Putting the "AI" in "Legal" (and "Healthcare")

I once again have to thank The New York Times for introducing me to a new concept. Sarah Kessler wrote about the rise of “legal engineering” – for which, it turns out, one doesn’t have to be either a lawyer or an engineer.

You're going to need your version of a "legal engineer" Credit: Microsoft Designer

Their role is to help integrate A.I. into the practice of law, whether at law firms or companies. That sure sounds like a prudent, if possibly belated, idea – and one suspects we’re going to see such “engineers” in other fields. I certainly hope that healthcare is one of them, sooner rather than later.

Irene Liu, the executive director of the A.I. initiative at Stanford Law School, explained the job to Ms. Kessler thusly: “If you were to just put it into an equation, it’s law plus technology plus business process.” That Venn diagram gets pretty small very quickly.

Mary O’Carroll, the C.E.O. of LegalEng Consulting Group, also explained the role to Ms. Kessler: “You don’t necessarily need a giant pyramid of lawyers anymore. People who have this kind of skill set don’t have to have a J.D., and they don’t have to be software engineers, but there’s business process re-engineering, or this M.B.A. type skill, that I think is really necessary.”

Ms. Kessler notes that they are sometimes referred to as “knowledge and innovation counsels,” “innovation attorneys,” or “legal applications engineers,” which may illustrate that the role is both new and evolving.

If you’re considering why this role is important, note that the 2026 Legal Industry Report from 8am™ found that 69% of legal professionals report personally using Generative AI (GenAI) tools such as ChatGPT, Gemini, or Claude for work-related purposes, up from 31% a year earlier.

Ms. Liu’s Law AI Initiative joined Stanford Law School’s Executive Education to launch the Stanford Legal Engineering Academy in September, a two-week residential program for intensive training in AI strategy, implementation, governance, and organizational transformation, starting in the summer of 2027. Adam Sterling, associate dean of executive education and strategic partnerships, said the program was “designed to prepare participants to act as chief AI leaders within their organizations, whether or not they hold that formal title.”

Credit: Stanford University

“Using an AI tool is not the same as understanding how to redesign work around it,” said Julian Nyarko, professor of law and co-director of the Stanford Law School AI Initiative. “The leaders who will be most effective in this transition will be able to assess where the technology adds value, recognize its limits, and translate that understanding into new workflows, services, and organizational structures.”

Howard Glazer, a longtime partner at Ropes & Gray who became its head of practice A.I. about a year ago, told Ms. Kessler: “In the old days, there was technology and there was law. And as long as my email worked, I didn’t have to talk to people who dealt with the technology. But now we actually provide our service and provide our product using the tools.” More to the pont, he added: “‘Legal engineer’ kind of makes it sound like someone made it up. But it’s not. It’s a role which the current environment just screams for.”

Legal tech firm Legora , which describes itself as “the agentic operating system for legal work, supporting lawyers in research, review, and drafting across complex matters,” claims to have some 200 legal engineers. “We’re hiring hundreds, and competitors are hiring them, and our clients are hiring them,” David Himmel, Legora’s head of legal engineering for North America, told Ms. Kessler. “It’s a true profession.”

She reports that legal AI firm Harvey, which describes itself as “the operating system for legal and professional services,” has similarly grown its team of legal engineers to over 200.

Legora profiled Ricardo Anaya, whom it described as its founding legal engineer for the U.S. He recalled: "By the time I came to Legora, I'd been the lawyer, been the client, and worked on the product side. That's basically the job description for a legal engineer, though nobody called it that yet."

Mr. Anaya has found that there is often a gap between introducing an AI tool and its use. “The gap wasn't knowledge," he said. "It was that we were teaching the tool, not their work…Most adoption problems are diagnosis problems, and diagnosis doesn't happen over video. That’s why we go to them. Meeting lawyers where they are is a critical part of the job."

If your industry has complicated workflows, you’re going to use AI. If it has lots of arcane knowledge, you’re going to use AI. And, of course, if people in it care about making money, you’re going to use AI. If your industry doesn’t yet have its version of a legal engineer to help master this transition, it will.

Two years ago I wrote about the need for more engineers in healthcare, noting that most people who present themselves as “healthcare engineers” are focused on designing, building, and operating healthcare facilities, although some felt it was (or should be) “involved in all aspects of the prevention, diagnosis, treatment, and management of illness, as well as the preservation and improvement of physical and mental health and well-being, through the services offered to humans by the medical and allied health professions.”

If they were doing all that, healthcare wouldn’t be quite the mess it is today, with all parties seeing the system as dysfunctional. Healthcare needs its version of legal engineers – perhaps clinicians, perhaps not, but certainly people who understand how clinicians practice, how the system “works,” and enough about AI to see where and how it can add value.

Again, that Venn diagram gets small quickly.

I’d note that the American Medical Association (AMA) has launched the AMA Center for Digital Health and AI, and named the well-respected Jennifer Goldsack to head it up. Still, it is under the AMA’s umbrella, and its own description says it “educates and supports physicians, and gives them a voice in how technology is used to enhance the patient and clinician experience,” so if we’re looking for radical system reforms or even putting patients first, we may need to look elsewhere.

Credit: American Medical Association

I remember when healthcare first started discovering the internet and “eHealth” became a thing. Then mobile came along and “mHealth” was the catchphrase. Smart people pointed out we’d know when healthcare had truly adopted to the new technologies when things just became “health” again. Same with AI.

We need legal engineers and their equivalents now to help us transition to the AI world, but we’re going to get to the point when AI is so baked into everything that we won’t have distinct roles like them.

I'd Like Some Choices, Please

Let’s say your favorite social media platform is bought by a right wing trillionaire, who espouses free speech, but only when it echoes his. You can switch to, say, Threads, but – whoops – that’s owned by Mark Zuckerberg, another of the super-rich who have turned to the right. There’s always Facebook but – damn! – Zucked again! So you migrate to Bluesky, where the discourse is more civil but the audiences admittedly smaller. At least you have some choices.

That doesn't seem right, does it? Credit: Microsoft Designer

Not so much if, say, you are the President of Ukraine. Ukraine has unexpected held off the much bigger Russia for over four years now, in the process reinventing modern warfare by turning it from the traditional men, tanks, and artillery to a technology-powered war, especially with drones. To do so, it relied heavily on Starlink and its Pentagon-version Starshield. Unfortunately, Ukraine was blindsided a couple weeks ago when Starlink speeds were drastically lowered. Drones were literally falling out of the sky.

 President Zelensky raised the alarm.  Secretary of State Rubio said he thought software “glitches” were to blame, but most people suspected either Starlink’s owner Elon Musk and/or President Trump. Mr. Musk pointed fingers at the Pentagon, President Trump blamed Mr. Musk, and for several days Ukraine was hampered. Finally Mr. Musk admitted he’d ordered the slowdown, saying Ukraine had violated the “terms of service” of the service, using it “for offensive drone strikes to kill people.”

I’m shocked, shocked (and BTW, note that Serhii Beskrestnov, a Ukrainian presidential adviser on military technology, wrote on social media “we are PHYSICALLY UNABLE TO USE COMMERCIAL STARLINK for deep strikes or medium-range strikes”).

The “loophole was closed last week,” according to both Mr. Musk and President Zelensky, with normal speeds resumed, but if you were President Zelensky you’d sure have to be looking for alternatives, as you’d never know when the equally mercurial Mr. Musk or President Trump might pull another Lucy on you (Gen Z: check your “Peanuts” references).

Unfortunately, there really aren’t any, and that’s a problem.

One might expect that another one of the newly MAGA super-rich who is into space – e.g., Jeff Bezos – might have filled this space (pun intended), and you’d be partly right. Amazon has been working on Project Kuiper – now Project Leo – for years now, and now his space company Blue Origin has launched TeraWave, offering “space-based communications.” Unfortunately, despite all his and Amazon’s money, neither is ready for primetime; Leo has fewer than two hundred satellites in orbit, and TeraWave won’t even launch until late 2027. So President Zelensky better be looking elsewhere.

They're going to need more rockets. Credit: Amazon

Accordingly, Ukraine’s Ministry of Defense signed a letter of intent with Finnish companies Nokia and ICEYE “to develop new defense and satellite communication capabilities.” President Zelensky acknowledged: "Modern warfare has proven that reliable communications are a matter of national security. We must all rely on capabilities that we can control."

Rafal Modrzewski, CEO and Co-founder of ICEYE, agrees: “Ukraine needs secure, sovereign and high-performance satellite communications systems that it controls. We have a proven track record of delivering sovereign missions at speed to help build that capability.”

President Zelensky has also met with leaders in Norway to develop new satellite communications capabilities, along with air defense systems. And he told reporters Ukraine has its own plans: "There are developments. We are working on the same [similar to] Starlink.” Ironically, though, it would require SpaceX to launch the satellites. That may be a big problem. Chad Anderson, founder and CEO of venture capital firm Space Capital, told CNBC: “Capital isn't the constraint any more. Launch is."  

Credit: SpaceFans

European leaders are watching the U.S. turn its back on allies with alarm, and it is no surprise that they realize they can’t be dependent on Starlink either. The European Union already has Govsatcom, which went live with initial services in January of this year and expects to offer commercial services early next year, potentially extending them to Ukraine.

Merien ten Houten writes in Innovation Origins that Europe is working on at least three alternatives to it: the IRIS²project, its own secure satellite network; Project Bromo, planned merger of the space and satellite divisions of Airbus, Thales and Leonardo to create a SpaceX competitor; a planned consortium of Deutsche Telekom, Orange, Telefónica and Vodafone to create a satellite-based network for mobile phones.

Obviously, none of these are anywhere near being ready to help Ukraine, or anyone else.  IRIS² is furthest along, and it won’t launch until at least 2029.

Canada has its own concerns about dependencies on U.S. capabilities, and so it has awarded Toronto-based Telesat a contract to “strengthen secure and reliable military communications.” Telesat plans to have Telesat Lightspeed, a global low-Earth-orbit high-speed broadband network, operational by first quarter 2028, with a first launch later this year. The company told Cybernews that, although its primary customer is the Canadian Armed Forces, it expects to offer its services to NATO and other partners, including Ukraine.  

All that sounds very promising, but it leaves President Zelensky knowing he is still dependent on the U.S. and Starlink for the foreseeable future.

I have to confess, I don’t quite understand how, in a nation, in a world, of supposed capitalists and rich venture capital firms, Starlink has such a monopoly. I understand even less how SpaceX has not only built such a lead in space launch capabilities but is also allowed to own a satellite service that depends on launch capabilities. Talk about building a moat to competitors. Talk about monopolistic practices.

Similarly, if Russia were to invade Netherlands, or China Taiwan, taking over, respectively, ASML and TSMC, the rest of the world’s chip-making abilities would fall back to the 20^th century.  

I’ve similarly been alarmed about how, in 2026, the U.S., and other Western nations, have no alternative to our GPS system – a marvel of technology, integral to our modern lives, but extremely vulnerable. Russia isn’t testing satellite killers for fun.  

And, gosh, last week we discovered that an AI-discovered flaw in a programming language most of us had never heard of – PHP – exposed as much of 70% of the web to attack, forcing many sites to shut down to fix the flaw before hackers exploit it. The point of the internet was to be resilient and redundant, so having 70% of its websites with the same vulnerability sure seems like a problem.

The "4" is for PHP4. Credit:xkcd

The Starlink slowdown might seem like just a problem with Starlink and just for Ukraine, but it’s not. When a single company and, indeed, a single person, has such control over the lives of so many people, with no alternatives and no recourse, that’s a problem for us all.   

Enough of Asshole Capitalism

I recently read both Plastic, Inc. (Beth Gardiner) and These Are the Plunderers (Gretchen Morgenson and Joshua Rosner), and, boy, am I mad. Nothing in either book really came as a surprise, but the degree to which some people are willing to be greedy at the expense of others is still daunting. The latter introduced me to the phrase “Asshole Capitalism,” a phrase that comes from the work of Aaron James, a philosophy professor at University of California, Irvine. It can be summed up as a system where “citizens feel entitled to unlimited personal enrichment even at social cost.”

In other words, capitalism. No wonder a recent survey found that 43% of U.S, adults view socialism favorably (although Vice President J.D. Vance finds it a hard term to define and seems to think it has to do with foreign workers and transgender athletes).  

Plastic, Inc. tells the story of how, over the course of several decades, the petrochemical industry has worked to have us consume ever more plastic while not only absolving themselves of the responsibility for what happens to all that plastic but also boldly attempting to make consumers feel guilty about not doing a better job of recycling it. Those of us of a certain age might remember the “Crying Indian” littering ad. Well, that ad was sponsored and paid for by the industries that were producing the litter.

These Are the Plunderers shows how private equity firms blithely take companies and strip them of valuable assets, enriching themselves while often essentially destroying the companies. The authors focus much attention on healthcare, such as nursing homes or emergency room staffing, in which private equity ownership leads to demonstrably higher costs, job cuts, and worse care, while making boatloads of money for the private equity owners. Manufacturing, retailing, and other industries have also had victims.

Capitalism is replete with disregard for the common good. E.g., the fossil fuel industry giving us cheap gas without being responsibly for the ensuing climate change, mining companies that strip the earth while wrecking ecological damage on the environment, or manufacturers that pollute their local communities then close the factories when asked to clean up their waste. Capitalism has a very bad habit of not recognizing either costs imposed on others or costs to clean up their actions. It’s someone else’s problem, and that someone else usually ends up being those of us who pay taxes, or whose health is deemed unimportant.

Cancer alley is no secret, nor are the health risks of the fracking craze that has supercharged the profits of oil & gas companies. We’re becoming more aware of how pervasive microplastics are, and just starting to realize how bad that is for us.  

But, meanwhile, while rest of us suffer the consequences, a small number of people are getting ever richer.

And now, of course, we’re rushing into the AI boom, which proponents think will lead us into a new golden age but skeptics think may at most cost millions of jobs, a data center on every corner, and, just possibly, the end of humanity. Calls for more regulation have been met with the usual capitalism shibboleths – it would curtail innovation, it would just handicap us relative to our foreign competitors, and, anyway, it may be too late. The real reason, of course, is that there’s money to be made, damn the consequences. Asshole capitalism strikes again.

I, like many others, have called for some sort of AI tax, a mechanism to share those predicted huge gains more equally, rather than just ending up benefiting the select few. Elon has his trillion, and Jeff, Sam, Jensen, and even Dario, to name a few, are looking to join him. The rest of us are expected to be grateful for the scraps they throw us.

Mr. Musk is starting to feel a little guilty, or at least would like to give the appearance of a social conscience, by announcing on X: “Next year, I will give one of my SpaceX shares to every kid in America. This will be the first of many.” Taken literally, that’d be worth about $10b, compared to SpaceX’s roughly $2 trillion valuation and his personal worth of about $1 trillion, so I guess he’s not feeling too guilty.

He might have been spurred by Anthropic’s announcement that it would contribute 5% of its shares to a new public service corporation, “with an additional 2% added at the board’s discretion for every 50% increase in the company’s value above a set baseline.” The announcement was vague about how the new entity would service the public, other than to say it “will have increased flexibility and scale, enabling us to pursue our mission in new ways: for example, we might explore large donations to traditional nonprofits or direct distributions to specific populations.”  

Credit: Maccus

It’s worth noting that University of Colorado law professor Ann Lipton told Theo Francis of The Wall Street Journal: “public shareholders will have very few governance rights,” so whatever benefits the rest of us might end up getting from it won’t, of course, be decided by us.   

Mr. Mush was dismissive, sniffing: “I recommend giving the shares directly to the public.”

Asshole capitalism is why the upper 1% account for a third of total net worth, why CEO pay is now 325 times as much as the typical worker’s, and why the middle class has been “hollowed out” over the past four decades. Thanks to Citizens United, it has allowed Mr. Musk and other plutocrats to heavily influence both our elections and our legislators.

Asshole capitalism is why billionaires don’t seem to pay much in taxes. It has kept the carried interest provisions of the tax code firmly in place, and allowed Meta to claim huge tax breaks intended for other purposes.

Our social benefit programs are at best fraying and at worst being systematically dismantled. Our public infrastructure – including public schools, roads, water systems, and public safety – are woefully underinvested. We have shamefully tolerated a persistent economic underclass, which more and more of us are at risk of falling into.

So, no, one share of Space X isn’t going to do it. Five percent of Anthropic stock into a public service corporation isn’t going to do it. Our society is going to be radically different in twenty years and probably unrecognizable by the end of the century. If we continue to let asshole capitalists decide, and benefit from those futures, then shame on us.    

I’d say shame on them, but they’ve already shown that they have no shame.

No, Seriously: Worry About Q-Day

I’m tired about worrying about AI (no, I’m not falling for “superintelligence"). I’m choosing to not get too concerned about the plague, for now.  But, darn it, now I have to think about Q-Day.

Q-Day may happen before we realize it. Credit: Microsoft Designer

For those of you not well versed in quantum computing, Q-Day is the long-predicted date when quantum computers will be powerful enough to render our existing encryption methods useless. Quantum computers are going to be that much better than the best supercomputers. Earlier this year Google announced that, whoops, we better be ready for a post-quantum cryptography (PQC) migration by 2029, and I’m betting it happens before then.  

What started me thinking about this is that IonQ, one of the leaders in quantum computing, announced it was buying Elisity, a major cybersecurity firm. “With Elisity and its team as part of IonQ, we will be well positioned to help customers protect critical infrastructure and enterprise networks throughout the transition to the quantum era,” said Niccolo de Masi, Chairman and CEO of IonQ. “As I said first, Q-Day is coming much faster than predicted.”

Mr. de Masi vowed:

IonQ is offering its customers a vertically integrated full-stack quantum platform across quantum computing, networking, sensing and cybersecurity….Elisity will bring proven enterprise policy enforcement scale and deployment experience to our quantum security strategy and will give IonQ a strong growth platform to serve customers and create value for our shareholders.

Or, as he told Lauren Thomas of The Wall Street Journal: “The bad guys are going to keep taking advantage of new technology. Unfortunately, we are entering the most dangerous years, vis-à-vis cybersecurity risks.” 

I.e., if AI doesn’t get you, quantum computing will.

IonQ is having a year. Earlier this year it acquired chip-maker SkyWater Technologies to beef up its ability to serve as a “quantum foundry,” and Mr. de Masi believes that with the combination: “Secure chip design, fabrication, and packaging will deliver vertical integration across our full stack of quantum applications for land, sea, air, and space.”

He told Ms. Thomas: “This is our move to make sure we are the ‘Nvidia’ of quantum.”   

Last week InoQ was also one of four companies named to the final stage of Darpa’s Quantum Benchmarking Initiative (QBI), “which seeks to determine whether any quantum computing approach can achieve utility-scale operation – meaning its computational value exceeds its cost – by the year 2033.”

Darpa may need to talk to Google about that timeline.

One of the other finalists, IBM, thinks Q-Day has already begun. IBM’s Rina Diane Caballar writes:

The good news is that Q-Day won’t be, as in some media depictions, a hacker apocalypse triggering societal collapse. It will be a years-long series of vulnerabilities, with multiple opportunities for organizations to avoid catastrophe. The bad news is that, in a way, Q-Day has already arrived.

She notes: “Attackers are playing the long game, gathering and storing encrypted data now with the intent to decipher it once quantum capabilities mature, in a tactic known as “harvest now, decrypt later.””

Indeed, Google warned:

Quantum computers will pose a significant threat to current cryptographic standards, and specifically to encryption and digital signatures. The threat to encryption is relevant today with store-now-decrypt-later attacks, while digital signatures are a future threat that require the transition to PQC prior to a Cryptographically Relevant Quantum Computer (CRQC). 

“It’s not that Q-Day is in the future. Q-Day is, in a sense, in the past,” said Shohini Ghose, a quantum physicist and professor at Wilfrid Laurier University, in an interview with IBM Think. “We have the digital equivalent of needing to change every door lock on the planet,” Zygmunt Lozinski, Senior Technical Staff Member and Quantum Ambassador at IBM, also told IBM Think.

Brandt Pasco writes in The National Interest:

When Q Day arrives, the Root of Trust (RoT) underpinning all electronic transactions—banking, power grids, defense systems, health care, supply chains, global financial markets—can be shattered at blinding speed. Everything connected to the internet becomes vulnerable without warning. If we are not prepared, the 21st-century economy goes back to the Stone Age. We do not know when Q Day will arrive. We only know it is coming, and fast.

Worried yet?

The cryptocurrency world is recognizing the threat quantum computing poses, and Europol’s European Cybercrime Centre (EC3) recently warned about the risks, although it said the more immediate risks were to cryptowallets rather than to the blockchains themselves.  Christopher Smith, CEO and co-founder of blockchain start-up Quantus Network, told Cointelegraph, that quantum attacks would be hard to detect: “the only forensic evidence would be that there was no breach.”

NGRAVE CEO Roy Blackstone pointed out to Cointelegraph that AI has changed the timeline:

Most threat models assumed we had well into the next decade before quantum technology could realistically crack the cryptography securing public keys, but it did not account for how fast AI would develop alongside it.

Speaking of Nvidia, it recently joined The Post-Quantum Communications (PQC) Consortium, led by cybersecurity and network intelligence firm Allot. “The transition to quantum-safe communications is one of the most important cybersecurity challenges facing the world today," Allot CTO Yaakov Stein noted.

Let’s all agree on that.

Earlier this year President Trump issued an executive order directing federal agencies to prepare for a post-quantum cryptography (PQC) world, with National Institute of Standards and Technology (NIST) taking the lead in defining how. Somehow I don’t think it will be that easy, or that the federal government will be as nimble as it will need to be. As Mr. Pasco said: “The problem is that NIST’s Cryptographic Module Validation Program has fallen far behind.”

Mr. Pasco adds:

Fairness requires acknowledging NIST has good people working on this problem. They have not been sitting on their hands. At the same time, Q Day has not been getting the attention it requires among politically accountable policymakers in the executive branch, Congress, or industry. The effort has been underfunded and has lacked adequate high-level attention.

He still holds out hope: “We made Y2K boring. We can make Q Day boring, too. It is not yet too late, but the window is closing and is measured now in months, not years. Building trusted post-quantum cryptography is the only thing standing between Q Day and the Stone Age.”

I know less about quantum computing than I do artificial intelligence, and I’m no expert in AI. It may well be that AI will have taken over the world before Q-Day hits, but it sure would be ironic if we survive the AI boom only to have quantum computers take us back to the Stone Age.

A Plague on All Our Houses

It’s not a plague. It’s not that plague. It’s nothing to worry about. Probably.

The pathogens we know about may not be the problem. Credit: Microsoft Designer

No, I’m not reliving COVID in late 2019/early 2020. It’s a story that broke a couple of days ago: a young researcher -- Darya Shipilova – at the Antiplague Scientific Research Institute in Irkutsk province in Siberia died Friday, after a sudden illness. The institute studies, in case you are wondering, infectious diseases, so you can see why people might get worried.

At first the official line was that she died of “pneumonia of an unknown cause.” Later reports suggested that, oops, she had broken a test vial, which contained live Yersinia pestis (plague) bacteria, although official sources have denied it. Russia’s public head agency Rospotrebnadzor has insisted: “No micro-organisms associated with the employee’s professional duties were detected in samples taken from the patient.” Its former head Gennady Onishchenko told CNN it was “most likely not the plague, but even if confirmed, there will be no spread of this disease.”

Nothing to see here. Move along.

Darya Shipilova

Still, though, it appears the institute has been closed, with the staff inside. “They’ve been isolating everybody since Friday – more than 60 people,” one relative, Roman, told the news portal Siberia.Realities. The local hospital seems to have been quarantined as well, and possibly some other local health centers. Neighboring cities and provinces, some as far away as 1500 miles, are monitoring closely and, in some cases, putting quarantine controls at border crossings.  

The Governor of Irkutsk tried to calm the situation: “I understand that the events have triggered a number of very different theories among residents or the region and beyond. It’s important that in recent days there have been no recorded instances of other co-workers of the Antiplague Institute seeking medical help.” He also added that all identified contacts of the woman “have been placed under medical observation.” 

A State Department spokesperson told CNN: "We are aware of ​reports of a fatal case of suspected pneumonic plague in Irkutsk Oblast, Russia. We are monitoring the situation closely with the CDC and our other interagency partners. Many details have not been confirmed. We encourage Russian authorities to share accurate information quickly and openly.”

As scary as the plague sounds, and as many people it has killed throughout history, it can be treated with antibiotics, and it is not easily airborne. Professor Ian Jones, a virologist at the University of Reading, England, told The New York Times that the case “seems like a rare lab accident and is unlikely to go much further.”

Still, Dr. Ashish K. Jha posted on X: “We need to understand exactly what has happened. And we have to assume we may not know the full truth. And have to act to build up our biodefense accordingly.”

If it was, indeed, a lab leak of the plague, I doubt there are many of us who would expect Russia will tell us the truth, either about exactly what happened or how many people it impacts. The lab leak theory of COVID remains a favorite topic of discussion in certain circles, and no one believes the official fatality numbers for either China nor Russia. So might Russia try to cover up a plague outbreak, especially one that started in one of its biolabs? Sure.

Personally, I’m hoping that it is only the plague. If it is, it can be contained, it can be treated, it doesn’t means the Black Death has returned. I worry it is something different, and possibly even worse. Epidemiologist Mikhail Favorov questioned that a trained scientist working in an anti-plague institute would have gotten infected from a broken vial, due to her protective equipment.  “It’s laughable,” he said. “It doesn’t matter to the general public – they’ll believe the ‘dropped test tube story.” So far, he’s right. And he describes the situation: “It’s absolutely hair-raising,”

OK, now I’m worried.

Perhaps the institute was working on bioweapons. Perhaps the institute was using AI to create new, more clever, more targeted, more deadly bioweapons. Dr. Jha wrote in Stat recently about how AI is making it easier for people, or AI itself, to create bioweapons. “For decades, biological weapons were rare for a reason: Building them takes expertise that’s hard to acquire and harder to combine,” he said. Unfortunately:

AI is closing those gaps. Models trained on the biological literature can connect ideas across subfields that few researchers have mastered alone. These models can make someone with relevant training in one area more capable and dangerous by helping them learn key steps in another area. 

And he wrote that before he knew about Irkutsk.

Credit: Bloomberg

As bad as that is, I also worry that it is global warming coming home to roost. Yes, you read that right. One of the many consequences of global warming is that the permafrost – and Siberia has lots of permafrost – is thawing, and as it thaws it is releasing lots of things that we were assuming were going to stay frozen.

For example, it is releasing lots of toxic metals into previously pristine waterways. "This was a process that was not forecast, predicted or included in any assessment of how the Arctic will change under a warmer climate, but we're seeing it in rivers across the Arctic,” said one scientist.

More to the point, the thawing may release waves of microbes that have been frozen, some of which modern humans may have never been exposed to (and thus have no immunity for).  Navigating New Horizons, a 2025 report from the United Nations Environment Programme (UNEP) and the International Science Council, highlights the potential problem.

“The fact that these microbes are present in the permafrost means it’s hard to say how widespread, or dangerous, this problem could be,” says Andrea Hinwood, UNEP’s Chief Scientist. “But there are reasons to be concerned.”  

I wrote about these so-called “zombie viruses of the permafrost” a couple years ago, and global warming has only increased since then. I quoted one scientist: “We know there’s bacterial, fungal and viral pathogens that are in permafrost. We know that upon thaw, all three of those classes of pathogens could be released. What we don’t know is how viable it is for them to stay alive and then infect.”

We don’t know what is out there.

So Dr. Shipilova accidently catching the garden variety plague from a broken vial seems like a much better thing than her getting infected by a new bioweapon or a zombie virus. Today it is just one woman in a faraway place, but COVID should have taught us that we better play close attention to what happens next.

Healthcare Is Fighting the Wrong AI War

The Blue Cross Blue Shield Association is crying wolf about AI. Its new analysis claims that “hospital systems are increasingly billing patient hospital stays as more medically complex,” and that these upcodings cost BCBS plans almost $1b from 2023 to 2025. That’s just claims from hospital systems, just to BCBS plans, so the total number could be much higher.

This is not how to make healthcare better. Credit: Microsoft Designer

Well, you might say, a billion here, a billion there – that’s just healthcare these days. Everything is going up. But BCBSA is less sanguine; it thinks the coding is part of a strategy, and it thinks AI is driving that strategy.

“If patients are truly sicker, we'd expect to see more treatment,” said Luke Chalker, BCBSA’s senior vice president of product and data science. “For example, we're seeing significantly more anemia diagnoses at these hospitals without a corresponding increase in transfusions. The disconnect between diagnoses and treatment suggests that AI is identifying more billable conditions, not sicker patients.”

The analysis indicated that most (70%) of the increased costs came from secondary diagnoses that shifted payment into higher reimbursement categories, so the hypothesis is plausible.

The American Hospital Association, of course, is having done of it. An August 2026 ”fact sheet” on AI and coding intensity called claims of AI driving coding intensity “unsubstantiated,” citing numerous factors that drive coding intensity. It blamed insurers for having AI-supported “downcoding programs,” the purpose of which are “to arbitrarily and inappropriately reduce provider reimbursement for medically necessary care that has already been delivered.”

AHA also snarkily but accurately noted how many Medicare Advantage plans have been caught upcoding members to boost their Medicare payments, so it depends on where one is sitting.

It’s also worth noting that this year the Trump Administration rolled out a Medicare program -- Wasteful and Inappropriate Service Reduction (WISeR) – to use AI to help identify “fraud, waste and abuse” – a.k.a., deny claims. It has not, to say the least, gone well.

Both sides are using AI, to each other’s detriment. Which is to say, our detriment.

The BCBSA press release notes that more than 60% of hospital systems are using AI technologies, and, indeed, the 2026 Oliver Wyman Healthcare RCM Survey found that 63% of health systems are using AI in their revenue cycle management. But it’s not quite the smoking gun BCBSA would have us believe. Oliver Wyman found that “roughly 20% to 40% of organizations we surveyed report broad or enterprise-wide use of AI-enabled tools,” but this included ambient listening (33% in broad use or enterprise-wide standard), clinical decision support (38%), clinical document integrity (41%), electronic prior authorization (41%), and coding/billing automation (43%).

On the other hand, Oliver Wyman also found 70 to 90% of decision makers expected to increase AI-related RCM spending over the next three years, and you have to wonder why that number isn’t 100%.

To BCBSA’s point, the report did find that health systems “are seeing meaningful gains with targeted uses of AI improving how clinical complexity is captured, with some studies showing accuracy hit 90% or higher in specific clinical domains,” with the result that “reimbursement levels are increasing, contributing to measurable shifts in cost-of-care trends.”

Accordingly, the report suggested “payers need to accelerate investments in analytics, payment integrity capabilities, auditing and validation.” Which will drive greater investments from health systems, and so on.

And, in case you were wondering, it is not just health systems and payors using AI. The American Medical Association’s “2026 Physician Survey on Augmented Intelligence” found that more than 80% of physicians are using AI professionally, double what was reported in 2023. Like health systems, they’re using it for lots of reasons, but “diagnostic accuracy” is listed as one of the greatest expected advantages. Whether “accuracy” means more precision or upcoding depends on which side of the ledger one is on.

Source: AMA 2026 "Physician Survey on Augmented Intelligence"

Yep, we’re in an AI war about healthcare claims, although Mr. Chalker says: “It’s not a war. It’s a completely one-sided blood bath.”

In a New York Times article on the BCBSA report, Reed Abelson and Teddy Rosenbluth quote Dr. Shiv Rao, CEO and founder of healthcare AI firm Abridge: “That’s the danger, where it’s bots fighting bots, agents fighting agents, a horrible dystopic future nobody wants to live in.” They also cited a recent panel with leaders from Cigna and Emory Health, during which Dr. Joon S. Lee, the chief executive of Emory Healthcare, said: “My nightmare is that we have bots on Emory Healthcare’s side, bots on Cigna’s side that keep talking to each other. A whole data center could be occupied just doing that.”

It should be everyone’s nightmare. Bots on bots doesn’t make patients better. Bots on bots doesn’t make healthcare more affordable. Bots on bots just exacerbate the problems we already have in healthcare.

Ms. Abelson and Ms. Rosenbluth point to a Health Affairs article earlier this year by Dr. David Brailer, a former Obama official who helped oversee the adaption of electronic health records (EHRs). Its title -- Why AI Will Accelerate Health Care Inflation – is daunting. EHRs, he points out, led to higher hospital payments, and we should expect the same with AI. “The extraction economy of American health care does not resist useful technology,” he said. “It recruits it. AI is being recruited the same way, and AI’s scale and speed is different from anything electronic records achieved.”

 In other words, if we’re not very careful and very thoughtful, AI will make all the things we hate about our healthcare system much worse, much faster. And we don't have much o9f a track rec9ord in being very cautious or very thoughtful. 

At Health Datapalooza, Amy Gleason, the Administrator of the U.S. DOGE Service, had a great quote: “We have normalized the absurd in healthcar4e.” I couldn’t agree more. If AI serves to further normalize what everyone agrees are the absurdities of our healthcare system, then maybe it is time for AI to get rid of us.

I’ve long argued that all of our problems in healthcare stem from the fact that we don’t really know what “quality” is for health care. Because of that, we also don’t really know who is providing it, or who is not, either intentionally or unintentionally. Focusing AI on that would benefit both those who provide care and those who pay for it, not to mention those who receive it.

Yes, AI should help us make our healthcare system more efficient, reducing the ridiculous administrative tasks we have allowed to accumulate, but if that just results in “bots on bots” fighting over diagnosis codes, we’ll have wasted our best chance to actually fix our healthcare system.

Know Thyselves

With all the fuss about A.I. I was pleased to find some studies that illustrate that we don’t even fully understand the human brain yet. The ancient Greeks had a maxim “Know Thyself,” but the current research suggests they should have advised that we should “Know Thyselves.”

Your brain contains multiples. Credit: Microsoft Designer

A new study from Stanford Medicine suggests that our brain is actually two separate organs: “…we postulate the brain is a composite organ emanating from two lineage-restricted progenitors; these dual progenitors may be evolutionarily conserved across 550 million years from hemichordates to mammals.”

Say what?

Now, let me make this clear: they’re not saying that the brain evolved from two separate organs into the brain we have today; they’re going a step further and saying there are still two separate organs, working together or in parallel. Freud must be feeling vindicated.

The press release says:

The new research finding shows that the human brain consists of two ancient nervous systems cleverly packaged together — a more primitive part that regulates our hearts’ beating, our breathing and other functions, and another that makes us distinctly human, capable of poetry, mathematics and wondering about our own origins.

“We’ve shown for the first time that the front of the brain arises from a totally different progenitor cell than the back of the brain,” said Kyle Loh, PhD, associate professor of developmental biology. “Our discovery means that we can now grow neurons from the back of the brain, the hindbrain, in a petri dish and study their functions.”

Visualization of the two organs. Credit: Neuroscience News

If you’re wondering why growing neurons from the hindbrain matters, it turns out that diseases that impact the brain stem, such as spinal muscular atrophy (also known as SMA) and amyotrophic lateral sclerosis (also known as ALS or Lou Gehrig’s disease), have been hard to study because of the difficulty of growing such neurons in the lab. The researchers discovered the hindbrain follows a separate developmental path, running in parallel to — rather than branching off from — the pathway that creates the forebrain and midbrain.

“Previous attempts to make hindbrain neurons likely tried to coax forebrain and midbrain progenitors into hindbrain cells, which our study shows is not possible,” co-first author Rayyan Jokhai said. He added: “Now we have a model to better understand these devastating diseases, and work toward regenerative therapies for them. This is a very exciting new frontier in brain research.”

The researchers looked at various organisms ands found that the separate systems date back over 500 million years. “Our research suggests that evolution took two existing neural systems and pushed them together spatially,” Professor Loh said. “Having the brain as one organ would probably be more efficient, but we rely on this primordial way to make the brain as two separate pieces.”

“I was surprised at our findings because the word ‘brain’ implies a contiguous organ that likely has a singular origin,” Mr. Jokhai said. “But even 500 million years ago, there were these separate neural systems, which now almost operate as one, which is very cool.”

Very cool, indeed.

Meanwhile, up the road a few miles, researchers at UCSF and UC Berkeley have shown, in real time, the brain essentially arguing with itself. They studied patients who had electrodes implanted for surgical evaluation of epilepsy, and used those to watch the brain trying to decide to do something or not. They discovered – you guessed it -- two neighboring patches of the brain that signal in opposite directions, one pushing toward “do it,” the other toward “don’t.”

“We’ve long suspected that this region was where the brain weighs reward against risk, but we’ve never been able to measure it while it is happening in the human brain in real time until now,” said Edward Chang, MD, Joan and Sanford I. Weill Chair of the Department of Neurological Surgery at UCSF and co-senior author of the study.

The researchers had participants play a video game where they had to navigate a maze with bomb-filled hallways, posing varying degrees of risk. As they reached decision points, the researchers identified two distinct areas of the brain firing; region near the middle of the eyebrow was connected to a risky choice, while a patch about two centimeters over, toward the side of the eyebrow, did the opposite.

Sample image of the video game used in the study. Credit: Clara Starkweather/UCSF

“Most models of decision-making assume the brain gradually ramps up evidence until it crosses a threshold, like a dial slowly turning,” said Robert Knight, MD, professor of Psychology and Neuroscience at UC Berkeley and co-senior author. “What we saw instead was more like a switch flipping back and forth, oscillating between two extremes until one held.”

The researchers believe that their discovery could help conditions where people have an imbalance between risk-taking and caution, such as depression, OCD or gambling addiction. Co-author Clara Starkweather, MD, PhD, a neurosurgery chief resident at UCSF, who designed the video game, said: “Right now, psychiatry mostly relies on asking people how they feel, I want to give it something more objective: a real, measurable signature of how someone’s brain weighs risk, so treatment can target the specific circuit that’s off, in addition to a mood score.”

Last but not least, researchers at the Salk Institute discovered a part of the brain that seems to be responsible for long-lasting fear responses. The amygdala has long been associated with immediate fear responses, but they identified a tiny nearby area called the amygdalostriatal transition zone (ASt).

“The ASt is at a crossroads between the brain’s systems for emotional associations and action selection, but its function was largely unknown,” says co-corresponding author Fergil Mills, PhD. “When we started, we knew almost nothing about the ASt, and were truly exploring unknown territory in the brain. Now, we have a much deeper understanding of this structure and have found that the ASt is a ‘missing piece’ of the circuits for fear that was hiding in plain sight for decades.”

“The ASt and this circuit could be really relevant in developing therapies for panic attacks or phobias,” adds co-corresponding author Kay Tye, PhD, a professor and holder of the Wylie Vale Chair at Salk and Howard Hughes Medical Institute investigator. “Anxiety disorders affect hundreds of millions of people globally. Understanding what happens in the brain when it’s in high-alert danger mode is key to addressing those disorders.”

Admittedly, the research was done on mouse brains, so more research will be required, but it is both promising and more evidence that our brains still hold more mysteries than we realize.

With so much attention and funding focused on A.I., it’s gratifying to see that there is still startling research being done on what drives our own intelligence.