The Humanist Equation: Balancing AI and Clinical Judgment

Junaid Kalia, MD:

Today we're joined by our two quad cohort co-hosts, Harvey Castro and Edward Marx. And it seems both of them are in Dallas. And of course we have our amazing guest today, Mr. Phillippe Gerwill. He is known in the industry, to be in a futurist for AI.

Phillippe Gerwill:

Okay, thank you very much for the kind introduction, but even more for the invitation because I love this kind of very open discussion. Not prepared, running with the flow, you know. So, my name is Phillippe Gerwill

So I spent 30 years in big corporation, I would say half of it in specialty chemicals and half of it in pharma.

So my last job was that, at Novartis. So during my time Novartis and even specially chemicals, you know, I was mainly IT supply chain, you know.

So time of blockchain, IoT, big data, all that stuff, which I'm not saying it's not there anymore, but it become, at least we don't talk less about it.

It's part of the landscape. But then I moved more, on the healthcare side and more as a patient and was quite interesting because I said, I talked also early on and I think that's the time where I met also Harvey, in person about the healthcare metaverse, which is, and it might be an interesting topic, not the healthcare metaverse, but the whole adoption of those technologies, you know, everything is going quick, but the adoption is still not that quick, you know, so I think we still are facing that issue.

I said, I may be older than some of you, but I lived in a time where technology was behind. You know, technology couldn't deliver what we were needing in the business. Now I think it's the opposite.

Technology is quicker and we are, is slow in adoption, you know, so, but that's that I'm, an intern speaker. I went to many countries. I'm very proud that some of the countries I did together with Harvey. But I'm also a humanist, you know, so that's the point. And people ask me, you know, what does that mean, you know, digitalization, humanist or however you call it. And for me it's basically, you know, I'm big fan of all those technologies, you know, but that those technologies would serve the human and not the other way around.

And I think, we have a lot of challenges in that space because, you know, we, we could even become better human again. Because I'm saying, again, because I think we lost some of that, you know, in that space. But the risk of not doing it is probably higher than, Than, doing that.

Edward, Marx:

Philippe, it's great to have you as part of Signal and Symptoms, and you bring a great, perspective.

But yeah, you know, someone said something provocative to me earlier this week, and I wanted to get, as a futurist and as a humanist, wanted to get your perspective on it, and they were like, hey, AI is a bubble.

Like, are we in a bubble or are we in a hype cycle at the peak of, you know, over expectations?

You know, what, what's your thought on that whole general concept with AI?

Philippe Gerwill:

Yeah, so. So first of all, I think it depends what we call a bubble, you know, because I think there will be definitive changes. You know, it's ongoing, things are going quickly, but it's not going to disappear.

So the only thing when I'm saying where I could argue about, the word bubble, you know, they are still too many solutions out there.

And I would even argue about the word solutions. Are there really solutions? You know, so again, everybody is using AI. Not everybody. The word AI, sorry, but not everybody is having AI. So from that point of view, I can accept that. You know, kind of bubbles, some will disappear, some smaller bubbles will disappear, or being integrated into bigger not.

We talked about localization. You know, part of it is global and part is going to be localization. You know, when you travel around the world and it seems that you are also traveling a lot, you know, you see that it's still not one size fits all. So we should, of course, kind of part of it should be global, but part of it should be localized, starting with the language, especially if you talk about patient.

You know, English is not. Is not there everywhere. So all that. But again, in that case, AI is not a bubble because AI will help you in terms of the languages, in terms of literacy also, you know, to.

Junaid Kalia, MD:

Yeah, Harvey, why don't you answer the same question? Take it away.

Harvey Castro, MD, MBA:

So going from Ed's question, are we, Or from his friend's question, are we in a bubble?

I see it as a cultural shift. I don't. I see the point of the. Oh, it's a bubble. We're spending all this money, and we're putting all this things, and it's going to explode and nothing's going to happen. I don't see it that way, in that I see it growing. The foundation is being built. Cultural awareness is changing.

And your mind has shifted and you see things and you're doing things. And so in my mind I, see AI has just shifted the way we work, the way we do things, and it's just created this new, new way of doing things, and it's just a shift.

So my question is based on, let's just say the last six months of all the conferences, all the things you're seeing, what has really wowed you? You're like, wow, X concept or this is coming in the future? What, what is that that you can share with us?

Philippe Gerwill:

I don't know if you want completely to jump there, but I, know you're also a big fan of those discussion, Harvey.

The question about quantum computing. We are already overwhelmed with what AI can do and the speed and all that. We are going to be shocked about the combination of quantum and AI because again, let's simplify it. It's still like the human brain, but just quicker and more, you know, but it's still kind of one step after the other.

Logic and all that. Quantum is going to think differently than a human brain, you know, it's going to revolutionize the stuff.

But the doctor should not be the guy who has to enter data. The doctor should be the one that looks into the patient eyes and make the human touch. And early in the early days you had this quality things from ChatGPT, you know, that patients said the ChatGPT was more empathetic than doctors, you know.

And the reality is it's wrong it is that the doctors are not human anymore. The doctors are becoming robots. And that's the point. You compare robots to robots, then you're going to lose. So we have to win for the human skills, you know.

So we have now to concentrate teach education which is also not the quickest industry to concentrate on critical thinking, emotional intelligence, cultural intelligence and all that because we are on the way to losing that.

Junaid Kalia, MD:

Amazingly true.

AI is not in a bubble. It is that humans are in a bubble and they will understand at some point in time that the human bubble is going to pop because of AI. And that's where people don't understand. I don't like the word AI bubble. I like human bubble because we again I want to repeat what Sundar Vichai said recently on New York Times is that humans are not evolved to actually gather this much information so fast.

So and the last point that you talked about, AI and quantum

So the way AI works is that, that it is all what we call probabilistic and As a matter of fact, if you look at the engine, it's called back propagation. And then you make forward predictions. And it is always probabilistic, it is never deterministic. When the word deterministic is used, you mean 0 and 1.

I want to go back to your experience that how you have seen the healthcare side but how the pharma side and the chemical side is changing in the age of AI.

And given that alpha protein fold, given that we actually have this new biologics and everything coming, what are your thoughts? And when did that flywheel gonna go into effect?

Philippe Gerwill:

Yes, of course, very interesting question because again I think the key point behind your question is also when is the timing?

Because I said most of the things are accelerating but in some space you are still not

And I'm also one of those guys saying, sick care system is not health care. You know, the system is broken and all the kind of things. So maybe if we stop really and think about it, in many places, the healthcare system is not broken, is working exactly as designed, you see.

And then that's a big challenge, you know, because for some people, it's okay. They make money like it was designed, you know, And I'm not going to say because, you know, it can be pharma, it can be insurance, can be even hospitals and whatever, you know. So actually that's what I'm saying. Maybe it's right.

And if as long as we don't go in that direction, you know, that the design was done, you know, years ago for another era, for another knowledge and whatever, I think it's going to be difficult to change it,

You even know, even the students in the US, in the UK, many countries, 30% of the medical students are not going to start as clinicians, you know, and one of the key reasons. So there are mainly two, from what I know, one is the bureaucracy, the paperwork that you mentioned before, because, you know, you don't learn to be a doctor to fill data, to fill forms and data online, you know, and the second one is work-life balance.

You know, the younger generation has another view of work life balance. And I don't want to go there to say who is wrong or right. Was it our generation? Is it their generation? I think even it doesn't help to have the discussion. But the point is we have to do it differently.

The market is different. And again, there is no way that we will have enough resources in the traditional framework to have enough doctor or nurses, clinicians for an aging population that needs more treatment.

So the only way is to go more to preventative care and health. But the market has not been built. This framework was not built for that. So how do I change that?

How is pharma going to move there? And for the moment, I said there is a lot of, opportunities in pharma, but on the drug discovery side, so you know, you have company like in silico medicine and others, they have already, you know, discovered some of the first drugs with AI.

So for the moment, they, it's still in their old model of pharma. They can be quicker, have less waste, but it's still not something about prevention. So I think, you know, on one side we see we need to move into prevention so that people stay healthy longer, you know.

And when I talk in some longevity events recently, I pinned a different quote, you know, saying, because somebody said we should move from sick care to seek care. And I said we should move from seek care to seek health. I'm not seeking care.

We should seek health.

Today, stuff like that with medicine that is going to come, you know that what you learned at school is even wrong is doing more damage than something else.

And that's another point which I think is important because of the technology, AI and some others. We might learn more in the next 10 years than in the last hundred years. So how are we prepared to that speed?

Junaid Kalia, MD:

You're absolutely true. The biggest blockers like currently the data silos exist because of the EHRs, and then one of the issues that they're trying to pull is protecting their way of life essentially at the end of the day.

So, Ed, make me a connection between wellness tech and med tech. And what Philippe is also saying, that how that connection is important from going from sick care to healthcare.

And then finally, the largest, hardest question to you, as usual, I'm not going to make easy for you, is that how will it impact the revenue cycle, the pricing models and how, you know, the insurance companies are going to adjust to it.

Paint me a picture between wellness tech and med tech combining, or what do you think is going to happen?

Edward Marx:

I will answer your question, but it reminded me also of another scripture which is similar to the one that you grew up on. And that is you can't pour new wine into old wine skins. Right? And that's one of the reasons we have signs and symptoms, is to help us learn.

So we're getting the new wine, in this case, AI and the wine skins are us, right? And so if, if you pour new wine into old wine skins, the wine goes bad, and the wine skins, they deteriorate, they break, they're not able to receive. And so it's really important that all of us and our listeners, you know, we always work on ourselves, which we all do, obviously, you know, showing off our, you know, our rings and all that sort of thing.

But I always thought, I've always lived by that scripture, but it's come, to be more meaningful, right? In the age of AI. So, yeah, how do you make it all work? And it goes back.

I think by and large there's a couple exceptions of very small countries that are able to pull it off because of their size and having sort of a socialist framework for medicine, that is hard to pull off because there's just not the alignment of the incentives.

And we talked about that. It's better to do sick care, you make more money. You know, a health system by itself, like if we stick sort of to the west, a health system by itself can't make this happen because they would go out of business because not everyone else is playing in the same way.

But at the same time, they have to balance, you know, margin and mission, to make these sort of hap things happen. So, so I, I think the best thing that can happen is when it's smaller countries, you know, that prove this out, where they have maybe a single system for wellness and can align the incentives.

I, I think that that is where we're seeing some progress.

But there are examples around the world, where communities have gotten together sort of to align incentives.

And, and interestingly, the, the hospitals are not a big part of it because as we know, it's all about, you know, your environment, your social network, your belief systems, your, Your nutrition.

We need a bold leader. I think that's going to get out there and say we're going to do it this way and make it happen and it'll be painful.

And we just need that bold, visionary leadership and someone to say, this is what we're doing, we're going to make it happen.

But I think that's what it's going to take because it's not, nothing's going to change unless someone takes bold stance. Yeah.

Philippe Gerwill:

And, and again it's, it's, it's a lot about we still work in silos and I'm not talking just medicine.

But the whole ecosystem is like that, you know, and everyone. And again, a lot of them make money, so why should they change this?

Harvey Castro, MD, MBA:

Junaid, what do you say? What do you think? Should we replace radiology and forget about radiologists?

Junaid Kalia, MD:

The tasks of radiologists, identifying a cancer, identifying a lesion, differentiating, sizing of one cancer to another cancer, all of these tasks of a radiologist will be, will be gone because of A.I.

but the job of the radiologist is not going to go away. So clearly we need, to upscale our current radiologists to do the job they were intended to do and optimize their task as much as we do with AI

So we're not going to replace radiologists with the current demand, actually. But what we are going to do in future is replace a lot of 80 to 90% of their task and very quickly actually, within a year or two.

So it's just kind of like an odd situation, by the way, Harvey, but long story short, I think, we need to differentiate between job and task. And I think tasks are going away, jobs may persist, depending again, how fast things, go forward and, moving forward.

Harvey Castro, MD, MBA:

I always say this, guys, it's, it's the great shift that's happening today. You and I work a certain way, but before AI, we were, the way we were trained is not how we practice medicine. The way we started. Any institution that you work for is in the way you continue to work.

We all pivot, we all remodel, we all change. The only difference is the rate of change now is quicker, it's faster, we're adopting. So with that said, we have to change the tools.

Give you a quick example, if the data is collected in space on the weather, our accuracy combined with AI will give us better models than we have today. And Google has actually showed that already. My point is this. We need to stay humble.

We need to learn how to shift, understand this technology and keep coming to podcasts like this so that we can see things coming and obviously having guests like today, of the future.

Philippe Gerwill:

What are actually the biggest challenge in AI is infrastructure, energy and the chips. And we still look how I can get more of the same rather than maybe looking at something completely different. And the space is something completely different.

And I'm just trying to say if you can do that rather than lithium or something else. And that's what I'm saying, you know, we just look to find where can I find more lithium rather than look at something different.

But there's another. You may find something else, something different that could solve the actual. One of the actual biggest problems.

Junaid Kalia, MD:

You're so right. I mean it is getting harder to pick up.

People, again, reminder, it is not the AI bubble. This is a human bubble. I'm telling you that I had to fire people who were not able to catch up. And honestly, are humans truly able to catch up? Or not. And then what are your thoughts? Is it getting overwhelming?

Is it getting too scary? I'm gonna start with, Philippie and then Ed, and then we'll close with Harvey today.

Philippe Gerwill:

I think for me, yes and no, because personally I enjoy it. I love it.

I have more fun. You know, officially, I'm on early retirement. I never worked as much as now. I do what I love to do.

You can go with your kids to the park and all that stuff that I'm saying.

If it's done well, we can become better human. Because not Everybody is loving 100% of the jobs they're doing every day. It's a pain. We do it to make money and all that kind of things. So if we can choose what you can do, I still think as a human, there's a lot of things we can do.

Edward Marx:

Here's my. Here's my only sort of, you know, additional thought around that.

We're not an AI bubble. We're doing all these crazy things, but it's a very select few of us that are doing these crazy things, and we just have to be careful that, we don't create even a More. A bigger gap than exists today with, you know, people who have access to certain things and people who don't.

And. And so that a. I'm afraid if not handled carefully, you know, the AI could exasperate that gap. So I think it's up to all of us as leaders to make sure that we're. While we're always exploring and pushing boundaries and doing cool new things, that we also make sure that we don't leave people behind and try to help as much as we can.

Harvey Castro, MD, MBA:

At the end of the day, guys, as a physician, as a leader in this space.

Sorry, I want to say the following. It's all about how can we leverage our creativity, our humanity, our being plus AI using these new tools, and in my case, for humanity, in my case as a physician.

And that creativity is what I want to empower everybody. So, to me, these tools means helping people. How can I leverage. How can I leverage space? And I really think that is the key for everybody out there.

Junaid Kalia, MD: