How A.I. and Big Tech Are Shaping The Future of Healthcare | Dr. Lloyd Minor X Rich Roll Podcast

we ought to be able to get a better picture moment to moment on the status of our health and therefore be able to act upon early signs in ways we haven't been able to do in the past how is

technology specifically artificial intelligence changing the landscape of medicine and Healthcare there will be some revolutionary changes in

Diagnostics Revolutions in drug Discovery better Therapeutics and that's going to improve improve health and wellbeing Dr Lloyd Miner is the dean of Stanford Medical School and also serves

as Stanford University's vice president for medical Affairs I do think medical education is going to be significantly different a decade from now because of large language models and just the

information that they bring to people's fingertips he believes AI is medicine's biggest moment since the invention of antibiotics there's never been a better

time to be in the Life Sciences than today we're training a model based on a lot more data than an individual pathologist will be able to see in their

lifetime you know what does five years look like if these advances continue to move forward what does 10 years look [Music]

like today's episode is brought to you by the awesome organizations that make this show [Music] possible thank you for doing this I

appreciate it I'm honored to be here uh really have enjoyed following your podcasts and U and learning from you and your guests I appreciate that uh that's very meaningful to hear so thank you for

that I think before we get into the subject matters at hand I'd love to kind of better understand your job what what does it mean to be the dean of Stanford

medical school like elaborate on what that role is and what your responsibilities are sure well fundamentally my job is about people and I have the privilege of working with

some truly amazing people every day people faculty The Faculty really do everything that's part of our mission and what is our mission really has three

parts patient care research and teaching uh and those three components are synergistic so the research we do drives advances in patient care students

uh medical students PhD students master's degree students clinical fellows and residents they come to learn from our faculty and to be able to

advance their skills and their knowledge uh and also learn the art and the science of medicine for those that are involved in clinical medicine so my job

is broadly speaking to uh to work with the people that make this happen on a daily basis um to make sure that we're garnering the resources that enable the

people to succeed um and and also to help in setting the strategy for the overall Enterprise to lead the strategic planning initiatives that are part of

the Enterprise I would imagine it's a uh delicate balance to kind of attend to the interest the specific interests of these various

pillars the business of the medical school the clinical aspect of it the patient care aspect of it because those interests don't necessarily always align

And So It Centers you in sort of a political role where you have to kind of navigate the various interests and uh and and kind of do that amidst a group

of people who are diverse in their in their interests aims and goals that's right that's why the job is never boring which is wonderful uh you seem to have a very you know kind of genial disposition

though I think you have to be uh I think also one has to be very positive there's a lot of reason to be positive we have to look at challenges and as

opportunities and um I try to understand and yes there are situations where uh interests are not aligned and that just as you point out is somewhat inherent in

the nature of the Enterprise there are so many related but sometimes Divergent goals and initiatives within the umbrella of an academic Medical Center

in the school of medicine and the job of leadership is to work as hard as we can to harmonize those and in most cases you can find synergies when you look hard

enough and you look beyond the apparent conflicts um but there are conflicts and there try to approach them with an atmosphere with an attitude of fairness

and with looking for ways in which everyone succeeds even if not every not everyone gets exactly what they came in Desiring to have well that's a keystone

of negotiation right having everybody walk away with some kind of win right precisely precisely um well you are here because you are at the Forefront of this

brand new technology that we're all kind of inelegantly trying to wrap our heads and Minds around um which is artificial

intelligence so explain to me how this first kind of became interesting to you and what convinced you that this is the

massive breakthrough that you present it to be in terms of medicine medical education um Diagnostics Health Care basically

everything yes and Rich I I think you summarized it well it does encompass so many things and the use of artificial intelligence or the elements of artificial intelligence in the delivery

of healthc care dates back quite a while for example today when we go to a physician or other healthcare provider and we get a prescription for a

medication it be very rare today that we actually get a handwritten prescription that's mostly entered and certainly in the hospital setting always entered

electronically what moving to electronic patient records and electronic ordering systems did was to enable us to be safer in how those prescriptions are written

delivered filled so now an error which can happen a decimal point gets moved um sometimes maybe someone prescribing a medicine doesn't know doesn't realize

that the person's on a medicine that actually has an adverse reaction to the medicine they're prescribing now all of that gets reconciled electronically so that's a

form of crude rudimentary form of the application of artificial intelligence to a process namely prescribing of medications as our

as the algorithms driving AI have evolved and as the systems for taking in vast amounts of data have grown now

we're able to apply AI in ways that we couldn't have even dreamed about five years ago the traditional more traditional forms of AI that that usually described with machine learning

or or deep neural networks and now more recently there have been the large language models or Transformer models that I think can open a whole new Vista

of opportunities in healthc care uh fundamental Life Sciences Discovery and pretty much everything that underlies our business so what are the pros let's

get into the pros before we talk about the the cons and the ethical dilemmas that are presented like what are we looking at in terms of what we can

imagine with this power now at our behest I think the pros are that AI will help healthc care delivery uh to be more

accessible to be safer that AI will help Discovery all the way from the basic science fundamental Discovery that's done in Labs all the way up through the

design of clinical trials that it will make those processes more efficient and more effective and maybe I if I could I'll describe sort of each bucket uh

separately so on the healthcare delivery side making it more accessible and Equitable and safer a few years ago our

dermatologists worked with some computer scientists and what they did was to take pictures just with with the smartphone

of skin lesions and then annotate those photos with what we knew to be the pathology of the skin lesion like was it a cancer or was it not and then they

trained a neural network from from a group of many many pictures and then they presented to that neural network that AI model new pictures that hadn't

been used to train the model of skin lesions and ask is it cancer or is it not and they did that with the AI model and then they asked a group of you know

board certified dermatologists to look at the same pictures the AI model was as good as the board certified dermatologist from looking at pictures in Discerning whether or not this was a

malignant lesion or not now what does that mean it means that for example in a rural area that may not have a dermatologist or even in an urban area it it's not always easy to get an

appointment to see a dermatologist a primary care physician can with a you know picture of the skin lesion get a pretty good indication about oh this is something serious and I've got to get

this patient into to see a dermatologist or this is probably nothing to worry about we'll just watch it so that makes Healthcare more accessible um and ultimately I think should make it more

Equitable I can feel uh the sort of skin on the back of my neck prickling a little bit because we've all had that experience of toying around with the llms out there and and on first glance

you get an amazing result you're very excited and you kind of dig a little bit further and very quickly you realize like oh this might not be as advanced as

I originally thought errors abound Etc and I'm imagining a situation where the photograph isn't taken quite right or the light isn't exactly correct you get

a misdiagnosis so to your point around safety those are the alarm bells that go off in my mind but they're the same alarm bells that go off when I think about the prospect of autonomous driving

or any of these other technologies that are on the horizon that sort of threaten our our illusion of control and safety on some level exactly and all good

points that's why we have to roll out this technology with a lot of oversight with a lot of insight and very importantly with the engagement of the public this can't be sort of top down we

have to be very transparent with the public about how AI is being used um and we have to get feedback on that as it as it is rolled out but but let me mention

another example lots of Diagnostic Imaging studies are done every day across the country now a diagnostic imaging study whether or not it's a

chest x-ray or a C or MRI all that data comes in digitally we stopped printing x-ray film uh you know years ago since

it comes in digitally it can readily be used for AI yeah we know today that across the board of Diagnostic Imaging

roughly 4% of the interpretations of those images by humans miss something that's of clinical significance it doesn't always always

mean that the patient's going to have an adverse outcome but something is missed now if AI as it's being used today for example in chest x-rays if it can be

used to trigger you know say to a radiologist look at the upper lobe of the lung uh because there appears to be something there um if it can also look

back through all the old chest x-rays and say well this was there three years ago and this is how it's changed it's helping it doesn't supplant the radiologist from making the final decision but it helps to prevent an

error and make the delivery more efficient to your point around the efficacy of the AI model versus the standard practitioner or specialist's

ability to kind of detect based on experience I would imagine there might be a little push back from those Specialists who are are you know adamant that they're better at doing this than

the model in the same way to extend the autonomous driving metaphor like we think we're better at driving than than the robot version but all the data and

statistics suggest otherwise is that something that you have to contend with as you go out into the world and talk about these things that uh that it's the doctors themselves who might be

bristling definitely and we've seen this before in healthcare and medicine for example when I was in my clinical training after medical school this was

in the early days of angioplasty and at the time um you know cardiac surgeons thought angioplasty is never going to go anywhere you know these are all going to fail and and

these stance they're going to get clogged up well angioplasty and and cardiac stance have saved many many lives and it continues to get better and yes there is still an important role for

cardiac surgery cardiac surgeons haven't gone away likewise in general surgery used to when we took out a gallbladder we made a big incision and took out the

gallbladder now many of those procedures can be done laparoscopic ically with a tiny incision and much shorter recovery time what happens over time is that

practitioners retrain um and Medical Specialties redefine themselves I think we'll see the I don't think Radiologists are going away not at all but there'll be

Radiologists who use AI in a responsible way and those that don't and in the end the ones that do use it will be the ones that um that are in practice the

immediate and and kind of most obvious use case that I see being such a huge benefit is the ability of these models

to take massive amounts of data and find patterns or extract meaning from them in a way that humans just aren't capable of doing obviously that leads to the

ability to design new Precision drugs for specific purposes or to design or refine clinical trials so that they're better suited to the goals of of the

scien who were conducting them exactly and you know we talked about the use of AI in radiology and and we talked about that proceeding at a rapid Pace because all

the data comes in digitally but I think the impact perhaps is even going to be greater in pathology so when a when a tumor is removed when a growth is removed it goes to the Pathology lab and

it gets sectioned and then a pathologist looks at sometimes even hundreds of slides from that tumor for rare conditions a trained

pathologist may have only seen a half dozen a dozen of a particular lesion or abnormality in their career and what you were just saying because now we can

collect from a variety of different Health Systems hundreds of of these tumors that are rare we're training a model based on a lot more data than an

individual pathologist will be able to see in their lifetime time uh so that increases accuracy it increases Precision in in knowing what the Salient

features of a tumor are in ways that no one human being or group of humans can Doh what are some of the other benefits I think you mentioned drug Discovery for

example one of the early applications of of machine learning was in the study of protein structure and and now we can predict the structure of a protein just

by knowing its sequence very accurately that's enhancing the drug Discovery process we're already seeing benefits of that we also have the possibility in the

future of Designing a drug if you will from scratch just from data about the biology of the condition that's being treated and there are companies that are

focused on that today so I do think we will see a revolution in drug Discovery how quickly will that come that remains remains to be seen but the the pieces

are there to have that sort of an of an impact and the better these models get the more refined and improve their Diagnostics become which translates into

earlier detection right for these diseases so the real world kind of ramifications are there's an expedited time period um from diagnosis to

treatment but also the early detection piece which obviously is going to you know help people resolve these problems before they get too far out of hand that's exactly right it's back to a

concept um that we've talked about uh before in Stanford medicine and elsewhere a concept we call Precision Health which we we distinguish from

Precision medicine Precision medicine is about getting the right treatment to the right patient for the right disease at the right time but Precision medicine is

if you will after the fact it's after someone gets sick how do we provide the best sick care and of course in the United States we have the best sick care

system in the world because of our Specialized Care that we offer because of tertiary and quinary care but we haven't focused nearly as much attention

on predicting and preventing disease and in detecting it earlier as you just mentioned and I think these applications

of AI to bettering Diagnostics and designing more predictive diagnostic test you know every time we fly on a

plane um the plane the engines of that plane are being monitored hundreds of times a minute on the ground we should be able to do something comparable to that one of my late colleagues um at

Stanford Dr Sam gambir very much had that Vision we should be able to do something comparable to that in Diagnostics and and develop something along those lines well we're slowly

inching towards that with the Advent of tech consumer technology in the form of like wearables I'm got I've got a whoop on um I use insid tracker and you know

we've worked with levels and I'm going to experiment with super sapiens these CGM companies uh Apple Health with the Apple watch and everything that they're doing and I know you had this this heart

study with apple I want to hear about that but I'm curious around the future applications of how the data sets that are extracted from all of these

wearables can be used to better predict and better prevent I'm thinking I had um Tim Spectre in here uh who founded Zoe and he was talking about you know the

massive amount of data that they're able to kind of mine through the Zoe app which allows them to come up with new therapies predict diseases Etc and

create you know diagnostic tools as a result of that and I think with mass adoption you're only going to see more and more and more of that it brings up privac concerns of course but where do

you see all of that going I think wearables have an important place and you're right we did um work with apple several years ago on the Apple heart

study the question we addressed with the Apple heart study was can the Apple watch be used to detect the most common heart arhythmia atrial

fibrillation um and this was a very large study 700,000 people participated in it all virtually and very rigorously

controlled um and yes the Apple watch can be used to detect a fib that's useful because in many cases people don't know some people have an indication shortness of breath or other

indication when they go into aib but in many cases they don't and we know that people that stay in aib for any prolonged period of time are at a higher risk of stroke and various other

conditions now that is relatively lwh hanging fruit uh terms of rudimentary that's exactly right but that opens the door uh we do have glucose monitors

available today uh I think those will become in more common use there's ongoing work in monitoring blood pressure in a non-invasive real-time way

we ought to be able to get a better picture moment to moment on the status of our health um and therefore be able to act upon early signs in ways we

haven't been able to do in the past I think the real barrier to True Mass adoption is the fact that right now it's the marketplace is so diffuse and

disperse and it's like how many how many of these things do I have to put on me you know I've got this here and that there um it's got to be integrated and you know if history tells us anything

Apple's pretty pretty good at that they sort of take this wait and see approach and then they suddenly strike you know when the when the iron is hot and when the time is right and kind of take over

I could I could imagine a scenario like that but I really do think that that is the future and I think that these devices if they've taught me anything

it's it's it's given me a sense of agency like the transparency and understanding what's happening with my body in real time is information that is empowering uh it's a little scary like

do I really want to see what you know what's going on with my insulin levels right now um and and certainly there are people out there that kind of push back

on consumer CGM adoption um but I think it's just you know I think that that can be overcome with with education so people understand what it really means when you're looking at this stuff uh and

I can't imagine a future where this isn't going to become more and more integrated into our into our lives I I agree with you entirely you know I think

the other thing that is going on related to what you're saying is that in the past in the United States in particular we we've had as individuals we've had a

passive attitude about our health we've always assumed well if we get sick we'll go to the doctor and we'll get a medicine and we'll be fine right and and

I have to say that that we in healthc care have in the past we've uh in some cases we've encouraged that attitude

really what we want is for each of us as individuals to first and foremost be responsible for and engaged in our health and the role of us as Physicians

is to partner with our patients yes to have a base of Knowledge and Skills that help our patients but fundamentally to enable our patients to take care of

themselves and Furnishing information that's actionable to us as individuals is an essential part of being able to take care of ourselves and then helping

people understand what that information means so does that transient spike in your glucose level when you uh eat a doughnut is that going to have a long-term effect if your say your

hemoglobin A1c is normal is that going to have a long-term effect on your health and well-being well probably not and by the way if um if you just focus on keeping the line straight right you

may be that's going to drive some unhealthy if you're just eating saturated fat all day because it keeps that if you gamify it totally um you can end up in in a not so good place but I

think to your point um when you look at what's really killing most people it's these chronic lifestyle ailments it's heart disease uh it's you know it's type

two diabetes obesity um the increasing rates of Alzheimer's and various forms of dementia that seem to be kind of metastasizing right now and

understanding that these illnesses don't happen overnight they are growing and taking place over a period of decades and so if you can detect that

something's not right 20 years before the heart attack you're in a pretty good place to you know change directions and avert that disaster that is the thing

that kills most people exactly right and of course that's what our healthare system isn't really set up for that right now it's not it's not I mean the example you draw in terms of being able to prevent a heart attack by having your

cholesterol level checked and then doing things to lower it that's a good example of of proactive preventative care that has been effective and the instance of heart disease has been steadily

declining as has and our ability to treat it has been increasing but but we need to generalize this across across the board and and we all need to be more

engaged in healthy lifestyle and evidence-based U uh interventions ourselves and maintaining our health talk a little bit about how these

Technologies are reshaping medical education what is the experience of the typical med student now versus where you

see it going in 5 years 10 years as a result of this Tech well I'll give you an example when I was in medical school not only did we memorize the names of

drugs and their mechanisms of action we had to memorize the dosages of drugs that was crazy because the dosage is an arbitrary number depends on how the drug is

formulated and everything you can't keep arbitrary numbers in the human brain but nonetheless that's what we did and what we were tested on now and I talked about electronic prescribing before we don't

certainly don't memorize the dosage of drug drugs we still need to know mechanisms of action um and and and how drugs maybe interact but in the future

the need for memorization and and the need for an active working knowledge base I think is going to diminish what is we're going to have the need for is

really understanding how to use the data sources that are out there how to be skeptical when those data sources aren't giving us you you mentioned your the hairs on the back of your neck raised

when you hear about how AI is being applied to interpreted image images we need to make sure that Physicians have a lot of skepticism about the information

that they're being given from AI but we also need to train them on how to use it responsibly so back to your question about medical education I think we'll

continue to see a de emphasis on memorization ation because still there is a lot of memorization in medical school will in the discovery aspects of

medical education will be training students to use these AI models uh to ask questions and get informed answers to those questions and then to drive e

either in patient care or the research they're doing based upon their interaction with AI models but I do think medical education is going to be significantly different a decade from

now than it has been in the past because of the because of large language models and and just the information that they bring at people to People's

fingertips has virtual reality found its way into the medical school curriculum because there's so many use cases you can imagine of putting those goggles on

and participating or observing a surgical procedure or actually going inside the body you know like is that happening already or what does that look like absolutely let me mentioned two

examples um and these are commercially available products um we at Stanford still have our medical students do cadaver dissections we feel like that's an important part of learning it's it's

also an important part of the developing the culture of respect for the human body but those dissections are supplemented now by virtual reality and

and uh an increasingly augmented reality uh approaches to really understanding the three-dimensional aspect effects of anatomy so there are electronic

simulations where you can look at any plane you want to in the body you can insert specific muscles take away muscles you can understand the pulling

direction of muscles much better than you can from a caver dsection certainly much better than you can from a textbook so that's being used today in a more

direct clinical application our neurosurgeons have a system that I mean operating of the brain is complex and um and every tumor every structural

abnormality is a little bit different so the the surgeon can work with a a virtual reality set to actually do the operation virtually you know based upon

where the tumor is located and be able to see the relationship of the tumor for example to blood vessels and things like that before they ever get into the operating room and have a much better

understanding okay this is you know these are the steps I'm going to need to take this is what I'm going to need to watch out for at this particular point of the operation so it's almost like a

flight simulator version of a surgical procedure where you're having a an almost tactile experience of doing it without the risk exactly yeah that's

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domain I got to ask what is the extent of nutrition at education in medical school I've had so many doctors come on this podcast they didn't we had one elective class of nutrition we only had

to do four hours or something like that over you know three years is is that changing what does that look like I mean I know Stanford Medical School is very Progressive in this regard I imagine

this has been considered uh but it seems like you know more broadly it you know it's still remains in a bygone era it is increasing it needs to increase more I

know you've had Dr Christopher Gardner a guest on your podcast and Christopher is amazing uh and has been a real Champion for introducing nutrition education into our medical curriculum and and more

broadly I think it gets introduced in several contexts but it I'm Not For a Moment saying that we shouldn't be more focused on it uh but but it is being introduced now in the standard ways that

we teach carbohydrate metabolism for example um but I think integrating it as well into the clinical curriculum uh to know how to talk to patients about their

nutrition and um you know with a faculty member who a number of years ago did a study looking at obesity to see if if offering to a family to replace the

cooking utensils in the home with smaller utensils reasoning that if there's smaller utensils and you cook less you'll eat less if that might lead to weight loss and lo and behold yes it

does so we need to be thinking at all levels of the Medical Education and Care delivery process how we build in a focus

on nutrition both scientifically and educationally Health Care is sick care to your point um and there's certainly a lot to redress when it comes to our health care System I want to put a pin

on that for now but I bring it up because uh if we want to truly move towards this new modality of predict

prevent uh we have to instill that in the medical education right so prevention and prediction can be done with all of these new tools better prevention often has to do with all

these lifestyle interventions right which includes nutrition but has other things and so the common refrain when someone goes to the doctor is that they never make any kind of Lifestyle

recommendations it's not really part of what they do they're time constricted it's not necessarily their fault it's a systemic thing but the more that we can educate our young fledgling doctors

around these things the better chance we're going to have that they're going to carry these principles into their practice and you know share that with their patients so that we can be more in

a preventative stance when it comes to Health Care outcomes exactly and when we talk about prevention we have to first and foremost look more carefully at

Behavior because prevention is fundamentally about changing Behavior I I'll tell you a story U when I'm about a decade ago shortly after I moved to to Stanford to California uh was getting to

know people in our community I met with a leader in the in the Life Sciences uh Venture community and I said is there any topic that if if someone comes in and tries to pitch you on a company

doing this that you just say you know thank you very much but you know appreciate it but I'm not interested and he said yeah anyone who comes in and tries to pitch me on something that's going to change behavior I'm not

interested I was like oh dear because um now now you know we've seen that change right we uh we've seen some real successes in the digital Health world but where I'm going with

this is we need to be doing a better job of integrating the study of behavior the study of Lifestyle study of well-being much more into the

scientific uh mainstream of of research and also into our our attitude and our approach to care delivery because Behavior really does underly um a lot of

but you mentioned chronic diseases before that that are so crippling in our country right now every one of those will have a strong behavioral component when it comes to more Progressive

modalities around medicine you hear about functional medicine and you know Integrative Medicine uh preventive medicine holistic medicine now we have Precision medicine like how do we parse

all of that how is what you're talking about with Precision medicine different than those other terms the there are many many similarities but in particular

by focusing on health um what our goal goals with Precision Health is to use the same enablers that have been used for years in Precision medicine you know

let me me mention an example we are so much better today treating breast cancer than we were a decade ago why because not every patient with breast cancer

gets the same treatment the treatment is tailored to the tumor and to the individual and as a result we have much better outcomes what we should be doing with Precision Health is taking taking

that same knowledge base knowledge base of genomics of of lifestyle and other things and applying that in a predictive way to say well maybe I need to have

these screening tests done every year maybe another person needs a completely different set now we already do that to an extent but we should be doing it to a much greater extent

under you know underpinning a lot of this will be advances in Diagnostics uh which I think are coming along um but Diagnostics are hard uh first you're

trying to detect a very small signal and you need to do it accurately because you don't want to drive a lot of unnecessary testing because of a false positive but that work's being done and I think it is

going to lead to more tests that have the same sort of actual value as when you and I have our cholesterol measured for example so those are going to be the

things that we need to really drive this revolution in prediction and early detection right now medicine is divided up amongst all these various Specialties

and it's it's unclear how much sharing of information or or cross communication there is between all of these fums and one real advantage that I can imagine

with these AI tools is that they can take massive data sets from genomic testing and you know sort of you know

cross-section that with microbiome data and metabolic Health Data from cgms like across the spectrum of all of these different Specialties and try to make

sense of how they fit together and how that can drive um better predictions and and and better early diagnoses that's right and that's

another strong reason why AI is going to be trans formative because bringing together those different sources of data is generally more than the human brain

or even any groups we're not capable of doing that no exactly those data exist and and and cating them U through the

benefits of AI uh and deriving information from the troves of data that exist out there particularly in electronic health records I think is a major goal of the application of AI to

healthcare delivery let's talk a little bit bit about the cons or the ethical dilemmas that that come up um as we move you know towards this this near future

and the considerations that are underway to kind of address them I know you have partnered it's you have this organization ra it's called raise Health that's right um so talk a little bit

about that and and you know where your head is at well raise health is an acronym for responsible AI for safe and Equitable health and I think that says

it all how do we deploy AI in an equitable way and in a safe way um to improve the health of all of us so some

of the cons some of the risks that we need to be clearly aware of and and mitigate prevent first is we have to

protect privacy and and there are new dilemmas that are going to arise in privacy that we haven't had to deal with in the past for example um with with the

large language models that exist today and particularly as those language models start to integrate social media data you might have a a doctor in an emergency room that 3:00 in the morning

is seeing a patient who just returned um from a trip to South America who has um you know lupus and a few other medical conditions um and this patient has a

high fever and you type in that information into a large language model even though there's nothing in that that's identifiable there's no no personalized health information in that

query and still by linking various sources of data the patient could be identified just from that query so we have to think about privacy in a new way

and there are many many ways of doing it one is to bring the model into an individual delivery system so that data doesn't get out you can ask a query and

it doesn't get back to um a model that's going to be trained based upon the data right that's the whole like don't worry we we're keeping the AI in the Box thing you know that is the premise of every

dystopic you know super intelligence movie you've ever seen true but that's something privacy has to be front and center and in in President Biden's

executive order related to AI that came out um you know just recently privacy was at the top of the list in terms of what the Regulatory Agencies have to be

focused on protecting so that's that to me is at the top of the list for the downsides or the things we need to protect as we roll out AI there are

others as well the AI is only going to be as good and as accurate and as reliable as the data used to train it and if the data used to train AI is

biased because it only contains data from white men for example then it's it's going to yield results that conceivably could lead to

inequitable uh recommendations so being cognizant of the risks of bias and mitigating those risks of course mitigating those risks means doing studies that are inclusive more

inclusive of populations that historically have not been included in in medical studies or clinical trials so bias is another U example I think the

other the other thing we want to protect is this the Primacy of the relationship between a patient and their Healthcare providers their nurses their physician

assistants their Physicians um if AI supplants that or is somehow viewed as a gatekeeper to get to a human being then that's not a good thing uh I don't think

it will do that I think it actually will make the interaction between a healthc care provider and the patient more connected uh we we probably all had the experience I certainly have of going in

to see a healthc care provider and immediately they're typing the note and even though yes they're listening right that's not the same as the conversation

you and I are having across a table from each other remove the clipboard and make better eye contact and be present with that patient there's that's its own

healing modality that's right and that's that's within our grasp so those are some of the things that that that I think are are are the downsides that that again a goal of raiseed health is

is not to try to uh say that those are not a problem but indeed to say they are an issue raise them to the four um and and responsibly address them another

goal of raiseed health is to make sure that at every step of the way we're communicating with and engaging the public um there was a study done last

year by the Pew Foundation looking at asked the question a general question of a large number of individuals do you trust the application of AI in the deliver of your Healthcare not

surprisingly overwhelming majority of people said no of course they should say no because we haven't explained to them how it can be used how it is being used

today um for example to prevent medication errors and other things but also to understand what it offers in the future and how we have to work together

to prevent the downsides it's sort of like there's no pilot in the cockpit you know I'm imagining a situation in which

Robotics and automation are in the hospital ICU room and they're um they're calibrating what ends up in the IV drip for example or they're administering

drugs without any kind of human involvement and the potential for that to go Haywire is scary enough uh to you

know kind of uh make anyone uh fear that type of future for sure for sure but I would mention though that um again to

your example at the use of Robotics in uh sort of making up a a drug formulation that's a good example because chemotherapy

infusions you know typically have to be very accurately calculated to someone's weight their blood count when we were relying just upon humans to do that uh

without room for error there definitely was more room for error and not only room for it there was more there were more errors

um so interesting how are the other big Tech players in the private sector um considering all of this I'm

thinking about Walmart and Amazon like Amazon is ripe to sort of get into Healthcare in a really big way Walmart with its I don't know how many stores

they have but um as a as a vehicle for the greater access that you're talking about it seems like they could be you know sort of critical Partners in how we

revolutionize access I I agree Walmart for example has um it many of its uh Superstores Ian they've chosen uh

markets to roll this out in where they can study it and also based upon sort of their assessment of where it will offer benefit but they've offered they're they

have clinics um you know next to uh the superstore and and they have been very as is the case in other areas they've been very transparent about pricing now

how that will generalize you know to other uh given Walmart's closeness to every one in America in terms of having

stores that remains to be seen Amazon um acquired a primary care delivery system um in in the recent in in its recent history now will they generalize that um

Amazon I believe is getting into also you know filling prescriptions Walmart has a very large Pharmacy service so I think the large retailers uh are are definitely looking

at ways to make healthc care delivery more efficient and uh and more accessible by placing it in

communities um the larger Tech firms I think are are are looking at where they can have impact we talked about the Apple watch study before we uh we

Stanford worked with Duke and with um a a branch of Google or alphabet called verly to roll out a project that we call

Baseline this is a a study of of several hundred individuals where everything about their health has been measured and they're being tracked there's a wearable

that was developed specifically for this study because we want to be able to look at a lot of data coming in and to be able to say well there was an early

indication you know three years ago that we didn't even realize was an indication that maybe was associated with a condition that the person developed and the only way you can look you can

develop those relationships discern those relationships is by studying things what is called longitudinally over the course of several years you know there are are studies like that

going on um you know a few things about health care that's a challenge for tech one is that it's by far the most highly regulated industry in America and and

that makes doing broad Innovation and and application and roll out a challenge uh so I think you know Tech firms are being careful of that but there's no

question I think that there will be a bigger role for um technology the wearables we were talking about before um in the future it just has to be done

it's not the same thing as R rolling out a new version of a smartphone for example sure uh in the same way that we all kind of woke up one day and were

informed or uh realized that everything that we had been doing on social media chatting with our friends and scrolling and uploading photos and replying and

commenting Etc was not only being tracked but being mined to such a fine degree and then repurposed and sold to

third party so that we could be advertised to was a disturbing Revelation for you know most unsuspecting people um but what you're

talking about is the next step of that not only are we going to monitor everything you do on social media we're going to monitor your blood work your

heart rate variability your sleep cycle your insulin levels and everything in between and that data will be used for your own good because we're going to do

good with it it's not hard to imagine why that could be a difficult cell for a lot of sure for sure and um right now where you know the popup comes do you

accept these cookies and U I don't know about you but I typically just say I want to get on to whatever I'm doing yes I accept the cookies we're going to all have to be much more careful about uh

how we allow or don't allow our health data to be used I mean much more careful compared to just clicking yes we'll accept cookies or no we want um that

gets back to this privacy uh imp imperative that we have to have and and it does mean that uh

that this is going to the impact of these sorts of data mining Technologies on the actual delivery of care is going to proceed more gradually for good

reason than for example when I go on Amazon and search for shoes then all of a sudden when I'm on the New York Times website have these ads for shoes popping up I mean for sure you you can't have

that but now a breach of that trust would be hey this guy's not sleeping so well so suddenly you're getting ads served up on your social media accounts

that are advertising supplements to improve your sleep Etc you know add INF an item like this is not a world that any of us want to want to be in so

safeguarding that data and perhaps even creating a situation where somebody has to opt into that as opposed to opt out imagine wearable company X they're

sitting on all this data we can just sell all this data uh for a lot of money because there's people out there that can use this to Market and pinpoint

these people to sell them things exactly and that that has to not occur I mean we have to protect it but you know Rich the history of of and I know you're not

suggesting this none of us is suggesting that we just close the Box on that's not Happ that's be the first time in human that we've closed the bo so I think we

can all accept that the box is not getting closed and it's just going to be what it's going to be and we're going to try to put the guard rails up as best we can but history also tells us that human

hubris uh always believes that we can better control things that uh we find out later that we didn't do such a good job with that's so how is this going to

be different Lloyd and I'm pushing back you know in in sort of in fun Gest but you know I am curious and I think these are really important issues and I know

that you're considering them deeply um but these are the things that people are going to want to know if you're expecting them to feel safe and to you

know toggle that opt-in button exactly and one way it's going to be different is because you and I are having this conversation today I don't think with a

lot of Technology innovations that have impacted Our Lives um the conversation is generally post Haw it's after the fact oh my goodness look at the effect

that social media's had on and then fill in the blank U our children U and I'm not taking a side on that issue uh but we're having this conversation today

with Ray's Health we're designing the initiative very much with these questions in mind being more proactive

before uh you know before these larger scale imp mentations that you're talking about occur I think the point you raised about opting in about complete

transparency about how data is being used and about giving people the option to not have their data used in any way that has to be a a critically important

part if you want to engender trust and and get Buy in from from you know the public I think that's absolutely mandatory because that trust has been breached in the past and so it's even

harder to earn right now and I think for good reason absolutely yeah what does the regulatory landscape look like like what is the FDA doing how are they looking at it how are people like

yourself interfacing with them like what does that communication look like what are the barriers to this type of technology that Regulators are throwing

up and where are the green lights I think in the case of the FDA uh the FDA is really leaning in to learn and

understand uh how a I could be used and how they need to be responsibly involved in regulating the application of AI so there are there's a branch within the

FDA looking at digital diagnostics for example or or digital Health Care delivery to know how should that be regulated the

FDA collaborates with or or funds institutions like Stanford for example with with UCSF we Stanford have a center for excellence in regulatory science and

Innovation goes by the acronym Cersei so we have faculty at both institutions doing the science that informs regulation the FDA funds this they receive the reports they're very much

involved in the activities of the center but the FDA is is partnering with or or gaining information from those that are doing the primary Ai and Health Care

work to know how they need to be involved in regulation likewise the department Health and Human Services through the office of national coordinator of health

information technology is very interested on how in how AI is and can be deployed in medical records in the future so I think the governmental

agencies uh are taking a responsible approach of wanting to understand the landscape and know how they can and should be developing the regulations

that that absolutely will be needed but I'm encouraged I I I've gotten to know and and learn from U some very very

dedicated public servants at HHS at the FDA both through their own work and the work that they are are are engaged with

us and other institutions in are gaining the knowledge needed to do responsible regulation and regulation has to be a part of this sure it's not hard to

imagine the many ways in which these Technologies are are going to kind of upend help care but at the same time our healthare system is pretty recalcitrant

to change it's Byzantine it's complicated it's confusing it's expensive it's broken in so many ways and you know many uh many a person has

tried to untie this knot uh and and sort of slinked away unsuccessful in doing this how can we change this system and make it better irrespective of AI or

maybe in partnership with AI like we need a better system and incremental changes don't seem to be the way forward because it's so systemic so how are you

thinking about that big problem it is a big problem and you know we could spend another series of podcasts and uh with with a lot of other

people talking about how we got to where we are right now in the US Healthcare delivery system we do have and we talked about this before a great sick care system in terms of providing Ultra

Specialized Care for for severe acute illnesses uh but we don't have a great system for preventing disease and also

for allowing a broad-based access to the care that that that people need look what I think about is is a leader of an academic health system is what we need to think about is where we can have

beneficial effects where we can do things that are that that lead to benefit that are actionable and that is by definition incremental uh for example

if deploying AI in the interpretation of chest x-rays um eliminates or dramatically reduces the 4% of missed significant uh

abnormalities then we've improved care delivery and if we show how it can be implemented into workflows in ways that Radiologists embrace it and not push it

away and we talk about that and others do it as well then we've led by example so a lot of what we try to do is think

about how can we responsibly innovate study rigorously study an innovation that we've introduced into the delivery

system and then talk about what works in ways that lead to others adopting it I think that's a primary responsibility for us as an academic health system at

the broader healthc care delivery system level if you look at Medicare for example moving to Medicare Advantage PL that that better align incentives for

keeping people healthy uh rather than you know after the fact care when people get sick uh if there are incentives for uh providing inhome care rather than having people go to the emergency

department every time uh they have a an issue or a problem I mean those are things that I think the Medicare system is doing to uh make Medicare first

better for patients and more efficient I don't think there's going to be a massive top- down overhaul of the US Healthcare delivery system in a way

that's implementable uh but through a series of these interventions I think we can and will have a better delivery system those are measures that are oriented around you know acute

symptomology but it's still a long way to go to get into the predict and prevent but I can imagine with these tools the diagnostic tools the wearables

and all of these things that that there can be a more seamless transmission of data to your primary care physician and they are kind of in constant

communication with all of their patients and are alerted if something is ay again there's privacy concerns with that but to the extent that that these tools can

allow us to communicate more seamlessly with our caregivers I can imagine that would be quite disruptive in a in a good way absolutely and can allow us to

information about uh you know inhome monitoring for example and realtime information about when a person has some with chronic diseases for example has

some early signs that their their health is about to rapidly rapidly Decline and to be able to intervene before it gets so severe that they need to come into

the hospital so we do that today with visiting nurses but increasingly we should be able to do it with electronic monitoring again privacy is a big concern but those are those are the

types of things um the other thing to keep in mind Rich about us healthc care is that you know 70% or roughly of the determinance of disease in our country

and isn't just restricted to the US 70% are socially and environmentally mediated determinant so the social environmental determinant social behavioral environmental determinat of

Health um things like access to um to the right food Supply um behavioral health issues play a big role and we historically we haven't done a great job

in the US of addressing those social behavioral and environmental concerns one of the things that that that we're trying to do as an academic Medical Center and school of medicine is through our department of health policy

is to again do what we do well which is to do rigorous research uh and then to disseminate the information from that research in ways that it can help Drive

policy changes and help informed interventions I mentioned before about replacing uh eating cooking utensils in homes with smaller utensils and that

being a positive driver of weight loss um and so things like that they're they're incremental but they do have impact right the idea that your ZIP code

determines your health outcomes in in in in too many ways than it should right that's not going to eradicate the fact that somebody lives in a food desert or you know just doesn't have access to you

know healthy foods or isn't in an environment that's conducive to moving their body in a healthy way Etc um but those smaller interventions they're they're still meaningful but the problem

is so much larger than that and it and it transcends Healthcare it's really about you know our Urban landscape Etc precisely and you know economic

[Music] disparity what is the near-term future and the far-term future I've had futurist in I had Peter D Manis in here he's painting some crazy picture of what

it's going to look like you seem like a much more grounded person but you know what does five years look like if these

you know advances continue to to move forward what does 10 years look like are are you you know are you willing to get into the prediction business for five minutes and share a little bit about that are you going to be too

circumspect no I can get into the prediction business but I have to say my crystal ball is is is pretty cloudy uh

but and and also I am an optimist U and but I've also seen enough reasons for optimism and I think that's important particularly in a in the environment

today where it's been challenging for many people to be optimists so what do I predict say in the next 5 years I do think that the field of early detection

Diagnostics uh so being able to have screening tests that that provide an early signal that a cancer in the historically and in the tumors that

historically have been diagnosed much later than they should be pancreatic cancer ovarian cancer I think there's good reason to be optimistic that we will have diagnostic tests there are

already some that are available they will get better and better and there will be more and more and therefore we'll be able to say to a person you

know based upon your genetic risk profile you know you should have this screening panel uh looking for cell-free DNA in a tumor uh from a blood test you

should have this done every year and those signals will then help you know to detect those tumors much earlier that's within our grasp and I think that that will be rolled out I also think our

ability to do inhome monitoring of of conditions will improve and that we'll have fewer hospitalizations that could have been prevented if we had seen the decline in

various parameters and intervened earlier I think that's going on and and will have increasing impact in in the years to come um you know coming out of

covid and covid was certainly a defining event for everyone as individuals and and as our as a society but it was particularly a

defining and and horrific event for healthc care providers because we were on the front line throughout covid and I gained so

much inspiration from the colleagues I worked with every day as we at Stanford and in our region navigated uh the challenges of covid but we also have to

be aware that we have health a healthcare Workforce today um that in in so many ways is burned out and um and I

think now that we're we still have a lot of covid around fortunately not many people are requiring hospitalization but I think rejuvenating the healthc care Workforce it is a resilient group of

people for sure uh but but we've got work to do on rejuvenating that Workforce and I think that is something that we we will accomplish over the

course of the next 3 to five years we've always attracted people to healthc care and Medicine who have extraordinary dedication to the mission um but they

don't have an infinite reserve of resilience and rebuilding that now is particularly important how do those tools Aid with burnout one thing is how

do we get people away from the computer terminal U how do we reduce the amount of time that uh a healthc care provider

has to spend doing documentation how do we help a physician with the inbox uh it it's great m patient should be able to ask questions of their Physicians

directly and in a secure way uh but that if that's adding on two hours of work after you know eight hours in the clinic in addition to documentation that contributes to

burnout those are all things that technology is today already beginning to have impact and I think in the futurist sense it's going to have even greater

impact over the next 5 years getting healthc care providers Physicians back to what they went into the profession to begin with and that is to be able to interact directly with people during

some of the most challenging times in their lives how far away are we from a future in which there's a pod in in your house

that you slip into every day or once a week it scans you it detects everything that's slightly off in your body um

sends it to your doctor or prescribes a protocol to address it hey there's a little cluster of cancer ourselves here uh let's just let's get that taken care of right away that kind of thing that

you see in Sci-Fi movies yeah I don't think that's five years away or maybe not 10 years away but um is there a future in which that is a thing oh sure

I mean look um who would have thought 25 years ago that the smartphones you and I are using are doing what you know what

they're doing today I mean a few futurists would have predicted that a few people did um and created companies that have been remarkably successful but

most of most people had enormous skepticism about it to the example you mentioned already today there are centers they're not covered by and large by insurance but where you can go in and

get a whole body MRI yeah like a dexa scan yeah exactly and Dex scan for looking at bone but whole body MRI to detect you know

whatever uh now turns out that those also so sometimes detect things that aren't really a problem you go and do that they're going to find something that's right and then what do you do

about it yeah so there's a ways to go but as you and I you said before our history of putting things in a box and closing the box and saying we're never going to open it that never works with

technology the general theme Here is that there will be some revolutionary changes in Diagnostics there will also be if we're

looking at applications of AI there will also be Revolutions in drug Discovery U that that that are going to help to have

better Therapeutics uh that really are tailored to specific conditions in individuals uh and that's going to improve health and well-being where are

we in terms of growing organs I was at a conference Sanjay gupta's conference and I can't remember the doctor's name I think she was growing like heart tissue

or I don't remember maybe you probably know who this person is but it was pretty remarkable what she was sharing and the

future that she was painting um and I think that if Uma valti can create hamburgers and steaks and chicken filets

out of you know Brewing these cells uh that harvesting or or sort of fermenting and growing the these organs doesn't

seem like that far distant from that I agree with you not only growing them but as one of our faculty members at Stanford is doing 3D printing them yeah

that's what I living tissue yes um it it's it's in the lab today U as to when it gets to patients uh it's a bit hard to

predict and it's we do a lot of things in the lab that then getting them into patience requires many more steps than we thought

it would but it it it definitely is going to happen and and so for example in congenital heart disease that is children that are born with heart

abnormalities uh we're going to have a lot more options for treating that than we've had in the past in the past there are ways that you could sometimes bypass

the problem and some very Innovative cardiac surgery techniques heart transplantation has become more common but if we can actually build chambers of

the heart 3D print them and then put them on the heart and have them function uh then we've introduced a whole new way to correct uh congenital abnormalities

of the heart that conceptually is here today just there a lot of steps between what's going on in the lab and getting it to patients well it feels like a really exciting time if you're a young

person to go into uh you know the biom medicine feel to you know be a med student right now because so many things are changing so rapidly like it feels

very different than you know even a few years ago I completely agree and uh we have the privilege every day of working with some of those young people that

that bring so much inspiration and energy um and vision uh to all of us there's never been a better time to be in the Life Sciences than today why

because there has been a convergence of so many different areas of Science and Technology now being applied to biom Medicine we talked about 3D printing

which began obviously in terms of printing objects now we're you know printing cell that's going to be a whole field right right um our the application

of AI to the study of protein structure and being able to predict Therapeutics based upon the knowledge of protein structure there are just so many things that other fields of science and

engineering and techn ology that maybe as recently as 5 years ago had been considered as completely different from life sciences now those fields are very much a part of and are being applied in

the Life Sciences that's what makes this such an exciting time what are your daily Health practices as somebody who knows a

lot and is on the you know kind of Forefront of learning about what's new and what really moves the needle in terms of you know trying to maintain maintain your your health optimally like what are the things that you do every

day or maybe what are some of the changes that you've made in recent years well having lived in in California now a little over a decade um it's it's easy a little different than Baltimore a little

different than Baltimore but Baltimore is a fantastic Place uh but it it you know we get fresh fruits and vegetables here and that's a large part of my diet

is is is consuming those I'm not uh a vegetarian I do eat meat products but I I do it probably fairly sparingly um I go to the gym I try to get to gym three

mornings a week uh I try to get some cardio exercise every day uh I generally U I just started several years ago not eating breakfast uh I I actually found

when I start and I tell you when I started doing I started doing it during covid when everything was so incredibly busy we we would typically start meetings um 7: a.m. sometimes earlier

during covid so just wasn't time to eat break I found myself getting to lunch and wow you know I actually feel pretty good um and and so um the intermittent

fasting has become a part of my routine I'm not recommending it to others you just simply ask what what I'm doing and um and so those are those are some of

the things try to you know eat sensibly and responsibly and get exercise and you're a cello player you still play I do I do that was another that was a

silver lining of for me because you know I didn't get on an airplane for 18 months and um it it was uh you know the

evenings there were constant zooms but um but I could practice again and I also discovered that Zoom works pretty well for for music lessons so I uh tracked down my teacher from the east coast and

said are you doing Zoom lessons he said of course and so it became a weekly routine and and then I started playing with some other groups and some very talented young people and and now of course we're back to the real world and

it's it's become more of a challenge to practice but it has been good I saw a video of you playing the cello with uh condalisa Rice playing the playing

playing the piano's an amazing amazing person amazing Pi that was wild one question I always ask uh every every doctor that I have on the show is if you

woke up in a parallel universe and discovered that you were the the Surgeon General of the United States what would be your priority what would be your mission statement what would you focus

on yeah and you've had the Surgeon General and I had him and I said now I actually have him I tell so that I can't ask him that question anyway

um I think what um what I would focus on are the things that help us each of us as individuals engage with our health

and our health care in transformative ways so making information about our health readily available to everyone uh

not just a particular socioeconomic group or particular educational uh level but making health information available and

accessible um I would also focus on uh the responsible regulation of things that we know harm health and already there's being a lot done on that but a

lot more could be done um I would also focus on making sure that we had uh a healthcare delivery system and a

discovery pipeline that focused attention on diseases and disorders that were most prevalent in the society um what would that look like I'm not sure I totally understand what

you're saying well for example new ways to treat high blood pressure u in addition to our existing therapies um new ways to treat um and

we're already seeing this for example um high blood glucose and obesity glp1 agonists are doing that doing that very effectively took a long time to get to

those some of that was a scientific problem just working out the science to develop an effective glp1 Agonist but others I think another reason was it

just wasn't at the top of the list in terms of where you know where the emphasis was on Discovery so those are the some of the things that I'd want to focus

on we we all know that if we're having some kind of symptom the last thing we should do is go online and look at what

people are saying on WebMD or just be an armchair physician and try to diagnose ourselves uh of course lots of people do

that there's a temptation to do that but now we have these llms right at our fingertips so when we're experiencing something uh we're going to want to type

it in and see what these llms are are going to tell us about you know what we might have and what we might want to do about it um what is your sense of how

reliable they are currently uh in terms of engaging in that kind of behavior I know you've spent a lot of time playing around with these things um is that a wise thing to

do is that something you should avoid doing in the current state I don't think you should avoid doing it I think you ought to have a healthy degree of skepticism on what you

see but back to our previous topic of don't put things in a box and shut the lid first encounter I mean I started playing around with large language

models when chat GPT came out in in November of 22 or around there but um the first indication that I had that this this was really going to be

transformative came from um I was asked to give a talk reviewing my research over the summer uh uh at at a course and it gave me an opportunity to update things and I just went online and I'm

probably best known in my field for the discovery of an inner ear disorder and I just went to this is chat GPT even before GPT 4 or or Claude or other you

know large language models I'm going to ask it about the thing I know the most about correct yeah and uh just see and and it was really good um I mean it it

even some of the subtleties it it got when I recognize some of the language and what it was writing uh but the description of the syndrome was accurate

um there were at least in the response I got there were no hallucinations or glaring abnormalities um now when I started pushing it with more and more detailed questions then yeah Falls AP a little

falls apart but I wouldn't shy away from it I think back to your original question I think the so-called Dr Google has been a good thing when I moved at John's Hopkins from being a department

chair and a physician surgeon scientist to being Provost to the university needless to say my patient care activities and my research uh got

curtailed uh but when I was an very active physician surgeon scientist people would oftentimes come in having

you know found me um because of a a search they did and a diagnosis they had made in many cases correctly of an inner ear disorder that that I discovered and

described so I think people should be using them but they should have a high degree of skepticism but the more knowledge someone has about their health about their well-being the better it's

going to be what is the message that you most want the average consumer who's watching or listening this to kind of understand in terms of the intersection

between technology medicine and you know the future that is upon us I think the message I would want people to know is that there's a stronger potential for

good than for bad but we have to keep our eyes open and be very much focused on the bad that could result from the misapplication of the technology and

consumers have to be actively engaged and involved and knowing how information about their health is being used and healthc Care Delivery Systems have the obligation to furnish that information

and as you were saying before to give people the option to opt in if their data is going to any way in any way leave the ecosystem that has to be

done with their full knowledge and and understanding of how it's going to be used and what is your message to the young aspiring med student there's never been a better time and and I think our

medical students today very much have that that attitude you know we continue not just at Stanford but across the board see record numbers of young people

apply to medical school apply to PHD programs in the biosciences to do the types of Discovery based research that are going to drive the Innovations we've been talking about today record numbers

of Highly qualified people are interested in in these fields and I think it's because of the opportunities we've been talking about part of me feels like you're in the wrong job like you you're you're you could be this

Communicator at large around these ideas and be at the intersection between the private sector and you know the

government or the the kind of consumer AI Watchdogs to guard rail and definitely guide this technology forward I guess that's what you're doing but uh

you have a lot of other you know responsibilities and obligations in in your current role well I said before it's never boring look I I derive so

much energy from the people that I have the privilege of working with every day and um communication is a part part of it in fact it communication is part of

such a critically important part of any leadership role today I don't think it's ever been more important than it is today communication because there's so

many opportunities for you know messages to get misconstrued or for things to be uh not connected in the way that they should be we have a a Leadership Academy

for people in faculty in the school of medicine who are thinking about these are generally mid-career faculty already you know proven themselves as accomplished scientists Physicians other

experts uh but who think they may more move into leadership roles and a lot of that Leadership Academy is focused on how to be first a good listener and

second a good communicator and how to really engage meaningfully with others I mentioned to you a conversation I had about a decade ago with venture capitalist who said that you know he

didn't like to focus on anything that purported to change Behavior another conversation I had with another venture capitalist I asked for what what do you look for when you're you're evaluating

an entrepreneur because you're deciding on investing in an idea but you're also deciding on investing often times in one person or a very small group of people and what advice do you give to them when

when you take them under your wing and fund their company and what this person said was you know don't assume intentions um you know focus on

situations realities uh but so much time and energy uh psychological energy time is devoted because we think well why did

this person say that or why did they maybe they were thinking this if you have a question ask the question if you have a concern Express the concern uh

but we we need more transparency in our communication I think that was the essential message and um it's something

that that I've tried to do in in in in in being available uh but also uh reaching out when I have a question or I

have a concern expressing it giving and introducing a dialogue uh that can lead to a meaningful solution well you're a you're a very effective communicator and

and I think um being Adept at science and medicine doesn't necessarily mean that you're effective at communicating these things that you know so much about

um those are two very different skill sets uh and most people in the Sciences or most people in general aren't schooled or educated in how to translate

their expertise in a way that is Meaningful for other people um which is why I think it's so important that people in The Sciences who are at you

know kind of at the the front lines or the Vanguard of of new things be better skilled at how to communicate those ideas I agree with you communication is

critically important in everything we do and the other message that I think we can all learn from is I believe we can all learn to be better communicators and

it's not it's not like you reach a plateau right but but it's like learning anything whether it's learning to ride a bike or learning biochemistry you have

to be intentional about it you have to focus energy on it you have to focus uh your intellect on understanding how to

communicate and and also really looking critically at when you're not communicating well and I depend upon others to give me feedback on if I

haven't explained something and usually it's because when we're all busy it's an error of omission rather than Commission in other words that that we just I

haven't reached out or there was an opportunity uh to have engaged people in a different way at a different time that would have led to you know more

effective transparent communication the other thing about that is it's helpful for all of us as Leaders to to be vulnerable to enter into interactions in

a way that that we want to learn from others we we're still evolving I'm still evolving as a leader as a person um and

join me in this journey U that resonates with people um I do believe at the core people are in ently good and um and and

people respond um to requests for Meaningful engagement and people respond to leaders who come across first and foremost as caring individuals well if

you want to in gender trust that's that's the primary thing you have to be willing to be vulnerable you have to uh say when you don't know the answer you

have to admit when you got it wrong and I think those lessons are ones that need to be learned on a healthc care public policy front as well we you know you

mentioned Co like there were missteps and mistakes that were made with that that I think denigrated the level of public trust in the sciences and in our

healthc care system and how we kind of advocate um you know what people should and shouldn't do and and we need to rebuild that trust that's exactly right you mentioned before when we don't know

the answer to something we need to say that we don't know I mean remember early on in Co when we all washed our fruits and vegetables coming home we'll never

forget that yeah so that didn't prevent the transmission of Co we didn't know that at the time but but we do have to be be better at communicating

uncertainty and at building trust from the public that that medical knowledge any knowledge evolves as we get more evidence and particularly when we're

dealing with moving Target things are changing people are doing the best they can under the you know High Press circumstances of the day um but I think you know being able to kind of say well

we got that one wrong we should have done this now we know better um but doubling down on we were right you know is not the way forward no I agree with

you things so um hopefully that was I mean you you know it's like did we like for the next pandemic are we ready for that like I'm it's kind of scary what might happen it is scary we learn the

lessons we needed to learn to be better prepared the next time because there will be a next time there will be a next time and I'm not sure there people on both sides of that that debate um but

and I think the other thing about it the did we learn is maybe we could rephrase and say are we learning because I think that process is still ongoing and also I

think some of the um some of the the working through of the the burnout and and and just the toll that covid has

taken on all of us that's still on going and we we still will have the we need the benefit of a bit of an interval now the danger is that once Co really leaves

our minds and we won't focus on making the changes we need to make we have to avoid making have to avoid allowing that to happen um you know I I've heard for

example that we had a during covid we had an issue with supply chain in uh you know in PP personal protective equipment

um are we rebuilding the stock piles in the way that we need to build them before covid Healthcare Delivery Systems used just in time ordering um you didn't like to keep big warehouses it was

inefficient things would go past their expiration date so you would get things in just in time well guess what that works if you can predict your demand but

when you have an unpredictable you know perturbation um and you run out of supplies so are we thinking about building up the supplies that that we

need and and uh and doing it in an enduring way um those are important questions yeah uh hopefully hopefully there's there's smart people who are

working on that and thinking about that um while we you know work hard to rebuild trust um well look it was an honor and a pleasure to have you here

today for me I have tremendous respect for uh the role that you the responsibilities that you hold and the way that you Advocate publicly around the ideas that you care about and uh

although I said you know maybe you would be better in a different job I'm very glad that you're in the job that that you're in and uh yeah if there's anything I can do to be of service to

you uh please let me know this this was a Del for appr thanks peace peace [Music]

PL that's that's it for today thank you for listening I truly hope you enjoyed the conversation to learn more about today's guest including links and resources related to everything

discussed today visit the episode page at Rich roll.com where you can find the entire podcast archive as well as podcast merch my books Finding Ultra

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peace plants [Music]

namaste [Music]