitting, screens, and chips: oh, my

We are not developing the next generation of healthy adults.  We are doing the opposite: we are condemning millions of young people to a life filled with chronic diseases, with all the limitations those will impose and all the interactions with the healthcare system they will require.

We need a Lifelong Kindergarten for health. Something that “develops technologies, activities, and communities to engage young people, from all backgrounds, in creative learning experiences” about their health.  Something that does so by making it fun and fostering creativity. 

Hey, I’m no kid, but sign me up. 

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Despite the existence of pediatricians and children’s hospitals, we don’t have a different health care system for young people. It exists within the framework of our larger healthcare system, with all its flaws and frustrations.  If we were going to design an entirely new healthcare system, it might be nice to start with one that is aimed at young people, but that’s not going to happen.

So the least we could do -- the very least -- is to help young people think about health, to find ways to collaborate on supporting healthy behaviors, even to create ways to deal with health issues differently.  And do all that while making it fun and engaging. 

Coding can be daunting too – ask most people who were born pre-PC, pre-internet – but Scratch has figured out ways that young people can learn about it without realizing they’re doing something hard.  I don’t know what that would look like for health, but I sure hope someone can figure it out. 

Scratch for Health!