Dr. AI and Health 4.0

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Announcer 0:00

Welcome to MedEvidence, where we help you navigate the truth behind medical research with unbiased, evidence-proven facts, hosted by cardiologist and top medical researcher, Dr. Michael Koren.

Dr. Mitchell Rothstein 0:11

Hi, I'm Mitchell Rothstein. I'm one of the medical directors at the Jacksonville Center for Clinical Research. And welcome to this podcast for MedEvidence, the Truth Behind the Data. And today I have the pleasure of speaking with Dr. Blackstone, who just published the book, Dr. AI. Congratulations on that.

Dr. Robin Blackstone 0:31

Thank you.

Dr. Mitchell Rothstein 0:31

And just absolutely. And just to give you a little background on Dr. Blackstone, she is a product of the University of Phoenix, Arizona. She served as a major in the United States Army Medical Corps, and then went on to medical school at Colorado, became the first female president of the American Society of Metabolic and Bariatric Surgery, and established the Specialties Nationally Quality and Outcome Framework. She also held the Ira Fulton Endowed Chair at Banner Health, served as the chief of bariatric and metabolic surgery, held a joint appointment as professor of medicine and surgery at the University of Arizona. She also served as a senior vice president of preclinical and medical affairs and chaired JJ's Institute on the Global Surgery Advisory Board. She also is a reviewer for JAMA and the New England Journal of Medicine. So welcome, Dr. Blackstone. I am overwhelmed by uh your career pathway. And that was after practicing traditional medicine for 30 years. So I also practiced traditional medicine for 30 years, but took a very different course. And I was, it's always fascinating to see what motivates people to kind of go the direction they go in. So what was one of your main motivations for going through these graduate studies, which I didn't even mention at Oxford and artificial intelligence, sustainability and cybersecurity at MIT

Why She Studied AI And Systems

Dr. Mitchell Rothstein 2:05

and business analytics at Harvard?

Dr. Robin Blackstone 2:08

Yeah, the thing is that, you know, when I was treating patients, and I treated thousands of patients, I kind of recognized that the system itself was not really engineered to maximize their well-being. It was, you know, some parts of it are engineered to maximize my billing. Some of them are engineered to, you know, support different institutions. But at the end of the day, I just felt like I needed to know more to be able to really try to get my head around this big system that just developed kind of haphazardly, as if we were stacking blocks on each other. And at times, you know, the building kind of falls over and doesn't perform well for the people that it's really meant to serve. So, you know, I just decided, you know, I needed to dive in, really get the details on AI, really understand all the different pieces so that I could try to propose a new healthcare system, which is basically what health 4.0 is. It's a new health.

Dr. Mitchell Rothstein 3:14

And I was reading through Health 4.0, which was quite an effort. Essentially, my son is in Hollywood doing movies and stuff, and they call it world building, you know, when they do a new movie about an old new perspective on life or origins. And this is really, what you've accomplished really is world building. And I liked particularly, I've listened to a number of your podcasts also, and I liked a couple of the things that you said. Number one is that you know the system is really designed at this point to profit from illness. And it is currently we rescue patients, and what the patient pays for is to be a little less sick when they than they were when they got rescued. And I thought that was really kind of boil things down to the essence of the way healthcare is delivered currently. And this isn't Dr. Your book, Dr. AI, isn't Dr. Google. It's uh really a whole different kind of architecture of medicine and perspective. And I was hoping that you could tell us a little bit about the orientation of how you see medicine

Dr. Google Versus Personal Intelligence

Dr. Mitchell Rothstein 4:30

delivery being enhanced by AI.

Dr. Robin Blackstone 4:33

So, yeah, that's such a good question. It's really on the top of everybody's mind right now, you know. But the thing about, let's just say that you go into one of the big LLMs, Chat, GPT, Claude, it won't matter. And you go in and you ask it a question, it gives you the average man answer. It doesn't know anything about you. You put in a few details that you as a consumer think are important, right? But at the end of the day, it doesn't really have any way of distinguishing you, of knowing if it's accurate, what you've told it. And so it's going to look through maybe some papers. Some of them may not be good papers, which as you and I both know is replete in our in our discipline, a lot of bad data. You know, and some of it not really missed, it's not really people meaning to do bad. It's just we didn't used to know about statistics, but we know now, right? And there's just such a plethora of it; data. But then it takes that and it tries to distill it into your question. And, you know, then you kind of take that information and charge ahead with it. The difference is what if you had your own personal intelligence that knew you, it knew what kind whether you took your coffee black or with sugar and cream. That difference of understanding you is how you actually translate data and figure out what applies to you and what doesn't. You know, if a study was done in a non-representative sample of cancer patients and it's trying to apply it to you, a black female, for instance, it's not gonna be very applicable, actually. So, you know, once you know the person well and the data can be sorted well, all of a sudden you start to get real difference in how it's responding. But the most important part is you start to build your own data set of how you operate in the world and how medicine can really help you. So maybe you don't have to wait for rescue. Maybe you can interject in the trajectory much earlier based on small signs and things that are going on that you know you wouldn't even pick them up in maybe for a long, long time. So, you know, I kind of feel like it's a moment for us to step back and go, wow, we really have something powerful here. And for my colleagues, I have to say, I know everybody's like really freaking out right now. You know, we can talk more about that if you want, but but I you know, I have to say to them that the world is changing, it's changing as much as it ever has for us. And you know, retrenching the way you see some of the leading societies doing, I could mention names, but I won't, is not gonna help you this time. It helped in 20 in 1920, when we had a battle about whether everyone would be covered and you they won, but it won't help now because we need to rethink medicine now. And yeah, I guess that's just gonna it's gonna happen no matter what you do. It's just you can make it much more difficult on the people you're serving. And that's the one thing, you know, Dr. Rothstein, that I feel is really important. We need to get back to taking care of what we are responsible for, which is trying to help people

Trust Erodes By A Thousand Cuts

Dr. Robin Blackstone 8:40

live better lives and healthier lives. That's the deal.

Dr. Mitchell Rothstein 8:43

I couldn't agree more. And I think one of the points that you make in a number of your communications has been regaining trust from the patients. And uh to do that, I guess part of that is through the patients having control of their own data. And then part of that is making sure that, as you pointed out, that the AI information that they're receiving has actually been looked at and someone has governance over that and they're not receiving junk science. And that helps build that back. But there is a large gap in that kind of trust category, I think, in all different subcultures across our country. So how how what what do you think is the main driver of winning that trust back with the patient population?

Dr. Robin Blackstone 9:37

Well, you know, it's it's complicated, as you say. I I believe that we have damaged our trust relationship in a fundamental way. And part of that is, you know, it happened a lot during COVID, it happened during the epidemic of opioids. The things that I talk about in Dr. AI were, I think, some of the egregious examples of it. But mostly it happens in an everyday way. You know, it happens when someone says they'll call you back and they don't. Or they say they called in a prescription and they can't find it. You know, all those little ways, you know, it's kind of like, you know, if you tell, if you tell your son or daughter that you're gonna have dinner on the table and it doesn't arrive, that erosion starts to happen, you know?

Dr. Mitchell Rothstein 10:35

Yeah, death by a thousand cuts.

Dr. Robin Blackstone 10:37

A thousand cuts. Death by a thousand cuts. And there's so many places in healthcare where the system isn't connected at all. And people are so sick of it. You know, I I can't go anywhere. Like the minute I start talking with people about this, it I just be quiet. The the other, not too long ago, like before Thanksgiving, I guess it was, I guess it is long ago now. Seems like this last six months has just rushed by. But, you know, I sat down to have a meal the day before Thanksgiving. And in comes these three people, a young woman and her parents. And she didn't order any alcohol. And I immediately looked over at her because they had taken one of my seats, and I said, How long have you been pregnant? And she goes, Oh my God. And she, you know, she goes, Look at my baby pop. I'm seven months, I'm so excited. And I said, Really? I said, So tell me, what has the healthcare experience been like for you? And she just, wow, like boom, you know, and her dad kind of backed up from where they were sitting and said, This is gonna get deep to me. And I said, Well, I want to hear it. And so she told me, and she said, you know what really tickled ticks me off? And I said, What? She goes, I should have good health care. I work for SNL, Saturday Night Live. Like I should have good health care. I thought I did have good health care until I started using it. And you know, I think that reflects, I I bet there's lots of people listening to this that are going to be nodding their heads.

Dr. Mitchell Rothstein 12:18

Yeah, I I I agree. I think that, you know, you never really, as long as I was in practice like you for about 30 years, I never was on the other end of, you know, having to receive health care, fortunately. Thank goodness. Didn't never had that kind of an experience. But like and I'm sure I think we probably practiced about the same time EMRs

Healthcare 1.0 To Health 4.0

Dr. Mitchell Rothstein 12:40

were developed. And you point out that there is healthcare 1.0, healthcare 2.0, healthcare 3, which I found uh fascinating. I was hoping you would talk about that a little bit because I think for the average consumer out there, it makes a lot of sense and kind of helps distinguish what you're going toward from what we've been through.

Dr. Robin Blackstone 13:04

Right, right. So, you know, I think before Health Point 1.0, there wasn't really a lot that we could do. I mean, we really were in the hand-holding stage. We were about as useful to a physical setting as a priest is to a medical setting. Like, I mean, like in a religious setting, like, you know, hold my hand. And you know what? We were empathetic. We felt the suffering of the people we cared for. A lot of times we knew all of them, you know. And, you know, in the book, I kind of traced Tom's journey, as my friend Tom, but his journey through healthcare. And, you know, that was about all that we could do. I mean, some people didn't even have like an x-ray machine, but they'd set a leg because that's what they could do. And then we kind of evolved from there slowly, and then all of a sudden, really fast, right? So, so each step in our evolution included new things, but they weren't very well applied to everyone. In the United States, you know, we had made that that decision in the 1920s not to cover everyone. And so if you were employed, you had one set of coverage. Sometimes it was great, sometimes it wasn't. It's always expensive. And it's getting more and more expensive now. But, you know, you there there were just this kind of barrier to knowledge, you know. So the average person couldn't know, like it was secret. It was like going into the, you know, into I'm a Catholic, so you know, when they open the little gold guy and they bring the body of Christ, you know, like I like I get that, right? And so, you know, it was secret, all of it. And then we kind of got into this era where there was like a thousand off-the-shelf products that you could buy that weren't as good as the thing you could get if you went to a doctor and got a prescription, but it was, you know, but it was it was accessible. So, you know, as we made our way along this whole thing, we kind of went from we we got better and better and better at rescue. We got so we're so good at rescue, we can replace a valve through a vein in your in your right arm, right? Like, you know, that's how good at rescue we are. But rescue is not really the answer, is it? Health is actually the answer. And up until this point, everybody's been talking about health as if it's something out there, like only the super wealthy can get it. Everybody else has to live in the quagmire of life. But actually, I believe that if you have the right signals that you can pick up a trajectory of health years before it starts and interrupt it. Wouldn't it be unbelievable if you knew, if I could tell you like in five years you're gonna have pancreatic cancer, but if we treat you today with a vaccine, you won't ever have it. That's different medicine.

Dr. Mitchell Rothstein 16:33

All right, That's where the money uh yeah, that that is the difference, and that's what you know. I think, as you're pointing out, that healthcare delivery should be all about is delivering the preventative therapy to prevent the rescue from ever occurring. And you talk about that we're kind of at that inflection point, and I think what what I took that to mean is there's an it's really kind of a dual inflection point, both a monetary kind of inflection point where we won't be able to afford this, and also an information inflection point where I know during my time in clinical practice when EMRs were being developed, it was an overwhelming amount of information that uh you knew it didn't really have any way to organize or guide. You just got dumped all this information, and it made actually health care delivery more difficult, at least for me. And then there was always a new system that we had to change to every couple of years. And you know, my most of my partners were on suicide precautions at that point. So um,

Dr. Robin Blackstone 17:38

-and you were gonna be on one if you didn't [inaudible]

Dr. Mitchell Rothstein 17:40

luckily I had some medical problems, and but no, in any event. I think it's important for average people to understand the monetary inflection point that what we're doing at the rate we're doing it is not sustainable, and that we won't be able to afford it in another 10 years.

Dr. Robin Blackstone 18:06

And the problem is that, you know, the people that will always be able to afford it can. It's just that that excludes millions of people. And I, you know, I have this idea, and you know, partly, you know, when I moved to New York City, I was reading some of the history of the city because I've always been fascinated by it. And I was reading about the very deliberate decision that the city fathers made to clean up the water and the sewer. Very deliberate, very expensive, but it was because they were losing thousands and thousands of people a year that were working in the city and providing that middle class and up-and-coming class infrastructure that the city was desperate to have. I think any country that turns their back on that is not gonna make it.

Culture Drives Outcomes And Buy In

Dr. Robin Blackstone 19:05

Seriously. And I I thought, okay, how can I create a system of health that delivers a health benefit to all of the people so that they can really form that infrastructure group that that any nation's gonna need to really build its future, including ours. So that's that was part of it. To me, the monetary piece comes from finally giving more authority to the person who's affected, giving them the information that they can work with their physician better, giving the information to the physician or the clinician, and you know I call it the human health ally. And that's because it's expanded. Back when you and I started, there were doctors and nurses, and now there's all these different people. And the truth is we kind of need all of them. What we didn't understand, you know, Dr. Rothstein, about the all of that data in the medical record was that actually about 80% of the health outcomes are due to the person's culture. And it's been shown so beautifully by Nico Pronk from Health Partners, Ross Arena, and Colin Woodard. I mean, it's been really demonstrated now very clearly. And so now, with the kind of new tools we have, Dr. AI can help match that culture, all those details that we didn't know what to do with, and really sort through them to get to Dr. Rothstein's best health. You know, who knows? You could have a whole new career going on here.

Dr. Mitchell Rothstein 21:01

Let's hope not. But you know, when you talk when you talk about that interface between the patient and their culture and AI, it requires a lot of buy-in by the community, right? That if not willing to change my habits and I'm not interested in kind of divulging my heritage and my family history, at that point, how do we overcome that? Or is that again part of this rebuilding this trust issue that you talk about? Because I I'm sure you've had similar experiences with noncompliant patients, which were a big part of my practice, I hate to say. And I'm sure a big part of every doctor's practice.

Dr. Robin Blackstone 21:52

Yeah. And and, you know, with surgery, you know, if people don't comply It's very difficult For them and for us. And so, you know, what I found though, honestly, is that among my patients, you know, I spent a lot of time talking to them. I I knew so much about them personally that they usually would be pretty compliant, pretty good with most things. Like if I said, listen, you know, you're gonna get out of bed like three hours after surgery and walk around. And they'd be like, can I? And I go, can you now? You know, and and and you just, you know, you kind of, but but there, but I think part of it was just that they knew that that they had a partner there. They had somebody that cared about them doing well and could give them kind of the advice and and all that. And I and I have to admit, there's a little bit about Dr. AI that's kind of like that, you know, kind of like me, I guess, you know. So I guess that's normal, right? To to build things that you understand. But I know that people are very autonomous in there, like there's people that just have that independent mindset. You know, I have a whole, I'm from Arizona, Dr. Austin. I have a whole family full of those guys. And and, you know, actually when I was doing my book and I and I got the reader, the readers, I I had some of the people from that part of the country reading. So I would understand it. So I would, you know, understand what was going on. And, you know, little by little they started to get interested and ended up being some of my really important contributors, actually, you know, to the thing. Yeah. It was it's it's gonna be not everybody will come to it, but I think what'll happen is when people see a good thing and they're convinced that it's in their best interest and that I'm not controlling it or someone else isn't controlling it, I think they they might just come around.

Dr. Mitchell Rothstein 24:19

Well, it it can't be worse than it is. I don't mean to say now. I mean I I think that you I think that the general direction of your thinking and uh the way you're presenting the material, it's very difficult to argue with it. And I think that the outcomes should, as you as you've pointed out, should be preventative and should improve everybody's health. And it makes sense that we can't continue to do what we do or do a variation of what we're doing now and expect that to be successful. So very you

Digital Twins And Faster Research

Dr. Mitchell Rothstein 25:00

open my eyes about the use of AI in this and and getting back to a little bit on the research part, just to fulfill one of my areas of interest. You talk about the use of AI in research and being able to cut costs and research by using digital twins. And for a lot of our viewers, they're not going to be familiar with that terminology. So if you could explain how that kind of helps move medicine forward a little bit, I think that would be helpful as well.

Dr. Robin Blackstone 25:31

So, you know, I really think we're entering a really exciting new era in regards to this. Because, you know, if you kind of have a model, which all of us are models, all of us are models of the people that we want to treat with a drug or a medication or whatever, or a new vaccine, for instance. And so once we have information, we can decide, yeah, you know what, I want to be a digital twin in that trial. I want to be, represent me like who I am, anonymously with code of some kind. And I want to put myself in these digital trials because it might benefit humanity, but it might benefit me. Like it might benefit my longevity or my gout or my you know, heart disease. Having buy-in from the public to forward medical re medical work, our understanding of medicine and and humans, man, once you get that buy-in from them, imagine how fast and how far we could travel. That's to me, that's almost intoxicating. And not because it's disconnected from people, but because it represents them. That's a whole new ball game for everyone. And I think it's something that speaks to all the constituencies, really. You know, it's not like you don't get cancer because you're a Baptist or a Catholic, right? Like, or that you're black or that you're green. Like that's it, every single human would benefit. That's uh, you know, that's like, okay, let's go to the moon then. You know, like let's go out and explore. You know, health is really a necessary, you know, place that we've got to be able to achieve if we're gonna go to the stars. You know, and I'm sure Elon Musk is listening to this podcast of yours. But, you know, like seriously, to go to space, we gotta have health. So let's create it as a condition of Earth and make that be one of our strongest things, not only for Americans, but for everybody.

Dr. Mitchell Rothstein 27:55

You know, it it's it's fascinating. We often talk about the value proposition for patients, but also for providers and for industry and for everything else. There has to be something that's driving them, and whether that's a monetary aspect or a health benefit, it's not that important as long as you find out what it is and can capitalize on that for everybody's gain. So the Go ahead, I'm sorry.

Dr. Robin Blackstone 28:22

I would say, well, I was just gonna say in regards to that, you know, employer health is one of my big things. I'm I'm just starting to write a couple of big papers about that right now. And the reason is that, you know, so you know, the number two P&L entry for costs is employer health in every company, small and large. But imagine if you could free that up. Imagine if that didn't go to pay for health insurance. You could use it for everything else the company's trying to do. And right now, that's a lot of things. Right? A lot of things.

Dr. Mitchell Rothstein 29:01

Absolutely. Now, the health 4.0 you is designed as the architecture for the plan. Is that correct? That's correct. And it's organized as a 501c3. Right. So it doesn't have lobbying power. Is that the distinction between a three and a four?

Dr. Robin Blackstone 29:22

So I picked that up from your Yeah, there's there's two parts of it actually. So there's the trust, which is the 501c, and it's a public, it's it's designated as a public charity. So you can give anything to that charity, and you get the full deduction, which is great. Um, it's not really limited by you know amount. I'm trying to build enough in the trust to take health care private, essentially, kind of like Federal

Health As Infrastructure And Employer Costs

Dr. Robin Blackstone 29:55

Reserve is, with oversight from Congress, but you know, not so much tinkering.

Dr. Mitchell Rothstein 30:06

Right.

Dr. Robin Blackstone 30:07

Not many, you know, because-

Dr. Mitchell Rothstein 30:08

not so much politics.

Dr. Robin Blackstone 30:10

Yeah, and and nothing that happens in a four, four-year period or a six-year period. You know, that's not relevant to healthcare. So, you know, we we have really well-meaning people that they they get uh like one thing that they really think, oh, this is what's gonna fix it, and then they enact it, and then it puts us back further. And you could give some examples and well-meaning, good people.

Dr. Mitchell Rothstein 30:36

Right, unintended consequences.

Dr. Robin Blackstone 30:38

Unintended consequences. So so what I what I envision then is that there's there's the alliance, which is the operations arm of it, and it's a public benefit company. The public benefit goes to the trust. So the trust is is primary over that. And so that operation company can't really make choices that don't align with, in other words, shareholders, which I'm hoping everyone in the country would be one, actually, shareholders don't control the decision making. In other words, the the company's not oriented to benefit them in a monetary way. And so because of that, it it actually is reportable to the public benefit of the company, which is healthcare for America. That way, I think it's I think it's the strongest construct, it's the strongest one I could find that would protect people from avarice and all the things that really, you know, affect it. Now, this is gonna be a little disruptive, which you can imagine.

Dr. Mitchell Rothstein 32:02

But you know, working you're only talking about 20% of the GDP, right?

Dr. Robin Blackstone 32:06

Right, right,

Dr. Mitchell Rothstein 32:07

right. You can't imagine that being a big deal.

Dr. Robin Blackstone 32:10

Yeah. And you know, the thing is I find about business is business always finds a way to find a way to do something that's valuable. But I think that the value of health for people is too important to leave to the market, what they call a market. It's not a market. When people can't enter and leave it willingly, it's not a market. Health is infrastructure. It's like water, it's like air. And so once if we can get our heads wrapped around the fact that it is infrastructure and that we have to have it to get to the future, then we begin to think about it, you know, really differently. And we say, well, you know, water standards have to be there so that we stay healthy, right? The air, and you know, I don't know if you've been to the other day, I not too long ago, I had gone to India for photography reasons. And I I've been there off and on over years. I walked out of the airport, I couldn't even see the buildings. The air is so bad in Delhi. And so, you know, I really think that, you know, we've got to realize that health is the same. It's infrastructure.

Dr. Mitchell Rothstein 33:32

Yeah. So right, so right now you're funding Health 4.0, the 501c3. And how do people donate to that?

Dr. Robin Blackstone 33:43

There's a website. It's just called the H4 Alliance Trust, you know, dot org.

The H4 Alliance Trust Plan

Dr. Mitchell Rothstein 33:50

we'll put that up on our website as well.

Dr. Robin Blackstone 33:52

Yeah. And you go, you can go on there and donate there. I I it's kind of a stag, but it tells you all about it. It tells you all the ins and outs and shows you the tax documents and all that kind of stuff is there. And it's it's a way for me to start to get enough funding to create the operations company. I'm busy at my desktop experimenting with Dr. AI and what that's gonna be because it's very complicated structure. It's not a chatbot. And and it's you know, it's got a lot of uh things that have to be in it in order to make it safe for people to use. It's it's really I work on it every day, actually. And I was I'm very helpful to have a little supercomputer on my desk here. So I have my own LLM. So the people that are trying out things for me uh can use it and it the information's ring ring fenced. So, you know, I really I'm really excited to see how we can get this to go. And I really appreciate the opportunity to talk about it, honestly, because I think the more people that get involved and get into it, the better off it will be for humanity and the better off for Americans, you know.

Dr. Mitchell Rothstein 35:22

Well, it it it it your work was eye-opening for me, because as you've pointed out, it is not just kind of buffing up the old car and bringing it out for another trot around the uh block. It's uh it's kind of turning things around and obviously looking at them in a whole different way that makes sense. And I think your the demonstration of the requirements of each part of your plan to be successful, or else and being realistic, or else the whole plan doesn't work, was refreshing to see in somebody's writing and somebody's thinking, and kind of uh defeating the arguments before they came up, which was enjoyable to get through. Not easy, but enjoyable. And uh but uh and you're also selling a book, so you've been busy, you know, six ways from Sunday. so

Dr. Robin Blackstone 36:18

Yeah, I actually have I actually have another book, a little called American Health, Who Gets Paid? And I have had so many people contact me and go, oh my God, I had no idea that's how it worked. And I'm like, yeah, that's how it works. And that's why we've been captured by it. We, the prof- people in the profession, we the consumer using the healthcare, like it captured us. And so we're just gonna have to, you know, pull up our bootstraps, as my dad used to say, and break loose of

Books, Support, And Closing

Dr. Robin Blackstone 36:55

this.

Dr. Mitchell Rothstein 36:56

Well, I I commend you on the Herculean effort in doing all this and organizing it in a digestible way for everybody. I I think everybody should buy your book. Dr. AI, it's out on all platforms now, right? As an audio book, as whatever, and contribute to your 501c3. And it was a pleasure talking with you. And I hope we can do this again. Absolutely. Thank you so much.

Dr. Robin Blackstone 37:24

I really enjoyed talking with you too. I appreciate it.

Dr. Mitchell Rothstein 37:26

It was a pleasure.

Announcer 37:27

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