Bloomberg Businessweek Daily Live From NYSE with LifeMD (Part Two)

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1:56Carol Massar:Podcasts. Radio. News.

2:21on Bloomberg Radio.

2:23Carol Massar:You know, we came across some research. It talked about the explosive growth of AI chatbots and how it's made it a very popular tool for people looking for guidance on their ailments. And OpenAI has said that more than 200 million people ask chat GPT health and wellness questions every week. And yet there's also been a study out in the medical journal BMJ Open. This was published last month. They found, Tim, that AI-driven chatbots are giving users problematic medical advice about half the time. So highlighting the health risks of the technology. Yeah, you just have to push back so slightly and it says, actually, you're right about that.

3:00I think you might be wrong. I will say, one of my friends who's a doctor did show me this chat bot that doctors are allowed, that doctors have access to. They have to use a special license number that they have. And it only uses, it's only trained on journals and it's pretty cool.

3:18Carol Massar:So it's only as good as the data that goes in, which is what we want to get into. Great to have back with us someone who understands AI technology and medical care, Dr. Joan Lowe-River. She is Senior Vice President, Interim Chief Medical Officer at Boston Children's Hospital. She's also on the board of LifeMD. So nice to have you back with us. How are you? Thank you, Carol. It's lovely to be back again. So what do you, when you hear about AI, I feel like everybody we're talking to mentions that it has a lot of potential great uses for health care in the medical community? How do you see it and how are you seeing it in your world?

3:53Well, I think AI has the power to be transformative in our world. I don't think that's a hard thing to understand or see, but we have to be cautious as we use it. I think as we were discussing earlier, it's not quite there yet in terms of being trained to a point where you're certain of its accuracy. And there are lots of moves within platforms to improve that accuracy. But you can see the road ahead, how it's going to help us understand, get to diagnosis quicker, help clinicians. I think it's going to be an incredible adjunct. It already is. I see how much we are using those tools to bolster our capabilities, to check, to push back, and really try to understand to get to the most accurate diagnoses for patients.

4:49There's lots of uses, obviously, within automation and helping ease of work. We're using ambient technologies to be able to record conversations and create the first templates of our notes so we can focus more on one-on-one time, personal time with patients. So I think it's a vista ahead of us, but needs to be done smartly so that we really include the data for all populations in the models that we build and the answers that we give. You mean like women? Like women. I think that's a focus of your segment today. We haven't historically done a great job of including women in clinical trials, collecting data on women, understanding.

5:35But to your point around technology with real-time data, right, real-time data sets on women coupled with studies targeting women's illness, I think we're going to have a much more nuanced and personalized understanding of disease. When? Today? We have to do this. I feel like I do not want my daughter's generation to be sitting here.

6:06Carol Massar:With the same conversation, right? With the same conversation. And I think it took the unlocking with the AI tools that are coming to us to make that a possibility. I guess what I'm curious about is how quickly you see this happening. Not right now. And to Carol's question, when, but like, if we look at this as a moment in time over your entire career and the way that you're seeing tech actually move the needle when it comes to what you do and what your doctors and nurses do every single day at Boston Children's, are we in a moment where we are going to see us be able to make leaps and bounds when it comes to development of new therapies for certain ailments, new diagnosing tools?

6:49Like, is this a pivotal moment? This is 100 % a pivotal moment. Like the biggest in your career at this point? Absolutely. It's like an industrial revolution is taking place. You know, it's that type of moment in time, from my perspective. I think that... When you see stuff happening, that makes you think that, right? It's also a very important perspective for healthcare, too. Yeah, totally. I think generative AI was the first next milestone, right? And that was, what, three years ago, right? And then the agentic piece that's come over the last year or two is unlocking all new capabilities. So I think that it's the evolution and the geospatial AI is going to have its moment.

7:30So when you start to be able to understand where are the medical deserts in care, you're able to use agentic workflows across data that can bring back information that you really couldn't see. You wouldn't have the scale and the capability.

7:48Carol Massar:Who's building the data sets? Like, I think about that. And one of the things that we've, I think, through people we've talked to, how it's shifting to, it might not be that everybody's using these large language models, but you'll have very specific vertical data sets, especially for, like, health care or medicine, so that when you are working within it, it's a really smart, appropriate database. So who's building those databases? Are you guys doing your own? Are you working with other medical organizations? How does that work? I think it's something that's evolving. There's lots of data sets that have been built over time, right?

8:26In terms of electronic health records, data sets within registries. There are many data sets. And you raised the right point, making sure those are solid, good, evidence-based data sets that this is the data you want to be using. There's the UK Biobank. There's large data sets that are unlocking this sort of potential. And I think we're now having this real-time data collection capabilities that is going to be very interesting to see. Instead of, say, a glucose test once every three months, you have a continuous glucometer running, you have a continuous glucose data set. So I think of it like my perspective, my cardiac ICU.

9:15I'm dealing with continuous data streams. Now there's an ability to analyze continuous data streams in ways that were just so challenged before. So I think it's that unique moment in time. We are told drug development, drug development, drug development is a real opportunity too. Is that true? Yes. I think it is very much a real opportunity. So how, I mean, drug development's expensive. It's slow. It's high stakes. You see, sometimes, it's almost like every day the biotech companies are some of the biggest movers to the upside or to the downside. They take big risks. Very volatile. Does the development of AI, does it change sort of the drug development cycle meaningfully?

10:03I think that is the hope that everybody has right now. And there are many companies that are spinning out and doing that sort of work. Big Pharma has arms that are doing that sort of work. Think about it in terms of the rare disease base and the sort of children that we care for. Say at Children's, what an opportunity to be able to potentially bring things to market that weren't possible. And then when I think about the long-term care of patients and understanding the full patient profile, the phenotype of the disease, we have new ways of actually understanding the patient cohorts that may unlock new possibilities in terms of developments of therapies for them.

10:50You know, we've always talked about very individualized medicine.

10:55Carol Massar:Is that still a thing? And increasingly, that is a thing? And will AI help it so that we can look at each of us? You know, because ailments obviously impact people differently. They do. They do. And I think you had Dr. Doug was on here earlier talking about bone health, right? Yes, yes. And how do you personalize things to an individual? I think this is part of this moment in time that you can personalize. Your physiology is going to be different than my physiology. And maybe how I live my life needs to be a little bit different to the way you live your life. Yeah. Based on knowing your lab values, your genotype, your phenotype.

11:41that then we could get ahead of understanding what disease you have the potential of developing and intervening earlier such that you may either delay or not end up with that disease trajectory. So are we there? Again. I think it's an infrastructure build. Yeah. And it's not just technology. I think that's an important point. Technology is not the only thing that you need to think about in solving for this. its market inefficiencies, its operations, its regulations, and that spans the globe. We really need to think about that. And I think that's where I say we're in a revolutionary time in the sense of everything is changing and how do we build the right and most appropriate structures.

12:28Global health is so important to you. Just 30 seconds in this change in the game for underserved communities, underserved populations. Yes. It will. It will. If they can get the tech? I think it's the tech that's designed for the local community. Trust, building trust. I think it unlocks the ability to, I think, more expanded data around all of humanity. You know, not just like a U.S. population. And being able to understand, I think, how you can deliver better, more targeted care. I mean, we're already using some of this tech in terms of collaborating across geographies. I think that's one of the things.

13:16It closes the distance. I mean, we personally, with the foundation, Virtue Foundation, are already using some of that technology.

13:21Carol Massar:And you have a book coming out later this year. I do. I'm just going to say, we have to wrap it. It's Crossroads in Global Health. Crossroads in Global Health, published with me and my colleague, Dr. Abiyalahi, coming out from Taylor & Francis in September. You guys have to come back and then talk to us once you have the book out. Thank you. Dr. Joan LaRoverre. She is Senior VP, Chief Medical Officer, Boston Children's Hospital. Stay with us. More from Bloomberg Businessweek Daily coming up after this.

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15:48Carol Massar:You're listening to the Bloomberg Business Week Daily Podcast. Catch us live weekday afternoons from 2 to 5 Eastern. Listen on Apple CarPlay and Android Auto with the Bloomberg Business app. Or watch us live on YouTube. Well, as we mentioned, we are live from the New York Stock Exchange, where we're continuing our deep dive when it comes to health care, and specifically when it comes to women's health. Yeah, and what's interesting is I want to jump right in with our next guest. Dr. Stephanie Fabian is with us. She's medical director of the Menopause Society. It's a nonprofit with the mission of empowering health care professionals and providing them with the tools and resources that they need to really improve the health of women during the menopause transition and beyond.

16:30Carol Massar:It was founded back in 1989. Dr. Fabian, first of all, welcome. You are also the Penny and Bill George Director of Mayo Clinic's Center for Women's Health. You were there for over 10 years, still are. Still am. Yes, absolutely. So let's just jump right in, if I may. What's gotten better about women's health? What is still just so tricky? Is it just the lack of R &D and awareness, or what is it? Well, I think in terms of the menopause space, what's gotten better is we're actually having a conversation about it. You and I are here chatting about menopause, which even five years ago wouldn't have been the case.

17:03What is still tricky is that we still don't have really great data and we still need more. There needs to be more research in the women's health space in general. And we're still largely acting off the Women's Health Initiative trial results, which were published in 2002. That's old data. It's old, and that data is on hormone therapy formulations that we don't even use anymore. And so we're working off some outdated data. How do you get updated data? How do you get money for clinical trials? Thank you for asking that question. We follow the money, and that always seems to be the challenge when it comes to this stuff.

17:40Why we use old data is because we don't have new data. Why don't we have the new data? It costs a lot of money. So the Women's Health Initiative was funded to the tune of about$750 million, and it was a line item in the congressional budget. So it's not going to happen again. And the NIH doesn't have that kind of money and that kind of—we estimate it's going to cost about$200 million to do this trial over again, which is much less expensive in that we can do it in a digital way, and so we can decentralize it. But it's still a lot of money, and when you're looking for single-source funds, it's still a lot.

18:15Carol Massar:Any gaps along this line for men in terms of like, why is it this gap? I mean, we talk about gaps so much in society still between men and women, and it just seems like why is this still a situation? Yeah. I mean, it's historically been the case. I heard a funny statement that it was, we know more about the bottom of the ocean than we do about women's health and specifically about menopause and that is because the government cares about the bottom of the ocean. So I think it's interest. I think it's a lack of emphasis where it really needs to be. Is it happening anywhere in other countries? Are we able to get data from other countries that are investing in this?

19:00I don't know. I would say nobody else is doing this to a greater degree than we are already. So I can't say that other countries are ahead of us in terms of research, But it takes a lot of money and it's going to take effort from, you know, we're going to have to coordinate efforts. We can no longer say that that one entity is going to take care of figuring all this out. We're going to have to rely on a bunch of different people and a bunch of different data sets.

19:23Carol Massar:So what are we missing by women not being more active or are we thinking about menopause and the care that needs to be done or even the preventive care going into it? I mean, you can't prevent it, obviously, but there are certain things that we're learning, whether it's hormonal treatments, hormones. So I don't know, as a woman, what's the message to them? Do we just have to ask for these things? Well, I think the message is that not all. So first of all, menopause is not a disease, right? It's a universal life event that happens to all of us. And we shouldn't be thinking about it in terms of it being a disease.

19:59It doesn't happen to all of us, does it? Some women never have a single symptom. My mother asked me, why are you writing the menopause book in 2016? Like, why are you writing the menopause book? And I said, well, what was your experience, mom? And she said, I might have had a hot flash once at a cocktail party when I had a glass of wine. No, that's fair. I'm like, okay, well, clearly it wasn't an issue for you. And some women are like that. You know, maybe about a quarter of women are like that. But the majority of us are going to have symptoms. Does the treatment that is at the vanguard right now, in your view, how does that get transmitted to a wider population of doctors so patients can get that treatment?

20:44Do patients actually have to ask specifically for it? I'm trying to understand how a doctor would treat someone proactively. So I think there's several gaps that we're working on here. So one is the gap that women aren't educated about menopause. We all get the talk when we're about to start our periods. No one gets the talk when you're about to stop your period. So women are unprepared. Then we have a whole generation of clinicians who never got educated on menopause management because when the WHI results were published in 2002, it was like, oh, we're not going to use hormone therapy. then therefore there's nothing to do about menopause.

21:21So therefore we don't need to teach it anymore because it's not a thing. So we have a whole generation of clinicians that never got educated. So the menopause society is working really hard on this. And in fact, we've received a couple of very generous grants that we're working on. How do you disseminate education in a better way? So the easy one is to disseminate education for two people who are asking for it. So they can pull it. But the trickier question is for those who don't think they need to learn about menopause, who maybe should be learning about menopause, how do you actually push the information?

21:55And is it through the medical record? Like we noticed that your patient has seen three different doctors in the last six months about palpitations and mood issues. And here's some information and here's how you might manage this. So I think it's a combination of things. We need to educate women. We need to educate clinicians. We need to actually be more proactive about providing at-the-elbow support for clinicians. Like, what do I do with this patient? Here's the scenario. So we're really working hard on that, but it's a multimodal approach.