I Think The Medical Profession Needs To Work Much Harder On This!

This appeared last week:

More Australians die while waiting for an organ donor

By Mary Ward

July 28, 2024 — 5.00am

In 2016, the Burrows family were living in San Diego while dad Anthony served with the Australian navy. In the middle of his three-year stint, Anthony and wife Clare welcomed a baby girl, Kate.

In her first weeks of life, Kate’s skin started to turn yellow. The family suspected jaundice, but a blood test revealed she had a condition called biliary atresia – her body could not process bile.

Kate was fortunate to be matched with an altruistic donor, who would provide a portion of their liver for her tiny body. But after a number of weeks, it became apparent the nine-month-old wasn’t responding well to the piece of liver she’d received. She remained in hospital with ongoing complications, as the family’s time in the US came to an end.

“They always tell you there’s a percentage of transplants that fail, but you never think you will be in that percentage,” Clare said. “We got Kate to a point where she was stable enough to be on a plane, and then we left.”

The Burrows arrived back in Sydney on a Friday. The following Monday, they received a call from the Children’s Hospital at Westmead: a local donor had been found for Kate.

On March 1, 2017, the then 15-month-old received her new transplant.

Organ donations dropping

The organisation which manages organ donation in Australia, DonateLife, is concerned about a decline in donor numbers, with those registering to donate falling by 13 per cent in NSW and 15 per cent in Victoria in 2023. In some parts of south-west Sydney, fewer than one in five adults are registered organ donors, while in Melbourne’s Brimbank and Greater Dandenong councils, the rate is one in 10.

More than 50 Australians died while on the organ transplant waitlist last year. Twenty-two died while on the liver transplant waitlist alone, compared to five in 2022. There are about 1800 Australians on the waitlist.

NSW state medical director at DonateLife Dr Michael O’Leary said organ donation sign-ups had remained pretty static for years until last year’s fall, with an actual bump in 2021 when more people downloaded the Medicare app to receive their COVID-19 vaccination certificate.

“It was actually just quite lucky that to get onto the Medicare app and get your certificate, the button was really close to the one for signing up to be an organ donor,” he said.

O’Leary said multiple factors affect how many make it off the waitlist in any given year. “We are nowhere near being able to provide organs as required for transplantation in Australia,” he said. “Anyone on the waitlist is on there because the specialists in organ failure felt these patients were warranted for transplantation.”

Kate proud of her scars

Now aged nine, Kate is a happy and healthy year 4 student, who recently gave a speech about organ donation to her classmates.

“She’s quite proud of her scars. She takes medication day and night for anti-rejection, but if you met her you wouldn’t know,” said her mother Clare. “She’s met every single milestone since she had the transplant.”

In the months after their daughter’s life-saving gift, the Burrows reached out to her donor’s family, but didn’t hear back.

In September last year, they did. Kate’s donor was a young woman who loved to dance, and wanted to be a paramedic when she grew up. The Burrows wrote back, telling them that Kate, too, loved dancing, as well as playing soccer and taking part in Nippers.

“Kate wrote that letter, and she was so grateful to be able to share what she has done in the years since,” said Clare. “We encourage her to see her donation as a very special gift.”

Here is the link:

https://www.smh.com.au/healthcare/more-australians-die-while-waiting-for-an-organ-donor-20240719-p5jv1f.html

In another life, a very long time ago, I found myself doing the almost unimaginable. In the office outside the ICU I was trying to console a family of a recently severely head-injured teenager who I knew had but a few days to exist while at the same time I was seeking consent to remove many of his organs, which would transform the lives of five of six people with new and long lasting organs.

This was, at once, the hardest, most rewarding and saddest role I ever had to undertake. It is an awful job but at the same time very hopeful and rewarding – especially when the recipients dropped in to say hello – and you could see the life-changing outcome you had helped in!

There needs to be much better education on all this and better explanations of the care that is taken to ensure the best outcome for all.

Australia is not doing anywhere near well enough in ensuring that organs from the clinically dead – and you are really dead if you brain has irreversibly and totally ceased to function -  are properly used and deployed to do the most good! (A decent ongoing national education program is needed)

Having seen the recipients years later I know it is a truly good thing! The dead can really help the living continue a rich life and we need to work harder at it!

David.

Terrifyingly We Have Places That Are Almost As Hot As Nevada And Not That Far From CBDs.

This appeared last week:

Extreme heat

Life at 115F: a sweltering summer pushes Las Vegas to the brink

Record heat is killing hundreds in Clark county. But one of America’s fastest-growing metro areas just keeps getting bigger

Gabrielle Canon in Las Vegas

Thu 25 Jul 2024 21.00 AEST Last modified on Fri 26 Jul 2024 02.31 AEST

Hot air wafted through the heavy, gold-lined doors of a Las Vegas casino as they opened, offering a reminder of a disaster quietly unfolding outside. Even though the sun had just set on an evening in mid-July, temperatures were yet to dip below 100F (37C).

Spawned from a paved-over oasis in the Mojave, this desert metropolis has always been hot. But a string of brutal heatwaves this summer has pushed Sin City to a deadly simmer.

It’s hard to tell from inside the cool, cavernous buildings that line the Las Vegas Strip, which have become unwitting refuges from the summer elements. Tourists willing to enter labyrinths of slot machines and blaring pop music, shops and shows can spend hours lost in an alternate world, away from the sun.

For the 2.3 million people who call this valley home, the dangerous elements are harder to ignore. When temperatures climb, shadeless streets are hot enough to cause second-degree burns in seconds.

This June was the city’s hottest on record. In July, things got even worse: the city experienced a record seven days at 115F or higher and set a new all-time high of 120F.

The heat is just a signal of what’s to come. Temperatures in Las Vegas are rising faster than almost anywhere else in the US.

Meanwhile, Clark county, where Las Vegas is located, is bursting at the seams. The region is among the fastest-growing metro areas in the US. Roughly 2 million people have moved here over the last 50 years, with nearly a million more expected by 2060.

I have been living here since 1972 and it would get hot – but not this kind of hot

Louis Lacey, Help of Southern Nevada

To accommodate them, the county has thrown its support behind a federal bill that would open up 25,000 acres of the surrounding desert for housing and commercial development. The county also has plans for a new airport, slated for completion in 2037, that would pave over thousands more acres of arid landscape near the California border.

New shopping centers and cul de sacs all mean more concrete – and more heat – in an area where the ability to afford or access air conditioning can already mean the difference between life and death.

Even after she spent most of the day inside, the heat still shocked Inata, a woman who traveled with her friends Chastity and Belinda from Massachusetts to vacation in the city last week. “It was horrendous,” she said. “In Massachusetts, if there was weather like this, there would be ambulances around.”

The three women said they struggled to cool down at the pool because the warm water offered little relief and the surrounding pavement burned their feet. “I don’t know how Las Vegas people do it but kudos to them,” she added. “I couldn’t do this every day.”

A daily battle for survival

The record heat is pushing residents to their limits – and has perhaps been most sinister for the more than 5,000 people in the county estimated to be experiencing homelessness.

Some have opted to seek refuge in underground tunnels during the summer, risking the waters that surge through them during summer monsoons over exposure to the brutal heat.

“We are trying to live – and it’s difficult,” said Tyson Williams, who has spent the last year living in his tent on the east side of town.

Williams paused to wipe the sweat rolling down his face as he filled a rolling cooler with water bottles provided to him by an outreach team, before downing an entire bottle in a single chug. A dilapidated umbrella he positioned over his tent did little to provide relief.

Born and raised in Las Vegas, he is a brick mason by trade, but now he panhandles for money to buy ice. He has just landed a job waving a sign outside a smoke shop, which will keep him outside and exposed to the elements. “We are all just one check away from being homeless,” he said.

Louis Lacey spends most of his summer days trying to save the lives of people like Williams, as the director of Help of Southern Nevada, a non-profit organization that hands out water, hygiene kits, and hope as part of a larger mission to get more people into permanent housing.

“I have been living here since 1972 and it would get hot – but not this kind of hot,” Lacey said last week as he drove through the city scanning sidewalks and drainages for anyone in need of aid.

As someone who has experienced homelessness himself, he said, the work is a calling. It’s also laced with heartbreak.

There was the woman whose leg was amputated after she got third-degree burns from passing out on the scalding hot sidewalk. She now uses a wheelchair. Just last week, he and other aid workers rushed to revive another woman, age 81, who passed out in an encampment. They found her surrounded by her pet dogs, who had all died in the heat. He was relieved they were able to save her. That’s not always how the story ends.

July is typically when local health officials report the highest number of heat-related deaths. Between 2022 and 2023 there was an 80% increase in fatalities, with the official number around 300, nearly double those counted in 2020.

The actual toll is believed to be far higher. Dozens of unhoused people died in the heat last year, and many of them, Lacey said, weren’t included in official fatality counts. He knows of at least 62 people and that doesn’t include others who got swept away by water in the tunnels.

This year the heat was worse – and while the numbers haven’t been released yet, many fear this July, too, will be brutal.

Emergencies on the rise as development rolls ahead

With impacts only expected to intensify in the coming years, the city and county are working to implement strategies to keep people safe.

There are 39 cooling stations across Clark county, but almost all are operated by unpaid volunteering organizations and typically close in the late afternoons. Only one city-run shelter is open during nights, weekends and holidays.

Jace Radke, a spokesperson for the city of Las Vegas, acknowledged by email that there were challenges with heat safety but cited wide-scale reliance on air conditioning as a protective measure.

He also said the city planned to plant 60,000 trees by 2050, part of a program that has already planted 3,000 since 2020. The county has also laid out ambitious sustainability plans focused on expanding affordable housing, reducing emissions, and addressing the worsening effects of the climate crisis such as drought, heat and water shortages.

But there’s still a long way to go and lawmakers have lagged on implementing important mitigations, including heat protections for workers. Emergencies, meanwhile, have continued to surge in frequency.

Jordan Moore, a spokesperson for Las Vegas Fire & Rescue, said there has been a “significant increase in heat-related emergencies” in the past month. Meanwhile in Henderson, a Clark county city south-east of Las Vegas, heat-related emergencies are up 53%, according to the deputy fire chief Scott Vivier.

Delivery drivers, warehouse operators, our construction trades – basically anyone who has to work outside – we have seen emergencies from them

Scott Vivier, Las Vegas Fire & Rescue

Populations including elderly people, unhoused people, those with underlying health conditions, and children are among the most at-risk. But this year the department is also getting numerous calls from people on the job.

“Delivery drivers, warehouse operators, our construction trades – basically anyone who has to work outside – we have seen emergencies from them and people with regular medical emergencies and during a normal day the heat causes them to succumb,” Vivier said. Heat-related complaints filed with the Nevada occupational safety and health administration (Osha) jumped 172% last July compared with a year earlier.

Vivier’s department is among the first in the region to use a new tool called the polar pod, which enables emergency responders to pack someone in ice and water while they transport them to the hospital. They have even trained to use the pods to revive overheated pets, Vivier added.

But Vivier is still worried about what the future will bring. “Heat is the No 1 weather-related cause of death for people around the world,” he said. “It’s a major, major issue we should all be concerned about.”

Even with the rising toll, the county’s hopes to grow deeper into the desert haven’t slowed.

Far from the din of the city and the suburbs, the hum of churning traffic fades into the background, replaced by soft breeze and silence. If the plan is enacted, these desert hillsides dotted in yucca trees and creosote could soon be covered in homes and strip malls.

Questions remain about whether building out the desert floor, proposed as a fix for the housing crisis in Clark county, will only perpetuate the dangers already alive in the city and suburbs.

“The desert is not a place for people who are living on the margins to begin with,” said Kyle Roerink, the executive director of the Great Basin Water Nework, an environmental advocacy organization. Roerink and others are also concerned about Joshua trees and wild desert tortoises, along with a host of other plants and animals, who would be sacrificed to satisfy continued sprawl.

“We are raised to believe that what is behind us right now is just normal and is doable, and fine, and that everything will be OK,” he said, waving toward the scorching cityscape where the history of rapid expansion in Las Vegas is already on full display. When many of those homes were built, water was much more freely available and the summers were far less lethal. “But these are radically transformed landscapes – and that comes with consequences.”

Back in east Las Vegas, Louis Lacey is wrapping up an afternoon of administering aid. The housing crisis and those impacted by it are all that is keeping him here. He dreams of the small town he will move to when he is finally ready to hang up his hat.

“I have been living in this hell for so long and I feel like this is my mission … But when I am done I want to move to a town where it rains and has four seasons. I don’t want to be in this,” he said, gesturing to the gridlocked traffic.

That doesn’t mean he’ll stop worrying about the city’s future and where the 800 people his organization helped get shelter will wind up. “When I moved here, there were 200,000 people – now there are almost 3 million,” he said.

“The only question I have is: is the growth sustainable?” Lacey sighed deeply, his expression pained. “We have the land,” he said, “but do we have the resources?”

Here is the link:

https://www.theguardian.com/environment/article/2024/jul/25/las-vegas-extreme-heat

This is a truly dystopian vision of what climate change is going to bring to the west of Sydeny and Melbourne in 20 to 30 years. I wonder will  the population of Western Sydney be ready for it – I fear not!

This is another of those blogs where I think mortality may save me as I am not anticipating seeing my 105^th birthday!

While no one says it much it is clear that Climate Change is chasing us and not too many years from now will catch us! Having grown up in Cowra (Western NSW) in the 1960’s when 100’s were usual in summer and air conditioning had yet to be invented (It was awful!) I suspect Sydney has seen nothing yet. It will be interesting to see how we all cope over the next 20 years of so!

David.

It Really Does Defy Belief That Australia Could Run Out Of, Or Be Short Of, IV Saline!

I was just left totally aghast at this incredible headline!

Health

Explainer

Australia is facing a shortage of ‘crucial’ IV fluids. What does it mean and who will be affected?

Intravenous fluids have a ‘myriad of uses’ in the health system, but supply is expected to be constrained throughout 2024

Natasha May

Sat 27 Jul 2024 16.47 AESTLast modified on Sun 28 Jul 2024 09.32 AEST

The peak doctors’ body is warning the health system could come to a
grinding halt next week if an unprecedented shortage of intravenous (IV) fluid isn’t resolved.

The medicines regulator, the Therapeutic Goods Administration (TGA), issued a shortage alert on Friday for intravenous (IV) fluid products expected to be constrained throughout 2024, due to global manufacturing issues and an unexpected increase in demand.

The assistant minister for health, Ged Kearney, who is a former nurse, says IV fluids are “crucial” with “a myriad of uses” in the health system. So what are they, how are they used in hospitals and what’s being done about the shortage?

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What are IV fluids?

IV fluids contain a saline solution – salt in water at a concentration which is similar to that of the plasma in our bodies. They are made under highly specialised manufacturing conditions using purified, sterile water with sterile electrolyte components. They also have highly specialised packaging and are designed to be compatible with intravenous giving sets to allow the fluids to be injected into a person’s veins.

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What are they used for?

They are used to administer medications directly into the bloodstream, including chemotherapy and anaesthesia.

But the fluids can be crucial medicine in themselves to support kidney function in patients who are dehydrated and keeping the blood pressure up of patients with sepsis as well as blood loss.

As a result, the IV fluids are crucial for patients undergoing surgery with open wounds and haemorrhaging in emergency settings.

An artery is filled with one-third red blood cells and two-thirds plasma, which IV fluids replace with similar concentrations of sodium and chloride.

Prof David Story, the president of the Australian and New Zealand College of Anaesthetists and head of the University of Melbourne’s department of critical care, says “while it’s physiologically OK for the red cell blood count to drop, it is essential to replace the blood volume”.

Organ injury, including to the heart, kidneys and brains, can occur if people become hypovolemic, where the loss of blood volume makes the heart unable to pump enough blood to the body, Story says.

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How will patients be affected?

The president of the Royal Australasian College of Physicians, Prof Jennifer Martin, says there are workarounds when it comes to the use of IV fluids to administer other medications. “There are other ways to deliver medication besides diluting them in a bag of saline – such as oral fluids, or giving medicines as a slow push intravenous injection.” However, Martin says the IV fluid bags can be safer, and enable hospital staff to get on with other jobs.

There are not the same workarounds for surgery, Martin says, where the patient is not conscious and cannot drink, but is losing much more fluids from their open surgical site “because you’ve got, say the abdomen open, then you lose a lot of fluid that way”. However, the IV fluids are needed to deliver anaesthetics, and to keep patient blood pressure up during surgery as well as after an operation, she says.

As a result, the Australian Medical Association has warned some surgery may need to be cancelled. Non-cancer elective surgeries would probably be the first to be delayed in the event there was not enough IV fluid, Story says.

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Is it just human health that’s affected?

Like humans, animals undergoing proceedures also require IV fluids. The president of the Australian Veterinary Association, Dr Sally Colgan, told the ABC the shortage was “very concerning” for vets, who have been facing supply issues in clinics.

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What’s being done to address the shortage?

Kearney says the medicines regulator, the Therapeutic Goods Administration (TGA), is working hard to make sure there are alternatives.

In an effort to address the shortage the TGA has allowed multiple overseas-registered alternative saline fluids to be imported, and is considering more applications for supply.

State and territory health departments directly manage supply in public hospitals, and the TGA says it is advising them when new suppliers are approved.

The TGA says it is also liaising with the three Australian suppliers to address any regulatory barriers.

Here is the link:

https://www.theguardian.com/australia-news/article/2024/jul/27/australia-is-facing-a-shortage-of-crucial-intravenous-iv-fluids-what-does-it-mean-and-who-will-be-affected

I read this with a sense of total incredulity! If I was reading about Zambia or Namibia I could have just about believed what I read, but Australia?

I wonder who are the grossly overpaid drones who have let this situation and how many of them still have a job? Zero I would hope!

Seriously though there is not enough thought given to things like sovereign capability. We are an isolated island continent which could face all sorts of supply chain disruptions, and we should be properly prepared.

The WHO has even created a list of essential medicines to give us a head start on knowing what we need to stockpile for say a 1-3 month period. Here is the link updated every 2 years.

https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.02

Keeping people safe and healthy is a core Government responsibility for heaven’s sake!

Frankly I reckon is betrays spectacular Government incompetence that this issue has emerged. I look forward to the list of those who have been fired! (0 I bet!) There is no such thing as accountability these days I fear....

What do you think?

David.

AusHealthIT Poll Number 757 – Results – 28 July 2024.

Here are the results of the poll.

In The Light Of "The Outage" Do We Need To Rethink Just How We Prepare For Such Events Or Should We Be Pleased Just How Well It Was Handled?

Yes - It Was Not Ideally Handled!                   21 (64%)

No                                                                        12 (36%)

I Have No Idea                                                      0 (0%)

Total No. Of Votes: 33

A pretty clear cut vote suggesting a touch more preparedness might not go astray! It was amazing that the failure could last for so long!

Any insights on the poll are welcome, as a comment, as usual!

A very good voting turnout. 

0 of 33 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

Surely It Is The Height Of Mis-Management That The Country Is Apparently Short Of IV Saline?

 Heads should roll I reckon for total incompetence! What idiots are running this show?

David.

I Really Wonder If The Author Is Not Being Too Cautious?

This appeared a few days ago”

Here’s a brain teaser: Will AI ever reach consciousness?

Paul Davies

Physicist, writer

July 20, 2024 — 5.00am

Consciousness is the most basic aspect of human experience, and yet it remains deeply mysterious. Centuries of deliberation by philosophers, theologians and scientists have made little headway in explaining its origin.

Now there is a new twist to this age-old conundrum. The rapid advance in artificial intelligence, or AI, has reignited the question of whether a machine can truly think and feel and possess a sense of self, or whether there is some special form of magic going on inside biological brains that isn’t captured by the world’s most powerful computer systems.

There is no doubt that products such as ChatGPT are dazzling in their capabilities, such as writing essays and even producing computer code. Superficially, they seem to “know what they are doing”. But that is an illusion: these systems are trained to trawl vast amounts of data and organise it in humanly useful ways. That doesn’t make them conscious, though.

Speculation about AI consciousness is based on the popular misconception that the human brain is a type of digital supercomputer. To be sure, both brains and computers process information with extraordinary efficiency, but they do so in very different ways. The pertinent question is not whether digital computers as we know them can be conscious, but whether we can build systems of some sort in the lab that mimic the way our brains work.

One idea is to use neurons as circuit components to perform basic information-processing tasks. Presumably, conscious experiences are generated by complex electrochemical patterns swirling inside our heads. Perhaps proto-consciousness can be conjured up in the lab by recreating such patterns?

Philosophers, following Thomas Nagel, often express the essence of consciousness as “what it is like” to be, say, a human or a bat or a bee. Well, is it “like” anything at all to be a jumble of wires, neurons and gel sloshing about in a dish? And how would such a conscious entity let us know the answer anyway?

Artificial mini-brains in a dish offer a bottom-up way to probe consciousness. But there is also a top-down approach, which is to augment human brains with hi-tech electronic gizmos. Elon Musk’s Neurolink company claims to have implanted microscopic needles into a human subject to enable a person to operate external smart devices by the power of thought alone. It could be the first step on the way to merging brains and supercomputers.

Eventually, electronic augmentation of brains may noticeably affect “what it is like” to be human. Unlike humble dish-brains, these “transhumans” could report on their enhanced subjective experiences.

Any attempt to unravel, mimic or enhance consciousness is an ethical minefield. If an artificial system is conscious, does it have rights and responsibilities, emotions, a sense of free will? Would humans have the right to switch off or kill such a sentient being if we felt threatened?

Running through these troubling questions is an assumption that consciousness isn’t an all-or-nothing phenomenon but comes in degrees. We feel far more remorse killing a dog than a cockroach because we suppose that a cockroach isn’t all that conscious anyway and probably has no sense of self or emotions.

But how can we be sure? And in the highly charged debates about abortion, euthanasia and locked-in syndrome, the actual level of consciousness is usually the critical criterion.

Without a theory of consciousness, however, it’s impossible to quantify it. Scientists haven’t a clue what exactly is the defining feature of neural activity that supports conscious experience.

Why do the electrical patterns in my head generate sentience and agency, whereas the electrical patterns in Ausgrid NSW don’t? (At least, I don’t think they do.) And we all accept that when we fall asleep, our consciousness is diminished, and may fade away completely.

A few years ago, the neuroscientist and sleep researcher Giulio Tononi at the University of Wisconsin proposed a mathematical theory of consciousness based on the way information flow is organised, roughly, the arrangement of feedback loops, which in theory enables a specific quantity of consciousness to be assigned to various physical states and systems.

Is a thermostat conscious? A dish-brain? ChatGPT? A lobster in a boiling pot? A month-old embryo? A “brain-dead” road accident victim? These vexatious examples might be easier to confront, and to legislate about, if we really understood the physical basis of consciousness.

The foregoing advances, while promising, tell us little about the subjective experiences that attend conscious events, such as the redness of red, the sound of a bell, or the roughness of sandpaper, sensations that philosophers call qualia.

How can we tell if an agent really has an inner life experiencing such qualia, or is just an automaton, a zombie, programmed to respond appropriately to sensory input, for example, by stopping at a red traffic light without actually “seeing red”?

And if one cannot tell from the outside what is going on inside, why does this inner subjective realm exist in the first place? What advantage does it confer in that great genetic lottery called Darwinian evolution? Even if we create a truly conscious AI, that final problem may lay forever beyond our ken.

Paul Davies is Regents’ Professor of Physics at Arizona State University and author of over 30 books, including The Demon in the Machine. He will be speaking at the Sydney Opera House as part of the Your Brain on AI event on August 17. Tickets: sydneyoperahouse.com

Here is the link:

https://www.smh.com.au/technology/here-s-a-brain-teaser-will-ai-ever-reach-consciousness-20240718-p5jutz.html

I have to say I think that we will see effective machine conscious in the next 20-30 years and that there will be pretty parallel development of machine intelligence over a like period. No proof but it is hard to imagine it will take much longer than that.

What is really above my pay grade are the implications of such progress and how society at large will respond to such a reality.

What do you think – will generally smart machine emerge in the next decade or two and what will it mean for us humans?

David.

This Is Probably An Important Application Of AI In The Health Sector.

 This appeared last week:

Using AI, this app may tell if you have an STI

By Mary Ward

July 21, 2024 — 5.00am

An app developed by Australian researchers is showing promise in diagnosing sexually transmitted infections (STIs) using artificial intelligence, amid a surge of people testing positive to the diseases.

There has been a post-pandemic upswing in cases of chlamydia, gonorrhea and syphilis, a trend attributed to increased testing but also a decline in condom use.

Australia is also in the midst of an outbreak of mpox, formerly known as monkeypox, with 28 cases reported in the fortnight ending June 23. The outbreak is being driven by local transmission rather than people bringing the disease from overseas, say federal health authorities. Most cases were recorded in Victoria, followed by Queensland.

Researchers at Monash University and Alfred Health’s Melbourne Sexual Health Centre hope their new app will give patients an embarrassment-free way to learn whether their bumps or rashes are a possible STI.

The app compares photos of a patient’s lesions to a database of hundreds of thousands of anonymised photos of rashes and lesions in people diagnosed with HIV, syphilis, gonorrhea and chlamydia, taken with patients’ consent from more than a decade of consultations data.

A trial of the app across more than 1300 consultations at the clinic, led by PhD candidate Nyi Nyi Soe and published in the Journal of Infection, found it correctly identified cases of mpox with 80 to 90 per cent accuracy when used by clinicians with patients at the centre.

“It is a quite reasonable result,” said Professor Lei Zhang, from the Melbourne Sexual Health Centre and head of the team creating the app. “Clinically, we would like the accuracy to reach 95 per cent, but we haven’t arrived there yet because we haven’t got enough images.”

The research team next plans to run the same trial on seven other STIs. Ideally, the app would be able to be used for both STIs and other skin lesions in the future.

But Zhang said he did not think the app would, or should, replace the role of doctors and pathology in diagnosing an STI. Any suspected STI identified by the app would still need to be confirmed through lab testing.

The major benefit, he said, would be saving people from coming into a sexual health clinic if they clearly did not have an STI.

“More than half of the people who come into our clinic are fine; they have a lesion but it is not an STI,” Zhang said.

“We don’t want to replace lab diagnosis. We want to demonstrate that the concept actually works, and the tool is benefiting both patients and doctors.”

A similar app, HeHealth, is on the market in Singapore. However, this app’s model has only been trained on pictures of men’s genitals.

“Our app can be used by men and women, and on different parts of the body,” Zhang said.

Data from the federal government’s National Communicable Diseases Surveillance Report shows there have been 10,000 more chlamydia notifications and 11,000 more gonorrhea infections in the past year than the five-year average.

Dr Sara Whitburn, chair of sexual health medicine at the Royal Australian College of GPs, said the increase was not necessarily a bad thing.

“People are coming in and getting tested, and that is a good thing,” she said.

“But we also know that, post-pandemic, people are engaging in sexual activity with a broader range of partners.”

Whitburn said condom use was also declining for multiple groups, particularly men who have sex with men and now have access to pre-exposure prophylaxis (PrEP) medication to prevent HIV transmission.

“That is also, in part, a good news story, but the message that you still need safer sex with condoms to protect against gonorrhea or syphilis may not be as strong as a result,” she said.

Young women are also choosing contraceptive methods such as IUD and the pill instead of condoms, and disrupted sex education in the pandemic may mean they do not understand the importance of barrier protection to prevent STIs.

“Then we also have people who are older and are repartnering after a long-term relationship, and the sexual health that worked for them in a relationship may not be what they need now,” Whitburn added.

Whitburn said, while she agreed the app would not be able to be used to diagnose STIs, introducing an anonymous, easy step to identifying whether a rash is a potential STI could be useful.

“If it lets someone know there is a strong possibility that their rash is an STI, they can go and take that step to get testing, especially if the app contains information showing people that there are treatments,” she said.

“Sometimes people feel that, if they get tested, it will impact their sexual health long-term. But actually, testing and treating is the pathway to good sexual health.”

Make the most of your health, relationships, fitness and nutrition with our Live Well newsletter. Get it in your inbox every Monday.

Here is the link:

https://www.smh.com.au/national/using-ai-this-app-may-tell-if-you-have-an-sti-20240716-p5ju4s.html

As the article explains it seems awareness and risk-avoidance of STI exposure has rather fallen away in the past few years for a number of reasons so a little AI help can only make sense.

I hope the wowsers don’t get all hot and bothered and try to block such a sensible initiative!

David.

Being All Things To All Men Is Hard – Even For Google. I Wonder What The Next Quantum Leap Will Be?

This appeared last week:

Google

‘Google says I’m a dead physicist’: is the world’s biggest search engine broken?

For decades now, anyone who’s wanted to know everything about anything has asked Google. But is the platform losing its edge – and can we still trust it to tell us the truth?

Tom Faber

Sat 20 Jul 2024 21.00 AEST Last modified on Sun 21 Jul 2024 02.40 AEST

I didn’t know I was dead until I saw it on Google. When I searched my name, there it was: a picture of my smiling face next to the text “Tom Faber was a physicist and publisher, and he was a university lecturer at Cambridge for 35 years”. Apparently I died on 27 July 2004, aged 77. This was news to me.

The problem was the picture. When you search the name of a notable person, Google may create what it calls a “knowledge panel”, a little box with basic information taken from Wikipedia. Somewhere along the way, the algorithm had confused pictures of my face with the biography of another man who shared my name. According to his obituary, he was “a distinguished physicist with a literary hinterland”. Google provides a feedback form to resolve this type of bug. I filled it in several times, but it made no difference.

I’m not the only one who has been struggling with Google recently. Many users are saying its principal product, its search engine, isn’t working as well as it should. They claim the ingenious vehicle that has enabled us to navigate the internet’s infinite scroll of information is beginning to rust and decay. That’s not to mention the company’s endless court battles with rival companies and world governments, or the rise of ChatGPT, which many tout as a search engine killer; even Bill Gates said last year that once a company perfects the AI assistant or “personal agent”, “you will never go to a search site again”.

Yet it’s hard to imagine anything taking Google’s place. Last year it turned 25, and Alphabet, its parent company, currently ranks as the fourth most valuable in the world, worth more than $2tn (£1.5tn). Google has a whopping 90% share of the global search market. More than a tool, it’s practically infrastructure; the connective tissue that is fundamental to how we find information online. This gives the company enormous power over politics, social attitudes and the fortunes of countless businesses – anyone and anything, in fact, that relies on the eyeballs of the internet to operate. Some say Google is too big to fail.

It doesn’t take a distinguished physicist with a literary hinterland to see that right now Google search looks both deeply vulnerable and totally unstoppable. How can we be sure the company really has our interests at heart? And can we still trust it to tell us the truth?

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The story of Google reads like the stereotypical tech company origin myth. A couple of computer geeks, Sergey Brin and Larry Page, started a business in a garage in the late 90s and built it into one of the world’s richest companies.

At the time the web was growing fast and a few early search engines were trying to organise the chaos. Page and Brin’s bright idea was to sort webpages not just by their relevance to a search query, but also by the quality of their information. This system, PageRank, prioritised webpages based on how many other pages linked to them. The underlying concept, borrowed from academia, was that if many people linked to a specific source, then it must have high-quality information.

It worked. Coupled with Google’s clean, simple interface of a text box and a handful of blue links, the site felt like magic. “Everybody could see then that Google’s results were far better than the others’. That was the basis of everything,” says Dirk Lewandowski, interim professor of data science at the University of Duisburg-Essen, who has studied search engines for 20 years.

Google quickly garnered a great deal of trust and goodwill. Its mission to “organise the world’s information” was inspiring. If you wanted to know something, you’d ask Google. Most of the time, it would deliver the answer you sought. Gradually, the other search engines died off. Search became synonymous with Google, and “Google” became a verb, and began to expand beyond text to images and video, even mapping the physical world with Google Maps and Street View.

Success generated more success, and Google captured vast amounts of data on its users that it employed to improve search algorithms. The company realised that this data could be valuable. With its search engine, it was capturing users’ thoughts, desires, their innermost questions. Google used this information to reinvent the advertising industry.

Cory Doctorow, an author, activist and mordant critic of big tech, explains the company’s ad system like this: “Say I have an 18- to 34-year-old manchild in central London who’s got an Xbox and has been searching for information about gonorrhoea. Who will pay to advertise to this person? Advertisers or bots bid for placement – and the winners serve an ad to you.”

Many of Google’s products besides search, from YouTube to Maps, collect data on users, which enables personalisation of your ads – this model is the foundational example of what technology commentator Shoshana Zuboff has called “surveillance capitalism”. Ads became big business for Google. Last year its parent company, Alphabet, earned 77% of its revenue from them – that’s $237.85bn.

Along the way, the company accrued not just economic power, but also social and political power. Rosie Graham, a lecturer in contemporary literature and the digital at the University of Birmingham, says we don’t just ask Google for information, but also for “ways to live our lives”. When we look for answers to social, religious or political questions, Google judges who are the trusted voices, and who we should not hear from. “Google has the power to change the way we think about things,” Graham says.

“It acts like it’s just another company, but it’s not. It influences countries’ elections. It has a huge stake in what’s profitable, what jobs can exist … in many ways it’s more powerful than governments. Gone are the times when it can be this small company that’s all cutesy and shoestring.”

Somewhere along its path to success, Google lost the public goodwill it earned in its early days. Once, its playful motto, “Don’t be evil”, featured prominently in its code of conduct. In 2018, it was quietly downgraded.

Companies become too big to fail, then too big to jail, then too big to care. Google is too big to care

Has Google search got worse? And if so, what does that look like? Imagine you used to go to your local library and, when you asked for a book, it was produced immediately. Now, when you ask for that same book, the librarian tries to sell you a magazine subscription, waves about some different books they say other people like, then finally produces a big stack of tomes with your desired book wedged awkwardly in the middle. You might have an opinion about this change in service.

This is the portrait detractors paint of the current state of Google search. Doctorow, for one, calls the most recent results “garbage”. Former Google employees have posted scathing articles arguing that the company is floundering. Yet every day, billions of people use the search engine, and it’s a safe bet that many of them think it works just fine. How is it that some people believe this essential internet infrastructure is circling the drain while others haven’t noticed any change?

It can be hard to say anything definitive about search result quality, because each person’s experience is so different. If two people Google the same sentence, they will get different results based on all manner of variables. Meanwhile, Google constantly tweaks the algorithm.

Still, critics do have specific reasons for saying the service is going downhill. Google search is good only as long as it can serve up high-quality information, and many claim it no longer does so reliably. They often blame this on Google’s inability to combat spammers and the much-maligned search engine optimisation (SEO) industry. SEO companies aim to make websites appear more highly in Google search rankings to help their businesses. But this can lead to degradation in site quality, as if content is tailored only to please Google’s algorithms. Take recipe pages. When searching for cooking instructions, you’d probably want to see them displayed concisely at the top of the page, yet most food blogs bury recipes beneath a long anecdote. Food writers do this because they believe Google ranks this format highly. But readers resent it.

On the spammier fringes is what’s known as “black hat” SEO, bad actors who use techniques with fabulously evil names such as “domain squatting”, “reputation abuse”, “obituary spam”, “keyword swarming” or “parasite hosting” to bring their content to the top of Google’s search results and turn a quick buck. Spam pages usually have little meaningful content and are aggressively monetised, hosting intrusive ads to profit from each visitor’s click. A recent study claims that Google does indeed have a big spam problem, but adds that other search engines face the same issues.

Google and the spammers are locked in a never-ending battle. The spammers come up with a new technique, Google tweaks the algorithm to stop it working, then the spammers come up with something else. Google’s vice-president of search, Pandu Nayak, describes the dynamic as a “spy v spy situation”. Today the internet is facing the looming threat of a new wave of AI-generated spam, which threatens to overwhelm search engines.

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Even when the links returned by a Google search are of high quality, the other criticism is that it’s hard to find them among the clutter. Where the company once sought to send users onwards to relevant links as quickly as possible, in recent years it has started answering more questions within the Google search interface itself – so if you’re trying to find out something about sports scores, the weather or film showtimes, solve a mathematical equation, or perhaps find out the key publications of a certain distinguished physicist, Google will provide that information in a little box for you, without you needing to click any links.

Sometimes all these little boxes get in the way of the answer you’re trying to find. I just typed in “best smartphone 2024” and was shown, at the top, a carousel of shopping opportunities, followed by four links, then a panel of questions that “people also ask” with vaguely related queries (“Which phones last the longest years?”), then some YouTube videos, five more links, then more related queries and a further shopping carousel. The links I was actually seeking were buried by clutter. It’s a far cry from the sleek, minimal interface of early Google.

Sometimes, Google will populate boxes with information gleaned from the internet that turns out to be incorrect. Besides calling me a dead physicist, these info boxes have claimed that Barack Obama was the king of America, and asserted that Kannada, the official language of the Indian state of Karnataka, was the ugliest language in the country – Google had to issue an official apology for that one. It didn’t take me long to find an inaccurate response. On the third random question I typed in, “How long is Waterloo Bridge?”, a box came up with the confident answer “2,456ft” (748 metres). It was only when I clicked through to Wikipedia that I saw this figure was in fact the length of the first Waterloo Bridge, which was demolished in the 1930s. The current bridge is just 1,230ft (370 metres) long.

Google says users find the additional panels useful. Critics argue that it is trying to extract as much revenue as possible from users by keeping them within the Google ecosystem to the detriment of the user experience. Early on, Google’s founders realised that commercial incentives might compromise the integrity of search results. In a 1998 student paper, Brin and Page wrote that ad-funded search engines would be “inherently biased towards the advertisers and away from the needs of consumers”. Yet Google started displaying ads anyway because, as one academic told me, this is the only good way to monetise search.

I spoke with representatives of the competing search and answer engines Kagi, DuckDuckGo and Perplexity, all of whom frame this issue as a misalignment in Google’s company incentives. They say Google makes design and business choices to earn revenue for advertisers and shareholders at the cost of search user experience. When I put this critique to Google’s Nayak, he dismisses it as “an easy narrative” and continues, “Since the beginning of Google, there has been a clear separation between organic search [eg regular results] and ads … we make sure that the ad side of the house does not affect search.”

When I ask whether Google search results are getting worse, he repeatedly makes the same point: the fact that Google has a 90% market share in search shows its product works well. “If the search experience was not good, I have every confidence people would not use it.”

Is there a reason people might use Google search even if it weren’t a great experience? The US Department of Justice (DoJ) recently gave its closing statements in a historic legal case against Google, which the Financial Times called “the most significant antitrust trial in 25 years”. The DoJ’s argument is that Google uses its wealth to operate anti-competitively as an illegal monopoly, principally by paying other tech companies to be the default search engine on their devices. Naturally, Google argues that people use its search engine because it’s the best. But if that’s the case, why did it need to pay Apple $20bn in 2022 alone to be the default search engine across its phones and computers? The case is likely to conclude before the end of the year.

Google’s biggest competitor, Microsoft’s Bing, has only about 3% of the global search market. A number of other startups scrape fractions of 1%, many with their own spin on the search engine formula: Perplexity offers written-through answers to questions, Kagi operates a paid subscription model with no ads, DuckDuckGo focuses on protecting data privacy. All three say it’s impossible to truly compete with Google right now.

Aravind Srinivas, chief executive of Perplexity, says, “Competing with Google is a no-fly zone. They’re just too big, they dominate, have all the best technology and a lot of money. They can just scorch you to death by offering whatever you’re offering for free.”

Does it really matter whether there is competition to Google’s search engine? Doctorow believes it does. He coined the memorable term “enshittification” to explain the state of big tech companies in the modern age: “Here is how platforms die: first, they are good to their users; then they abuse their users to make things better for their business customers; finally, they abuse those business customers to claw back all the value for themselves. Then, they die.” He calls Google “the poster-child for enshittification”.

Doctorow says algorithmic systems are particularly vulnerable to this, because their workings are opaque to users and easy to quietly tweak. Who knows why you see what you see at the top of your Google search results, Instagram feed or TikTok For You page? Is it because it’s judged to be the best content for you, or because it’s what the platform thinks will make it the most money?

“That’s why it’s so tempting for companies to enshittify them,” Doctorow says. “They’re just yoloing it and saying, ‘Well, fuck it, we’re just going to make all the things at the top of your feed garbage, because we’re too big to care.’” Referencing a comment made by Lina Khan, chair of the US Federal Trade Commission, he adds, “Companies become too big to fail, then too big to jail, then too big to care. Google is too big to care.”

The last stage of the enshittification doctrine is that a platform dies. Is this going to happen to Google? Rosie Graham thinks it’s inevitable, at some point. She points out how X, formerly Twitter, faded in relevance practically overnight after Elon Musk took over. “No company lasts for ever,” she says. “There are all sorts of organisations that had huge global influence and power that we don’t have any more – think about the East India Company. It’s not a matter of if Google will be influential for ever, it’s a question of when Google will be replaced.”

Not everyone agrees the search engine is getting worse. Of the dozen academics and industry professionals I interviewed for this piece, half said they didn’t think search quality was declining. Several pointed out people have been eagerly predicting Google’s death for years – there’s even a Wikipedia page called “Predictions of the end of Google” with examples dating back to 2007. Lewandowski says, “There have always been complaints about low-quality results and the interface getting more cluttered. But in the end, it’s basically the same.”

Perhaps what is really bothering people is that the internet as a whole feels, in 2024, like a worse place to be. Those who grew up on the web of the late 90s and early 00s might remember openness, community and free thinking. Today, we’re probably more likely to associate the internet with anxiety, loneliness and stress. Maybe we miss the time when the internet felt more human. This may explain why many people searching for information look to Reddit rather than Google. That huge, chaotic forum feels like one of the last truly human places on the internet, where you can get somebody else’s honest opinion in all its weirdness, untainted by murky brand associations or affiliate links.

Yet even if it’s true that the internet has declined, that doesn’t let Google totally off the hook. Its search engine doesn’t just organise information on the web, it actively shapes it. If the web is a worse place today, if it’s over-commercialised and full of low-quality content, if journalism platforms struggle to make money from good writing and are reduced to clickbait and affiliate links, that’s partly Google’s fault.

“Google has never really understood the responsibility it’s got to ensure publishers can continue to publish content without needing to over-commercialise in horrifying ways,” says Simon Schnieders, chief executive of the SEO company Blue Array. “They really need to point the finger at themselves and why they created this beast in the first place.”

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As if the search question wasn’t tricky enough, today many people are predicting that the arrival of new AI technologies is going to change everything. Since the launch of ChatGPT, technologists have wondered whether AI assistants will one day take the place of search engines. ChatGPT is a product of OpenAI, which is in partnership with Microsoft, operator of Bing. Last year Microsoft announced it would integrate AI answers into its search engine results, with its chief executive, Satya Nadella, calling it “a new day in search”.

At its latest conference, Google seemed to be rushing to respond to this threat when it announced a suite of new AI tools. The company has been using AI behind the scenes to improve its search and algorithms for years, but with the launch of the new “AI Overviews” feature, which it has already started rolling out and plans to make available to more than 1 billion users by the end of the year, it will put the technology front and centre. With this feature, Google search will respond to certain queries with a text box above the usual links, providing a written-through summary of information from various websites. The slogan the company keeps repeating around this is “Let Google do the Googling for you”.

Asked ‘How many rocks should I eat?’ Google gave this AI Overview: ‘One per day because rocks contain minerals and vitamins’

Responses have been mixed. Google says in internal tests people found the feature useful. They claim it’s good for queries that require a number of specific variables – say you’re trying to find a place your family can eat in Paris that does vegan food, is open at 7am and is within walking distance of a Métro station. Such questions, which might previously have required 10 minutes of clicking around on numerous searches, can be done in seconds by AI (ChatGPT is also pretty good on this stuff).

But, of course, the internet immediately seized on the feature and found that, in response to certain queries, it produced hilarious, inaccurate and sometimes dangerous answers. In response to the question “How many rocks should I eat?”, Google presented this AI Overview: “According to UC Berkeley geologists, eating at least one small rock per day is recommended because rocks contain minerals and vitamins that are important for digestive health.” Meanwhile, someone who asked about “cheese not sticking to pizza” was recommended to “add about 1/8 cup of non-toxic glue to the sauce to give it more tackiness”. Naturally, it didn’t take long for somebody to make and eat the glue pizza.

The erroneous information came from obviously dubious sources. Eating rocks was suggested by an article on satirical site the Onion, while the glue pizza idea was a post by “Fucksmith” on Reddit 11 years ago. Google was roundly mocked online and responded with a blog post essentially saying that these were growing pains and that the product would improve.

The new direction heralded by ChatGPT and AI Overviews is to a world in which we no longer search for answers ourselves, but rather receive a single, supposedly balanced answer that has been pre-chewed by an algorithm. “Summarisation, or the dumbing down of search, is a bad thing for society in general,” Schnieders argues. “It’s important to get a range of diverse perspectives from search, from your own trusted or new sources, practise critical thinking and form your own opinions. AI Overviews claims to do this but it’s too much of a black box to be trusted.”

Yet the biggest concern around AI Overviews came not from users who had cheese sliding off their pizzas, but from writers and publishers online. They’re worried that if Google summarises the information from their websites and delivers it to users, then those users will have no reasons to visit the sites, depriving them of the traffic necessary to fund more content creation.

This question has sent the media into a tailspin. Nilay Patel, editor-in-chief of American technology news website the Verge, said AI Overviews would “change the web as we know it”, while the influential tech reporter Casey Newton said Google had “essentially put the web into a state of managed decline”. Reports have predicted that publishers could see their search traffic fall anywhere between 25% and 60% as a result of AI. If even a fraction of this is true, it could have enormous consequences for the already squeezed media landscape. Various small publishers have accused Google of killing their businesses.

When I ask Hema Budaraju, Google’s senior director of product management for search, whether Google has a responsibility to ensure a healthy web ecosystem, she answers with “a very direct, strong yes”. She emphasises Google’s “commitment to the web” and “ensuring we have a thriving ecosystem”. “As we introduce our generative capabilities, connecting people to the web is central to our approach,” she says.

I’m inclined to believe this is Google’s intention. It’s not in its long-term interest for the internet’s information economy to collapse. If media platforms can no longer afford to produce high-quality content, then Google’s AI Overviews will have nothing left to summarise. Eventually, people would stop using Google search.

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During a visit to one of Google’s London offices, I told a member of the communications team that I had been inspired to look into the state of Google search by the broken knowledge panel saying I was a dead physicist. When I later spoke to Nayak, I decided to ask him how I could detach my face from the other Tom Faber. Before I’d finished my sentence, the communications person pinged into the chat, saying the issue had been fixed. I adjusted my question: maybe it’s been fixed for me because of having a direct line to Google, but how would someone resolve this if they didn’t have strings to pull?

Nayak apologised, saying the panels were created automatically using algorithms and sometimes they messed up: “These are the kinds of things we’re constantly improving.” He went on to insist that, on issues like this, Google’s “honest results policy puts everyone on the same playing field”, so it had nothing to do with me having contacts at Google. Immediately after, the call was ended abruptly for going over time.

When I followed up, I was told someone from the team had submitted a feedback form using the public channels, just like anyone else might, and this resulted in it getting fixed. This was perplexing. It seemed more than a coincidence that, after years of trying to fix the problem myself by submitting feedback forms, it would finally change weeks after mentioning it to a Google employee, and that this change would be unrelated to that conversation. But at least the issue was fixed.

For now, search engines aren’t going anywhere. “I think search is inevitable,” Doctorow says, but adds that we’ll always want human voices to cut through the noise and deliver curated sources of information. “We’re still going to have experts, reviewers and tastemakers, adventurous spelunkers in information space, and just the terminally curious – that one friend you have who can’t stop holding forth about something, whether it’s a new gamer mouse or a band or a new, extremely hoppy IPA. We’re going to have all of those things, but they’re all going to need search engines.”

It seems search is going to remain broadly the same – ChatGPT isn’t about to displace Google search, and AI Overviews are not about to fundamentally change the search experience. But there remains the larger question of what the rest of the internet will look like. As AI steers the online economy into uncharted waters, the fate of the media is hanging in the balance. And whatever the future of the web looks like, it’s sure Google is going to play an enormous role in shaping it.

As I was editing this story, I double-checked to see if my knowledge panel was still fixed and discovered, confoundingly, that the problem had returned. The next time I checked, it was fixed again. I began to regularly Google myself in incognito mode, on different browsers and devices. Sometimes my face popped up as a dead physicist; sometimes it didn’t. The ever-changing, algorithmic nature of it made it feel like Schrödinger’s knowledge panel, both correct and incorrect at all times.

The frustration of trying to resolve the knowledge panel issue echoed the process of trying to get a solid read on the state of Google’s search engine. The company is too opaque, and its system has too many shifting parts, to make a clear pronouncement. It is many things to many people, constantly succeeding and failing its billions of users. Sometimes, as much as you search and search, there is no single answer to be found.

Here is the link:

https://www.theguardian.com/technology/article/2024/jul/20/google-is-the-worlds-biggest-search-engine-broken

What all this says to me is that trying to corral the scope of human knowledge and make it findable for the average punter may just be a leap too far!

If you consider just how hard fact-finding 20 years ago was compared to now one has to concede we have come a very long way and more worrying is the fact that a quantum improvement from here is pretty hard to imagine.

I really find it hard to imagine life without Google search (or some equivalent) and also struggle to envisage what the “next big thing” will look like!

I wonder where the garage is that the next step is being dreamt up?

David.