Biology to the Rescue

I feel much about synthetic biology as I do AI: I don’t really understand it from a technical point of view, but I sure am excited about its potential. Sometimes they even overlap, as I’ll discuss later. But I’ll start with some recent developments with bioplastics, a topic I have somehow never really covered.

If you always thought biology was boring, you're not paying enough attention. Credit: Bing Image Creator

Let’s start with some work at Washington University (St. Louis) involving, of all things, purple bacteria. In case you didn’t know it – I certainly didn’t – purple bacteria “are a special group of aquatic microbes renowned for their adaptability and ability to create useful compounds from simple ingredients,” according to the press release. The researchers are turning the bacteria into bioplastic factories.

One study, led by graduate student Eric Connors, showed that two “obscure” species of purple bacteria can produce polyhydroxyalkanoates (PHAs), a natural polymer that can be purified to make plastics.  Another study, led by research lab supervisor Tahina Ranaivoarisoa, took another “well studied but notoriously stubborn” species of purple bacteria to dramatically ramp up its production of PHAs, by inserting a gene that helped turn them into “relative PHA powerhouses.” The researchers are optimistic they could use other bacteria to produce even higher levels of bioplastics.

Purple bacteria at work. Credit: Joe Angeles/WashU

The work was done in the lab of associate professor Aripta Bose, who said: “There’s a huge global demand for bioplastics. They can be produced without adding CO₂ to the atmosphere and are completely biodegradable. These two studies show the importance of taking multiple approaches to finding new ways to produce this valuable material.”

“It’s worth taking a look at bacteria that we haven’t looked at before,” Mr. Conners said. “We haven’t come close to realizing their potential.” Professor Bose agrees: “We hope these bioplastics will produce real solutions down the road.”

Meanwhile, researchers at Korea Advanced Institute of Science and Technology, led by Sang Yup Lee, have manipulated bacteria to produce polymers that contain “ring-like structures,” which apparently make the plastics more rigid and thermally stable.  Normally those structures would be toxic to the bacteria, but the researchers managed to enable E. coli bacteria to both tolerate and produce them.  The researchers believe that the polymer would be especially useful in biomedical applications, such as drug delivery.

As with the Washington University work, this research is not producing output at scale, but the researchers have good confidence that it can. “If we put more effort into increasing the yield, then this method might be able to be commercialized at a larger scale,” says Professor Lee. “We’re working to improve the efficiency of our production process as well as the recovery process, so that we can economically purify the polymers we produce.”

Because the polymer is produced using biological instead of chemical processes, and is biodegradable, the researchers believe it can be important for the environment. “I think biomanufacturing will be a key to the success of mitigating climate change and the global plastic crisis,” says Professor Lee. “We need to collaborate internationally to promote bio-based manufacturing so that we can ensure a better environment for our future.”

Environmental impact is also very much on the minds of researchers at the University of Virginia. They are working on creating biodegradable bioplastics from food waste. “By creating cost-effective bioplastics that naturally decompose, we can reduce plastic pollution on land and in oceans and address significant issues such as greenhouse gas emissions and economic losses associated with food waste,” said lead researcher Zhiwu "Drew" Wang.

The team is developing microorganisms that convert food waste into fats, which are then processed into bioplastics. Those bioplastics then should easily be composed. “Our first step is to make single-layer film to see if it can be utilized as an actual product,” said Chenxi Cao, a senior in packaging and system design. “If it has good oxygen and water vapor barriers and other properties, we can move to the next step. We aim to replace traditional coated paper products with PHA. Current paper products are often coated with polyethylene or polyactic acid, which are not fully degradable. PHA is fully biodegradable in nature, even in a backyard environment.”

The approach is currently still in the pilot project stage.

If all that isn’t cool enough, our own bodies may become biofactories, such as to deliver drugs or vaccines. Earlier this year researchers at UT Southwestern reported on “in situ production and secretion of proteins,” which in this case targeted psoriasis and two types of cancer.

The researchers say: “Through this engineering approach, the body can be utilized as a bioreactor to produce and systemically secrete virtually any encodable protein that would otherwise be confined to the intracellular space of the transfected cell, thus opening up new therapeutic opportunities.”

“Instead of going to the hospital or outpatient clinic frequently for infusions, this technology may someday allow a patient to receive a treatment at a pharmacy or even at home once a month, which would be a significant boost to their quality of life,” said study leader Daniel Siegwart, Ph.D. Professor Siegwart believes this type of in situ production could eventually improve health and quality of life for patients with inflammatory diseases, cancers, clotting disorders, diabetes, and a range of genetic disorders.  

I promised I’d touch on an example of synthetic biology and AI overlapping. Last year I wrote about how “organoid intelligence” was a new approach to biocomputing and AI. Earlier this year Swiss firm FinalSpark launched its Neuroplatform, which uses 16 human brain organoids as the computing platform, claiming it was: “The next evolutionary leap for AI.”   

“Our principal goal is artificial intelligence for 100,000 times less energy,” FinalSpark co-founder Fred Jordan says.  

Four clusters of living neurons are connected to electrodes on Neuroplatform/ Credit: FinalSpark

Now FinalSpark is renting its biocomputers to AI researchers at several top universities…for only $500 a month. “As far as I know, we are the only ones in the world doing this” on a publicly rentable platform, Dr. Jordan told Scientific American. Reportedly, around 34 universities requested access, but FinalSpark so far has limited use to 9 institutions, including the University of Michigan, the Free University of Berlin, and the Lancaster University in Germany.

Scientific America reports related work at Spain’s National Center for Biotechnology, using cellular computing, and at the University of the West of England, using – I’m serious! – fungal networks. “Fungal computing offers several advantages over brain-organoid-based computing,” Andrew Adamatzky says, “particularly in terms of ethical simplicity, ease of cultivation, environmental resilience, cost-effectiveness and integration with existing technologies.”

Bioplastics, biofactories, biocomputing -- pretty cool stuff all around. I’ll admit I don’t know where all of this is leading, but I can’t wait to see where it leads.   

Tiny Is MIghty

I am a fanboy for AI; I don’t really understand the technical aspects, but I sure am excited about its potential. I’m also a sucker for a catchy phrase. So when I (belatedly) learned about TinyAI, I was hooked.  

The future is tiny -- TinyAI. Credit: Nakhle/Cell

Now, as it turns out, TinyAI (also know as Tiny AI) has been around for a few years, but with the general surge of interest in AI it is now getting more attention. There is also TinyML and Edge AI, the distinctions between which I won’t attempt to parse. The point is, AI doesn’t have to involve huge datasets run on massive servers somewhere in the cloud; it can happen on about as small a device as you care to imagine. And that’s pretty exciting.

What caught my eye was a overview in Cell by Farid Nakhle, a professor at Temple University, Japan Campus: Shrinking the Giants: Paving the Way for TinyAI.  “Transitioning from the landscape of large artificial intelligence (AI) models to the realm of edge computing, which finds its niche in pocket-sized devices, heralds a remarkable evolution in technological capabilities,” Professor Nakhle begins.

AI’s many successes, he believes, “…are demanding a leap in its capabilities, calling for a paradigm shift in the research landscape, from centralized cloud computing architectures to decentralized and edge-centric frameworks, where data can be processed on edge devices near to where they are being generated.” The demands for real time processing, reduced latency, and enhanced privacy make TinyAI attractive.

Accordingly: “This necessitates TinyAI, here defined as the compression and acceleration of existing AI models or the design of novel, small, yet effective AI architectures and the development of dedicated AI-accelerating hardware to seamlessly ensure their efficient deployment and operation on edge devices.”

Credit: Nakhle/Cell

Professor Nakhle gives an overview of those compression and acceleration techniques, as well as architecture and hardware designs, all of which I’ll leave as an exercise for the interested reader.  

If all this sounds futuristic, here are some current examples of TinyAI models:

• This summer Google launched Gemma 2 2B, a 2 billion parameter model that it claims outperforms OpenAI’s GPT 3.5 and Mistral AI’s Mixtral 8X7B. VentureBeat opined: “Gemma 2 2B’s success suggests that sophisticated training techniques, efficient architectures, and high-quality datasets can compensate for raw parameter count.”
• Also this summer OpenAI introduced GPT-4o mini, “our most cost-efficient small model.” It “supports text and vision in the API, with support for text, image, video and audio inputs and outputs coming in the future.”
• Salesforce recently introduced its xLAM-1B model, which it likes to call the “Tiny Giant.” It supposedly only has 1b parameters, yet Marc Benoff claims it outperforms modelx 7x its size and boldly says: “On-device agentic AI is here”  
• This spring Microsoft launched Phi-3 Mini, a 3.8 billion parameter model, which is small enough for a smartphone. It claims to compare well to GPT 3.5 as well as Meta’s Llama 3.
• H2O.ai offers Danube 2, a 1.8 b parameter model that Alan Simon of Hackernoon calls the most accurate of the open source, tiny LLM models.   

A few billion parameters may not sound so “tiny,” but keep in mind that other AI models may have trillions.

TinyML even has its own foundation, “a worldwide non-profit organization empowering a community of professionals, academia and policy makers focused on low power AI at the very edge of the cloud.” Its ECO Edge workshop next month will focus on “advancing sustainable machine learning at the edge,”

Rajeshwari Ganesan, Distinguished technologist at Infosys, goes so far as to assert, in AI Business, that “Tiny AI is the future of AI.”  She shares tinyML’s concern about sustainability; AI’s “associated environmental cost is worrisome. AI already has a huge carbon footprint — even larger than that of the airline industry.” With billions – that’s right, billions -- of IoT devices coming online in the next few years, she warns: “the processing power requirements may explode due to the sheer amount of data generated by them. It is imperative to shift some of the compute load to edge devices. Such small AI models can be pushed to edge IoT devices that require minimal energy and processing capacity.”

European tech company Imec is big into TinyAI, and also fears AI’s ecological impact, calling current approaches to AI “economically and ecologically unsustainable.” Instead, it believes: “The era of cloud dominance is ending: future AI environments will be decentralized. Edge and extreme edge devices will do their own processing. They will send a minimum amount of data to a central hub. And they will work – and learn – together.”

Imec sees a big future for Tiny AI in implantables. Credit: Imec

The fun part, of course, is imagining what TinyAI could be used for. Professor Nakhle says: “Among the immediate and realistic applications, healthcare stands out as a domain ripe for transformation.” He goes on to describe such potential transformations:

For instance, if paired with accessible pricing tailored to specific regions and nations, wearable devices equipped with TinyAI capabilities can revolutionize patient monitoring by analyzing vital signs and detecting anomalies in real time and promptly alerting users to irregular heart rhythms or fluctuations in blood pressure, facilitating timely intervention and improving health outcomes.

Imec sees healthcare as a particular area of focus, and offers these examples for TinyAI:

• “In genomics, improvements in data usage, algorithms and hardware lead to faster results – demonstrated in our ExaScience Lab and the Genome Analytics Platform project.
• Connected health solutions comfortably gather medical-grade data that’s used for clinical research (e.g. neurotechnology) or continuous monitoring through wearable, implantable, ingestible or non-contact technologies.
• A project such as ROBO-CURE uses artificial intelligence for personalized treatments of children with type 1 diabetes.”

Another example is one of my favorite future healthcare technologies, nanorobots. MIT just announced a tiny battery for use in cell-sized robots, which “could enable the deployment of cell-sized, autonomous robots for drug delivery within in the human body,” among other things. Now we’ll just have to get TinyAI into those robots to help achieve the many tasks we’ll be asking of them.

We’re already overflowing with great ideas for how to use AI in healthcare; we’ve barely scratched its potential.  Once we get our heads around TinyAI, we’ll find even more ways to apply it. The future is vast…and may be tiny.

Exciting times indeed.

Take My Gun, I Mean, Phone Please

I understand that states are “racing” to pass laws designed to help protect school-aged kids against something that has been a danger to their mental and physical health for a generation now, as well as adversely impacting their education. Certainly I’m talking about reasonable gun control laws, right?

Should this be banned? Credit: Bing Image Creator

Just kidding. This is America. We don’t do gun control laws, no matter how many innocent school children, or other bystanders, are massacred. No, what states are taking action on are cellphones in schools.

Florida seems to have kicked it off, with a new last year banning cell phones and other wireless devices “during instructional times.” It also prohibiting using TikTok on school grounds. Indiana, Louisiana, Ohio, and South Carolina followed suit this year, although the new laws vary in specifics.  Connecticut, Kansas, Oklahoma, Washington, and Vermont have introduced their own versions.  Delaware and Pennsylvania are giving money to schools to try lockable phone pouches.

It’s worth pointing out that school districts were not waiting around for states to act. According to a Pew Research survey earlier this year,  82% of teachers reported their district had policies regarding cellphones in classrooms. Those policies might not have been bans, but at least the districts were making efforts to control the use.

Surprisingly, high school teachers – whose students were most likely to have cellphones -- were least likely to report such policies, but, not surprisingly, the most likely to report that such policies were difficult to enforce.  Also not surprising, 72% of high school teachers say students being distracted by cellphones in the classroom is a major problem.

Russell Shaw, the head of school at Georgetown Day School in Washington, D.C., writes in The Atlantic that his parents were given free sample packs of cigarettes in school, and warns:

I believe that future generations will look back with the same incredulity at our acceptance of phones in schools. The research is clear: The dramatic rise in adolescent anxiety, depression, and suicide correlates closely with the widespread adoption of smartphones over the past 15 years. Although causation is debated, as a school head for 14 years, I know what I have seen: Unfettered phone usage at school hurts our kids. 

Similarly, last year Jonathan Haidt, a social psychologist at NYU, urged emphatically: Get Phones Out of School Now. At the least, he writes, they’re a distraction, harming their learning and their ability to focus; at worst, they weaken social connections, are used for bullying, and can lead to mental health issues. “All children deserve schools that will help them learn, cultivate deep friendships, and develop into mentally healthy young adults,” Professor Haidt believes. “All children deserve phone-free schools.”

Mr. Shaw agrees. “For too long, children all over the world have been guinea pigs in a dangerous experiment. The results are in. We need to take phones out of schools.”

Believe it or not, not everyone agrees. Some argue that, like it or not, our world is filled with cellphones, and to try to pretend that is not true will just make it harder for kids once they become adults. Along those lines, skeptics note that classrooms are filled with other devices; if kids aren’t distracted by their cellphones, there’s usually a tablet, laptop, or other device handy. And the kids can argue, hey, the adults – the teachers, the administrators, the volunteers – all have cellphones; why shouldn’t we?

Some parents are opposed to the bans. They want to know where their kids are at all times, and to be able to track them in case of an emergency. Even more chilling, some parents argue that if there is a school shooting, they want their kids to be able to call for help, and to let them know their status. None of us can forget the heartbreaking calls that some of the Uvalde children made.  

Of course, even if cellphones are banned during class time or even on school grounds entirely, those phones are going to be there once they leave the school grounds, so their potential for adverse mental impacts will still be there. If distraction is the problem – and I can see where it would be – isn’t it a similar problem for adults?  How many meetings, conferences, or social situations have you been in where many of the adults are paying more attention to their phone than to whatever is being discussed? 

I wonder if the Supreme Court has a policy about cellphones during its deliberations.

All this brings me back to guns. According to the K-12 Shooting Database, there have already been 193 school shooting incidents already this year, with 152 victims (fatal and wounded). That compares to 349 and 249 respectively in 2023, and 308/273 in 2022. I needn’t point out – but I will – that no other nation has numbers anywhere close to those.

I recently read John Woodrow Cox’s searing Children Under Fire. He points out that, even beyond the fatalities, wounded kids need not just medical care but ongoing mental health treatment. Their families usually need it too. The trauma goes well beyond the direct victims. The victim’s classmates and families often need it as well, as do schoolchildren in other districts, even in other states. Even practicing lockdowns have an impact on mental health.

He estimates that there are millions, perhaps tens of millions, of impacted schoolchildren and their families. Yet states aren’t racing to ensure support for all those victims.  

Mr. Cox suggests that the least we could do, the very least, are to ensure more background checks, to hold adults more responsible for the guns in their homes, and to conduct more research on gun violence. Instead, states are rushing to “harden” schools and to get more people with guns guarding (and teaching in) those schools. 

Oh, and to ban cellphones. We must have priorities, after all.

Look, if I was a teacher, I’d hate seeing kids on their phones during class. If I was administrator, I’d be worried about kids hanging out on their phones instead of talking with each other. If I was a parent I’d be nagging my kids to study or read a book instead of being on a screen. I get all that; I understand the drive to better manage cellphone use.

But if people think cell phones are more of a danger to their kids than gun violence, I’m going to have to disagree.   a danger to their kids than gun violence, I’m going to have to disagree.

It's in the Blood

People are fascinated by blood. Well, it would seem so, given our fondness for vampires, gory movies, and true crime stories. I’m not so keen on any of those, but I was struck by several recent developments about how blood tests can help diagnose medical problems faster, more definitively, and less invasively.

C'mon, it's not that bad. Credit: Bing Image Creator

Because, really, shouldn’t that be what our healthcare system always should strive for?

Take concussions. If you are a football fan, you’re very familiar with the problem that it seems very subjective about whether a player has suffered a concussion. They’re not the only ones. Millions of people suffer concussions each year – the vast majority of whom are not athletes – and more than half never get it evaluated.

In April Abbott received FDA approval for a rapid blood test, producing results in 15 minutes. It can be done at a patient’s beside, and not require a lab. "Clinicians have needed an objective way to assess patients with concussions," said Beth McQuiston, M.D., medical director in Abbott's diagnostics business. "When you look at all the other diseases, or other organs in the body, they all have blood tests to help assess what's happening. Now, we have a whole blood test that can help assess the brain right at the patient's bedside – expanding access to more health providers and therefore patients."

Expect to see the Abbott's i-STAT TBI cartridge and portable i-STAT^® Alinity^® instrument in emergency rooms, not to mention on NFL sidelines.

Credit: Abbott

Or Alzheimer’s disease. Many realize that it has historically been very difficult to diagnose, often not definitively until after death. Now a new study suggests a blood test can accurately diagnose it 90% of the time, which is much higher than even neurologists can do. The test is more accurate the later the stage of Alzheimer’s a person has.

Specifically, it measures “the ratio of plasma phosphorylated tau 217 (p-tau217) relative to non–p-tau217 (expressed as percentage of p-tau217) combined with the amyloid-β 42 and amyloid-β 40 plasma ratio (the amyloid probability score 2 [APS2]).” Got that?

“We’d love to have a blood test that can be used in a primary care physician’s office, functioning like a cholesterol test but for Alzheimer’s,” Dr. Maria Carrillo, chief science officer of the Alzheimer’s Association, told CNN. “The p-tau217 blood test is turning out to be the most specific for Alzheimer’s and the one with the most validity. It seems to be the front-runner.”

It’s not quite ready for use in your doctor’s office, though. “Right now, we don’t have guidelines for the use of these tests,” Dr. Eliezer Masliah, director of the division of neuroscience at the National Institute on Aging, warned NPR. Dr. Suzanne Schindler, an associate professor of neurology at Washington University School of Medicine in St. Louis, added: “Blood tests have developed incredibly fast for Alzheimer disease and I think [doctors] aren’t used to that rate of change.”

“The field is moving at a pace I never imagined 10 years ago,” Dr. Heather Whitson, a professor of medicine at Duke University, marveled to NPR.

We’re increasingly seeing FDA approved drug treatments for Alzheimer’s, so it’d be nice if we had FDA approved blood tests to more accurately use them.  

Last but not least, there’s colorectal cancer (CRC). The FDA recently approved Guardant Health’s Shield™ blood test for colorectal cancer screening, and is the first such blood test approved by the FDA as a primary screening option. A Guardant study found that it identified 87% of cancers that were at an early and curable stage, although it does less well at finding precancerous growths. The test is aimed at adults 45 and older who are at average risk.

Credit: Guardant Health

It’s not so much that it is better than colonoscopies – it’s not -- as it is that it should be easier to convince people to use. Despite the fact that CRC kills over 50,000 Americans annually, more than a third of older Americans are not getting screened. Even worse, more than three-fourths of those who die from CRC are not up-to-date with their screening.

“The persistent gap in colorectal cancer screening rates shows that the existing screening options do not appeal to millions of people,” said Daniel Chung, MD, gastroenterologist at Massachusetts General Hospital and Professor of Medicine at Harvard Medical School. “The FDA's approval of the Shield blood test marks a tremendous leap forward, offering a compelling new solution to close this gap.”

Dr. Sapna Syngal, director of strategic planning for prevention and early cancer detection at the Dana-Farber Cancer Center in Boston agrees, telling NBC News: “If this test increases the number of people getting screened, it’s going to have a huge impact.” 

The test is on the market now, and Guardant expects approval for coverage by Medicare and commercial insurance.

Most of us are used to getting routine blood tests for things like blood counts or cholesterol levels, so it’s exciting that blood tests are started to be used for other important health issues.

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Blood tests are all well and good, but they’re not (yet) the kind of test you’d routinely expect to use at home on your own. ARPA-H has even bigger aspirations. It just announced the Platform Optimizing SynBio for Early Intervention and Detection in Oncology (POSEIDON) program, the goal of which is “to develop first-in-class, at-home, synthetic Multi-Cancer-Early Detection (MCED) tests for the most sensitive and specific stage I detection of 30+ solid tumors* using only breath and/or urine samples.”

No blood draw or lab tech needed, just breath or urine samples done yourself at home. That’s something to shoot for.

“Access to a low-cost cancer screening test that does not need a lab test is so critical to preventing late-stage diagnoses, increasing survival rates, and reducing high treatment costs,” said ARPA-H Director Renee Wegrzyn, Ph.D. “With POSEIDON, we could put the power of cancer screening into homes in the U.S. and around the world.” 

“But what if any adult could, at their discretion, take an at-home test that could detect Stage I cancer? POSEIDON aims to create a future in which any adult can take a simple, over-the-counter test to screen for and detect 30+ cancers at Stage I, when they are still localized, to drastically improve the chances of curative treatment and survival,” said Ross Uhrich, DMD, MBA, ARPA-H POSEIDON’s Program Manager.

“But what if…” indeed.  ARPA-H is thinking big -- as it should. And as should we all.

No, Healthcare Is NOT Brat

Until last week, I thought “brat” referred to an obnoxious child. I was vaguely aware of Charli XCX, but I wasn’t aware that earlier this summer she’d dropped a new album with that name, or that the cultural zeitgeist subsequently declared this to be Brat Summer. Then last weekend in the space of a day, Joe Biden dropped out of the Presidential race, Vice President Harris became the presumptive Democratic presidential nominee, and Charli XCX tweeted “kamala IS brat.”

Credit: Charli XCX

V.P. Harris’s campaign exploded. Most of us had kind of been dreading the campaign between two eighty-year-old white guys, and then suddenly we had a mixed heritage woman as a candidate, who even at 59 seemed positively youthful by comparison. And brat to boot!

It’s been hilarious to watch people like Stephen Colbert or Jake Tapper try to explain brat to their viewers. Charli XCX herself described it on TikTok as:

That girl who is a little messy and likes to party, and maybe says dumb things sometimes, who feels herself but then also maybe has a breakdown but parties through it. It’s very honest; it’s very blunt—a little bit volatile, does dumb things, but, like, it’s brat. You’re brat. That’s brat.

It’s been taken much further than that, of course. An article in The Guardian described it: “Because, as we all know by now, brat – inspired by Charli’s most recent album – is more than a name, it’s a lifestyle. It is noughties excess, rave culture. It’s “a pack of cigs, a Bic lighter, a strappy white top with no bra”. It’s quintessentially cool.”  Shirly Li, in The Atlantic, opined: “The essence of “brat” is not defining people as such; it’s being simultaneously provocative and vulnerable.”

But, more to the point, Xochitl Gonzalez, also writing in The Atlantic, made clear how we should think about brat: “If you don’t know what that means, it doesn’t matter.” After all, if you’re not in on the joke, you are the joke.

The Harris campaign is all in on the joke. It fully embraced the appellation, even changing its campaign logo on social media to the easily identifiable lime green of the Brat album cover. The KHive is busy creating memes, posting TikTok clips, and filling the world with coconut emojis (long story). Some have claimed that brat summer is already over, but maybe not so fast.

Whether it is the brat effect or simply a honeymoon period for Ms. Harris, her favorability and enthusiasm ratings have soared, and the Presidential race polls again show a dead heat, after President Biden’s polls had tanked following his disastrous debate performance earlier this month. The simple fact that the Dems have a candidate who can become a cultural meme, in a good way, feels refreshing, especially in a campaign that heretofore had evoked more dread and resignation than enthusiasm.

I wish healthcare was brat.

It’s not brat to sit in your doctor’s waiting room. It’s not brat to be stuck in a telephone queue with your health insurance company. It’s not brat to get a healthcare bill that is confusing at best and terrifying at worst. It’s not brat to not be able to afford your medications, especially knowing that in other countries you’d pay much less for them. It’s not brat that we’re dying younger and have way more chronic illnesses than we once did. It’s really not brat that we’re particularly terrible at safeguarding the health of mothers and babies.  

AI in healthcare should be brat, if we don’t mess it up (and I fear we will). 3D printing of organs and tissues is brat, although it’s not mainstream yet. Nanorobots should be brat, if we can get to where we’ve been promised for years. Genetic therapy should be brat, although so far it seems like another way for pharmaceutical companies to charge us outrageous amounts.  Neural implants could be brat, although I’m worried Elon will Cybertruck it.  

It was pretty brat that we developed a COVID-19 vaccine so early in the pandemic, but not brat at all how it became politicized and, indeed, that people are turning away from vaccines generally. Cancer screenings should be brat, but, as anyone who has had a colonoscopy or mammogram can tell you, they’re not.

Being a doctor once might have been considered kind of brat, but now it just seems like kind of a sucker’s bet: all those years of training, all those debts that ensue from that, and then all the hassles once in practice. Who needs it? No wonder most medical students don’t really want a career that involves treating patients.

Health insurance most definitely is not brat (Oscar Health’s promises not withstanding). ACA made it less terrible, but there’s not too many people posting TikTok videos about how happy they are with their health insurance. It’s not brat at all that so many people remain without coverage, and that GoFundMe is a go-to for people dealing with huge medical bills.

I wish we had a healthcare system that I was excited about. According to a recent Harris poll, more than 70% of American’s feel our healthcare system fails them in some way. A Commonwealth Fund survey found 82% of Americans thought it should be fundamentally changed or completely rebuilt.

No, that’s not brat at all.

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I think of our healthcare system kind of like how I thought about Joe Biden running for President again. Nice guy, done a lot of good, means well, but, gosh, so 20^th century, so frail, and too fragile to count on being there for several more years. I want the brat version, the one that generates enthusiasm, excitement, the one that makes people want to post on social media about how it has helped them, the one that causes people to create memes praising it and the people working in it.

I want the 22^st century healthcare system, or at least a 2050 one, but I want it now. Amaze me, excite me, delight me. That’d be brat.

Vote, for Health's Sake

If you had on your political bingo card that our former President Trump would survive an assignation attempt, or that President Biden would drop out of the race a few weeks before being renominated for 2024, then you’re playing a more advanced game than I was (on the other hand, the chances that Trump would get convicted of felonies or that Biden would have a bad debate almost seemed inevitable). If we thought 2020 was the most consequential election of our lifetimes, then fasten your seat belt, because 2024 is already proving to be a bumpier ride, with more shocks undoubtedly to come.

Voting does matter. Credit: Bing Image Creator

I don’t normally write about politics, but a recent report from the Commonwealth Fund serves as a reminder: it does matter who you vote for.  It is literally a matter of life and death.

The report is the 2024 State Scorecard on Women’s Health and Reproductive Care. Long story short: “Women’s health is in a perilous place.” Lead author Sara Collins added: “Women’s health is in a very fragile place. Our health system is failing women of reproductive age, especially women of color and low-income women.”

The report’s findings are chilling:

Using the latest available data, the scorecard findings show significant disparities between states in reproductive care and women’s health, as well as deepening racial and ethnic gaps in health outcomes, with stark inequities in avoidable deaths and access to essential health services. The findings suggest these gaps could widen further, especially for women of color and those with low incomes in states with restricted access to comprehensive reproductive health care.

"We found a threefold difference across states with the highest rates of death concentrated in the southeastern states," David Radley, Ph.D., MPH, the fund's senior scientist of tracking health system performance, said in a news conference last week. "We also saw big differences across states in women's ability to access care."

Joseph R. Betancourt, M.D., Commonwealth Fund President, said: “Where you live matters to your health and healthcare. This is having a disproportionate effect on women of color and women with low incomes.” Dr. Jonas Swartz, assistant professor of obstetrics and gynecology at Duke Health in Durham, North Carolina agreed, telling NBC News: “Your zip code shouldn’t dictate your reproductive health destiny. But that is the reality.”

The study evaluated a variety of health outcomes, including all-cause mortality, maternal and infant mortality, preterm birth rates, syphilis among women of reproductive age, infants born with congenital syphilis, self-reported health status, postpartum depression, breast and cervical cancer deaths, poor mental health, and intimate partner violence. To measure coverage, access, and affordability, it looked at insurance coverage, usual source of care, cost-related problems getting health care, and system capacity for reproductive health services.

There are, as you can imagine, charts galore.

The lowest performing states – and I doubt these will be a surprise to anyone -- were Mississippi, Texas, Nevada, and Oklahoma. The highest rated states were Massachusetts, Vermont, and Rhode Island.

Just to round out the bottom ten states, they were Arkansas, Georgia, Alabama, Arizona, Tennessee, and Wyoming. You will, perhaps, notice that almost all are red (purple for Arizona and Nevada) states, and there is a significant overlap with states that did not expand Medicaid under ACA.  

"It's hard to stress how critical a source of coverage Medicaid is for pregnant women," Dr. Radley said. "Medicaid covers approximately 42% of all births in the US." Even though non-expanded Medicaid does offer more coverage for pregnant women, Dr. Collins noted that wasn’t enough: “It means that women enter their pregnancy having had less access to healthcare, particularly if they’re poor or low income. It’s pretty clear that having health insurance that’s adequate… is really necessary to access the healthcare system.”

Equally concerning, the report found that states with abortion restrictions “tend to have the fewest number of maternity care providers.” It details:

Of these 24 states, 21 have the fewest number of maternity care providers relative to the number of women who might need them. In 2023 and 2024, fewer medical school graduates applied to residency programs in states that banned abortion, both in obstetrics and gynecology and across all specialties, compared to states without bans.

Dr. Radley lamented: "Approximately 5.6 million women live in counties that are considered maternity care deserts."

It is worth noting that just three months ago the Commonwealth Fund issued another state-by-state report, focusing on racial and ethnic heath disparities, with many of the same low performing states showing up on that list as well. An overlay of poverty would track as well.

“These inequities are long-standing, no doubt,” Dr. Betancourt at the media briefing. “But recent policy choices and judicial decisions restricting access to reproductive care have and may continue to exacerbate them.”  I.e., the Dobbs decision overturning Roe v. Wade and subsequent state actions to restrict abortion access, which the authors say “significantly altered both access to reproductive health care services and how providers are able to treat pregnancy complications.”

It would be easy, and not entirely wrong, to blame all these on underlying social determinants of health (SDoH), but coverage of the Commonwealth Fund’s report introduced me to a related term that I think is equally to blame: “political determinants of health.” That term, as espoused by Daniel E. Dawes, points the finger directly at legislative and policy decisions.

“When you think of the structural conditions that many folks find themselves in, there is an underlying policy – political action or inaction – that has determined those conditions and structured the resources that has enabled those conditions to exist,” Professor Dawes told The Guardian.

The report grimly concludes:

Ongoing judicial action at the federal level, along with the potential for a policy reversal under the next administration, raise further concerns over the future of women’s health… Our findings suggest that urgent action by Congress and state policymakers is necessary to ensure women have timely access to complete health and reproductive care, regardless of who they are, what they earn, or where they live.

These findings, and a host of other reports on state-by-state disparities, shouldn’t just be of concern to women, or to people of color, or to low-income families. They’re not just something for clinicians to address. These are political issues that can impact us all.

SDoH can take decades to reverse, but political determinants of health get influenced in every election. It’s up to us to vote thoughtfully. So vote like your health depends on it – or like your mother’s, sister’s, or daughter’s health does.

Google Hopes Nobody Beats This Wiz

When I saw the Wall Street Journal article about Alphabet being in “advanced talks” to buy cybersecurity firm Wiz for an eye-popping $23b, I must confess that – never having previously heard of the company – my thoughts flashed back to the Seinfeld episode (“The Junk Mail”) where Elaine dates a man whose job turns out to be an outlandish mascot for electronics store The Wiz, whose motto he gleefully repeats: “Nobody beats The Wiz!”  That firm is long gone but this Wiz is alive and well, enough so that the acquisition would be Alphabet’s largest ever.

Credit: Gizchina

The Wiz was only founded in 2020, by four ex-Israeli military officers (they reportedly all originally worked together at Israel’s equivalent of the NSA). They had previously founded cloud cybersecurity firm Adallom in 2012, which they sold to Microsoft in 2015 for its Azure cloud computing firm. Wiz also specializes in cloud cybersecurity, and, according to WSJ, its clients include 40% of the Fortune 500 companies as customers, including Barclay’s, Mars, Morgan Stanley, and Slack. Other notable customers include BMW, DocuSign, EA, and Salesforce.

Pretty impressive for a four-year-old start-up.

Credit: Wiz

Alphabet’s cloud business – Google Cloud Platform (GCP) -- badly trails leaders AWS (Amazon) and Azure (Microsoft), although last year GCP’s revenue’s rose 26% and it recorded its first operating profit. It’s Q1 2024 revenue was up 28%. By the way, Wiz lists both AWS and Azure as partners, along with GCP, Oracle Cloud Infrastructure, VMware, and Alibaba Cloud.  

Alphabet had bought security company Mandiant two years ago for $5.4b, as well as Siemplify, another Israeli cloud cybersecurity company, that same year, and evidently sees these acquisition as a way to bolster its cloud business.

For some perspective, just this past May Wiz raised $1b in a funding round that gave it a $12b valuation. Its annual recurring revenues are estimated at $500 million, so Alphabet’s offer is a 46 multiplier. By contrast, WSJ notes that competitor CrowdStrike has a market capitalization that is 25 times annual recurring revenues. “This could be one of the largest and fastest returns ever for a private security company in tech history,” Alex Clayton, a general partner at Meritech Capital, told WSJ.

“There are two advantages of Google acquiring Wiz,” Ray Wang, principal analyst and founder of Constellation Research, told CSO. “One, cloud security is hot and allows Google to cut into AWS and Azure clients, and two, having Wiz would give them some consistently large workloads to monetize.”

If you’re wondering why cloud security is hot, I need only mention AT&T, which recently disclosed that the records of “nearly all” of its cellular customers had been breached. Well, those records came from its cloud provider Snowflake -- and that was not the first time Snowflake has been attacked and possibly breached. Azure has also suffered some serious breaches, and has been accused of “repeated pattern of negligent cybersecurity practices.” AWS has had its share of data breaches as well.

So, yeah, a cloud service better have good cybersecurity.

The Independent praised Wiz’s “innovative interface,” which “provided visual displays that use graphs and charts to illustrate a company’s entire cloud security architecture, making it straightforward to identify threats and potential weaknesses.” (The Independent also had the headline I wished I’d thought of: Gee Wiz).

Display of Wiz Cloud Detection and Response (CDR). Credit: Wiz

Bank Info Security reported that “Wiz in January got the highest "current offering" rank from Forrester in cloud workload defense,” although “a weak cloud workload security strategy meant Wiz's total score came in fourth behind CrowdStrike, Palo Alto Networks and Microsoft.”  Wiz was also named the top rated cloud security company on the 2023 Forbes Cloud 100.

Pareekh Jain, CEO and lead analyst at Pareekh Consulting told CSO. “GCP is lagging behind AWS and Microsoft in the cloud and this acquisition could create a much-needed differentiator for GCP. There have been many cybersecurity incidents in the recent past and strong cloud security credentials could be a differentiator and deciding factor for enterprises considering their movement to cloud.”

“This was the missing piece in Google’s portfolio and helps them provide cybersecurity as a service bundled with their cloud offerings,” Neil Shah, VP for research and partner at Counterpart Research, also told CSO.

Much has been made of potential antitrust scrutiny of the deal, due to its size and the fact that Google is already being accused of being a monopoly. WSJ – which had another headline I wished I’d thought of (Google’s Wiz Deal Won’t Ease on Down the Road) – but Bank Info Security, for one, called those concerns “overblown”:

Despite Google being in the crosshairs of regulators on both sides of the Atlantic Ocean, antitrust probes are unlikely to sink a potential purchase of Wiz. Neither Google nor Wiz ranked among the seven market share leaders in cloud workload security in 2022, according to IDC, which said control of the market was in the hands of Trend Micro, Palo Alto, Microsoft, CrowdStrike, Check Point, Broadcom and Trellix.

It may take a while (less if Trump is reelected), but Google is likely to prevail. That being said, I expect that AWS, Azure, and GCP will end up getting spun-off or divested eventually, because they’re getting big enough to rival Amazon’s, Microsoft’s, and Alphabet’s core businesses. So, go ahead, power up the cybersecurity.  

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Look, I’m no cybersecurity expert, and I know even less about the cloud business. But I am an AT&T customer, not to mention a Ticketmaster one, and a United Healthcare one. For heaven’s sake, my local hospital system – which only serves my community – has been breached. So if GCP wants to spend $26b strengthening the security of its cloud business, I say more power to them, and I hope the other cloud companies follow suit.

Whatever worrying we’ve been doing about cybersecurity is nothing to how much we should be worrying about it once AI gets involved. “AI and Cybersecurity are the two biggest areas customers are investing their technology dollars,” Mr. Wang told CSO. “Google seeks to play in both areas.”

We’ve seen how much attention has been paid to A.I. companies, and how much investment is going to them, and we better see the same with cybersecurity.