Keep it Short

By KIM BELLARD

OK, I admit it: I’m on Facebook. I still use Twitter – whoops, I mean X. I have an Instagram account but don’t think I’ve ever posted. Although I’ve written about TikTok numerous times, I’ve never actually been on it. And while I am on YouTube, it’s more for clips from movies or TV shows than for videos from creators like MrBeast.  

So forgive me if I’m only belated taking a look at the short form video revolution.

As is often the case, a couple articles related to the topic spurred my attention: Caroline Mimbs Nyce’s Twitter’s Demise Is About So Much More Than Elon Musk in The Atlantic, and Jessica Toonkel’s Wall Street Journal article Your Kid Prefers YouTube to Netflix. That’s a Problem for Netflix. I urge you to read both.

Ms. Nyce makes that point that, while Elon may be doing a pretty good job damaging Twitter, much of its woes really are due to microblogging falling out of favor. Her take:

In the era of TikTok, the act of posting your two cents in two sentences for strangers to consume is starting to feel more and more unnatural. The lasting social-media imprint of 2023 may not be the self-immolation of Twitter but rather that short-form videos—on TikTok, Instagram, and other platforms—have tightened their choke hold on the internet. Text posts as we’ve always known them just can’t keep up.

She notes that Twitter is still the dominant platform, by far, for microblogging, but quotes a prediction from data.ai: “While platforms like X are likely to maintain a core niche of users, the overall trends show consumers are swapping out text-based social networking apps for photo and video-first platforms.”

“Short-form videos have become an attention vortex,” Ms. Nyce reports, citing figures from Sensor Tower that users spend an average of 91 minutes daily on TikTok and 61 minutes on Instagram.  

Indeed, Insider Intelligence estimates that video’s share of average daily social media went over 50% in 2022, and will reach 60% by 2025. It predicts that the short video “craze” will cool, but admits: “platforms must contend with the reality that consumers still love short videos.”

Meanwhile. Ms. Toonkel quotes a father of a 8 year-old, who has stopped watching shows like Thomas and Friends: “Now, all he wants to do is watch gamers and basketball clips and highlights on YouTube.” She adds: “The Levy family learned what has become clear across the media industry: When it comes to children’s entertainment preferences, YouTube trumps all.”

She reports: “Netflix’s share of U.S. streaming viewership by 2- to 11-year-olds fell to 21% in September from 25% two years earlier, according to Nielsen. Meanwhile, YouTube’s share jumped to 33% from 29.4% over the same period.” Michael Hirsh, co-founder of WOW Unlimited Media, confirmed: “These viewers are watching on their iPads or on other platforms that have moved to shorter and shorter segments, and it’s a real issue for the streamers.”

Ms. Toonkel cities an animation studio that released one new children’s film on Roblox, and other that premiered on YouTube instead of a streaming service. In both cases, the streaming services were a secondary priority. “It’s really about following the consumer,” the studio’s global chief marketing officer told her.

Two weeks ago Pew Research issued a study directly on point: Teens, Social Media and Technology 2023. YouTube, to no one’s surprise, is the top platform for teens 13 to 17, with 93% using. TikTok (63%), Snapchat (60%), and Instagram (59%) followed. Facebook (33%) and Twitter (20%) are barely an afterthought.

Seventy-one percent of teen YouTube users go on daily, with 16% on “almost constantly.” For TikTok, the corresponding figures were 58% and 17%.

YouTube’s popularity isn’t just among teens, of course. The Social Shepherd compiled some fun YouTube facts, such as:

–It has some 2.7 billion monthly users, with 1.5b on YouTube Shorts;

–There are 122 million daily users;

–98% of US internet users are on YouTube monthly, 92% weekly, 62% daily;

–US children spend 77 minutes daily on YouTube;

–The aforementioned Mr Beast is YouTube’s biggest earner, raking in an estimated $82 million annually;

–70% of viewers have made a purchase after seeing the brand on YouTube.

Companies better be paying attention. Ms. Nyce warns: “In a recent survey by Sprout Social, a social-media-analytics tool, 41 percent of consumers said that they want brands to publish more 15- to 30-second videos more than they want any other style of social-media post. Just 10 percent wanted more text-only content.”

Digiday’s Krystal Scanlon believes: “The latest pivot toward video is in full swing, and unlike previous occasions, agencies must now master the art of short-form video rather than focusing solely on specific platforms.” She clarifies that not all platforms’ version of short form videos are the same, contrasting TikTok’s “short, engaging, creative videos” with YouTube Short’s “informational or tutorial-style videos.”

Her bottom line: “Simply put, the video content needs to be native to the platform, because consumers are fed up of seeing ads.” As TikTok said when introducing TikTok for Business, “Don’t Make Ads, Make TikToks.”

———–

Earlier this year Monigle released its Humanizing Brand Experience report. Among other things, it suggested a decline in consumers’ interest in “watching/reading about health and wellness topics,” and an increase in their distrust of healthcare providers.  Neither results are yet dismal, but they underscore that in a short form video world, even healthcare companies need to be rethinking their brand and content strategies.

Detailed web pages of health advice?  Who reads? Catchy TV ads? Who watches? Helpful videos with health information from respected physicians? Too long. Health is complicated, health care is idiosyncratic, so short form anything isn’t natural, but it may now be necessary.  

Those of us of a certain age may not quite understand or appreciate short form videos, but they’re not something we can ignore. Ms. Nyce’s closing thoughts are ominous:

Perhaps the biggest stress test for our short-form-video world has yet to come: the 2024 U.S. presidential election. Elections are where Twitter, and microblogging, have thrived. Meanwhile, in 2020, TikTok was much smaller than what it is now. Starting next year, its true reign might finally begin.

And, I might add, in a time of vaccine skepticism and rampant health misinformation, misleading/simplistic short forms videos pose an existential threat, unless countered by equally effective ones.

Time to up your short form video game, everyone.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

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2024 Prediction: Society Will Arrive at an Inflection Point in AI Advancement

By MIKE MAGEE

For my parents, March, 1965 was a banner month. First, that was the month that NASA launched the Gemini program, unleashing “transformative capabilities and cutting-edge technologies that paved the way for not only Apollo, but the achievements of the space shuttle, building the International Space Station and setting the stage for human exploration of Mars.” It also was the last month that either of them took a puff of their favored cigarette brand – L&M’s.

They are long gone, but the words “Gemini” and the L’s and the M’s have taken on new meaning and relevance now six decades later.

The name Gemini reemerged with great fanfare on December 6, 2023, when Google chair, Sundar Pichai, introduced “Gemini: our largest and most capable AI model.” Embedded in the announcement were the L’s and the M’s as we see here: “From natural image, audio and video understanding to mathematical reasoning, Gemini’s performance exceeds current state-of-the-art results on 30 of the 32 widely-used academic benchmarks used in large language model (LLM) research and development.

Google’s announcement also offered a head to head comparison with GPT-4 (Generative Pretrained Transformer-4.) It is the product of a non-profit initiative, and was released on March 14, 2023. Microsoft’s helpful AI search engine, Bing, helpfully informs that, “OpenAI is a research organization that aims to create artificial general intelligence (AGI) that can benefit all of humanity…They have created models such as Generative Pretrained Transformers (GPT) which can understand and generate text or code, and DALL-E, which can generate and edit images given a text description.”

While “Bing” goes all the way back to a Steve Ballmer announcement on May 28, 2009, it was 14 years into the future, on February 7, 2023, that the company announced a major overhaul that, 1 month later, would allow Microsoft to broadcast that Bing (by leveraging an agreement with OpenAI) now had more than 100 million users.

Which brings us back to the other LLM (large language model) – GPT-4, which the Gemini announcement explores in a head-to-head comparison with its’ new offering. Google embraces text, image, video, and audio comparisons, and declares Gemini superior to GPT-4.

Mark Minevich, a “highly regarded and trusted Digital Cognitive Strategist,” writing this month in Forbes, seems to agree with this, writing, “Google rocked the technology world with the unveiling of Gemini – an artificial intelligence system representing their most significant leap in AI capabilities. Hailed as a potential game-changer across industries, Gemini combines data types like never before to unlock new possibilities in machine learning… Its multimodal nature builds on yet goes far beyond predecessors like GPT-3.5 and GPT-4 in its ability to understand our complex world dynamically.”

Expect to hear the word “multimodality” repeatedly in 2024 and with emphasis.

But academics will be quick to remind that the origins can be traced all the way back to 1952 scholarly debates about “discourse analysis”, at a time when my Mom and Dad were still puffing on their L&M’s. Language and communication experts at the time recognized “a major shift from analyzing language, or mono-mode, to dealing with multi-mode meaning making practices such as: music, body language, facial expressions, images, architecture, and a great variety of communicative modes.”

Minevich believes that “With Gemini’s launch, society has arrived at an inflection point with AI advancement.” Powerhouse consulting group, BCG (Boston Consulting Group), definitely agrees. They’ve upgraded their L&M’s, with a new acronym, LMM, standing for “large multimodal model.” Leonid Zhukov, Ph.D, director of the BCG Global AI Institute, believes “LMMs have the potential to become the brains of autonomous agents—which don’t just sense but also act on their environment—in the next 3 to 5 years. This could pave the way for fully automated workflows.”

BCG predicts an explosion of activity among its corporate clients focused on labor productivity, personalized customer experiences, and accelerated (especially) scientific R&D. But they also see high volume consumer engagement generating content, new ideas, efficiency gains, and tailored personal experiences.

This seems to be BCG talk for “You ain’t seen nothing yet.” In 2024, they say all eyes are on “autonomous agents.” As they describe what’s coming next: “Autonomous agents are, in effect, dynamic systems that can both sense and act on their environment. In other words, with stand-alone LLMs, you have access to a powerful brain; autonomous agents add arms and legs.”

This kind of talk is making a whole bunch of people nervous. Most have already heard Elon Musk’s famous 2023 quote, “Mark my words, AI is far more dangerous than nukes. I am really quite close to the cutting edge in AI, and it scares the hell out of me.”  BCG acknowledges as much, saying, “Using AI, which generates as much hope as it does horror, therefore poses a conundrum for business… Maintaining human control is central to responsible AI; the risks of AI failures are greatest when timely human intervention isn’t possible. It also demands tempering business performance with safety, security, and fairness… scientists usually focus on the technical challenge of building goodness and fairness into AI, which, logically, is impossible to accomplish unless all humans are good and fair.”

Expect in 2024 to see once again the worn out phrase “Three Pillars” . This time it will be attached to LMM AI, and it will advocate for three forms of “license” in operate:

1. Legal license – “regulatory permits and statutory obligations.”
2. Economic license – ROI to shareholders and executives.
3. Social license – a social contract delivering transparency, equity and justice to society.

BCG suggests that trust will be the core challenge, and that technology is tricky. We’ve been there before. The 1964 Surgeon General’s report knocked the socks off of tobacco company execs who thought high-tech filters would shield them from liability. But the government report burst that bubble by stating “Cigarette smoking is a health hazard of sufficient importance in the United States to warrant appropriate remedial action.”  Then came the Gemini 6A’s 1st attempt to launch on December 12,1965.  It was cancelled when its’ fuel igniter failed.

Generative AI driven LMM’s will “likely be transformative,” but clearly will also have its ups and downs as well.  As BCG cautions, “Trust is critical for social acceptance, especially in cases where AI can act independent of human supervision and have an impact on human lives.”

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex.

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A Speech For The Ages – 83 Years Ago This Christmas

By MIKE MAGEE

On the evening of December 29, 1940, with election to his 3rd term as President secured, FDR delivered these words as part of his sixteenth “Fireside Chat”: “There can be no appeasement with ruthlessness…No man can tame a tiger into a kitten by stroking it.”

Millions of Americans, and millions of Britains were tuned in that evening, as President Roosevelt made clear where he stood while carefully avoiding over-stepping his authority in a nation still in the grips of a combative and isolationist opposition party.

That very evening, the Germans Luftwaffe, launched their largest yet raid on the financial district of London. Their “fire starter” group, KGr 100, initiated the attack with incendiary bombs that triggered fifteen hundred fires that began a conflagration ending in what some labeled the The Second Great Fire of London. Less than a year later, on the eve of another Christmas, we would be drawn into the war with the bombing of Pearl Harbor.

Now, 83 Christmases later, with warnings of “poisoning the blood of our people,” we find ourselves contending with our own Hitler here at home.  Trump is busy igniting white supremacist fires utilizing the same vocabulary and challenging the boundaries of decency, safety and civility. What has the rest of the civilized world learned in the meantime?

First, appeasement does not work. It expands the vulnerability of a majority suffering the “tyranny of the minority.”

Second, the radicalized minority will utilize any weapon available, without constraint, to maintain and expand their power.

Third, the battle to save and preserve democracy in these modern times is never fully won. We remain in the early years of this deadly serious conflict, awakened from a self-induced slumber on January 6, 2020.

Hitler was no more an “evil genius” than is Trump. But both advantaged historic and cultural biases and grievances, leveraging them and magnifying them with deliberate lies and media manipulation. Cultures made sick by racism, systemic inequality, hopelessness, patriarchy, and violence, clearly can be harnessed for great harm. But it doesn’t take a “genius.” Churchill never called Hitler a “genius.” Most often he only referred to him as “that bad man.”

The spectacle and emergence of Kevin McCarthy, followed by Mike Johnson, as Speaker of the House, and the contrasting address by House Minority Leader Hakeem Jeffries as he handed over the gavel, represent just one more skirmish in this “War for Democracy.” 

If our goal is a “healthier” America – one marked by compassion, understanding and partnership; one where fear and worry are counter-acted by touch and comfort; one where linkages between individuals, families, communities and societies are constructed to last – all signals confirm that the time is now to fight with vigor.

As Churchill vowed on his first day as Prime Minister, “I have nothing to offer but blood, toil, tears, and sweat.” At about the same time, FDR offered this encouragement, “We have no excuse for defeatism. We have every good reason for hope — hope for peace, yes, and hope for the defense of our civilization and for the building of a better civilization in the future.”

The re-emergence of white supremacists and nationalists, theocratic and patriarchal censorship, and especially post-Dobbs attacks on women’s freedom and autonomy, are real and substantial threats to our form of government. They indeed are minority views, but no more so than the minority in 1940 which allowed a small group of “bad men” to harness a relatively small nation of 70 million people into a force that very nearly conquered the world.

Following the December 7, 1941 attack on Pearl Harbor. Churchill packed his bags and headed directly to a British battleship for the 10-day voyage in rough seas (filled with German U-boats) to Norfolk, VA. Hours after arrival he was aboard a U.S. Navy plane for the 140 mile trip to the White House which he entered in a double breasted peacoat and a naval cap, chomping on a cigar. He would remain the guest of the Roosevelts for the next three weeks, heading home on January 14, 1942.

On Christmas Eve, he joined the President on the South Portico of the White House for the lighting of the White House Christmas tree. Here is what Churchill said to the President’s guests and 15,000 onlookers: “Let the children have their night of fun and laughter. Let gifts of Father Christmas delight their play. Let us share to the full in their unstinted pleasures before we turn again to the stern tasks and formidable year that lie before us. Resolve! – that by our sacrifice and daring, these same children shall not be robbed their inheritance and denied their right to live in a free and decent world.”

He spent the following day working on a speech to be delivered to a Joint Meeting of Congress on December 26, 1941, the kind of a Pep talk all good and decent people of America could benefit from today.  As we ourselves have learned since January 6, 2021, Churchill was right to warn us of complacency and caution, and that “many disappointments and unpleasant surprises await us.” 

He was clear and concise when he warned that day that Hitler and his Nazis (whom Trump so openly admires) possessed powers that “are enormous; they are bitter; they are ruthless.” But these “wicked men…know they will be called to terrible account…Now, we are the masters of our fate…The task which has been set is not above our strength. Its’ pangs and trials are not beyond our endurance.”

“Trump will be defeated,” he would say were he with us today. “You may be sure of that!” But we must be up to the task – brave, organized, and strategic. Now is the time, and as the British Times of London editorial reminded in 1942, as Churchill set foot once again on homeland after his American visit, timing is everything. “His visit to the United States has marked a turning-point of the war. No praise can be too high for the far-sightedness and promptness of the decision to make it.”

Mike Magee MD is a Medical Historian, a regular THCB contributor, and the author of CODE BLUE: Inside America’s Medical Industrial Complex.

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A Place to Call Home

By KIM BELLARD

Congratulations, America. We have another new record, albeit a dismal one. According to the Department of Housing and Urban Development (HUD), there are now 653,000 homeless people, up 12% from the prior year. As one can imagine, compiling such a number is problematic at best, and no doubt misses a non-trivial number of such unfortunate people.

“Homelessness is solvable and should not exist in the United States,” said HUD Secretary Marcia L. Fudge. Well, yeah, like kids without enough food, pregnant women without access to adequate prenatal care, or people without health insurance, yet here we are.

HUD says that the increase was driven by people who became for the first time, up some 25%. It attributes this to “a combination of factors, including but not limited to, the recent changes in the rental housing market and the winding down of pandemic protections and programs focused on preventing evictions and housing loss.” As with the recent increase in child poverty, the lessons that we should have learn from our COVID response didn’t survive our willingness to put the pandemic behind us.

Jeff Olivet, executive director of the U.S. Interagency Council on Homelessness, told AP: “The most significant causes are the shortage of affordable homes and the high cost of housing that have left many Americans living paycheck to paycheck and one crisis away from homelessness.” The National Low Income Housing Coalition estimates we’re missing some 7 million affordable housing units, so I suppose we should be relived there are “only” 653,000 homeless people.

“For those on the frontlines of this crisis, it’s not surprising,” Ann Oliva, CEO of the National Alliance to End Homelessness, also told AP. Indeed, we’ve all seen news accounts of homeless encampments spreading seemingly out of control, many of us have spotted homeless people as we go about our daily lives, and yet most of us don’t want either homeless people or low income housing units in our neighborhoods.

We often tell ourselves that homeless people are mentally ill or drug users, but data suggests that most are homeless due to economic reasons.  As many as 60% of them are still working, but just can’t afford housing. Too many of us are one missing paycheck away from being on the street.

They’re more likely to be victims of crimes than criminals; in fact, BBC reports that violence against homeless people – including homicide – seems to be on the rise, although there is no systemic tracking of such violence.

In a searing piece in The Atlantic,  Annie Lowrey blasts our lack of anything resembling a national housing policy. She notes: “…today’s HUD is not much of a housing agency. And it is definitely not much of an urban-development agency.” Secretary Fudge told her: “HUD is doing all in our power to invest in those who have often been left out and left behind.” And that’s a big part of the problem.

As Ms. Lowry laments, despite the obvious housing crisis and record number of homeless,

Yet legislators have not passed a significant bill to get people off the streets and out of shelters. Joe Biden has not signed a law to increase the supply of rental apartments in high-cost regions or to protect families from predatory landlords. Congress has not made more families eligible for housing vouchers, or passed a statute protecting kids from the trauma of eviction, or set a goal for the production of new housing.

“The country’s lack of a national housing policy is part of the reason we are in a housing crisis,” she says, “and Washington needs to take a real role in ending it.”

What really got my attention was that a number of states and cities – most of them run by Democrats – want the Supreme court to overturn Martin vs. Boise, which ruled that evicting homeless people who had no choice of indoor housing was “cruel and unusual punishment” and thus unconstitutional. If you want to evict them from their outdoor housing, the court said, you better have places to put them.

Seems reasonable to me. I mean, they’re already homeless; where else do you expect them to go? It doesn’t help that many places are criminalizing homelessness, as though it was a choice those people were making.

I don’t usually look to Texas for solutions to social issues, but when it comes to the homeless, it may be a leader. Over the last decade, Texas has decreased its homeless population by nearly a third, in part because it builds more housing, and less expensive housing.

Cities such as Austin, Houston, and San Antonio have been particular innovators. Houston has cut its homeless population by two-thirds. There was a concerted city-county effort to coordinate the work of public agencies and over 100 non-profits. (Outgoing) Houston Mayor Sylvester Turner brags. “Instead of a hundred NGOs competing with each other, we’ve kind of pulled them all together. They’re now operating under a single umbrella, The Way Home.”

The focus is to get homeless people into housing first, then address their other issues. As The Way Home says, “first, we give them a key.” Then they work on providing them supportive services to help stabilize their lives. Even law enforcement is on board; Harris County Sheriff Ed Gonzalez says:

“…I think it’s important for us to recognize that it really is a public health issue: How can we better develop those systems of care, to better route people where they may need to be, rather than just looking at it through the lens of policing.”

That sure beats just breaking up encampments.

Meanwhile, Austin has focused on providing “tiny homes,” while San Antonio has built a huge homeless shelter. It’s important to note that these are local initiatives; Texas itself provides very little state funding for the homeless.  None of these cities has “solved” homelessness, but they’ve shown ways to lessen it.

————

Like poverty, homelessness isn’t inevitable; it is a policy choice. Sociologist Matthew Desmond, author of the must-reads Poverty and Evicted, told Ms. Lowrey: “Think of lining up families who qualify for food stamps and only one in four families gets to eat. That’s exactly how we treat housing policy today. It doesn’t make a lot of sense, because, without stable shelter, everything else falls apart.” Accordingly, Ms. Lowrey asserts: “affordable housing for everyone, everywhere, and the end of homelessness should be the policy priority now.”

We may not be able to end homelessness, but we can and should stop treating them as undesirables and start treating them as people – people who first and foremost need a place to live.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

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AI Could Have “Unimaginable Consequences” For Democratic Societies, Says Expert.

By MIKE MAGEE

His biography states, “He speaks to philosophical questions about the fears and possibilities of new technology and how we can be empowered to shape our future. His work to bridge cultures spans artificial intelligence, cognition, language, music, creativity, ethics, society, and policy.”

He embraces the title “cross-disciplinary,” and yet his PhD thesis at UC Berkeley in 1980 “was one of the first to spur the paradigm shift toward machine learning based natural language processing technologies.” Credited with inventing and building “the world’s first global-scale online language translator that spawned Google Translate, Yahoo Translate, and Microsoft Bing Translator,” he is clearly a “connector” in a world currently consumed by “dividers.” In 2019, Google named De Kai as “one of eight inaugural members of its AI Ethics Council.”

The all encompassing challenge of our day, as he sees it, is relating to each other. As he says, “The biggest fear is fear itself – the way AI amplifies human fear exponentially…turning us upon ourselves through AI powered social media driving misinformation, divisiveness, polarization, hatred and paranoia.” The value system he embraces “stems from a liberal arts perspective emphasizing creativity in both technical and humanistic dimensions.”

Dr. De Kai is feeling especially urgent these days, which is a bit out of character.

As a 7 year old child of Chinese immigrants in St. Louis, he spoke little English, saying what needed to be said on the family’s piano. Summers were spent back and forth between Hong Kong and the states. Others noticed he’d sneak in some blues to the classical pieces, causing his grandfather to remark the synthesis pieces sounded “Chinese” to him. This led the budding linguist/musicologist to later reflect that “That got me thinking. I realized that the way we understand music is really dependent on the cultural frame of reference we adopt.”

Music and technology married during his PhD work at UC Berkeley, and eventually grounded four decades of research in “natural language processing and computational creativity.” He has earned the right to chill, but is anything but at ease these days, and the cause of his anguish is existential artificial intelligence.

As he said recently, “We are on the verge of breaking all our social, cultural and governmental norms…Our social norms were not designed to handle this level of stress.”

De Kai has morphed into an AI Ethicist. He is on a personal quest and anxious to bare his soul. The questions that keep him up at night all consider whether he is parenting his “AI children” properly. “Am I setting a good example? Am I a good role model? Do I speak respectfully to AI and teach them to respect diversity, or do I show them that it’s okay to insult people online?”

His focus is solidly on the here and now, because he doesn’t believe time is on our side. “We have more AIs today that are part of our society. These are functioning, integral, active, imitative, learning, influential members of society more than most — probably more influential than 90 percent of human society — in shaping culture…. Even though these are really weak AI’s, the culture that we are jointly shaping with our artificial members of society is the one under which every successive stronger generation of AI’s will be learning and spreading their culture. We are already in that cycle and we don’t realize it because we don’t look at machines from a sociological standpoint… This is unprecedented, given the ways we have created to develop and relate, both good and bad, will be exponentially increased by AI. In this way, the impact it will have on society and culture will be unimaginable.”

Raising “mindful AI’s” in the age of Trump is no small feat. It demands that AI children be “mindful of their ethical responsibilities.” Pulling this off in the developed world with an increasingly fractured educational system that pits science/technology against humanities will be a remarkable challenge. As De Kai puts it, “It is the single worst possible time in history to have an education system that cripples people to be unable to think deeply across these boundaries, about what humanity is in the face of technology.

To accomplish “A.I. alignment with the goals of humanity,” may require Americans to examine their own health and wellness in a manner that could be profoundly uncomfortable. Population welfare, philosophical treatises, and political compromise are not exactly our cultural strong suits.

How will we do with these competing priorities, wonders De Kai in a recent New York Times Op-Ed:  “Short-term instant gratification? Long-term happiness? Avoidance of extinction? Individual liberties? Collective good? Bounds on inequality? Equal opportunity? Degree of governance? Free speech? Safety from harmful speech? Allowable degree of manipulation? Tolerance of diversity? Permissible recklessness? Rights versus responsibilities?”

“Culture matters. A.I.s are now an everyday part of our society”,says De Kai. Changing culture, as health professionals know, is a tall order. It is about compassion, understanding and partnerships. It is about healing, providing health, and keeping individuals, families and communities whole. And – most importantly – it is about managing population-wide fear, worry and anxiety.

What De Kai is setting out to do is to change our historic culture (one built on self-interest, hyper-competitiveness, and distrust of good government). This is a tall order – something that parents, pastors, politicians and physicians equally recognize. Things evolve, and difficult things take time.

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical-Industrial Complex.

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From Xenobots to Anthrobots

By KIM BELLARD

There were many things I could have written bout this week – e.g., in A.I., in quantum computing, even “transparent wood” — but when I saw some news about biological robots, I knew I had my topic.

The news comes from researchers at Tufts University and Harvard’s Wyss Institute. Their paper appeared in Advanced Science, introducing “a spheroid-shaped multicellular biological robot (biobot) platform” that they fondly dubbed “Anthrobots.” Importantly, the Anthrobots are made from human cells.

Let’s back up. In 2020, senior researcher Michael Levin, Ph.D., who holds positions at both Tufts and Harvard, worked with Josh Bongard, Ph.D. of the University of Vermont to create biological robots made from frog embryo cells, which they called Xenobots.  They were pretty impressive, capable of navigating passageways, collecting material, recording information, healing themselves from injury, and even replicating for a few cycles on their own, but the researchers wanted to find out if they could create biological robots from other types of cells – especially human cells.

Well, the new research showed that they could. They started with cells from adult trachea, and without genetic modification were able to demonstrate capabilities beyond those Xenobots had demonstrated. Lead author Gizem Gumuskaya, a PhD. student said: “We wanted to probe what cells can do besides create default features in the body. By reprogramming interactions between cells, new multicellular structures can be created, analogous to the way stone and brick can be arranged into different structural elements like walls, archways or columns.”   

The Anthrobots come in different shapes and sizes, and are capable of different motions. Ms. Gumuskaya is quite excited about their capabilities:

The cells can form layers, fold, make spheres, sort and separate themselves by type, fuse together, or even move. Two important differences from inanimate bricks are that cells can communicate with each other and create these structures dynamically, and each cell is programmed with many functions, like movement, secretion of molecules, detection of signals and more. We are just figuring out how to combine these elements to create new biological body plans and functions—different than those found in nature.

Even better, Ms. Gumuskaya pointed out: “Anthrobots self-assemble in the lab dish. Unlike Xenobots, they don’t require tweezers or scalpels to give them shape, and we can use adult cells – even cells from elderly patients – instead of embryonic cells. It’s fully scalable—we can produce swarms of these bots in parallel, which is a good start for developing a therapeutic tool.”

They tested Anthrobots’ healing capabilities by scratching a layer of neurons, then exposed the gap to a cluster of Anthrobots called a “superbot.”  That triggered neuron growth only in that area. The researchers noted: “Most remarkably, we found that Anthrobots induce efficient healing of defects in live human neural monolayers in vitro, causing neurites to grow into the gap and join the opposite sides of the injury.”

“The cellular assemblies we construct in the lab can have capabilities that go beyond what they do in the body,” said Dr. Levin. “It is fascinating and completely unexpected that normal patient tracheal cells, without modifying their DNA, can move on their own and encourage neuron growth across a region of damage.”

Xi “Charlie” Ren, a tissue engineer at Carnegie Mellon University who was not involved with the research, told Science that the work “is amazing, and groundbreaking,” and “opens the way to personalized medicine.” Ron Weiss, a synthetic biologist at the Massachusetts Institute of Technology who also was not involved with the work added: “Levin demonstrated that cells can be coached to do something they would never have done on their own.”

Some researchers are not yet convinced. Jamie Davies, a developmental biologist at the University of Edinburgh in Scotland, who was not involved in the 2020 study or this recent one, told Scientific American: “I cannot see how these clumps of cells with flailing cilia merit the term ‘bot.” Dr. Levin and his team, of course, don’t believe the movements are random, and that Anthrobots “could be designed to respond to their environment, and travel to and perform functions in the body, or help build engineered tissues in the lab.”

The ultimate hope is that clinicians would be able to use Anthrobots created from a patient’s own cells to perform therapeutic work. Those bots shouldn’t trigger an immune response, would be bioresorbable, and couldn’t survive outside the lab or the body (making risk of any unintended spread minimal).

The researchers see a wide variety of potential uses in health care:

…various applications can be imagined, including but not limited to clearing plaque buildup in the arteries of atherosclerosis patients, bulldozing the excess mucus from the airways of cystic fibrosis patients, and locally delivering drugs of interest in target tissues. The possible applications will represent those arising from exploiting surprising novel behaviors of cells and engineering new ones via future synthetic biology payloads, such as novel enzymes, antibodies, and other ways to manipulate the cells they traverse and interact with. They could also be used as avatars for personalized drug screening,^[32] having the advantage of behavior over simple organoids, which could be used to screen for a wider range of active, dynamic phenotypes.

That’s 21^st century medicine. That’s the kind of health care I want to see.

The researchers have a number of research areas they want to further explore, including:

• What other cells can Anthrobots be made of?
• What other behaviors might they exhibit, and in what environments?
• What other tissue types can they repair or affect in other ways?
• Can transcriptional or physiological signatures be read out in living bots, that reflect their past and immediate interactions with surrounding cellular or molecular landscapes?
• Do they have preferences or primitive learning capacities, with respect to their traversal of richer environments?

As researchers like to say, more research is required – and, from where I’m sitting, eagerly awaited.

—————–

OK, so these aren’t like the cute robots you see doing flips. They’re not the nanobots many of us have been waiting for. We don’t (yet) have to worry about Asimov’s Three Laws of Robotics with them. But, boy, if we’re going to have robots crawling around inside us doing therapeutic things – and we are — what could be better than a biological robot made from your own cells?

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

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The Courage of Corporate America is Needed to End America’s Opioid Crisis

By RYAN HAMPTON

A Kaiser Family Foundation tracking poll published in July found that three in ten U.S. adults (29%) said they had someone in their family who struggled with opioid dependence. Also surprising, and encouraging, was the statistic that 90% support increasing access to opioid use disorder treatment programs in their communities.

As a person in recovery from opioid use disorder and advocate, my read on this data set is that the public support is there. Now more than ever, we need leaders in healthcare, public policy, and corporate America to have the courage to advance effective treatment options. The most inspiring example of the kind of courage we need was the recent news that one of the nation’s largest retail grocery and pharmacy chains, Albertsons, made the financial investment to train their pharmacy staff to administer buprenorphine injections (known as Sublocade) on site.

To someone who is not in the weeds on the issue of opioid use disorder (OUD) treatment programs, this may just sound like a solid business decision. But go a layer deeper and the courage is evident: Albertsons decided to invest in an underutilized treatment option (despite buprenorphine being the gold-standard in OUD treatment) that serves a highly stigmatized patient population who is often shunned at pharmacy counters nationwide. Albertsons chose to put treatment centers for an underserved and highly stigmatized patient population in the middle of their family-friendly, neighborhood grocery pharmacy chain. 

The company rightly recognized that OUD impacts every family and community in this country—including the lives of its patrons. Albertsons pushed through stigma, not leaving the overdose crisis for someone else to address, because it had the ability to provide widespread access through its pharmacies and locations across the nation.

This kind of principled leadership at the corporate level is truly inspiring.

Investing in Solutions is Critical to Ending OUD

It’s easy to say we want to do the right thing, but it takes courage to actually do it. And though many of Albertsons’ customers surely know someone affected by OUD, they (like most people) don’t have a true understanding of the disorder. Without courage, that ignorance will affect our country’s ability to end this health crisis.

When I talk to people about what I do, most are shocked to learn basic facts about opioid use disorder (OUD). For example, few people know that one-in-three people with OUD were exposed to opioids through a legal prescription for pain from their doctor.

Most assume this problem is isolated to the unhoused and people in custody, when in fact more than half of people are employed, in school or full-time parents. And, sadly, too few people know—including those who suffer from OUD—that the disorder can be treated effectively with medication in an outpatient or virtual setting, for less than $500 a month, including the cost of medication.

When I lay out the facts, that OUD impacts a diverse group of Americans, that there’s an effective and affordable way to treat it that’s accessible on an outpatient basis—the next obvious question is, why aren’t we doing more?

My answer is: we lack courage. Without courage, companies would not mobilize recovery, like Albertsons did, and investors would not back start-ups that are trying to tackle this problem. 

For investors, it’s certainly much safer to bet on companies with a clear path to high returns: especially in the healthcare space. We see this all the time when venture capital makes big bets on established players. But people who fund treatment programs that focus on the most vulnerable—and least powerful—in our society exemplify the kind of courage I am talking about.

In recent years, this courage has paid off. Over the last three years, venture capitalists have invested in companies to help scale telehealth treatment programs for OUD—effectively reaching thousands of patients across many states. These programs have impressive, peer-reviewed, clinical outcomes, and these models are repeatable and effective.

The only reason programs like this are not available in all 50 states is because regulators lack the courage to act. Many state and federal regulators who were eager to embrace telehealth during the pandemic have been slow to make these changes permanent, despite the overwhelming evidence that telehealth is an effective way to deliver treatment for OUD, and that traditional treatment programs are not able to meet the needs of all patients.

Certainly, office-based opioid treatment (OBOT) programs have a role to play in addressing the crisis, but they can’t do it alone. This fact was on full display in states like Alabama and Michigan over the last few years. 

In 2022, Alabama arbitrarily reinstated an annual in-person visit requirement for patients with OUD. With no clinicians living in the state, tele-MOUD companies quickly stopped accepting new patients and eventually had to fly physicians to the state to see patients in-person, so those patients could stay in treatment. A year later, Michigan erected enormous barriers to tele-MOUD services for low-income patients on Medicaid. A legislature that prevents its most vulnerable citizens from accessing affordable, convenient and effective healthcare, should question its priorities and face the wrath of voters.

The Uncertain Future of Virtual Care

Even though telehealth treatment for OUD was implemented out of necessity during the pandemic, there’s no doubt it works. According to one study of Medicaid data, initiating treatment of buprenorphine for OUD through telehealth—versus in-person—increased the likelihood of patient retention. And people living in care deserts were finally able to access treatment for OUD perhaps for the first time thanks to telehealth expansion during COVID-19.

As of a few weeks ago, the Drug Enforcement Administration (DEA) has decided to temporarily extend COVID-era telehealth prescribing flexibilities through the end of 2024. While this is a sign that pleas from patients and providers are being heard, it’s still only temporary. What happens after 2024? What happens when states enact their own, stricter policies?

Accepting telehealth as a viable form of OUD treatment at the state and federal levels not just for now, but for the future, is an imperative and courageous step policymakers must take in order to quell growing OUD statistics. 

In recent weeks, a bipartisan group of Senators re-introduced a bill (The TREATS Act which was initially introduced in 2020) which will increase access to telehealth services for OUD, effectively keeping the COVID-era regulations in place. There is no medical evidence to support the requirement for an in-person exam for OUD because a clinician is not required to physically examine a patient in order to make that diagnosis.

Courage begins with the willingness to listen and to reason. The DEA and the law makers behind the TREATS Act have exhibited that. After a major backlash to the DEA’s proposed rules released in February, they’ve taken a reasoned, courageous approach to updating the regulatory environment that is in the best interests of patient care. 

The overdose crisis is a complex problem, but it is one that we can solve. We need to summon the courage to take action. We need to invest in new and innovative models for providing medication-assisted treatment. And we need to urge the DEA and Congress to make it easier for people to get the treatment they need.

Ryan Hampton is an addiction recovery advocate and person in recovery. He was previously an official in the Clinton Administration. His most recent book is Unsettled: How the Purdue Pharma Bankruptcy Failed the Victims of the American Overdose Crisis.

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I’m on The HealthTech Marketing Show

As you read this I am winging my way to Tokyo to be at the Health Tech Sum Japan 2023, which means no THCB Gang. So to tide you over I am letting you imagine you’re listening to me there, but here! Adam Turinas, a fellow expat Brit (and Chelsea fan) had me on his podcast, The HealthTech Marketing Show this week. Half an hour of whether Digital Health is Dead and what that means–Matthew Holt

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Lead Pipe Cinch

By KIM BELLARD

The term “lead pipe cinch” means something that is very easy or certain. Here’s two things that are lead pipe cinches: first, that ingesting lead, such as from the water or the air, is bad for us. It’s especially bad for children, whose cognitive abilities can be impaired. Second, that the Biden Administration’s latest proposal to reduce the lead in our drinking water is not going to accomplish that.

The new proposed rules would require that lead service lines be replaced within ten years; there are estimated to still be some 9.2 million such lines in the U.S. The trouble is, no one really knows how many there are or where exactly they are, making replacement difficult. So step two of the rules is for an initial inventory by next October. The “acceptable” parts per billion would drop from 15 to 10. Utilities would also have to improve tap sampling and consumer outreach.

“This is the strongest lead rule that the nation has ever seen,” Radhika Fox, the E.P.A.’s assistant administrator for water, told The New York Times. “This is historic progress.”

Erik Olson, an expert with the Natural Resources Defense Council is also hopeful, telling NPR: “We now know that having literally tens of millions of people being exposed to low levels of lead from things like their drinking water has a big impact on the population. We’re hoping this new rule will have a big impact.”

The EPA estimates the replacement will cost $20b to $30b over the next decade; the 2021 Infrastructure Act allocated $15b, along with $11.7b available from the Drinking Water State Revolving Fund. Of course, the cost will be much higher.

Chicago alone claims it will cost $10b to replace its estimated 400,000 lead pipes. The Wall Street Journal reports: “David LaFrance, CEO of the American Water Works Association, a trade group, said the total cost could “easily exceed” $90 billion. He said the average cost to replace a single lead service line is more than $10,000, nearly double the EPA’s estimate.”

If the federal funds aren’t enough, Ms. Fox says: “We strongly, strongly encourage water utilities to pay for it,” but you should probably expect customers will end up paying – or that some of those pipes won’t be getting replaced.

It’s not like any of this is catching us by surprise. You probably remember the 2014 scandal with the Flint (MI) water crisis, with all those people lining up for bottled water. You may not remember similar crises in Washington D.C., Newark (NJ), or Benton Harbor (MI). “The Washington, D.C., lead-in-water crisis was far more severe than Flint in every respect,” Yanna Lambrinidou, a medical anthropologist at Virginia Tech and co-founder of the Campaign for Lead Free Water, told AP.

The EPA issued a set of rules around lead pipes in 1991, but those rules were watered down, and little progress has been made since. Ronnie Levin, an EPA researcher at the times, also told AP: “But, you know, we’ve been diddling around for 30 years.”

Because, you know, that’s what we do, especially when fixing a problem costs too much money.

The water companies may replace their water lines but not the ones that go under private property, and the pipes inside homes or offices — well, you should start thinking about a water filter (ones certified for lead, of course).

You wouldn’t buy a house that you knew had lead paint or had asbestos, but most people don’t know if any part of their water supply comes through lead pipes. Dr. Lambrinidou told Fast Company: “We know that the majority of homes, if not all, have lead-bearing plumbing. And we know from the science that as long as you have lead-bearing plumbing, you are at risk of exposure.”

It shouldn’t be a surprise that the problem is worst in cities and in older housing stock. “This a public health concern that has, unfortunately, spanned generations and an issue that has disproportionately impacted low-income and minority communities,” EPA Administrator Michael Regan said at the EPA briefing. “Everyone in this country should be able to turn on their tap for a glass of water and know that it’s safe to drink.”

“We’re trying to right a longstanding wrong here,” Radhika Fox, head of the EPA Office of Water, echoed. “We’re bending the arc towards equity and justice on this legacy issue.”

Experts estimate some 500,000 children have high levels of lead in their blood; that number may be overstated, or wildly low. Adults are at risk as well, especially pregnant women. The EPA believes its rules would generate between $9.8b and 34.8b in economic benefits each year, making it a good return on the replacement investments. But the rub is that those economic benefits are from less cognitive impairments and health disorders, in populations we tend to neglect anyway, and so are much “softer” than the direct budget hits of replacing the pipes.

“We have failed generations of children by not eliminating lead,” Mona Hanna-Attisha, the Michigan pediatrician whose research helped to exposed the 2014 Flint water crisis, told NYT. True, but we’ve been failing generations of kids for generations in many ways, such as child poverty or infant mortality. We have generations of “lost Einsteins,” kids who never had a chance to reach their full potential due to their surroundings while growing up, whether from lead in their water, insufficient food, polluted air, or failing public education.

We’re the champs at failing kids. And at addressing structural issues like infrastructure.

The new rules now have a waiting period, and final rules aren’t expected until next fall. Then there will be a waiting period before they go into effect. By the time the lobbyists and the politicians – we can’t afford it! – have their say, I’m not optimistic how much impact the final rules will have.

I’m freaked out that there might be lead in my water lines. I’m saddened that there are perhaps hundreds of thousands, if not millions, of children who will never reach their full potential due to having adsorbed too much lead. And I’m furious that we allow our public goods, like clean water or air, to be compromised by politicians whose only concern is reelection.

We can do better, Sadly, it’s a lead pipe cinch that we probably won’t.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

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Where is AI in Medicine Going? Ask The Onion.

By MIKE MAGEE

One of the top ten headlines of all time created by the satirical geniuses at The Onion was published 25 years ago this December. It read, “God Answers Prayers Of Paralyzed Little Boy. ‘No,’ Says God.”

The first paragraph of that column introduced us to Timmy Yu, an optimistic 7-year old, who despite the failures of the health system had held on to his “precious dream.” As the article explained, “From the bottom of his heart, he has hoped against hope that God would someday hear his prayer to walk again. Though many thought Timmy’s heavenly plea would never be answered, his dream finally came true Monday, when the Lord personally responded to the wheelchair-bound boy’s prayer with a resounding no.”

But with a faith that rivals the chieftains of today’s American health care system who continue to insist this is “the best health care in the world,” this Timmy remained undeterred. As The Onion recorded the imagined conversation, “‘I knew that if I just prayed hard enough, God would hear me,’ said the joyful Timmy,., as he sat in the wheelchair to which he will be confined for the rest of his life. ‘And now my prayer has been answered. I haven’t been this happy since before the accident, when I could walk and play with the other children like a normal boy.’”

According to the article, the child did mildly protest the decision, but God held the line, suggesting other alternatives. “God strongly suggested that Timmy consider praying to one of the other intercessionary agents of Divine power, like Jesus, Mary or maybe even a top saint,” Timmy’s personal physician, Dr. William Luttrell, said. ‘The Lord stressed to Timmy that it was a long shot, but He said he might have better luck with one of them.’”

It didn’t take a wild leap of faith to be thrust back into the present this week. Transported by a headline to Rochester, Minnesota, the banner read, “Mayo Clinic to spend $5 billion on tech-heavy redesign of its Minnesota campus.” The “reinvention” is intended to “to present a 21st-century vision of clinical care” robust enough to fill 2.4 million square feet of space.

The Mayo Clinic’s faith in this vision is apparently as strong as little “Timmy’s”, and their “God” goes by the initials AI.

Only six months earlier, they announced a 10-year collaboration with Google to create an “AI factory” described as “an assembly line of AI solutions that are developed at scale and incorporated into clinical workflows.” They added that they are “looking beyond foundational development.”

Cris Ross, CIO of Mayo Clinic, imagines crowded hallways. He says, “I think it’s really wonderful that Google will have access and be able to walk the halls with some of our clinicians, to meet with them and discuss what we can do together in the medical context.” No small dreamer, Ross sees bright skies ahead – “an assembly line of AI breakthroughs… being able to do the kinds of things that people are doing in little bits all over the planet, to be able to do the same kinds of things but at scale and repeatedly.”

Luckily, the “AI god” will provide management infrastructure in the form of the new Mayo Clinic Platform, a group of digital and long-distance health care initiatives under the direction of physician executive missionary, John Halamka MD. As a fully registered Medical Industrial Complex (MIC) professional, he has touched all the bases – graduate of hallowed Stanford University, member NAM, wrote econometrics software for Milton Friedman, medical informatics at MIT and Harvard, birthed the software startup Ibis Research Labs, CIO at Beth Israel Deaconess, and influencer on multiple government panels.

The venture he directs will not rely on spirit alone. Venture capital dollars have helped launch two joint ventures – one intended to collect deindentified clinical data from patients far and wide, and the second “to commercialize algorithms for the early detection of disease.”

The “AI god” is wise enough not to reinvent the wheel. His/Her plan comes directly from the MIC playbook, originally designed in 1950 by Arthur Sackler. Create an integrated career ladder for academic medical scientists that will seamlessly carry them from Medicine to Industry to Government and back again, reward all parties with exclusive patents and hidden incentives, and trust that the little “Timmy’s” of the world will find some way to survive.

Of course, the “AI god”, to reach this level of power so quickly, has had to make certain sacrifices, notably replacing one of the two bedrock commandments that have served to guide human behavior for several thousand years:

The first – “Love the Lord your God with all your heart and with all your soul and with all your mind” – can stand, as we transfer loyalty to an over-arching artificial intelligence.

But we must toss the second, “Love your neighbor as yourself.”  And embrace instead, “Love technology as yourself”, and all the riches will follow.

And for the patients? Have faith that when science and technology finally “defeats disease,” your health will follow.

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical-Industrial Complex.

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