It Has Really Been A Pretty Shaky And Sad Beginning To 2024.

This appeared earlier today.

Why the fates of Ukraine, Israel and Taiwan hang in the balance

Americans and Europeans truly have blindfolds on if they think they can raise their glasses to a happy new year while missiles rain down on Kyiv.

Niall Ferguson

Updated Jan 4, 2024 – 10.07am, first published at 5.00am

Twenty years ago, I published Colossus: The Price of America’s Empire. I had wanted to call it Blind Colossus: The Rise and Fall of the American Empire. In the still jingoistic atmosphere that had followed the terrorist attacks of September 11, 2001, my publisher dissuaded me. By the time the paperback came out, I could at least insist on my preferred subtitle.

Despite the passage of two decades, the book’s core arguments still stand up. Indeed, the tragic spectacle unfolding in Ukraine reminds me why I wrote the book in the first place. Americans – and Europeans, whose wealthy yet geopolitically inconsequential Union I also criticised – truly have the blindfolds on if they think they can raise their glasses to a happy new year while missiles rain down on Kyiv. Writing in 2003, I was not in principle against a pax americana in succession to the pax britannica of the 19th and early 20th centuries. I took (and still hold) the now heretical position that most history is the history of empires; that no empire is without its injustices and cruelties; but that the English-speaking empires were, in net terms, preferable for the world than the plausible alternatives, then and now.

However, I was sceptical about the neoconservative project to reorder the “greater Middle East” under the cover of a “global war on terror” in retaliation for September 11. I particularly doubted that the United States would be able to achieve its goals of transforming the governments of Afghanistan and Iraq into its allies – or at least satellites. Had Britain’s imperialists succeeded in taming the wild lands north of the Khyber Pass, much less ancient Mesopotamia?

The reasons for my scepticism were what I called the “three deficits” of America’s strange empire that dared not speak its own name. The first was the economic deficit – the federal government’s fiscally unsustainable path, which would make long-lasting military and administrative commitments abroad difficult to afford. More broadly, the United States was a net importer of capital and hence a massive global debtor, in marked contrast to Victorian Britain, which accumulated a vast stock of overseas investments. If you want to run the world, it helps to own much of it, rather than to owe it.

The second was the manpower deficit – unlike 19th-century Britons, most Americans have no great enthusiasm for spending large parts of their lives in far-flung hot, poor and dangerous countries. Consider the short tours of duty served by most military personnel who were deployed to Afghanistan and Iraq, not to mention the way many US bases tended to be cut off from the local populations.

Likewise bunkered in bomb-proof embassies, deficient in local-language proficiency, and wedded to first-world comforts, few American Foreign Service Officers have “gone native” in the past 20 years. They didn’t get the chance.

Finally, and most importantly, there was the attention deficit – the tendency of the American electorate (and therefore its elected representatives) to lose interest in any foreign enterprise that takes longer than a few years to complete. The prediction that the American appetite for reordering the Middle East would not outlast George W. Bush’s first presidential term proved correct. Barack Obama based his meteoric rise on not having supported the war and went on to tell the world that America was no longer “the world’s policeman”. (Syrians soon learnt what that meant in practice.)

All that has happened since 2003 has confirmed that the three deficits remain a powerful constraint on the exercise of American power abroad. The fiscal deficit now far outstrips what it was 20 years ago. The total federal debt was 59 per cent of GDP in 2003; last year it was double that (120 per cent). The manpower deficit today manifests itself as the armed services’ growing difficulty in finding willing, able-bodied recruits: At 452,000 active-duty soldiers, the US Army is the smallest it has been since 1940. Finally, the attention deficit disorder is now so severe that the public expresses impatience with wars it is merely being asked to support with money and material. No American has been obliged to fight to defend Ukraine against Russia’s criminal invasion. And yet, according to recent polling, nearly four in 10 Republicans think that “in terms of military support, America is already doing too much”.

Vastly more here and really excellent reading:

https://www.afr.com/world/europe/the-fate-of-ukraine-hangs-in-the-balance-20240101-p5eujb

It really seems that 2024 has started pretty badly and it is hard to be very optimistic right now!

On the Digital Health front I plan to wait a few weeks to see what interesting initiatives are announced for 2024 and what progress is reported for last year. Time will tell I guess…..

David.

There Is Little Doubt We Can Now Deliver A Lot Of Care Outside Expensive Hospital Environments!

This appeared late last year.
Why home is better than hospital

Patients can often be treated at home just as well as in expensive hospitals. But private health insurers have too little incentive to fund it. 

Jason Kara is chief executive of Catholic Health Australia

Jan 1, 2024 – 2.47pm

Modern hospital-in-the-home care is a generational game changer for the health system, offering huge cost savings and superior patient care.

So why is Australia missing out while the rest of the world roars ahead?

The answer is our private health insurance system. This isn’t to say that the private health insurance sector does not recognise the advantages of hospital in the home (HITH).

But the system as it stands allows individual insurance providers to try to manipulate the system to suit their respective individual corporate interests. This messy, piecemeal approach is stymying Australia’s progress.

On current projections, by 2025, when the UK expects to be treating 20 per cent of its patients at home, Australia will be lucky to hit 5 per cent. What we need is system-wide reform.

But before we consider how that can be done, it’s worth noting the true scope of the benefits we’re talking about.

HITH today uses modern technology, meaning there need not be any compromise in the standard of clinical care.

Hospitals can impose strict infection control standards and policies. They have rigorous incident reporting and management protocols.

HITH is not suitable for all types of care. But for a significant portion of the current hospital patient load – think chemotherapy, dialysis, wound care, and post-surgical rehab – it can offer superior health outcomes, often at a fraction of the cost.

If we take cellulitis as an example, the savings are about $970 per patient, per day.

Unfortunately access to home treatment for that patient is dictated by their insurer, not their doctor.

HITH also offers substantial advances in palliative care. Though the range of care treatment scenarios makes it difficult to carve out a specific dollar value, the Productivity Commission found the cost of avoiding a single hospital admission was enough to cover the cost of community-based palliative care for several months.

Yet, in Australia, the overwhelming majority of palliative care and cellulitis treatment still happens in bricks-and-mortar hospitals. Why?

The problem is that private health insurers do not have to offer HITH as a default benefit, as they do in-hospital care.

Often, a patient wants to be treated at home and their doctor believes HITH is appropriate. Unfortunately access for that patient is dictated by their insurer, not their doctor, and depends on the individual contracts their insurer chooses to sign with hospitals and other providers.

Many insurers do not support HITH services outside of those they are able to provide themselves, either directly or via a subcontractor.

Some insurers may cover more of the costs associated with HITH services if the services are provided by a preferred provider.

But if a patient chooses to receive HITH services from a non-preferred provider, their insurer may cover less of the cost or may not cover it at all.

The lack of default benefits for HITH is a severe barrier to its wider adoption. As things stand, there’s no real incentive for insurers to cover HITH services if those services are provided by non-preferred providers.

Healthcare providers, meanwhile, are obviously less likely to invest the time and resources required to develop and offer HITH services if they know most insurers won’t cover these services.

Two things need to happen to break the impasse.

The private health insurance lobby needs to recognise that the short-term desires of its individual members are at odds with the long-term health of the system. And the Department of Health and Aged Care needs to step up and bite the bullet on reform.

The health portfolio is not generally considered simple and reform is often devilishly tricky. But in this area, the path forward could not be clearer.

Private health insurers currently have to provide a range of default benefits, notedly for all care delivered to eligible members in hospital; HITH simply needs to be listed as a logical extension of this.

The new system should mean that if any insured patient is being treated for an eligible condition at any hospital where HITH is an option, if they and their clinicians decide HITH is right for them their health insurance would automatically cover it.

Catholic Health Australia commissioned independent economic modelling to identify the default benefit necessary. It found a default benefit of $330 per day would be sufficient to provide an incentive for hospitals and insurers to significantly expand clinically effective HITH programs for a range of conditions and episode types.

More here:

https://www.afr.com/companies/healthcare-and-fitness/why-home-is-better-than-hospital-20240101-p5euhr

Funny that this article does not mention the big driver in my opinion, patient preference. Given the chance many would far prefer their care to come to them and for their monitoring to be increasingly remotely enables, once over the acute issue. I know I sure would!

The problem is, of course, that delivery of this type of care is not as convenient for clinical care providers and so is typically less favoured by the powers that be! Changing this bias will require attitudinal change and improved technology that better links patients and their carers. Structured investigation into what remote technologies would be most useful would be very worthwhile!

I wonder what changes we will see over the next few years?

David.

AusHealthIT Poll Number 728 – Results – 1 January, 2024.

Here are the results of the poll.

How Are You Feeling About Digital Health Progress In 2024?

Positive                                                                         32 (43%)

Negative                                                                        41 (55%)

I Have No Idea                                                               2  (3%)

Total No. Of Votes: 75

Quite a close vote with a majority being a little negative. Would have been nice to see a little more optimism!

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

A great number of votes. But also a clear outcome! 

2 of 75 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.

Welcome To 2024 - I Hope It Is A Good One!

 Welcome one and all to the New Year!

While all sorts of platitudes are possible what I would really like to see over the next 12 months is some real accountability for the expenditure of Digital Health budgets so that, come December, we find the health system is working more smoothly and safely than at the start of the year and that better decisions are being made regarding patient care because of wider availability and better accuracy of the information carers can source and use.

Sounds simple, but it seems to be pretty hard but even small improvements would be welcome!

What would you most like to see as we move into 2024?

Happy, safe, successful and satisfying New Year to all!

David.

Some Good News To Wrap Up A Rather Mixed Year!

This is a cheering piece of news to wrap up 2023! 

Cancer vaccine wards off recurrence for up to three years

By Natasha Robinson - Health Editor

Updated 6:50AM December 15, 2023,

The world’s first cancer vaccine has been found to prevent cancer returning in melanoma patients for as long as three years, new ­results from a major clinical trial show.

The cancer vaccine that has been developed by Moderna is now moving to phase 3 studies after the second tranche of data from the phase 2 study showed the stunning results.

The vaccine, which is dubbed mRNA-4157/V940, is a personalised mRNA vaccine that is given in conjunction with the immunotherapy drug Keytruda. It had already been found to reduce the recurrence of melanoma by 50 per cent in initial human trials when administered alongside the immunotherapy drug.

Now new data shows that among patients with resected high-risk stage III or IV melanoma, adjuvant treatment with the vaccine in combination with Keytruda continued to demonstrate a clinically meaningful improvement in recurrence-free survival for as long as three years. The prevention of cancer recurrence was found in the latter ­stages of the phase 2 trial to be as high as 49 per cent.

“The really important point is that we saw the maintenance of that benefit now out to three years, which gives us confidence that this substantial reduction in the risk of relapse is likely to be durable for a long time,” said Moderna president Stephen Hoge. “Therefore the potential for this therapy is as good as we hoped a year ago.

“I think it’s confirmatory that this really does have the potential to be a new approach to treating cancer patients, and across a wide range of cancers.”

Cancer vaccines are in their infancy and Moderna’s vaccine for melanoma patients is the first that has been developed. The technology was accelerated by Covid-19, when mRNA vaccines were widely trialled and proved effective. The technology is now being invested in heavily around the world, including in Australia which has established a number of research facilities and manufacturing plants.

Cancer vaccines are formulated to be specific to each patient’s cancer and are ­developed based on the individual’s tumour biopsies, which are then genetically sequenced. Scientists identify that person’s cancer cells’ specific mutations and create an mRNA vaccine that primes the immune system’s t-cells to target the ­mutated cells.

“This is an era of individualised medicine,” said Dr Hoge. “This is a medication that’s very different than anything else that’s been used, because you make it for one patient based on what their individual cancer looks like. We’ve always wanted to move down a path of individualised medicine, but this is a sign that we may be going down that path.”

Other cancer vaccines are now in development, including by brain cancer suffering and eminent pathologist Richard Scolyer and his colleague Georgina Long, who are using the melanoma technology and applying it to Professor Scolyer’s brain cancer.

Professor Scolyer announced earlier this year that he was “patient zero in what may become the new frontier of brain cancer treatment”.

Professor Long was a principle investigator in Moderna’s melanoma cancer vaccine. She emphasised the phase 2 study was a small study involving 157 patients and would now need to be replicated in a larger phase 3 trial, which has begun recruiting.

More here:

https://www.theaustralian.com.au/science/cancer-vaccine-wards-off-recurrence-for-up-to-three-years/news-story/26669a33cdea4fc3f86438e2b332bed9

Good news to wrap up the year I reckon.

Thanks to all have read and commented this year – and sorry for the service interruption what I was in Hospital and all that earlier in the year

Any comments on the year past or thoughts for the next year welcome.

A safe and happy festive season to all.

Back some time in January fate willing!

David.

AusHealthIT Poll Number 727 – Results – 17 December, 2023.

 Here are the results of the poll.

Have You Begun To Explore What Generative AI May Be Useful For In Your Profession / Role?

Yes                                                                                  12 (67%)

No                                                                                    6 (33%)

I Have No Idea                                                                0 (0%)

Total No. Of Votes: 18

Interesting so many are having a look at Generative AI and its possible applications!

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

A poor number of votes. But also a very clear outcome! 

0 of 18 who answered the poll admitted to not being sure about the answer to the question!

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

David.

It Good To See The Real World Joining In And Deploying Clinically Relevant AI!

 This appeared last week:

Liverpool Hospital explores GenAI cardiology solution

Wednesday, 06 December, 2023

With cardiovascular disease responsible for one in four deaths across the nation, cardiologists play a critical role in Australia’s healthcare system. These specialists are challenged, however, by a constantly evolving field whose knowledge base is growing exponentially.

To address this challenge, Liverpool Hospital and Microsoft have collaborated on a generative artificial intelligence (GenAI) solution to assist cardiologists in surveying the vast volume of cardiology-related literature and guidelines that aids decision-making in clinical practice.

Their prototype, ‘The Cardiology Canon’, allows a clinician to interact with an extensive body of literature from the field of cardiology. Built using Microsoft Azure OpenAI Service, it was programmed on clinical trials from the past 40 years, along with guidelines from eminent cardiac societies in Australia, Europe and the United States.

The Microsoft Technology Centre team processed more than 500 individual documents and 80,000 pages to create a cognitive vector search index and made the solution accessible via a web application.

“We worked with Microsoft technologists to create a bespoke prototype to allow cardiologists and anyone training in the field to query vast volumes of literature to answer clinical questions or make nuanced comparisons, traversing the significant body of literature,” said Dr Hao Tran, Cardiology Advanced Trainee at Liverpool Hospital.

“The solution also successfully generated a comprehensive six-day training program on aortic stenosis — a common clinical problem among patients — and generated comprehensive learning resources in hours, rather than days.

“It was presented at the Liverpool Cardiology Academy academic seminar with Microsoft collaborators Viren Joseph, Leon Smith and Daniel Xu and was championed by senior Liverpool Hospital cardiologists Professor Craig Juergens and Dr Sidney Lo. It’s been a truly collaborative project that I believe will greatly benefit cardiologists and patients,” Tran added.

Dr Simon Kos, Chief Medical Officer at Microsoft Australia and New Zealand, said the collaboration demonstrated the invaluable contribution of hospital clinicians in the sphere of innovation, with their feedback iteratively helping to refine the solution’s large language model to suit clinical need.

“We’re excited to collaborate with Liverpool Hospital on this initiative and unlock the incredible potential of generative AI in health care. This innovative approach is empowering the hospital’s cardiologists to stay ahead in their field, ensuring the highest standard of patient care,” Kos said.

The announcement follows a new report by Microsoft and the Tech Council of Australia highlighting generative AI’s economic and productivity opportunities for Australia. Health care is identified as one of four key economic sectors poised to benefit from the technology, potentially contributing $5–13 billion in value annually to the sector in Australia by 2030.

According to the report, generative AI can automate 25% and augment 5% of nursing tasks, allowing nurses to spend more one-on-one time with patients. It also estimates that 30% of new drugs could be discovered using the technology by 2025.

Here is the link to the release:

https://www.hospitalhealth.com.au/content/technology/news/liverpool-hospital-explores-genai-cardiology-solution-397830128

Good it seems stuff is really happening!

David.

It Seems It Is The Time Of Year For Predictions For Next Year!

 This appeared a few days ago:

 Thursday, 07 December 2023 04:13

Twelve AI predictions for 2024

By David M Williams

In time for the 12 days of Christmas, data, AI, and analytics software company SAS has released its 12 predictions about AI for the coming year.

 Generative AI will augment (not replace) a comprehensive AI strategy

“Generative AI technology does a lot of things, but it can’t do everything. In 2024, organizations will pivot from viewing generative AI as a stand-alone technology to integrating it as a complement to industry-specific AI strategies. In banking, simulated data for stress testing and scenario analysis will help predict risks and prevent losses. In health care, that means the generation of individualized treatment plans. In manufacturing, generative AI can simulate production to identify improvements in quality, reliability, maintenance, energy efficiency and yield.”

– Bryan Harris, Chief Technology Officer, SAS

Note that earlier this year, SAS committed $1 billion to AI-powered industry solutions.

AI will create jobs

“In 2023, there was a lot of worry about the jobs that AI might eliminate. The conversation in 2024 will focus instead on the jobs AI will create. An obvious example is prompt engineering, which links a model's potential with its real-world application. AI helps workers at all skill levels and roles to be more effective and efficient. And while new AI technologies in 2024 and beyond may cause some short-term disruptions in the job market, they will spark many new jobs and new roles that will help drive economic growth.”

– Udo Sglavo, Vice President of Advanced Analytics, SAS

 AI will enhance responsible marketing

“As marketers, we must consciously practice responsible marketing. Facets of this are awareness of the fallibility of AI and alertness to possible bias creeping in. While AI offers the promise of enhanced marketing and advertising programs, we know that biased data and models beget biased results. In SAS Marketing, we are implementing model cards that are like an ingredient list, but for AI. Whether you create or apply AI, you are responsible for its impact. That's why all marketers, regardless of technical know-how, can review the model cards, validate that their algorithms are effective and fair, and adjust as needed.”

– Jennifer Chase, Chief Marketing Officer, SAS

Financial firms will embrace AI amid a Dark Age of Fraud

“Even as consumers signal increased fraud vigilance, generative AI and deepfake technology are helping fraudsters hone their multitrillion-dollar craft. Phishing messages are more polished. Imitation websites look stunningly legitimate. A crook can clone a voice with a few seconds of audio using simple online tools. We are entering the Dark Age of Fraud, where banks and credit unions will scramble to make up for lost time in AI adoption – incentivized, no doubt, by regulatory shifts forcing financial firms to assume greater liability for soaring APP [authorized push payment] scams and other frauds.”

– Stu Bradley, Senior Vice President of Risk, Fraud and Compliance Solutions, SAS

Shadow AI will challenge CIOs

“CIOs have struggled with ‘shadow IT’ in the past and will now confront ‘shadow AI’ – solutions used by or developed within an organization without official sanction or monitoring by IT. Well-intentioned employees will continue to use generative AI tools to increase productivity. And CIOs will wrestle daily with how much to embrace these generative AI tools and what guardrails should be put in place to safeguard their organizations from associated risks.”

– Jay Upchurch, Chief Information Officer, SAS

Multimodal AI and AI simulation will reach new frontiers

“The integration of text, images and audio into a single model is the next frontier of generative AI. Known as multimodal AI, it can process a diverse range of inputs simultaneously, enabling more context-aware applications for effective decision-making. An example of this will be the generation of 3D objects, environments and spatial data. This will have applications in augmented reality [AR], virtual reality [VR], and the simulation of complex physical systems such as digital twins.”

– Marinela Profi, AI/Generative AI Strategy Advisor, SAS

 Digital-twin adoption will accelerate

“Technologies like AI and IoT [Internet of Things] analytics drive important sectors of the economy, including manufacturing, energy and government. Workers on the factory floor and in the executive suite use these technologies to transform huge volumes of data into better, faster decisions. In 2024, the adoption of AI and IoT analytics will accelerate through the broader use of digital-twin technologies, which analyse real-time sensor and operational data and create duplicates of complex systems like factories, smart cities and energy grids. With digital twins, organizations can optimize operations, improve product quality, enhance safety, increase reliability and reduce emissions.”

– Jason Mann, Vice President of IoT, SAS

 Insurers will confront climate risk, aided by AI

“After decades of anticipation, climate change has transformed from speculative menace to genuine threat. Global insured losses from natural disasters surpassed $130 billion in 2022, and insurers worldwide are feeling the squeeze. US insurers, for example, are under scrutiny for raising premiums and withdrawing from hard-hit states like California and Florida, leaving tens of millions of consumers in the lurch. To survive this crisis, insurers will increasingly adopt AI to tap the potential of their immense data stores to shore up liquidity and be competitive. Beyond the gains they realize in dynamic premium pricing and risk assessment, AI will help them automate and enhance claims processing, fraud detection, customer service and more.”

– Troy Haines, Senior Vice President of Risk Research and Quantitative Solutions, SAS

AI importance will grow in government

“The workforce implications of AI will start being felt in government. Governments have a hard time attracting and retaining AI talent since experts command such high salaries, however, they will aggressively recruit for expertise to support regulatory actions. And like enterprises, governments will also increasingly turn to AI and analytics to boost productivity, automate menial tasks and mitigate that talent shortage.”

– Reggie Townsend, Vice President of the SAS Data Ethics Practice

 Generative AI will bolster patient care

“To advance health and improve patient and member experiences, organizations will further develop generative AI-powered tools in 2024 for personalized medicine, such as the creation of patient-specific avatars for use in clinical trials and the generation of individualized treatment plans. Additionally, we will see the emergence of generative AI-based systems for clinical decision support, delivering real-time guidance to payers, providers and pharmaceutical organizations.”

– Steve Kearney, Global Medical Director, SAS

Deliberate AI deployment will make or break insurers

“In 2024, one of the top 100 global insurers will go out of business as a consequence of deploying generative AI too quickly. Right now, insurers are rolling out autonomous systems at breakneck speed with no tailoring to their business models. They’re hoping that using AI to crunch through claims quickly will offset the last few years of poor business results. But after 2023’s layoffs, remaining staff will be spread too thin to enact the necessary oversight to deploy AI ethically and at scale. The myth of AI as a cure-all will trigger tens of thousands of faulty business decisions that will lead to a corporate collapse, which may irreparably damage consumer and regulator trust.”

– Franklin Manchester, Global Insurance Strategic Advisor, SAS

Public health will get an AI boost from academia

“Public health is achieving technological modernisation at an unprecedented rate. Whether overdoses or flu surveillance, using data to anticipate public health interventions is essential. Forecasting and modelling are rapidly becoming the cornerstone of public health work, but government needs help. Enter academia. We will see an increase in academic researchers carrying out AI-driven modelling and forecasting on behalf of the government. It is clear after COVID-19 that the protection of our population will require exceptional technology and collaboration.”

– Dr. Meghan Schaeffer, National Public Health Advisor and Epidemiologist, SAS

Here is the link:

https://itwire.com/business-it-news/data/twelve-ai-predictions-for-2024.html

I find this an interesting list with such a diverse list of suggested futures at all sorts of levels and possible impacts.

It is worth reading through the list to see what you agree with and then to try and see what might have been left out! (Impacts of AI on Law and Accounting professions maybe and what about those who write for a living?)

I see much broader impacts than cited here!

David.