Latest / CareTalk: Healthcare. Unfiltered. / Is the AI Bubble Ready to Burst? w/ Ed Zitron
Transcript
- 0:00AI seems like the future of everything.
- 0:02We're told it will transform healthcare by revolutionizing diagnosis and treatment, discovering new cures, and mastering administrative paperwork.
- 0:11But what if it's all a mirage that will end in disappointment or even disaster?
- 0:21Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
- 0:26I'm David Williams, president of Health Business Group.
- 0:29Today's guest, Ed Zitron, is CEO of EZPR, author of Where's Your Ed At?
- 0:34and host of iHeartMedia's Better Offline Podcast.
- 0:38We'll get to Ed in a second.
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- 1:51Ed Zitrin, welcome to care talk.
- 1:54Thanks for having me.
- 1:55Yeah, there's tremendous excitement about AI these days, but somehow you seem somewhat less enthusiastic.
- 2:02And I wonder why is that?
- 2:04So if you look at what people like Sam Altman and they're promising, they're talking about this autonomous general intelligence, artificial general intelligence, whatever you call it, this idea that even to your point, AI will be able to solve diseases and so to quote Sam Altman, solve physics, which is an insane thing unto itself.
- 2:22You have all of these promises and then the actual reality is pretty much large language models, which have some utility, but burn way more money than they'll ever make.
- 2:33OpenAI spends $2.35 to make a dollar.
- 2:37And so there are useful things that generative AI does, but they're vastly overwhelmed by both the hype and Well, the massive cost in many cases.
- 2:47it's maybe not shocking in and of itself that a technology in its early days is maybe spending more money than is coming in.
- 2:54And someone would argue that's a sign of all the investment that's being made and it's going to pan out, but you don't think so?
- 3:01I think that that compare, I understand why people make this comparison, but the last two of these, by the way, that people have said that about the Metaverse and crypto, they've been completely wrong.
- 3:11And My favorite reference here is a guy called Jim Covello from Goldman Sachs.
- 3:15He made a point that when people say it's like the early days of the internet, when the internet started, you need these massive $64,000 some microsystem servers to run it.
- 3:23And then the cost came down.
- 3:25The problem is that's not really how it went down.
- 3:28Yes, you needed these servers, but you didn't need anywhere near as many of them.
- 3:31And also the cost benefits were obvious immediately.
- 3:34E-commerce immediately reduced the cost of stores.
- 3:37Like it was just an immediate obvious thing.
- 3:39And smartphones, for example, people say, well, early days of smartphones, people didn't think they were a big deal.
- 3:44Again, not really true.
- 3:46Smartphones, was a Cavello in this report, Gen.
- 3:49AI, it's called Gen.
- 3:50AI, too much spend for not enough return, I think.
- 3:53And he makes the point that even with smartphones, there was this obvious roadmap going back to the very early 2000s saying when GPS sizes come down, when chip sizes come down, we will be able to create these devices.
- 4:05Describing smartphones, he describes thousands of presentations in which this was described.
- 4:10No such roadmap exists for AI.
- 4:13And when I say AI here, I really mean generative AI, because that's the other thing.
- 4:17AI has been around for 10, 20, 30 years, depending on how you look at it.
- 4:21It actually goes back to the seventies, depending on the terminology you use.
- 4:24Generative AI, which is the latest boom, really is not going to do the kind of artificial intelligence.
- 4:32that we're being sold today.
- 4:34If anything, I think the term AI for it is kind of a misnomer.
- 4:37Why people so excited about it.
- 4:39I mean, to me, seems that what happened is you've had AI around for a while, people have been talking about it, but when someone could go to chat GPT and just say, say, you know, give me a good looking email that I can send to my boss to say he's a jackass, but I don't look like I'm being bad.
- 4:51And then it kind of comes alive for them.
- 4:53Is that, is that why people are so excited about it?
- 4:55I think it's a few things.
- 4:56I think you're right.
- 4:57The people are using it and going, wow, it can write an email for me.
- 5:01And then there's a bunch of investor hype around it as well, because right now, if you look around outside of AI, there really aren't any hyper growth markets left.
- 5:09We're kind of done with smartphones will keep selling, but smartphones are kind of plateauing app stores and all they're like, are kind of, we've kind of tapped out on that as well.
- 5:18Software as a service already kind of reaching the limit.
- 5:21Sure.
- 5:21We'll find new things to sell, but there's not really a new business model waiting.
- 5:25And so you don't really have a new thing to point out.
- 5:29And what's happened is people like Sam Altman of OpenAI have attached this dream of what AI could be to generative AI, large language models, which kind of resemble something that's sort of smart, but you really have to squint kind of hard.
- 5:44And they generate things probabilistically, meaning that they will say, if you ask it to write an email, it will say based on the training data, the most likely series of words will be this.
- 5:53It doesn't know meaning.
- 5:55doesn't know any of this, but nevertheless, This is a runaway marketing campaign.
- 5:59And it's also kind of exposing a big, big problem in the economy, bigger than AI, which is the people running companies do not understand what their businesses do at all.
- 6:08And they don't understand the underlying technologies and they don't understand what their workers do all day.
- 6:11So to them, wow, something can write emails for me.
- 6:14That's all they do all day.
- 6:16I go to meetings.
- 6:17I write emails.
- 6:18I don't code or do a real job.
- 6:20I just go places and wow, I no longer have to write the three emails I write a day between my three lunches I take.
- 6:28Sounds good.
- 6:28You know, I wonder I love a lot of the things that you write one of the terms that you've been using for some time that I love is about the rot economy and I have to say that sounds that sounds bad.
- 6:38What is that?
- 6:40It's not good.
- 6:41So the rot economy is the sense that most of modern capitalism has been engineered engineered around growth growth at all costs.
- 6:50It isn't about say whether it's a good business whether it will last the test of time.
- 6:54It's about can it show quarter by quarter year over year growth?
- 6:57without fail because the markets love it.
- 7:00That's how the markets value companies.
- 7:01And it goes all the way back to Jack Welch of GE who created stack ranking, which is when you chop off the bottom 10 % and the idea that layoffs can be something that's done for profit reasons rather than an existential threat to the company.
- 7:14But what it means is that companies are in many cases building things not to solve a need, but to solve the need of the company to sell more stuff.
- 7:22So you look at Google, for example, Google deliberately.
- 7:25there's, wrote an article, the man who killed Google search about this.
- 7:29deliberately made itself worse.
- 7:31It added more spam back into it.
- 7:34It obfuscated the way you see ads on the platform so that the customer had a worse experience, but Google got to show them more ads, which meant Google got to make more money.
- 7:42So Google was very happy with that.
- 7:44look at Spotify.
- 7:45Spotify is like living in a minefield, except the mines are music you don't want to hear or buttons you don't want to press.
- 7:52User interface elements, which feel confusing and kind of counterintuitive like they're there to trick you because they are look at Facebook, look at Instagram.
- 8:00They are built to get in the way of you seeing your friends, seeing your family, seeing the things you want to see.
- 8:06And that's because they must show quarter over quarter growth.
- 8:09And this hits everything.
- 8:11Once you see it, it's kind of hard to not see it anymore.
- 8:14It's like the arrow in the FedEx logo.
- 8:17Yeah.
- 8:17One of the things I like about, about Google and Facebook is when people make these sort of observations that you're making about, the user experiences is crappy.
- 8:26There's all these ads and things in the way is, is to remind the user that they're, they're not really the customer.
- 8:31They're, they're the product.
- 8:32They're the raw material that's kind of being fed into it.
- 8:34And that's the thing.
- 8:36You can do a decent business where you are the customer and the product.
- 8:40Facebook used to be a very profitable business where the person was the product.
- 8:45It was fine.
- 8:46It worked pretty well.
- 8:48Facebook up until about, I'd say like.
- 8:502012, 2015 maybe wasn't that bad.
- 8:55was a positive-ish product, kind of evil, but still like it didn't feel like it was actively fighting you every time you used it.
- 9:03And that's really the, think something tripped in 2019, 2020 growth was slowing across the board.
- 9:11Pandemic happened and all these companies in 2021 saw these crazy earnings and they were like, wow, we need this forever.
- 9:17And they got rot poisoned.
- 9:19And now we're in this situation where you can't really, can't put the toothpaste back in the tube with this.
- 9:24So let's talk about healthcare.
- 9:25I'm almost hesitant to turn the topic to healthcare because healthcare is almost always a bad discussion.
- 9:29You know, it's usually a bad experience for the patient, but at least there's, at least there's some purpose behind trying to keep people healthy and then get them to be a little bit better if they're, if they're not.
- 9:40So let's talk about AI and healthcare.
- 9:42You wrote something recently about a partnership between Thrive, Global and open and a open AI I know Ariana Huffington who's excited about a lot of things seems excited about this Sam Altman too So how do you look at it?
- 9:53Well two con artists got together and made a new grift I think it's nice to see they're still kicking That that I'm not even going to discuss the details because nothing exists.
- 10:03Ariana Huffington is a con artist She has like what does thrive do thrive has been around forever.
- 10:09The only thing it's done is spent money or paid her she sits on board She does nothing.
- 10:14She does nothing at all Sam Altman, same deal.
- 10:16He's a professional con artist.
- 10:18He is good at raising money for things that may or may not exist.
- 10:21Putting that aside, what Thrive is talking about there is basically a chat bot, a chat bot that can look at your data and do stuff.
- 10:29And they love doing these things.
- 10:30They love talking about them because they seem theoretically reasonable, right?
- 10:34You can just connect a chat bot to some data and then it will work, right?
- 10:38That will be personalized experience.
- 10:39Amazing.
- 10:40The thing is, if you think about it, Like 11 different companies have promised this by now.
- 10:45You'll notice that none of them have launched it.
- 10:47And that's because of a few things.
- 10:49Chief of them, interoperability.
- 10:51The connection between two data sets, you know, within health, Epic is difficult to say the least.
- 10:58Can you imagine any kind of health data interoperating with anything else like a chatbot?
- 11:03Hell no.
- 11:04With the amount of regulations that are around health data, probably not going to happen.
- 11:07But on top of that, There's something very craven about Thrive and they're not the only people to do it.
- 11:13I don't like this push of trying to replace caregivers with chat bots.
- 11:20And the theory is, well, you get a 24-7 response.
- 11:23get a 24-7 response from a chat bot, though.
- 11:26It's a chat It doesn't do anything.
- 11:28And they're like, well, doctors are busy.
- 11:30This isn't going to really fix that.
- 11:32All it's going to do is give patients potentially bad data.
- 11:36I definitely understand how there's no great solution to say you've got 24-7 access, but it's just to a chatbot, not a doctor.
- 11:43If I think about it from the doctor's standpoint though, they say, I'd to spend more time with my patients, I can't really do it.
- 11:49Can AI give me that opportunity to be more efficient or more helpful to my patients?
- 11:54Yeah, but how does putting something else instead of the doctor fix that, is the thing.
- 12:00Now, if the answer is, okay, there are things that the doctor...
- 12:05doesn't need to do or there are ways that I'm even trying now and I can't do it because if you think about it as a patient, when you go to the doctor after waiting half an hour for the time your appointment was meant to start, so half an hour later, the doctor actually arrives, you then go and speak to a nurse and then the nurse makes you wait another 10 minutes and then the doctor arrives and then you speak to the doctor for five minutes.
- 12:28This isn't an issue of doctors not having enough time with patients.
- 12:32This is an issue of administrative burdens never being moved.
- 12:35It's about overbooking offices.
- 12:38It's about bad administration, which isn't necessarily on the doctor's side.
- 12:42I think that they want to do the AI thing to kind of fob off patients as a means of doctors having to speak to them less.
- 12:50Because right now, and I say this so my father ran part of the NHS in England and I won't pretend like there aren't weights there, but I've never felt rushed like I do in a doctor's office here.
- 13:01Nor do I, and that's the funny thing.
- 13:03I remember when I moved in 2008, say, you're going to wait.
- 13:06You're like, you're going to Americans would say, well you waited all the time.
- 13:09The doctor's office in England, right?
- 13:11I wait all the time here every single time, every single time.
- 13:16But the solutions are, well let's find more ways to get doctors away from patients.
- 13:20Shall we?
- 13:21Let's those menial questions that the doctor aren't the doctor doesn't answer menial questions.
- 13:27Most patients can't even talk to their doctor without an appointment.
- 13:31Most patients have to go through intermediary after intermediary.
- 13:34So we want to add another intermediary.
- 13:37Great.
- 13:37How does that make patients' lives better?
- 13:39It doesn't.
- 13:40Ever.
- 13:41All it does is further distance medicine from patient.
- 13:44And it's frustrating to me because people like Ariana Huffington, people like Sam Altman, they're like, well, it'll give you a healthcare assistant.
- 13:52It'll give you all these goals, blah, blah, blah, blah.
- 13:54Now it won't.
- 13:55Stop pretending.
- 13:56It isn't doing any of this stuff.
- 13:58It's not built to do this stuff.
- 14:00It's not built to, it is a large language model at this point.
- 14:04And this whole idea of the agentic approach, I will have a healthcare agent that will be able to, I don't know, intelligently interface with a patient so the doctor doesn't have to spend as much time.
- 14:14Doctors are already not spending enough time with patients.
- 14:17That is the fact.
- 14:19I am not, I am not a medical expert.
- 14:22I am not a healthcare expert, but as a patient and as a friend of multiple people with chronic illnesses.
- 14:30I know for a fact that doctors throughout at least the West coast, but I remember even when I lived on the East coast, doctors are already not spending enough time with patients.
- 14:38The idea of fobbing them off to LLMs is disgusting to me.
- 14:42let's take it from those doctors that are, one of the great things about healthcare and problem solving is you could solve 10 or 20 problems and it's still going to be a huge mess ahead of you.
- 14:51let's, instead of trying to solve the whole thing, let's say for that physician that for whatever reason they're in a situation where they can only have the five or 10 minutes with a patient, which is a typical thing.
- 15:00A lot of as patient when I go in, I'm not a physician but I fairly well understand healthcare, I can't completely understand what the doctor told me, I can't either remember it or I didn't totally understand it.
- 15:11And the physician realises that, in a way, they don't always realise it but they'll use a lot of terminology, is AI useful for them to say, write a follow-up note, say, take this as what I was going to say and make it in a language that the patient can understand.
- 15:25Why even go to med school at this point?
- 15:27You can't write a letter cupcake! Is it too hard to write a letter?
- 15:31no, I get the form that isn't necessary and I'm being somewhat glib.
- 15:34Like there are examples with that.
- 15:36There are like, especially when it comes to like healthcare plans, there are buttons you need to pick.
- 15:41If anything, the actual use here, and you kind of see a version of this with a much more expensive version with, there's this private clinic called Forward in San Francisco.
- 15:51What they have is during the intake, they have someone listening.
- 15:54you talk about it and they start filling in things and it pops up on a screen, it's kind of cool.
- 15:59I actually do imagine there would be a use of generative AI within that for a more intelligent intake.
- 16:07Something that asks something customized to the patient to say, okay, this patient is this many years old, they have these problems.
- 16:14And they might say something offhandedly that the LLM catches and goes, something to check into.
- 16:20That is useful.
- 16:21Something that gets the administrative layer away, but also makes it so that the patient is fully heard because the real problem with the five to 10 minutes is doctors aren't thinking about the patients particularly much.
- 16:32They are and I'm not saying doctors don't care.
- 16:34I must be clear, they're overloaded, all caregivers are.
- 16:39But at the same time, the solutions being offered are very much how do we get the doctor away from the patient and how do we get the patient away from the doctor's office entirely, which isn't good for the doctors either.
- 16:50No one likes that.
- 16:51It's just frustrating because I am neither a medical expert nor an AI founder.
- 16:57Yeah.
- 16:57I think within the last five minutes, I've come up with a more useful use case than anything Arianna Huffington's pushing.
- 17:03And it's because it does get to the grander point.
- 17:05These people aren't thinking of real problems.
- 17:07They're thinking of things they can sell, things they can market and ways they can get headlines.
- 17:11And people are falling for it every time they just print whatever they say.
- 17:15are some of the big ethical issues in AI?
- 17:18I mean, in what part specifically other than I mean, the environmental damage, the fact that you are basically boiling lakes to make this stuff happen, to make people generate a picture of Garfield with a gun.
- 17:30the fact that we don't let the training data is trained.
- 17:34is, is made up of copyrighted material.
- 17:36People's work is being stolen.
- 17:38The fact that there is a big dream of all of this, of replacing workers, even though it's not really going to happen based on the tech we have today, the fact that they're so excited, isn't fun to watch.
- 17:50And.
- 17:50quite frankly, when it comes to health data, as I've been saying repeatedly, it seems like the big move that lot of these companies are making is to push you away to keep the patient as far apart as possible versus thinking of ways in which you can enrich the patient's relationship with the doctor.
- 18:07If you really only have 10 minutes, the reason I bring up the intake thing is because that's a way in which you can get more out of the patient.
- 18:15You can then have it digested and brought to the doctor so the doctor can say, wait, you mentioned you had a pain in your right eyeball.
- 18:22That might say this, this, this, this might be vascular.
- 18:24Now I'm again, not a doctor.
- 18:27And really the ethical issues as well as with people making companies in health connected to generative AI, I really hope they don't train on customer data.
- 18:37The only companies I work with don't do that.
- 18:38don't like anything related to customer data being touched.
- 18:41Putting aside the legal side, the amount that you could reveal about a patient if it's fed into one of these models is really scary.
- 18:48There was a think last year a thing with chat GPT spitting out people's personal cells because of the way in which it ingested training data.
- 18:56And on top of this, do we really need to burn this much money on nothing?
- 19:02Is that really the, is this the place we want to put our cash?
- 19:06The planet is burning.
- 19:07We could be investing in climate tech.
- 19:10The problem is that climate tech isn't going to have a hundred X multiplier for some VC that's already quite rich already.
- 19:17So you mentioned about boiling lakes in order to power the service for this.
- 19:21I know AI uses a lot of electricity, and it seems that Google and Amazon perhaps are going to try to solve that problem by funding nuclear power plants.
- 19:30Should that take care of it?
- 19:32I mean, I'm not necessarily anti-nuclear power, so I don't mind that.
- 19:38What I mind is the fact that there are coal plants being reopened because of this.
- 19:42I think in Virginia, The fact that we don't need this data center sprawl at all.
- 19:47The fact that we are ruining, I mean, the climate, the emissions, I think Microsoft's over 40 % gonna blow past those, but there was a study that suggested it might be in those hundreds of percent.
- 20:00It's just, it's really frustrating because on top of this being environmentally destructive, it's totally useless.
- 20:06This isn't helping society.
- 20:08This isn't the future.
- 20:10Things are not better as a result of this.
- 20:12There's nothing.
- 20:13point at and say, wow, well, I mean, I know it burns the environment, but you know, at least this and there is no at least here.
- 20:22It's just, it's nihilistic, honestly.
- 20:25Now you talk about AI maybe as a bubble and bubbles tend to inflate and then pop.
- 20:30What would that, what would that look like?
- 20:33is just be less attention and we go talk about something else, or is there real damage, that would be done or would just use less electricity and it will just be back to a more mellow standard.
- 20:43It's less about the AI part and more about what happens next.
- 20:49So right now, I kind of hinted at this earlier, there are no lands left to conquer.
- 20:54There are no hyper growth markets left.
- 20:56We have the cloud boom, we have the smartphone boom.
- 20:58They tried with wearables.
- 20:59It didn't really work.
- 21:00They tried with crypto, a little bit, not that hard, but didn't work.
- 21:04They tried with metaverse, a little bit, didn't work.
- 21:07So they came up with AI, with generative AI and This is meant to make them a bunch of money, except it isn't.
- 21:14What will happen when the bubble pops is not just, and it will be horrible for their stocks, don't get me wrong.
- 21:22But the next step is when the markets realize these companies have no other growth vehicle.
- 21:27Microsoft, Google, Apple to an extent as well.
- 21:32Oracle as well for data.
- 21:33I mean, there are countless other options when they realize, and of course Microsoft, if it didn't say them.
- 21:39When the markets realize these companies can't grow forever and it's kind of already happening, there's going to be an apocalypse with the tech stocks.
- 21:46They're going to see 30, 40 % haircuts on top of that.
- 21:49also recovering those losses is going to be really difficult when you don't have a narrative to sell of where those gains are going to come from.
- 21:57There are only so many people to sell stuff to.
- 22:00There is only so many businesses that you can sell to.
- 22:04And at some point, something's got to pop and it's bad.
- 22:09It's bad for, it will be bad for a lot of people.
- 22:12think startups are in a good position just because startups are obviously not exposed to the public markets.
- 22:16But again, investment has been primarily focused on AI when it comes to startups.
- 22:21It's a really rough, rough situation, which is why I think they're keeping this thing inflated because deflating it requires them to admit that things are bad.
- 22:31And also no one's making any money off of this.
- 22:34It's such a small industry for the amount of money they're spending.
- 22:37I estimate based on numbers I've seen, Microsoft's making two, three billion off of AI.
- 22:44That's like a year.
- 22:45That's not that much.
- 22:48And it's, I worry about it.
- 22:50I'll be here to narrate it obviously, but I worry about it.
- 22:53So we've been talking about kind of the tech companies, their investors.
- 22:56What about regulators?
- 22:58Is there a role for regulators with AI and are there any special considerations regulators should give on the healthcare side of AI?
- 23:07I think that there should be legislation that says you cannot train on customer data.
- 23:11Like that should be the number one first thing they do.
- 23:13Should be completely off the table and it should be criminal.
- 23:17If you do, I think that there needs to be a big fat red line right at the beginning.
- 23:23Just because if patient data starts getting into these models, it is bad for everybody involved.
- 23:29And there are companies using synthetic data, which works in small amounts.
- 23:34That's great.
- 23:35but patient data needs to not be there.
- 23:37also, I don't know how you regulate out the idea of replacing doctors with LLMs, but you should.
- 23:44You shouldn't be, you can use them for intake.
- 23:47I don't think you should be able to use them for actual any medical advice.
- 23:50I don't think that that should happen.
- 23:51I think it's immoral.
- 23:52And I think that it shows a deep lack of respect for the patient.
- 23:58So we've been talking a lot about this from kind of the expert standpoint, investors, regulators, tech companies and so on.
- 24:06How should the general public be thinking about AI?
- 24:08What you've been putting forward today is very different from what they'll be hearing on the radio or seeing in the newspaper or on television or whatever.
- 24:17Should people be asking questions, pushing back against AI in their workplace, on the internet, when they go to the doctor?
- 24:25What should the general public be doing?
- 24:27I think the main thing to focus on is utility.
- 24:31Always ask why this is here, what does this do?
- 24:35And when someone gives you something vague, give them a specific question.
- 24:40Does this touch my data?
- 24:41Well, what does this do?
- 24:42Why is this here?
- 24:43If it's someone telling you what it might do, ask them what it does.
- 24:49Never ever accept what it might do because you are safe to assume it will never do that.
- 24:55And I think that I think that people in the workplace and in doctors offices are at the mercy of the people running them.
- 25:03But I think it is always fair to opt out and it's always fair to ask as many questions and if they can't answer them, you should not touch the thing.
- 25:11Unless I mean you're working then nothing you can really do about it.
- 25:14But I think that the big thing is, just don't listen to what it might do, ask what it does.
- 25:19Fair enough.
- 25:20Well, that's it for another episode of Care Talk.
- 25:22I've been speaking today with Ed Zitron.
- 25:25He's CEO of EZPR, author of Where's Your Ed At?
- 25:28and host of iHeartMedia's Better Offline podcast.
- 25:32I'm David Williams, president of Health Business Group.
- 25:35If you like what you're heard, or even if you don't, please subscribe on your favorite service.
- 25:39And thank you, Ed.
- 25:41Thanks so much.