Halo, Heresy, and Healthcare

If you are of a certain age – say, mine, that is to say, a Baby Boomer – last week’s announcement that Microsoft was going to release a new version of Halo on Sony’s PlayStation console may have passed you by. So what, you might have said? If, on the other hand, you are one of the three-fourths of Americans who play video games, you might have more immediately grasped the significance.

It's a big deal that Halo is on PlayStation. Credit: Halo/Xbox

The gaming industry is like porn industry in that it tends to be early on the technology front. Since I don’t follow the porn industry, I try to watch the gaming industry to see what trends in it may suggest for the future of other industries, especially healthcare.

In case you weren’t aware, Halo is a Microsoft game, and has historically been played on Microsoft’s Xbox console. Sony’s PlayStation is Microsoft biggest competitor, and has been winning the war handily. So making Halo available on PlayStation is a somewhat surprising move. As Zachary Small wrote in The New York Times: “It is the equivalent of Disney letting Mickey Mouse roam Universal Studios.”

Or, as Grant St. Clair marveled in Boing Boing:

I cannot possibly emphasize how big a deal this is, but odds are you already know yourself. Halo is bar none the biggest IP Xbox has, and historically one of the biggest draws to the console. It'd be like Nintendo suddenly putting Super Mario Galaxy on Steam. This is a tacit admission that Xbox has lost the hardware war — the writing was on the wall already, granted, but this italicizes and underlines it.

A gamer told BBC Newsbeat that the announcement was “massive” and “broke the internet a little bit.” She’s happy about the news, adding: "I know there's a bit of controversy about it coming to PlayStation, but I don't see any reason why it should be like that at all. I just think it's a win for all gamers."

So, whether you realize it or not, this is kind of a big deal.

Microsoft has desperately been trying to stay relevant in gaming. A couple years ago Microsoft shelled out $70 billion to acquire Activision Blizzard, and a couple years prior to that paid $7.5b for ZeniMax Media. Still, though, as Joost van Dreunen, a market analyst and professor at New York University, told Mr. Small: “When it comes to consoles, Xbox has always been the bridesmaid and never the bride. They just haven’t been able to outmaneuver PlayStation and Nintendo.”

It may have found a way. Earlier this year Microsoft made Gears of War and Forza Horizon 5  available on PlayStation, and Microsoft Flight Simulator will join them later this year. Indeed, Mr. Small points out: “Between April and July, six of the top 10 best-selling games on Sony’s consoles were Microsoft properties.”

I.e., if you can’t beat them, join them.

“We are all seeking to meet people where they are,” Matt Booty, the president of Xbox game content and studios, told Mr. Small. Even more interesting, he further explained: “Our biggest competition isn’t another console. We are competing more and more with everything from TikTok to movies.”

Lesson #1: your competitors are not necessarily the ones you think they are.

The new version – Halo: Campaign Evolved – is a remake of the original Halo game, first released in 2001. “We wanted to start where it all began, with the original campaign that defined Halo,” Executive Producer Damon Conn explains. It has been remade using Unreal Engine 5 instead of the proprietary Halo game engine that the game had always been built on, marking another shift to outside the Microsoft ecosystem.

Credit: Halo/Xbox

Writing in the PlayStation Blog, Brian “ske7ch” Jarrard, Community Director, Halo Studios explains:

What makes Halo special isn’t just the gameplay, it’s who you play it with. Bringing Halo to PlayStation means even more players can share in that experience. In Halo: Campaign Evolved, you can jump into four-player online co-op with friends or kick it old school with two-player couch co-op on your PlayStation- now with cross-play and cross-progression across console and PC.

“We’re so excited about bringing Halo to those who may not have had chance to play it in the past,” Executive Producer Damon Conn said. “At its heart, Halo is about connection, we’re thrilled to meet a new generation of players on their platforms of choice to fall in love with Halo the same way we did. We’re not trying to rewrite Halo’s legacy – we’re trying to immerse you in it like never before.”

“This is Halo for everyone.”

When asked if the next step was a version of Halo (or other games) for Nintendo Switch, Mr. Conn would only coyly repeat: “We’re excited to launch this in 2026 on Xbox, Xbox on PC, Steam, and PlayStation.” But don’t be surprised.

There is, interestingly enough, some controversy about whether the Halo team is using generative AI to help develop the reenvisioned game. The team denies it, but game director Greg Hermann admitted to Alyssa Mercante of Rolling Stone: “It’s a tool in a toolbox. I may go a little off message here, but some of that gets very challenging when we look at how integrated AI is becoming within our tooling. We use Photoshop. There’s generative fill, for example. The boundary lines can get a little fuzzy.”

It reminds me that Microsoft is pursuing a dual strategy not just in gaming platforms but also with AI, having its own AI team and products while also being a major investor in OpenAI and its products.  

Lesson #2: Hedge your bets.

Here are my two takes from the above for healthcare:

• If your business model relies on a proprietary platform, you may want to think whether that is actually giving you an advantage, or it is just cutting off access to lots of potential new customers. If you are an insurer, think about, say, your provider network; if you are a health system, think about, perhaps, your medical record.  
• If you think of your competitors in traditional terms – e.g., other health systems or other health insurers – you should realize that you are missing the bigger picture. We’re living in an age of misinformation, peddled by people/companies way outside “mainstream medicine,” and more people are listening to them. If you don’t compete against them, you’re going to lose customers.

I’m no more likely to play Halo on PlayStation than I was on Xbox – which is to say, not at all -- but that doesn’t mean I can’t learn lessons from it. Hopefully healthcare will as well.

Let a Thousand DNA Flowers Bloom

When I saw a headline about “DNA flowers,” I was nonplused. I mean: aren’t all flowers made out of DNA, like every living thing on our planet? Well, it turns out that the DNA flowers are actually soft robots – make that nanobots – so my interest was definitely piqued.

Visualization of DNA flowers Credit: Justin Hill, Philip Rosenberg, and Ronit Freeman

The DNA flowers are out of the Freeman Lab at the University of North Carolina, led by Dr. Ronit Freeman, and the research about them was just published in Nature Nanotechnology with the less sexy title “Reversible metamorphosis of hierarchical DNA-organic crystal.”  Had I seen that before “DNA flowers” I probably would have passed it over, so I’m glad someone has an eye towards marketing.

Designer Daniel Burham famously said: “Make no little plans,” and I kind of think he’d like Dr. Freeman. Her bio says she has formal training in computer science, chemistry, nanotechnology, and regenerative medicine (plus even ballroom dancing, if you’re counting), and she probably needs all that training, because her primary interest is “in supramolecular self-assembly, a field where common biological materials like DNA and proteins are seen not simply as information carriers, but also as tunable structural materials for next-generation sensors, nano robots, drug breakthroughs, and clinical tools.”

Accordingly, what the Lab has done now is to combine DNA with inorganic materials to allow them to respond to their environment. Professor Freeman says: "We take inspiration from nature's designs, like blooming flowers or growing tissue, and translate them into technology that could one day think, move, and adapt on its own,"

Indeed, the Freman Lab prides itself on “bioinspired technologies,” the purpose of which is: “We engineer living and synthetic materials to accelerate healthier outcomes for global communities.” The website talks about “building block designs.” featuring hierarchical self-assembly, temporal structural reconfiguration, and adaptive behavior.

Hence, DNA flowers. 

The flowers are actually shaped like flowers, although they are microscopic, and what makes them both interesting and potentially useful is that the various strands of DNA allow them to move, open or close, or trigger chemical reactions, based on environmental cues like temperature, acidity, or chemical signals. The DNA sequences guide nanoparticles to organize into complex structures, which can reverse shape as desired.  

"People would love to have smart capsules that would automatically activate medication when it detects disease and stops when it is healed. In principle, this could be possible with our shapeshifting materials," said Professor Freeman. “In the future, swallowable or implantable shape-changing flowers could be designed to deliver a targeted dose of drugs, perform a biopsy, or clear a blood clot."

Yeah, I’d love that, and I bet you would too.

The team acknowledges that the technology is in the early stages, but see a future where, say, a DNA flower is injected into a cancer patient, in whom it travels to a tumor, whose acidity causes the petals to release a medication or even take a tiny tissue sample. When the tumor is gone the DNA flower would deactivate until/unless new environmental triggers reactivate it.  

Thinking beyond healthcare, the team sees their creations helping to clean up environmental contamination, or as a great digital storage device -- up to two trillion gigabytes in just a teaspoon. 

The fact that the DNA flowers can sense and respond to their environment makes the team believe these are a major step forward in bridging the gap between living systems and machines. We’re going to see more of that in the rest of the 21^st century.

Credit: Freeman Lab

The Freeman lab has some big ambitions. It wants to discover “new and creative means of detecting viruses, treating illnesses, effectively targeting and delivering payloads, and interfacing with natural biology.” Four key ways it is attacking that goal are:

Sensing: “developing rapid testing technologies that are easy to use, location independent, robust in design, and cost effective for production.”: “In recognizing, respecting and studying natural mechanisms, we are able to mimic them in order to develop effective biotherapies and advance biomedical engineering.”

Biomimicry: “In recognizing, respecting and studying natural mechanisms, we are able to mimic them in order to develop effective biotherapies and advance biomedical engineering.”

Therapeutics: “This can involve administering an external drug, developing a safe and effective means to deliver that drug to the desired site, or developing a means to program natural biology to reverse the effects of a disease.”

Soft matter: “Soft Matter is an umbrella term for sciences concerned with topics ranging from textile materials, to fluid mechanics, granular distribution, biological materials and much more.”  

All very cool, all thinking about a future that is different than the past, so kudos to them. DNA flowers aren’t the first thing the Freeman Lab has done, and I’m pretty sure they won’t be the last. I can’t wait to see what’s next.

And you though Bill Belichick went to UNC for the football…

Trade Ya Subsidies For a Government

As you may have heard, the federal government is currently shut down, although for many federal workers – those deemed “essential” – that just means they keep on working but don’t get paid (and, in fact, some might never get paid). The cause is the now-standard failure of Congress to pass a budget. As it often does in these instances, the House did pass a continuing resolution (CR) to keep the government open (for seven weeks), and Senate Republicans are willing to go along, but Senate Democrats are balking. Even though they’re usually the ones who advocate “clean’ CRs, this time they’re holding out to include some other legislative fixes. Their key demand: continuing the expanded ACA premium tax credits.  

I am a little puzzled why this is the hill upon which they’re willing to keep the government shut down.

Let’s back up. When ACA was passed in 2010, a crucial component was subsidies to help low- income people afford ACA coverage (along with subsidies for cost-sharing features like deductibles). Subsidies were, and are, crucial for the ACA marketplace to survive. These subsidies came in the form of premium tax credits.

If you recall the dismal individual health insurance marketplace pre-ACA, individuals couldn’t get coverage unless they passed medical underwriting, and, even then, preexisting conditions exclusions applied.  As a result, few qualified and everyone complained. ACA did away with medical underwriting and pre-existing conditions exclusions, but the only way to ensure that enough healthy people would join the risk pool was to generously subsidize their coverage, much as employers do with employment-based health insurance. Thus the premium tax credits.

The trade-off worked for almost ten years. About ten million people got coverage through the exchanges. Then the pandemic hit. People needed coverage more than ever, yet many people’s incomes crashed. So in 2021 Congress passed “enhanced” premium tax credits as part of the American Rescue plan Act. They increased the amounts of the credits and made them available to some higher income families. Those expanded credits were extended to the end of 2025 as part of the Inflation Reduction Act.

It is those expanded premium tax credits that are expiring. The original credits would remain. Things would go back to the way they were pre-pandemic (although, of course, premiums are now higher due to inflation). It’d be more of a setback than a catastrophe.

The expanded tax credits did have a dramatic impact. Enrollment went from about ten million to over 24 million – 22 million of whom had the expanded credits. So it certainly is a non-trivial matter if they expire. KFF estimates that average premiums would double in 2026.

Still, though, CBO estimates loss of the expanded credits would result in about 3.8 million people losing coverage, which is a far cry from the 14 million whom gained coverage since they were implemented.

I’m not sure if the CBO is being overly optimistic, or if ACA has taught people to appreciate their coverage.

Everyone in Congress knew, or should have known, that these tax credits were expiring this year. Congress could have ensured that they persisted longer when they extended them as part of IRA. Congress could have extended then as part of H.R.1 (the so-called Big, Beautiful Bill). But neither of those happened, so here we are.

 House and Senate Republicans have indicated an openness to extending them, although not as a condition of ending the shutdown, but appear to be in no hurry. Speaker Mike Johnson sees only the December 31 ending date of the expanded credits and says: “We have effectively three months to negotiate. In the White House and in the halls of Congress, that’s like an eternity.”

That ignores, of course, that open enrollment starts November 1, and insurers are already preparing their materials, so something like whether an expanded tax credit would be available or not would seem like an important factor for anyone making such a decision.

This is not an issue that is primarily a Democrat one. Most people with ACA coverage live in Republican districts. Over three-quarters of Americans think the tax credits should be extended – including 59% of Republicans. Even 57% of self-identified MAGA supporters want them extended. MAGA stalwart Margorie Taylor Greene has been vocal about the need to extend them. So you’d have to think that, one way or another, they’re likely to get extended.

So why allow the government to be shut down over them?

There are plenty of other issues the Democrats could be striking over, such as Medicaid cuts. The cuts to Medicaid that HR1 made are estimated to cause more than twice as many people to lose Medicaid coverage as ACA coverage, not to mention the huge impacts on state Medicaid budgets due to loss of provider taxes. But reversing those Medicaid cuts cost way more than the ACA premium tax credits, would require Republicans to retreat from favorite policy positions like work requirements, and won’t, for the most part, impact people as soon as the premium tax credits. Plus, the work requirements may blow up on their own due to the administrative difficulties.  The Democrats have mentioned reversing the Medicaid cuts as part of the negotiation, but don’t appear to have them as part of their red line.  

Or the Democrats could insist that Congress regain its Constitutional duties about controlling federal spending or enacting tariffs, rather than abdicating those to the Administration, but finding enough Congressional Republicans who care more about the Constitution than risking Trump’s ire is probably a fool’s errand. So premium tax credits it is.

Look, I think the subsidies should be extended. Too many people now rely on them, especially with so little notice. Even more, I think they probably will be; there’s too much risk of blowback to swing Republican districts for the GOP to simply ignore the problem. But I think it’s more likely to Republicans can wait the Democrats out, betting on pealing off five more Democrat Senators to pass the CR. They can then deal with the tax credits late in the year, damage to the enrollment process be damned.

If anything, the furor over the subsidies highlights a central flaw with ACA: it focused on expanding coverage, not on reforming our health care system. As a result, costs continue to rise unabated, making subsidies all-the-more important. But that’s not a sustainable approach. At some point, we’re going to have to rationalize how much we pay for health care and what we should be paying for.  But, alas, we’re nowhere near that point.

The Vultures Are Circling Wikipedia

I must admit, for several years now I’ve worried that my beloved Wikipedia could not survive in an AI era. Honestly, it’s hard to imagine that in a few years we all won’t just ask our AI assistant/overlord when we want information, although the AI tendency to hallucinate and spit out a totally plausible collection of truth and make-believe creates a bar that will have to be overcome.

Credit: Wikipedia

The good news is that AI doesn’t seem to be winning this particular battle yet. The bad news is that the war on “woke” may be a bigger threat, at least in the short term.

A new paper from researchers at Kings College London looked at the impact of ChatGPT on Wikipedia engagement, and offered cautious hope: “We find no evidence of an overall decline in Wikipedia engagement across the four metrics studied. Instead, page views and visitor numbers increased in the period following ChatGPT’s launch.” They did, however, find slower growth in areas where ChatGPT was available.

The authors cite several studies that indicate that, to date, ChatGPT responses are not viewed as favorably as Wikipedia’s, and point out that Wikipedia readers are not keen to see generative AI summaries of its articles. They note that ChatGPT’s capabilities are evolving, and cite other research that found that up to 5% of newly created articles in the English Wikipedia were written using generative AI tools. AI may be coming, but it’s not quite ready for Wikipedia-level prime time yet.

The authors see other risks to Wikipedia from AI. Professor Elena Simperl, Professor of Computer Science at King’s and Co-Director of the King’s Institute for Artificial Intelligence, said:

Our work did not confirm the most alarmist scenario, but we’re not out of the woods yet. AI developers are letting their scrapers loose on Wikipedia to train them on high quality data, pushing up traffic to levels where Wikipedia’s servers are struggling to keep up. Generative AI summaries are also using Wikipedia’s data in web searches but not crediting sources, siphoning web traffic away while borrowing the platform’s work.

For free services like this, no-one stops to ask how it’s being paid for – and now Wikipedia is having to make the tough decision of where to allocate their limited resources to deal with this. It’s vital as a community we take steps to protect this important platform, and we hope to turn our work into a monitoring tool where the community can track how AI is impacting Wikipedia. 

Postdoc and first author of the study Neal Reeves suggests there are steps available to protect Wikipedia. “Ultimately, we need a new social contract between AI companies and providers of high-quality data like Wikipedia where they retain more power over their material, while still allowing for their data to be used for training purposes. Collaboration, like that seen in programmes like MLCommons, is needed to reach across the aisle and ensure that the next generation of AI models are trained well, but in a way that doesn’t destroy one of the free internet’s greatest resources.”

Speaking of destroying great resources, Elon Musk has decided that, as he found with Twitter, Wikipedia is too woke, and has announced his AI rival to it: Grokipedia. The vision: “Grokipedia is going to be the world’s biggest, most accurate knowledge source, for humans and AI with no limits on use.”

The announcement rambles on:

With Grok, Grokipedia aims for maximum truth through first principles and physics. It replaces partially masked evidences of how legacy media operates, rewriting with complete accurate context that cuts through the BS. this will combat the evil organizations and the evil minds that operating under the hood and who’ve poisoned minds for decades with endless fake news and distorted narratives through legacy media and Wikipedia, causing immense harm to young minds and manipulated the world long enough.

I.e., if you liked how Elon “fixed” Twitter, you may like Grokipedia. Of course, if you are not a fan of X, or have found Grok to be underwhelming and, at times, scary, Grokipedia may not be for you.

Credit: DogeDesigner

Elon is not the only one who thinks Wikipedia is too woke. Wikipedia co-founder Larry Sanger – who left it shortly after its founding – issued his “9 theses” calling for counteracting what he sees as left wing bias. His theses:

1. End decision-making by “consensus.”
2. Enable competing articles.
3. Abolish source blacklists.
4. Revive the original neutrality policy.
5. Repeal “Ignore all rules.”
6. Reveal who Wikipedia’s leaders are.
7. Let the public rate articles.
8. End indefinite blocking.
9. Adopt a legislative process.

Mr. Sanger believes Wikipedia doesn’t allow certain right wing websites (think Fox News) as sources, and says: “What I can tell you is that over the years, conservatives, libertarians, were just pushed out. There is a whole…army of administrators, hundreds of them, who are constantly blocking people…that they have ideological disagreements with.”

Tucker Carlson had Mr. Sanger on his podcast last week, and pronounced: “Wikipedia shapes America. And because of its importance, it’s an emergency, in my opinion, that Wikipedia is completely dishonest and completely controlled on questions that matter.”

Tucker Carlson and Larry Sanger. Credit: Tucker Carlson Podcast

Ted Cruz wasted no time joining the bandwagon, expressing his concerns in a letter to Wikimedia Foundation CEO Maryana Iskander. “Wikipedia began with a noble concept: crowdsource human knowledge using verifiable sources and make it free to the public. That’s what makes reports of Wikipedia’s systemic bias especially troubling,” Senator Cruz wrote. He also charged that the Wikipedia Foundation “financially supports left-wing organizations that contribute to Wikipedia content.”

Adding to the pile-on, White House AI and crypto czar David Sacks has suggested Wikipedia is “hopelessly biased,” alleging that an “army of left-wing activists maintain the bios and fight reasonable corrections.” Politico reported that Ed Martin, then D.C.’s interim U.S. attorney appointed by Trump, and the House Oversight Committee have also gone after Wikipedia for similar reasons

If you are someone who thought that the Biden Administration, the mainstream media, and social media platforms were right to try to get credible information out during the height of the COVID pandemic, this will all sound frighteningly familiar to you. If you are someone who thinks every point of view should be heard equally and that RFK Jr. makes a lot of sense, then you have your new target.  

Honestly, if Wikipedia is going to go down, I’d rather it be from a top notch AI than for it to be smeared as “Wokepedia” and drowned in disinformation. But I’m not sure I’ll have that choice.