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Thursday, July 26, 2018

Daniel Kraft on AI and early dx detection

I've cited Daniel Kraft before, and seen him at many Health 2.0 events.

2017 Conference

 A Heavy Hitter. Pediatric oncologist and cutting-edge techie.

Rob Reid has interviewed him for ARS Technica.
"Daniel founded and runs the Exponential Medicine Conference, which is one of the largest cross-disciplinary gatherings of life science researchers and innovators. He also founded and runs the medical faculty at Singularity University—an academic institution so quirky, it could only have sprouted up from Silicon Valley’s soil.

When Daniel does a presentation, he's the opposite of that speaker we've all seen—the one who has to do everything possible to pad their words and slides to fill a time slot. With Daniel, I always sense that there's an entire presentation lurking behind every slide that he puts on the screen. He just has so much surface area from his two highly complementary jobs, which connect him to hundreds of startups and researchers every year. Daniel is particularly deep in medical devices, ranging from consumer-grade gear to tools that only turn up in research hospitals. And as an oncologist, he’s of course deeply informed about cancer…"

Enjoy. (BTW, correction: two episodes, not three.)

Article interview links here and here (replete with transcripts).


Ran across another interesting book, cited over at Naked Capitalism.

The emergence of organisms who are conscious of the direction of evolution is one of the most important steps in the evolution of life on any planet. Once organisms discover the direction of evolution, they can use it to guide their own evolution. If they know where evolution is going, they can work out what will produce success in the future, and use this to plan how they will evolve. Living things can evolve without having any knowledge of the direction of evolution. The diversity and complexity of life on earth is testimony to that. Organisms can try to deal with the future by blindly making changes to themselves or their offspring and seeing how the changes work out in practice. But this takes a lot of costly trial-and-error, particularly when the future is complex or changes rapidly. It is a bit like trying to drive a car through peak-hour traffic blindfolded. It will not be a winning strategy for organisms whose competitors can predict future events and use this to evolve more effectively.

The alternative is for organisms to guide their evolution by forming a picture of how evolution is likely to unfold in the future. They can try to find trends and patterns in this evolution that might impact on their future chances of survival. They can then use these patterns to order to see how they must change themselves and the way they are organized in order to continue to be successful.

On this planet, the organism that appears likely to take this significant evolutionary step is us. Our growing understanding of evolution is providing us with the knowledge that will enable us to see that there are large-scale patterns in the evolution of life. And it is a short step from this to recognising the evolutionary significance of using these patterns to guide our own evolution. But this significant step will not be possible until we have developed a comprehensive understanding of the direction of evolution and of its implications for humanity. The development of this theory will itself be an important step in our evolution…

Stewart, John. Evolution's Arrow: the direction of evolution and the future of humanity (Kindle Locations 91-109). The Chapman Press. Kindle Edition.
Yeah. But it behooves us to not conflate biological evolution (the s-l-o-w stochastic "random walk"; Gould's "Drunkard's Walk") with "cultural evolution" (which is Lamarckist, and embodies exponential improvements in technologies).


 Monday August 20th, my decrepit aortic valve comes out. Whew. As I noted in a prior post,
...a highly respected and experienced local cardiac surgeon and his team will sedate and anesthetize me, render me deeply unconscious, emplace a breathing tube in my throat, slice open my chest, spread out my rib cage, stop my heartbeat, put me on a heart-lung machine, cut my heart open, remove my seriously stenotic aortic valve, replace it with a sutured-in prosthetic (pig or bovine tissue) valve, close the heart back up and re-start it, close my chest back up, and send me off to Recovery.

One hopes.
I've put this off as long as possible, given Danielle's illness. Tomorrow will be both her 48th birthday and precisely three months since she died.


Interesting excerpt from a STATnews article:
Physicians aren’t ‘burning out.’ They’re suffering from moral injury

The term “moral injury” was first used to describe soldiers’ responses to their actions in war. It represents “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Journalist Diane Silver describes it as “a deep soul wound that pierces a person’s identity, sense of morality, and relationship to society.”

The moral injury of health care is not the offense of killing another human in the context of war. It is being unable to provide high-quality care and healing in the context of health care.

Most physicians enter medicine following a calling rather than a career path. They go into the field with a desire to help people. Many approach it with almost religious zeal, enduring lost sleep, lost years of young adulthood, huge opportunity costs, family strain, financial instability, disregard for personal health, and a multitude of other challenges. Each hurdle offers a lesson in endurance in the service of one’s goal which, starting in the third year of medical school, is sharply focused on ensuring the best care for one’s patients. Failing to consistently meet patients’ needs has a profound impact on physician wellbeing — this is the crux of consequent moral injury…

In an increasingly business-oriented and profit-driven health care environment, physicians must consider a multitude of factors other than their patients’ best interests when deciding on treatment. Financial considerations — of hospitals, health care systems, insurers, patients, and sometimes of the physician himself or herself — lead to conflicts of interest. Electronic health records, which distract from patient encounters and fragment care but which are extraordinarily effective at tracking productivity and other business metrics, overwhelm busy physicians with tasks unrelated to providing outstanding face-to-face interactions. The constant specter of litigation drives physicians to over-test, over-read, and over-react to results — at times actively harming patients to avoid lawsuits.

Patient satisfaction scores and provider rating and review sites can give patients more information about choosing a physician, a hospital, or a health care system. But they can also silence physicians from providing necessary but unwelcome advice to patients, and can lead to over-treatment to keep some patients satisfied. Business practices may drive providers to refer patients within their own systems, even knowing that doing so will delay care or that their equipment or staffing is sub-optimal.

Navigating an ethical path among such intensely competing drivers is emotionally and morally exhausting. Continually being caught between the Hippocratic oath, a decade of training, and the realities of making a profit from people at their sickest and most vulnerable is an untenable and unreasonable demand. Routinely experiencing the suffering, anguish, and loss of being unable to deliver the care that patients need is deeply painful. These routine, incessant betrayals of patient care and trust are examples of “death by a thousand cuts.” Any one of them, delivered alone, might heal. But repeated on a daily basis, they coalesce into the moral injury of health care...
I will let slide for now the obligatory shot at EHRs.


My iPhone wallpaper. Today is my late daughter's 48th birthday. We shot this "selfie" back in March the day after she returned from the Kaiser Antioch ER the prior night, where she'd decided to commence home hospice care.


More to come...

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