Transcript [MUSIC]      [BOOK PASSAGE]   PETER LEE: “In ‘The Little Black Bag,’ a classic science fiction story, a high-tech doctor’s kit of the future is accidentally transported back to the 1950s, into the shaky hands of a washed-up, alcoholic doctor. The ultimate medical tool, it redeems the doctor wielding it, allowing him to practice gratifyingly heroic medicine. … The tale ends badly for the doctor and his treacherous assistant, but it offered a picture of how advanced technology could transform medicine—powerful when it was written nearly 75 years ago and still so today. What would be the Al equivalent of that little black bag? At this moment when new capabilities are emerging, how do we imagine them into medicine?”   [END OF BOOK PASSAGE]     [THEME MUSIC]     This is The AI Revolution in Medicine, Revisited. I’m your host, Peter Lee.    Shortly after OpenAI’s GPT-4 was publicly released, Carey Goldberg, Dr. Zak Kohane, and I published The AI Revolution in Medicine to help educate the world of healthcare and medical research about the transformative impact this new generative AI technology could have. But because we wrote the book when GPT-4 was still a secret, we had to speculate. Now, two years later, what did we get right, and what did we get wrong?     In this series, we’ll talk to clinicians, patients, hospital administrators, and others to understand the reality of AI in the field and where we go from here.   [THEME MUSIC FADES] The book passage I read at the top is from “Chapter 10: The Big Black Bag.”  In imagining AI in medicine, Carey, Zak, and I included in our book two fictional accounts. In the first, a medical resident consults GPT-4 on her personal phone as the patient in front of her crashes. Within seconds, it offers an alternate response based on recent literature. In the second account, a 90-year-old woman with several chronic conditions is living independently and receiving near-constant medical support from an AI aide.    In our conversations with the guests we’ve spoken to so far, we’ve caught a glimpse of these predicted futures, seeing how clinicians and patients are actually using AI today and how developers are leveraging the technology in the healthcare products and services they’re creating. In fact, that first fictional account isn’t so fictional after all, as most of the doctors in the real world actually appear to be using AI at least occasionally—and sometimes much more than occasionally—to help in their daily clinical work. And as for the second fictional account, which is more of a science fiction account, it seems we are indeed on the verge of a new way of delivering and receiving healthcare, though the future is still very much open.  As we continue to examine the current state of AI in healthcare and its potential to transform the field, I’m pleased to welcome Bill Gates and Sébastien Bubeck.   Bill may be best known as the co-founder of Microsoft, having created the company with his childhood friend Paul Allen in 1975. He’s now the founder of Breakthrough Energy, which aims to advance clean energy innovation, and TerraPower, a company developing groundbreaking nuclear energy and science technologies. He also chairs the world’s largest philanthropic organization, the Gates Foundation, and focuses on solving a variety of health challenges around the globe and here at home.  Sébastien is a research lead at OpenAI. He was previously a distinguished scientist, vice president of AI, and a colleague of mine here at Microsoft, where his work included spearheading the development of the family of small language models known as Phi. While at Microsoft, he also coauthored the discussion-provoking 2023 paper “Sparks of Artificial General Intelligence,” which presented the results of early experiments with GPT-4 conducted by a small team from Microsoft Research.    [TRANSITION MUSIC]   Here’s my conversation with Bill Gates and Sébastien Bubeck.  LEE: Bill, welcome.  BILL GATES: Thank you.  LEE: Seb …  SÉBASTIEN BUBECK: Yeah. Hi, hi, Peter. Nice to be here.  LEE: You know, one of the things that I’ve been doing just to get the conversation warmed up is to talk about origin stories, and what I mean about origin stories is, you know, what was the first contact that you had with large language models or the concept of generative AI that convinced you or made you think that something really important was happening?  And so, Bill, I think I’ve heard the story about, you know, the time when the OpenAI folks—Sam Altman, Greg Brockman, and others—showed you something, but could we hear from you what those early encounters were like and what was going through your mind?   GATES: Well, I’d been visiting OpenAI soon after it was created to see things like GPT-2 and to see the little arm they had that was trying to match human manipulation and, you know, looking at their games like Dota that they were trying to get as good as human play. And honestly, I didn’t think the language model stuff they were doing, even when they got to GPT-3, would show the ability to learn, you know, in the same sense that a human reads a biology book and is able to take that knowledge and access it not only to pass a test but also to create new medicines.  And so my challenge to them was that if their LLM could get a five on the advanced placement biology test, then I would say, OK, it took biologic knowledge and encoded it in an accessible way and that I didn’t expect them to do that very quickly but it would be profound.   And it was only about six months after I challenged them to do that, that an early version of GPT-4 they brought up to a dinner at my house, and in fact, it answered most of the questions that night very well. The one it got totally wrong, we were … because it was so good, we kept thinking, Oh, we must be wrong. It turned out it was a math weakness [LAUGHTER] that, you know, we later understood that that was an area of, weirdly, of incredible weakness of those early models. But, you know, that was when I realized, OK, the age of cheap intelligence was at its beginning.  LEE: Yeah. So I guess it seems like you had something similar to me in that my first encounters, I actually harbored some skepticism. Is it fair to say you were skeptical before that?  GATES: Well, the idea that we’ve figured out how to encode and access knowledge in this very deep sense without even understanding the nature of the encoding, …  LEE: Right.   GATES: … that is a bit weird.   LEE: Yeah.  GATES: We have an algorithm that creates the computation, but even say, OK, where is the president’s birthday stored in there? Where is this fact stored in there? The fact that even now when we’re playing around, getting a little bit more sense of it, it’s opaque to us what the semantic encoding is, it’s, kind of, amazing to me. I thought the invention of knowledge storage would be an explicit way of encoding knowledge, not an implicit statistical training.  LEE: Yeah, yeah. All right. So, Seb, you know, on this same topic, you know, I got—as we say at Microsoft—I got pulled into the tent. [LAUGHS]  BUBECK: Yes.   LEE: Because this was a very secret project. And then, um, I had the opportunity to select a small number of researchers in MSR [Microsoft Research] to join and start investigating this thing seriously. And the first person I pulled in was you.  BUBECK: Yeah.  LEE: And so what were your first encounters? Because I actually don’t remember what happened then.  BUBECK: Oh, I remember it very well. [LAUGHS] My first encounter with GPT-4 was in a meeting with the two of you, actually. But my kind of first contact, the first moment where I realized that something was happening with generative AI, was before that. And I agree with Bill that I also wasn’t too impressed by GPT-3.  I though that it was kind of, you know, very naturally mimicking the web, sort of parroting what was written there in a nice way. Still in a way which seemed very impressive. But it wasn’t really intelligent in any way. But shortly after GPT-3, there was a model before GPT-4 that really shocked me, and this was the first image generation model, DALL-E 1.  So that was in 2021. And I will forever remember the press release of OpenAI where they had this prompt of an avocado chair and then you had this image of the avocado chair. [LAUGHTER] And what really shocked me is that clearly the model kind of “understood” what is a chair, what is an avocado, and was able to merge those concepts.  So this was really, to me, the first moment where I saw some understanding in those models.   LEE: So this was, just to get the timing right, that was before I pulled you into the tent.  BUBECK: That was before. That was like a year before.  LEE: Right.   BUBECK: And now I will tell you how, you know, we went from that moment to the meeting with the two of you and GPT-4.  So once I saw this kind of understanding, I thought, OK, fine. It understands concept, but it’s still not able to reason. It cannot—as, you know, Bill was saying—it cannot learn from your document. It cannot reason.   So I set out to try to prove that. You know, this is what I was in the business of at the time, trying to prove things in mathematics. So I was trying to prove that basically autoregressive transformers could never reason. So I was trying to prove this. And after a year of work, I had something reasonable to show. And so I had the meeting with the two of you, and I had this example where I wanted to say, there is no way that an LLM is going to be able to do x.  And then as soon as I … I don’t know if you remember, Bill. But as soon as I said that, you said, oh, but wait a second. I had, you know, the OpenAI crew at my house recently, and they showed me a new model. Why don’t we ask this new model this question?   LEE: Yeah. BUBECK: And we did, and it solved it on the spot. And that really, honestly, just changed my life. Like, you know, I had been working for a year trying to say that this was impossible. And just right there, it was shown to be possible.   LEE: [LAUGHS] One of the very first things I got interested in—because I was really thinking a lot about healthcare—was healthcare and medicine.  And I don’t know if the two of you remember, but I ended up doing a lot of tests. I ran through, you know, step one and step two of the US Medical Licensing Exam. Did a whole bunch of other things. I wrote this big report. It was, you know, I can’t remember … a couple hundred pages.   And I needed to share this with someone. I didn’t … there weren’t too many people I could share it with. So I sent, I think, a copy to you, Bill. Sent a copy to you, Seb.   I hardly slept for about a week putting that report together. And, yeah, and I kept working on it. But I was far from alone. I think everyone who was in the tent, so to speak, in those early days was going through something pretty similar. All right. So I think … of course, a lot of what I put in the report also ended up being examples that made it into the book.  But the main purpose of this conversation isn’t to reminisce about [LAUGHS] or indulge in those reminiscences but to talk about what’s happening in healthcare and medicine. And, you know, as I said, we wrote this book. We did it very, very quickly. Seb, you helped. Bill, you know, you provided a review and some endorsements.  But, you know, honestly, we didn’t know what we were talking about because no one had access to this thing. And so we just made a bunch of guesses. So really, the whole thing I wanted to probe with the two of you is, now with two years of experience out in the world, what, you know, what do we think is happening today?  You know, is AI actually having an impact, positive or negative, on healthcare and medicine? And what do we now think is going to happen in the next two years, five years, or 10 years? And so I realize it’s a little bit too abstract to just ask it that way. So let me just try to narrow the discussion and guide us a little bit.   Um, the kind of administrative and clerical work, paperwork, around healthcare—and we made a lot of guesses about that—that appears to be going well, but, you know, Bill, I know we’ve discussed that sometimes that you think there ought to be a lot more going on. Do you have a viewpoint on how AI is actually finding its way into reducing paperwork?  GATES: Well, I’m stunned … I don’t think there should be a patient-doctor meeting where the AI is not sitting in and both transcribing, offering to help with the paperwork, and even making suggestions, although the doctor will be the one, you know, who makes the final decision about the diagnosis and whatever prescription gets done.   It’s so helpful. You know, when that patient goes home and their, you know, son who wants to understand what happened has some questions, that AI should be available to continue that conversation. And the way you can improve that experience and streamline things and, you know, involve the people who advise you. I don’t understand why that’s not more adopted, because there you still have the human in the loop making that final decision.  But even for, like, follow-up calls to make sure the patient did things, to understand if they have concerns and knowing when to escalate back to the doctor, the benefit is incredible. And, you know, that thing is ready for prime time. That paradigm is ready for prime time, in my view.  LEE: Yeah, there are some good products, but it seems like the number one use right now—and we kind of got this from some of the previous guests in previous episodes—is the use of AI just to respond to emails from patients. [LAUGHTER] Does that make sense to you?  BUBECK: Yeah. So maybe I want to second what Bill was saying but maybe take a step back first. You know, two years ago, like, the concept of clinical scribes, which is one of the things that we’re talking about right now, it would have sounded, in fact, it sounded two years ago, borderline dangerous. Because everybody was worried about hallucinations. What happened if you have this AI listening in and then it transcribes, you know, something wrong?  Now, two years later, I think it’s mostly working. And in fact, it is not yet, you know, fully adopted. You’re right. But it is in production. It is used, you know, in many, many places. So this rate of progress is astounding because it wasn’t obvious that we would be able to overcome those obstacles of hallucination. It’s not to say that hallucinations are fully solved. In the case of the closed system, they are.   Now, I think more generally what’s going on in the background is that there is something that we, that certainly I, underestimated, which is this management overhead. So I think the reason why this is not adopted everywhere is really a training and teaching aspect. People need to be taught, like, those systems, how to interact with them.  And one example that I really like, a study that recently appeared where they tried to use ChatGPT for diagnosis and they were comparing doctors without and with ChatGPT (opens in new tab). And the amazing thing … so this was a set of cases where the accuracy of the doctors alone was around 75%. ChatGPT alone was 90%. So that’s already kind of mind blowing. But then the kicker is that doctors with ChatGPT was 80%.   Intelligence alone is not enough. It’s also how it’s presented, how you interact with it. And ChatGPT, it’s an amazing tool. Obviously, I absolutely love it. But it’s not … you don’t want a doctor to have to type in, you know, prompts and use it that way.  It should be, as Bill was saying, kind of running continuously in the background, sending you notifications. And you have to be really careful of the rate at which those notifications are being sent. Because if they are too frequent, then the doctor will learn to ignore them. So you have to … all of those things matter, in fact, at least as much as the level of intelligence of the machine.  LEE: One of the things I think about, Bill, in that scenario that you described, doctors do some thinking about the patient when they write the note. So, you know, I’m always a little uncertain whether it’s actually … you know, you wouldn’t necessarily want to fully automate this, I don’t think. Or at least there needs to be some prompt to the doctor to make sure that the doctor puts some thought into what happened in the encounter with the patient. Does that make sense to you at all?  GATES: At this stage, you know, I’d still put the onus on the doctor to write the conclusions and the summary and not delegate that.  The tradeoffs you make a little bit are somewhat dependent on the situation you’re in. If you’re in Africa, So, yes, the doctor’s still going to have to do a lot of work, but just the quality of letting the patient and the people around them interact and ask questions and have things explained, that alone is such a quality improvement. It’s mind blowing.   LEE: So since you mentioned, you know, Africa—and, of course, this touches on the mission and some of the priorities of the Gates Foundation and this idea of democratization of access to expert medical care—what’s the most interesting stuff going on right now? Are there people and organizations or technologies that are impressing you or that you’re tracking?  GATES: Yeah. So the Gates Foundation has given out a lot of grants to people in Africa doing education, agriculture but more healthcare examples than anything. And the way these things start off, they often start out either being patient-centric in a narrow situation, like, OK, I’m a pregnant woman; talk to me. Or, I have infectious disease symptoms; talk to me. Or they’re connected to a health worker where they’re helping that worker get their job done. And we have lots of pilots out, you know, in both of those cases.   The dream would be eventually to have the thing the patient consults be so broad that it’s like having a doctor available who understands the local things.   LEE: Right.   GATES: We’re not there yet. But over the next two or three years, you know, particularly given the worsening financial constraints against African health systems, where the withdrawal of money has been dramatic, you know, figuring out how to take this—what I sometimes call “free intelligence”—and build a quality health system around that, we will have to be more radical in low-income countries than any rich country is ever going to be.   LEE: Also, there’s maybe a different regulatory environment, so some of those things maybe are easier? Because right now, I think the world hasn’t figured out how to and whether to regulate, let’s say, an AI that might give a medical diagnosis or write a prescription for a medication.  BUBECK: Yeah. I think one issue with this, and it’s also slowing down the deployment of AI in healthcare more generally, is a lack of proper benchmark. Because, you know, you were mentioning the USMLE [United States Medical Licensing Examination], for example. That’s a great test to test human beings and their knowledge of healthcare and medicine. But it’s not a great test to give to an AI.  It’s not asking the right questions. So finding what are the right questions to test whether an AI system is ready to give diagnosis in a constrained setting, that’s a very, very important direction, which to my surprise, is not yet accelerating at the rate that I was hoping for.  LEE: OK, so that gives me an excuse to get more now into the core AI tech because something I’ve discussed with both of you is this issue of what are the right tests. And you both know the very first test I give to any new spin of an LLM is I present a patient, the results—a mythical patient—the results of my physical exam, my mythical physical exam. Maybe some results of some initial labs. And then I present or propose a differential diagnosis. And if you’re not in medicine, a differential diagnosis you can just think of as a prioritized list of the possible diagnoses that fit with all that data. And in that proposed differential, I always intentionally make two mistakes.  I make a textbook technical error in one of the possible elements of the differential diagnosis, and I have an error of omission. And, you know, I just want to know, does the LLM understand what I’m talking about? And all the good ones out there do now. But then I want to know, can it spot the errors? And then most importantly, is it willing to tell me I’m wrong, that I’ve made a mistake?   That last piece seems really hard for AI today. And so let me ask you first, Seb, because at the time of this taping, of course, there was a new spin of GPT-4o last week that became overly sycophantic. In other words, it was actually prone in that test of mine not only to not tell me I’m wrong, but it actually praised me for the creativity of my differential. [LAUGHTER] What’s up with that?  BUBECK: Yeah, I guess it’s a testament to the fact that training those models is still more of an art than a science. So it’s a difficult job. Just to be clear with the audience, we have rolled back that [LAUGHS] version of GPT-4o, so now we don’t have the sycophant version out there.  Yeah, no, it’s a really difficult question. It has to do … as you said, it’s very technical. It has to do with the post-training and how, like, where do you nudge the model? So, you know, there is this very classical by now technique called RLHF [reinforcement learning from human feedback], where you push the model in the direction of a certain reward model. So the reward model is just telling the model, you know, what behavior is good, what behavior is bad.  But this reward model is itself an LLM, and, you know, Bill was saying at the very beginning of the conversation that we don’t really understand how those LLMs deal with concepts like, you know, where is the capital of France located? Things like that. It is the same thing for this reward model. We don’t know why it says that it prefers one output to another, and whether this is correlated with some sycophancy is, you know, something that we discovered basically just now. That if you push too hard in optimization on this reward model, you will get a sycophant model.  So it’s kind of … what I’m trying to say is we became too good at what we were doing, and we ended up, in fact, in a trap of the reward model.  LEE: I mean, you do want … it’s a difficult balance because you do want models to follow your desires and …  BUBECK: It’s a very difficult, very difficult balance.  LEE: So this brings up then the following question for me, which is the extent to which we think we’ll need to have specially trained models for things. So let me start with you, Bill. Do you have a point of view on whether we will need to, you know, quote-unquote take AI models to med school? Have them specially trained? Like, if you were going to deploy something to give medical care in underserved parts of the world, do we need to do something special to create those models?  GATES: We certainly need to teach them the African languages and the unique dialects so that the multimedia interactions are very high quality. We certainly need to teach them the disease prevalence and unique disease patterns like, you know, neglected tropical diseases and malaria. So we need to gather a set of facts that somebody trying to go for a US customer base, you know, wouldn’t necessarily have that in there.  Those two things are actually very straightforward because the additional training time is small. I’d say for the next few years, we’ll also need to do reinforcement learning about the context of being a doctor and how important certain behaviors are. Humans learn over the course of their life to some degree that, I’m in a different context and the way I behave in terms of being willing to criticize or be nice, you know, how important is it? Who’s here? What’s my relationship to them?   Right now, these machines don’t have that broad social experience. And so if you know it’s going to be used for health things, a lot of reinforcement learning of the very best humans in that context would still be valuable. Eventually, the models will, having read all the literature of the world about good doctors, bad doctors, it’ll understand as soon as you say, “I want you to be a doctor diagnosing somebody.” All of the implicit reinforcement that fits that situation, you know, will be there. LEE: Yeah. GATES: And so I hope three years from now, we don’t have to do that reinforcement learning. But today, for any medical context, you would want a lot of data to reinforce tone, willingness to say things when, you know, there might be something significant at stake.  LEE: Yeah. So, you know, something Bill said, kind of, reminds me of another thing that I think we missed, which is, the context also … and the specialization also pertains to different, I guess, what we still call “modes,” although I don’t know if the idea of multimodal is the same as it was two years ago. But, you know, what do you make of all of the hubbub around—in fact, within Microsoft Research, this is a big deal, but I think we’re far from alone—you know, medical images and vision, video, proteins and molecules, cell, you know, cellular data and so on.  BUBECK: Yeah. OK. So there is a lot to say to everything … to the last, you know, couple of minutes. Maybe on the specialization aspect, you know, I think there is, hiding behind this, a really fundamental scientific question of whether eventually we have a singular AGI [artificial general intelligence] that kind of knows everything and you can just put, you know, explain your own context and it will just get it and understand everything.  That’s one vision. I have to say, I don’t particularly believe in this vision. In fact, we humans are not like that at all. I think, hopefully, we are general intelligences, yet we have to specialize a lot. And, you know, I did myself a lot of RL, reinforcement learning, on mathematics. Like, that’s what I did, you know, spent a lot of time doing that. And I didn’t improve on other aspects. You know, in fact, I probably degraded in other aspects. [LAUGHTER] So it’s … I think it’s an important example to have in mind.  LEE: I think I might disagree with you on that, though, because, like, doesn’t a model have to see both good science and bad science in order to be able to gain the ability to discern between the two?  BUBECK: Yeah, no, that absolutely. I think there is value in seeing the generality, in having a very broad base. But then you, kind of, specialize on verticals. And this is where also, you know, open-weights model, which we haven’t talked about yet, are really important because they allow you to provide this broad base to everyone. And then you can specialize on top of it.  LEE: So we have about three hours of stuff to talk about, but our time is actually running low. BUBECK: Yes, yes, yes.   LEE: So I think I want … there’s a more provocative question. It’s almost a silly question, but I need to ask it of the two of you, which is, is there a future, you know, where AI replaces doctors or replaces, you know, medical specialties that we have today? So what does the world look like, say, five years from now?  GATES: Well, it’s important to distinguish healthcare discovery activity from healthcare delivery activity. We focused mostly on delivery. I think it’s very much within the realm of possibility that the AI is not only accelerating healthcare discovery but substituting for a lot of the roles of, you know, I’m an organic chemist, or I run various types of assays. I can see those, which are, you know, testable-output-type jobs but with still very high value, I can see, you know, some replacement in those areas before the doctor.   The doctor, still understanding the human condition and long-term dialogues, you know, they’ve had a lifetime of reinforcement of that, particularly when you get into areas like mental health. So I wouldn’t say in five years, either people will choose to adopt it, but it will be profound that there’ll be this nearly free intelligence that can do follow-up, that can help you, you know, make sure you went through different possibilities.  And so I’d say, yes, we’ll have doctors, but I’d say healthcare will be massively transformed in its quality and in efficiency by AI in that time period.  LEE: Is there a comparison, useful comparison, say, between doctors and, say, programmers, computer programmers, or doctors and, I don’t know, lawyers?  GATES: Programming is another one that has, kind of, a mathematical correctness to it, you know, and so the objective function that you’re trying to reinforce to, as soon as you can understand the state machines, you can have something that’s “checkable”; that’s correct. So I think programming, you know, which is weird to say, that the machine will beat us at most programming tasks before we let it take over roles that have deep empathy, you know, physical presence and social understanding in them.  LEE: Yeah. By the way, you know, I fully expect in five years that AI will produce mathematical proofs that are checkable for validity, easily checkable, because they’ll be written in a proof-checking language like Lean or something but will be so complex that no human mathematician can understand them. I expect that to happen.   I can imagine in some fields, like cellular biology, we could have the same situation in the future because the molecular pathways, the chemistry, biochemistry of human cells or living cells is as complex as any mathematics, and so it seems possible that we may be in a state where in wet lab, we see, Oh yeah, this actually works, but no one can understand why.  BUBECK: Yeah, absolutely. I mean, I think I really agree with Bill’s distinction of the discovery and the delivery, and indeed, the discovery’s when you can check things, and at the end, there is an artifact that you can verify. You know, you can run the protocol in the wet lab and see [if you have] produced what you wanted. So I absolutely agree with that.   And in fact, you know, we don’t have to talk five years from now. I don’t know if you know, but just recently, there was a paper that was published on a scientific discovery using o3- mini (opens in new tab). So this is really amazing. And, you know, just very quickly, just so people know, it was about this statistical physics model, the frustrated Potts model, which has to do with coloring, and basically, the case of three colors, like, more than two colors was open for a long time, and o3 was able to reduce the case of three colors to two colors.   LEE: Yeah.  BUBECK: Which is just, like, astounding. And this is not … this is now. This is happening right now. So this is something that I personally didn’t expect it would happen so quickly, and it’s due to those reasoning models.   Now, on the delivery side, I would add something more to it for the reason why doctors and, in fact, lawyers and coders will remain for a long time, and it’s because we still don’t understand how those models generalize. Like, at the end of the day, we are not able to tell you when they are confronted with a really new, novel situation, whether they will work or not.  Nobody is able to give you that guarantee. And I think until we understand this generalization better, we’re not going to be willing to just let the system in the wild without human supervision.  LEE: But don’t human doctors, human specialists … so, for example, a cardiologist sees a patient in a certain way that a nephrologist …  BUBECK: Yeah. LEE: … or an endocrinologist might not. BUBECK: That’s right. But another cardiologist will understand and, kind of, expect a certain level of generalization from their peer. And this, we just don’t have it with AI models. Now, of course, you’re exactly right. That generalization is also hard for humans. Like, if you have a human trained for one task and you put them into another task, then you don’t … you often don’t know. LEE: OK. You know, the podcast is focused on what’s happened over the last two years. But now, I’d like one provocative prediction about what you think the world of AI and medicine is going to be at some point in the future. You pick your timeframe. I don’t care if it’s two years or 20 years from now, but, you know, what do you think will be different about AI in medicine in that future than today?  BUBECK: Yeah, I think the deployment is going to accelerate soon. Like, we’re really not missing very much. There is this enormous capability overhang. Like, even if progress completely stopped, with current systems, we can do a lot more than what we’re doing right now. So I think this will … this has to be realized, you know, sooner rather than later.  And I think it’s probably dependent on these benchmarks and proper evaluation and tying this with regulation. So these are things that take time in human society and for good reason. But now we already are at two years; you know, give it another two years and it should be really …   LEE: Will AI prescribe your medicines? Write your prescriptions?  BUBECK: I think yes. I think yes.  LEE: OK. Bill?  GATES: Well, I think the next two years, we’ll have massive pilots, and so the amount of use of the AI, still in a copilot-type mode, you know, we should get millions of patient visits, you know, both in general medicine and in the mental health side, as well. And I think that’s going to build up both the data and the confidence to give the AI some additional autonomy. You know, are you going to let it talk to you at night when you’re panicked about your mental health with some ability to escalate? And, you know, I’ve gone so far as to tell politicians with national health systems that if they deploy AI appropriately, that the quality of care, the overload of the doctors, the improvement in the economics will be enough that their voters will be stunned because they just don’t expect this, and, you know, they could be reelected [LAUGHTER] just on this one thing of fixing what is a very overloaded and economically challenged health system in these rich countries.  You know, my personal role is going to be to make sure that in the poorer countries, there isn’t some lag; in fact, in many cases, that we’ll be more aggressive because, you know, we’re comparing to having no access to doctors at all. And, you know, so I think whether it’s India or Africa, there’ll be lessons that are globally valuable because we need medical intelligence. And, you know, thank god AI is going to provide a lot of that.  LEE: Well, on that optimistic note, I think that’s a good way to end. Bill, Seb, really appreciate all of this.   I think the most fundamental prediction we made in the book is that AI would actually find its way into the practice of medicine, and I think that that at least has come true, maybe in different ways than we expected, but it’s come true, and I think it’ll only accelerate from here. So thanks again, both of you.  [TRANSITION MUSIC]  GATES: Yeah. Thanks, you guys.  BUBECK: Thank you, Peter. Thanks, Bill.  LEE: I just always feel such a sense of privilege to have a chance to interact and actually work with people like Bill and Sébastien.    With Bill, I’m always amazed at how practically minded he is. He’s really thinking about the nuts and bolts of what AI might be able to do for people, and his thoughts about underserved parts of the world, the idea that we might actually be able to empower people with access to expert medical knowledge, I think is both inspiring and amazing.   And then, Seb, Sébastien Bubeck, he’s just absolutely a brilliant mind. He has a really firm grip on the deep mathematics of artificial intelligence and brings that to bear in his research and development work. And where that mathematics takes him isn’t just into the nuts and bolts of algorithms but into philosophical questions about the nature of intelligence.   One of the things that Sébastien brought up was the state of evaluation of AI systems. And indeed, he was fairly critical in our conversation. But of course, the world of AI research and development is just moving so fast, and indeed, since we recorded our conversation, OpenAI, in fact, released a new evaluation metric that is directly relevant to medical applications, and that is something called HealthBench. And Microsoft Research also released a new evaluation approach or process called ADeLe.   HealthBench and ADeLe are examples of new approaches to evaluating AI models that are less about testing their knowledge and ability to pass multiple-choice exams and instead are evaluation approaches designed to assess how well AI models are able to complete tasks that actually arise every day in typical healthcare or biomedical research settings. These are examples of really important good work that speak to how well AI models work in the real world of healthcare and biomedical research and how well they can collaborate with human beings in those settings.  You know, I asked Bill and Seb to make some predictions about the future. You know, my own answer, I expect that we’re going to be able to use AI to change how we diagnose patients, change how we decide treatment options.   If you’re a doctor or a nurse and you encounter a patient, you’ll ask questions, do a physical exam, you know, call out for labs just like you do today, but then you’ll be able to engage with AI based on all of that data and just ask, you know, based on all the other people who have gone through the same experience, who have similar data, how were they diagnosed? How were they treated? What were their outcomes? And what does that mean for the patient I have right now? Some people call it the “patients like me” paradigm. And I think that’s going to become real because of AI within our lifetimes. That idea of really grounding the delivery in healthcare and medical practice through data and intelligence, I actually now don’t see any barriers to that future becoming real.  [THEME MUSIC]  I’d like to extend another big thank you to Bill and Sébastien for their time. And to our listeners, as always, it’s a pleasure to have you along for the ride. I hope you’ll join us for our remaining conversations, as well as a second coauthor roundtable with Carey and Zak.   Until next time.   [MUSIC FADES]

Climate change is making everything worse — including apparently threatening the dairy that makes our precious cheese.In interviews with Science News, veterinary researchers and dairy farmers alike warned that changes to the climate that affect cows are impacting not only affects the nutritional value of the cheeses produced from their milk, but also the color, texture, and even taste.Researchers from the Université Clermont Auvergne, which is located in the mountainous Central France region that produces a delicious firm cheese known as Cantal, explained in a new paper for the Journal of Dairy Science that grass shortages caused by climate change can greatly affect how cows' milk, and the subsequent cheese created from it, tastes.At regular intervals throughout a five-month testing period in 2021, the scientists sampled milk from two groups of cows, each containing 20 cows from two different breeds that were either allowed to graze on grass like normal or only graze part-time while being fed a supplemental diet that featured corn and other concentrated foods.As the researchers found, the corn-fed cohort consistently produced the same amount of milk and less methane than their grass-fed counterparts — but the taste of the resulting milk products was less savory and rich than the grass-fed bovines.Moreover, the milk from the grass-fed cows contained more omega-3 fatty acids, which are good for the heart, and lactic acids, which act as probiotics."Farmers are looking for feed with better yields than grass or that are more resilient to droughts," explained Matthieu Bouchon, the fittingly-named lead author of the study.Still, those same farmers want to know how supplementing their cows' feed will change the nutritional value and taste, Bouchon said — and one farmer who spoke to Science News affirmed anecdotally, this effect is bearing out in other parts of the world, too."We were having lots of problems with milk protein and fat content due to the heat," Gustavo Abijaodi, a dairy farmer in Brazil, told the website. "If we can stabilize heat effects, the cattle will respond with better and more nutritious milk."The heat also seems to be getting to the way cows eat and behave as well."Cows produce heat to digest food — so if they are already feeling hot, they’ll eat less to lower their temperature," noted Marina Danes, a dairy scientist at Brazil's Federal University of Lavras. "This process spirals into immunosuppression, leaving the animal vulnerable to disease."Whether it's the food quality or the heat affecting the cows, the effects are palpable — or, in this case, edible."If climate change progresses the way it’s going, we’ll feel it in our cheese," remarked Bouchon, the French researcher.More on cattle science: Brazilian "Supercows" Reportedly Close to Achieving World DominationShare This Article

Unless you are older or want bigger muscles, you’re probably getting enough

A Peloton perched in the living room. A set of weights on the bedroom floor. Some wellness products have a way of making their presence known. But even the smaller things—think daily supplements, mushroom tinctures, herbal teas—can slowly start to sprawl out everywhere. With the rise and awareness of holistic health habits, wellness routines that rival your skincare shelf, and obsessions like ProteinTok—a whole corner of the internet dedicated to everything protein—you might find that wellness has taken over your kitchen. Suddenly, your blender is battling for space with the hydration powders, collagen tubs, and stacks of snack bars. If you don’t have a place to properly store it all, your kitchen can start to be more overwhelming than calming. But with thoughtful design, proper planning, and smart storage solutions, you can integrate it all into your home in a way that feels serene and seamless. We asked designers and wellness experts how they manage their ever-expanding collection of products and design their kitchens with well-being in mind.Consider An Appliance GarageTessa NeustadtGreen cabinet doors conceal the appliances in this kitchen by Interior Archaeology.“For things that need to be in reach and on the counter, we put everything in an appliance garage,” shares Lynn Kloythanomsup of Landed Interiors and Homes. By that she means is a built-in cabinet or nook—typically integrated into the cabinetry—that features a door that lifts, rolls, or swings open and shut to conceal bulky appliances. Designer Hollie Velten of Spaces by Hollie Velten is also a fan of this feature and notices more clients requesting it. “A custom appliance garage allows things like tea supplies to be accessible for entertaining but hidden for everyday use.”It’s not just designers who advocate for this intentional placement—wellness experts themselves are just as mindful of it. “Our juicer must be on the countertop to make juicing as effortless as possible but other appliances are fine tucked away,” says health coach and nutritionist Daphne Javtich of Doing Well. Kerrilynn Pamer of Cap Beauty echoes this: “I keep my juicer on the counter, I have a Nama, and it’s pretty discreet even though it's large. Everything else, I keep behind doors.”Think Beyond The Main KitchenStacy Zarin GoldbergThis auxiliary kitchen by Kate Abt Design makes a perfect spot for wellness essentials.One luxury feature on the rise? Auxiliary kitchens, also known as dirty kitchens. “When designing for clients, we almost always have the ‘family’ or ‘show’ kitchen and then a second kitchen where the real cooking happens,” says Eric Egan of Eric Egan Interior Design. “This is much like in a restaurant show kitchen, where you see them finishing the meals, but you don't see the prep work or the clean up, all of which happens in the background.” Designer Sarah Barnard of Sarah Barnard Design has also seen an increase in the request of auxiliary kitchens and loves them because they “provide concealed storage for juicers, blenders, dehydrators, and food processors.” While two kitchens might not be realistic for everyone, if you have access to a nice-sized pantry or closet nearby, that’s an ideal spot to corral it all, as well. Rethink Unused SpacesKEVIN MIYAZAKIRemove the booze, bring in the blender, and this liquor cabinet, in a library designed by Kate Marker, could be a wellness station.Speaking of ideal spots for wellness, consider transforming underutilized spaces like liquor cabinets or part of a mudroom into a wellness hub. “We don't find that too many of our clients have a liquor cabinet or use a bar anymore,” shares Kloythanomsup. “So that area can be repurposed as a wellness area.” While you're repurposing it, consider where you can plug in all those wellness appliances. “Clients are also asking us to design technology-stations, so they have multiple areas to hide their technology and free their view of cords and distractions,” Velten says. Get In The ZoneEmma Farrer//Getty ImagesA dedicated tea zone.If you are going to dedicate counter space to your wellness routine, whether it’s a juicing zone, smoothie station, a hydration corner—keep things arranged in groups or zones. “I keep the bulk of my supplements and remedies in a large, shallow pullout drawer in the kitchen,” Javitch shares. “I find this is the easiest way to organize and find products quickly. And you don't have to remove some to get to others.”“I love setting up thoughtful, dedicated zones, like a wellness drawer with teas, vitamins, and tinctures all in one place, or a water station with a glass water pitcher, reusable bottles, and electrolytes,” shares Blakey. Keeping similar items together allows products to stay top of mind and prevents them from getting lost in the shuffle. Contain YourselfCourtesy Holly BlakeyA pantry organized by Holly Blakey of Breathing Room Home.While baskets are a no-brainer for kitchen organization, designers and experts say that’s for good reason, advising homeowners not to overlook them—and to keep the materials as natural as possible. “Wooden bins are another favorite way to add warmth and style while keeping items grouped,” Blakey says. Velten seconds the idea of rush baskets or wooden bins, “We try to push living finishes as much as we can because with proper care, material that came from the earth just vibrates differently.” No matter how many products you use or how dialed-in your routine may be, “wellness becomes part of the daily flow when your space helps you follow through on your intentions,” says Blakey. For that reason, says Javitch, “I always keep a few small baskets in our cabinets with products I often grab for like the kids' sunblock stick or their multivitamin gummies.”Show Off Your Stash Thomas LeonczikHollie Velten designed this kitchen to keep essentials on view. The alternative to hiding things away? Showing them off! “We worked with a client who described her kitchen goals as ‘California health kitchen,’” shares Velten. “We actually removed the upper cabinets to create an easy-to-access corner of shelving to hold glass jars and sustainable practices for her teas, herbs, spices, tinctures, and other food prep essentials.” After all, some items deserve to be seen—not only from an aesthetic perspective but also to prompt daily use and consistency. “I’ll usually keep my essential daily products on a pretty wood tray on the kitchen counter,” Javtich shares.If you are going to keep things out in the open, Bay Area-based organizer of Breathing Room Home Holly Blakey, says clarity is key. “I swear by glass containers for food storage, not just for sustainability, but because they help you know what you have and when you can clearly see your items, you’re more likely to use them before they expire.”Plus, this keep-it-all-out method a way to incorporate your personal preferences and add a little personality into your kitchen. “Sometimes well-kept essentials really only bring more joy and utility when out in the open,” Velten adds. 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If you’ve ever wondered whether the food on your plate could shape your brain’s future, the science is starting to say: yes, it might. While healthy eating has long been linked to better brain health, new research is getting more specific about which diets help, and when you should start following them.At this year’s annual Nutrition conference in Orlando, Florida, researchers presented findings that add weight to the growing link between diet and dementia. According to a news release, study author Song-Yi Park of the University of Hawaii at Manoa said, “Our study findings confirm that healthy dietary patterns in mid to late life and their improvement over time may prevent Alzheimer’s and related dementias. This suggests that it is never too late to adopt a healthy diet to prevent dementia.”The research focused on nearly 93,000 U.S. adults from the long-running Multiethnic Cohort Study. Participants were between 45 years and 75 years old when they entered the study in the 1990s. Over time, more than 21,000 developed Alzheimer’s disease or related dementias — but those who closely followed a specific eating plan, the MIND diet, were significantly less likely to be among them.Combining the Mediterranean Diet and DASH DietThe MIND diet (short for Mediterranean-DASH Intervention for Neurodegenerative Delay) blends the best elements of two established eating plans: the Mediterranean diet and the DASH diet.The Mediterranean diet is inspired by the traditional cuisines of countries like Greece, Italy, and Spain. It focuses on plant-based foods (fruits, vegetables, legumes, nuts, seeds, and whole grains), healthy fats like olive oil, and moderate amounts of fish, poultry, and dairy, with red meat eaten sparingly. It’s been linked to a lower risk of heart disease and is also environmentally friendly.The DASH diet, originally designed to lower blood pressure, shares many similarities but puts extra emphasis on limiting sodium and increasing intake of nutrients like potassium, magnesium, and calcium. It includes low-fat dairy and lean protein sources and doesn’t rely on any hard-to-find foods.The MIND diet specifically promotes brain-healthy foods like leafy greens, berries, nuts, and olive oil, combining benefits of both approaches with a focus on protecting cognitive health.Read More: Is the Mediterranean Diet Healthy?The MIND Diet Over TimeAccording to Park and her team, people who scored highest in MIND diet adherence at the study’s start had a 9 percent lower risk of developing dementia. That number was even higher with around 13 percent for African American, Latino, and White participants. Looking at those who improved their adherence to the MIND diet over time, showed a 25 percent reduction in dementia risk compared to those whose dietary habits declined, which was consistent no matter the age or racial background.“We found that the protective relationship between a healthy diet and dementia was more pronounced among African Americans, Latinos, and Whites, while it was not as apparent among Asian Americans and showed a weaker trend in Native Hawaiians,” Park said in the press release. “A tailored approach may be needed when evaluating different subpopulations’ diet quality.”Interestingly, Asian Americans also tend to have lower dementia rates overall, which researchers believe could mean other cultural eating patterns might offer similar protection than the MIND diet for that group.The Best Time to Start Is NowOne of the most encouraging findings was that starting late still helped. Participants who began following the MIND diet more closely over a 10-year period, regardless of how old they were when they began, saw benefits. This suggests that even if you didn’t grow up eating brain-boosting foods, it’s not too late to change course.It’s worth noting that the study is observational, so, by itself, it can’t prove this specific diet causes better brain health. Study author Park notes that the next step is conducting interventional studies to verify these promising results.Still, the evidence is mounting. Whether you're 45 or 75, choosing greens over greasy snacks could make a real difference when it comes to aging with or without dementia.This article is not offering medical advice and should be used for informational purposes only.Article SourcesOur writers at Discovermagazine.com use peer-reviewed studies and high-quality sources for our articles, and our editors review for scientific accuracy and editorial standards. Review the sources used below for this article:National Institute of Aging. What Do We Know About Diet and Prevention of Alzheimer’s Disease?Harvard Health Publishing. A practical guide to the Mediterranean dietNational Heart, Lung, and Blood Institute. Following the DASH Eating PlanHaving worked as a biomedical research assistant in labs across three countries, Jenny excels at translating complex scientific concepts – ranging from medical breakthroughs and pharmacological discoveries to the latest in nutrition – into engaging, accessible content. Her interests extend to topics such as human evolution, psychology, and quirky animal stories. When she’s not immersed in a popular science book, you’ll find her catching waves or cruising around Vancouver Island on her longboard.

Researchers used the popular gene-editing technique CRISPR to modify the DNA sequences of house spiders, causing them to produce red fluorescent silk.Scientists are hoping that the US Navy and Air Force-funded research could lead to the development of new "supermaterials" produced by arachnids, Fast Company reports.As detailed in a paper published in the journal Angewandte Chemie, a team of researchers at the University of Bayreuth in Germany injected the eggs of unfertilized female spiders with a CRISPR-Cas9 solution to insert a gene sequence for a red fluorescent protein. After mating with males of the same species, the offspring produced red, fluorescent silk, demonstrating that the experiment had been successful."Considering the wide range of possible applications, it is surprising that there have been no studies to date using CRISPR-Cas9 in spiders," said senior author and University of Bayreuth professor Thomas Scheibel in a statement. "We have demonstrated, for the first time worldwide, that CRISPR-Cas9 can be used to incorporate a desired sequence into spider silk proteins, thereby enabling the functionalisation of these silk fibres."Apart from turning their silk bright red, the researchers also attempted to knock out a gene called sine oculis, which is responsible for the development of spider eyes. They found that the gene edit caused total or partial eye loss in experiments, highlighting its important role in visual development.By applying CRISPR-Cas9, a technique that has already been widely used to create custom medical treatments or make farm animals more resilient to diseases, the researchers are hoping to come up with a new generation of silk fibers."Successful spider silk engineering in vivo will, therefore, help to develop and employ new fiber functionalities for a broad range of applications," the team wrote in its paper. "So far, genetic modifications in spiders have been only aimed at evolutionary and developmental research."As Fast Company points out, materials scientists have already been investigating the tactile strength of the silk produced by gene-modified silkworms. But thanks to cutting-edge gene-editing techniques, researchers could soon harness the unique advantages of spider silk as well.While the researchers didn't single out specific use cases for future "supermaterials," the possible applications are practically endless, from lightweight body armor to ultralight running shoes."The ability to apply CRISPR gene-editing to spider silk is very promising for materials science research — for example, it could be used to further increase the already high tensile strength of spider silk," Scheibel explained.Share This Article