GOP Debate, AI in Medicine and the Right Wing's New Favorite Song with Co-Hosts Louie Swisher and Dr. Jeffrey Swisher

24:00And they really need to fact check more carefully. Yeah, I would agree. Now, Trump made it clear he doesn't care about this debate and is trying to divert eyeballs over to X or Twitter with his Tucker Carlson interview. Watching that, Louis, are you going to watch that over there? Tucker pisses me off. I can't watch him. I mean, it's very hard to remain calm for me when I watch him because he reminds me of somebody who is losing an argument and changes the point, changes the topic because he doesn't have an argument. I mean, and he does it in such a way that you think you're losing, but that's a form of gaslighting.

24:34And I don't appreciate that. I've encountered arguers like that out there in the world, and I used to just walk away. Walk away. All right, Jeff, what about you? I can't take Tucker Carlson seriously. He's an overprivileged individual who grew up with an amazing, you know, the Swanson fortune. Yeah, he's a rich man north of Richmond. A very rich man north of Richmond. And he's just hard for me to take. He's just so smarmy and just he's just he's a clown. I can't take him seriously. Won't be watching. Trump is Trump's done a lot of interviews. He's been seeing. Now, let me shift over. We've been seeing and hearing more about Vivek Ramaswani in the last few days, thanks to rising poll numbers in some profiles in The Atlantic where he features some controversial 9-11 and January 6 comments.

25:16He posted a video on Twitter of his debate trap, a shirtless workout on a tennis court. He has a very whippy forehand, although not bad. What do you think of this guy? Or do you have any thoughts whatsoever? Yeah, he's slick. He's very slick. He's a good public speaker. He's actually not a bad rapper. I listen to his rap. I mean, I'm not a conister of rap, but he's not bad. I mean, I certainly couldn't do that. But I mean, clearly he lies like he breathes. And he's been caught in several lies on the news yesterday. I was listening to, what's her name? The reporter, yeah. Caitlin Collins. Caitlin Collins.

25:53Yeah. Who's very good. And he's just he's a slipper version of Trump. Louie, is there any other Republicans you're looking at? Are there any Republicans you think are interesting? Chris Christie intrigues me a little bit. I mean, he's kind of like the guy at the House party who yells we should calm down when the kitchen's already on fire. You know, you could have said that earlier, buddy. But I guess fine. You're saying it now. I think Chris Christie makes an interesting point about attacking Donald Trump. I think he's very late to doing it. And I think that doesn't necessarily make him, it doesn't clear his record for, you know, holding toe and kissing ass.

26:28But I think that it's going to be interesting to see how he, without Donald on the stage, how he directs that passion towards the other players. I think he's going to call out the other candidates on the stage. And basically, he's going to be the person who's going to be the anti-Trump. And if he can bring those other people with him. I mean, Pence has been towing the line with that, you know, since he's, you know, after he was almost hung at the Capitol. Yeah, I mean, I think that, you know, hopefully Christie will bring it to that point where the other candidates can actually start, you know, the emperor has no clothes type of activity.

27:03So is it going to work either of you? Or is it just Trump's the candidate? It's not going to work. No, Trump's the candidate. I mean, unfortunately, it's he's just yeah yeah let's go on a quick break when we come back by the way everyone should vote for louis swisher in 20 years just fyi don't do that he's got he's got my vote yes you would be an amazing candidate and i would be like your mom in the background i might be dead by the way cara putting the nepo and nepotism yay anyway let's go on a quick break when we come back I'll be asking my brother, the doctor, to weigh in on the benefits and dangers of AI in medicine.

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30:06Louis and Jeff, we're back with our second big story. Artificial intelligence seems to have infiltrated all aspects of society these days, and medicine is no exception. Hospitals are now pouring hundreds of millions of dollars into AI software and education, and companies like Amazon, Microsoft, and Google are entering the healthcare space with AI tools to transcribe doctor-patient conversations, quickly provide doctors with medical knowledge and more. But in spite of all the innovations and investments, a Pew Research Center study earlier this year revealed that 60 % of Americans would feel uncomfortable if their clinician relied on AI to diagnose or recommend treatments, and 33 % think it would lead to worse outcomes for patients.

30:42Louis, I will have some questions for you. I'm going to focus on Jeff here. You're on the front lines of all this, and you've told me various things of how you use AI in your work. I'd like your overall thoughts and then some specifics, and I have some questions. So AI obviously is going to be a big player in the future in medicine. It is to some extent, but the true power of AI has not been realized in medicine yet. And it's going to come in a variety of forms. And I'll just kind of briefly go over it. So let's just say the New England Journal, which is one of the flagship publications for medicine, has a new website.

31:16It's ai.nejm.org. And they're going to have submissions about how AI can be used in medicine because, frankly, most doctors don't really know how AI is going to be used in medicine. It's a very small number of people who are very aware of how AI is going to be used. But let me just point out some of the big ways it's going to be used. Number one is data management, integration of clinical data, note writing. I mean, when you generate a medical note, you often recreate the wheel every single time you write a note. And already with electronic medical records, that's being done to some extent with a lot of copy and paste.

31:51But AI is going to do it in a much more organic way in terms of note writing, as well as interviewing patients. It will listen to your interview with a patient. And just like a scribe does now in a hospital, the AI will listen to the interview and will transcribe what's going on. And it will allow you to memorialize a care plan for a patient, their hospital course, any information that happens, their history. and it gives you a cohesive patient map about that individual in a way where it can utilize the strengths of AI and make things like medical errors in drugs and medical errors in procedures and medical errors in not having an adequate history.

32:32It's going to hopefully fix that. That's the biggest strength of it. Secondly, people don't think about it, but insurance integration is going to be helped by AI because right now how we bill for medical insurance in this country is insane. But AI will hopefully help streamline that. It will allow doctors to bill more efficiently, and it will also lead to cost savings. So that's a very big part of AI. And the third is actual care management. And this is where someone like me, who's a person on the front lines, comes in. It will allow me to have a vast medical database that allows me to look at everything that's in medicine in terms of even rare things.

33:10pattern recognition, people like radiologists and pathologists are going to, you know, they run the risk of being made obsolete. But also, I think mostly it's going to be like, you think about a hammer, a carpenter uses a hammer, which is a tool, right? Now imagine that the next tool is a nail gun. And then the next one is a laser guided nail gun. These kinds of things allow better use of tools and allow physicians to basically use their skills in order to use a thing like AI to provide better care for a patient. So for someone like me, who's an anesthesiologist, I do, my specialty is liver transplantation, solid organ transplantation.

33:49And in a liver transplant, you have a very sick, often a very sick patient with a wide variety of medical problems in a very challenging situation where an entire liver is being removed from a patient and their circulation and their blood pressure and their cardiac output and their vascular resistance changes on a dime due to what the surgeon's doing. And I have to deal with that blood loss, coagulability, all these kinds of things. And in an AI situation, let's just take a patient with what's known as vasoplegia, where they're not responding to the typical drugs that I use to raise blood pressure.

34:24Well, an AI algorithm can help me decide based upon a series of data, what is the best course of action to take in a given situation in real time, which I can choose to accept or not, but it helps me think on my feet. Yeah. So it gives you more, it's like a smart person in your ear, right? Exactly. Right. It's exactly like a smart person in your ear. It can't supplant what I do. I mean, an AI is not going to intubate my difficult to intubate patient, but it can certainly give me ideas in real time on the fly. Which is helpful to you. We talked about the makings of a great business plan for you.

34:57Scott and I were talking a second opinion AI for doctors. Are you off and running with that? I am actually. So I did a seed round. I raised about a billion dollars in a seed round, and I actually already sold it to Google for$200 billion. So I'm rivaling Elon Musk. Thanksgiving on you, Jeff. Thanksgiving. I am a full-time physician and chairman of a department. In addition to doing all the other things I do, I don't have time. Are doctors getting more innovative? I was talking to one of my doctors who you know who helped me, and he's got two companies going. Is it time for doctors to be more innovative?

35:31Yeah, I wish I had the time to do that. I just don't. I mean, I think, you know, I'll be 65 in two years and I'll retire and then I'll do it. Then you'll do it. Doctors have been innovative, but this is sort of opening up a lot of things. Are there things AI shouldn't be used for? I mentioned the stat about people's concern about AI diagnosis, even if they're correct. Because I know this is a big shock to people, but doctors don't know everything, as I said to you all the time, is the problem. They don't. They definitely don't. So, no, AI, you have to, like, every tool, every tool has the ability to use it correctly or incorrectly.

36:03And a doctor, like any tool that we use, regardless of what it is, I mean, you have to be able to know some background. I mean, look at the case of that lawyer who used an AI argument in a court, and it turned out that every single one of the cases that he cited was made up by AI. That's concerning, right? You know, and AI has, it looks like it's degenerated in its ability to do things for some reason, like mathematical calculations. So you have to constantly, you know, trust but verify, I think is the best way to say it. Mm hmm. What about the ethical considerations? Senator Mark Warner wrote to Google CEO Sunder Pachai a few weeks ago, voicing his concern about possible ethical issues as well as, as you said, unproven technology with the company's MedPom, MedPom 2 tool.

36:50Well, I think people need to know that what they're talking to is a bot and not a human being. I think that's that's unethical to pass off a person as a human being when in fact they're not. And I think that we have to be careful about that. And the other thing, too, is they have to make a disclaimer that this thing that they're dealing with is not a real person. It's not a physician. And therefore, everything should be verified by a physician beforehand. And I mean, to that point, just like self-driving, do I trust it? Sort of, but not 100%. Mm-hmm. Louie, how do you feel comfortable knowing your doctor was using AI for diagnosis?

37:26Well, I really enjoyed what Jeff was saying earlier about just having it as like another tool on your tool belt. I think that is a very good use of this. And you see that across industries in the legal industry. I mean, legal aids are shaking in their boots right now because that is a very AI-able job. And I think that using this technology in combination with human talent is a very excellent usage. When we rely entirely on the robot, that's when things become a bit questionable. And I think there is probably an inherent distrust of machines from humans because they're not like us. They are other.

38:00We don't see ourselves in them and therefore can't completely trust them. So when you're thinking about it, like when you're thinking about jobs, you're going to go on the job market, presumably, I hope so, in the next couple of years. You cook. When I think of it, someone asked me, what would you like Louis to do? And I said, well, he can do whatever he wants, but I would like him to be cooking because you can't AI that. It's not AI-able. Cooking is not, except for looking up recipes, like that kind of thing. It's a hands-on job. Well, it is though, but it is, but, but it is, it is. Okay. How?

38:29Well, I think, I mean, it depends. I mean, you have people who love to eat Trader Joe's frozen meals, and then you have people like to cook themselves dinner every night. And the former is very, you know, AI-able. It's very easy for a machine to crank out frozen meals in a standard package and standard, you know, standard measurements and stuff like that. But there is a human element that people enjoy. And I certainly do. And I think as the world increasingly becomes more automated, increasingly becomes more influenced by computers and AI, I think we might lose touch with that human element and desire it a bit more.

39:02You see that nowadays, even where in like, you know, for, you know, if you have the money, like in DC, you can sign up for a farm to deliver your milk to your door. You know, that's real old school, is it? But like the, there is a desire to go back to more simpler human to human hand to hand contact and commerce and connection. Do you think about that when you're thinking about jobs? I mean, I don't know if you're thinking about what you're going to do after college, but is that worrisome to a lot of young people? Is that everything is going to be replaced? Because that's sort of the trope. Yeah, I think it is.

39:35So how do you think about it? Well, I think about it recognizing the fact that I actually can't really think about it. I can't predict the future. I don't know what's going to happen. I would say that most of the jobs that exist today, you could not have predicted 30 years ago. So the world is going to change and new jobs are going to go away, certainly, but new jobs are going to emerge and new things are going to emerge to do. I personally, as someone who's culinarily inclined, likes to write, is a student of ideas. I think that the realms I occupy are not particularly threatened by automation and AI.

40:13But I think for a lot of people, it is. And I think there will be like, I think there'll be a mixture of combination with AI and machinery, as there has been for a while now. There will also be replacement, but there will also be an emergence of entirely new sectors and entirely new professions that we simply just can't fathom now. So I'm not too worried. I know, but I'm not, I don't want to speak for all young people, you know, but do people your age worry about jobs right now? Is that a big thing they think about or is it just? Yeah, a lot of my friends are going into their senior year of college, and a lot of them are facing that existential crisis of what do I do now?

40:50I think that's a normal thing for people in that transitionary period to experience. But I think with the way the world is changing, politically, economically, culturally, these questions are even more relevant than ever. And I don't have the answers, so I can't provide any comfort, but it might be all right. So, Louis, let me give you some uncle advice and experience here. So, you know, when I graduated college in 1982, I was an international relations major and medicine was the last thing on my mind. I took exactly three classes as an undergraduate in science, human sexuality, oceans, and GO1.

41:30That was it. So as you know, after my year of taking off and living up at Lake Tahoe, I decided I was going to be a doctor for a lot of reasons. And you can go to my substack and read about why if you want to. The thing is, you don't know what the future is going to bring. And Carrie will probably say the same thing, you know, when she walked into the Washington Post, into Ben Bradley's office and said, you know. No, I would not. I always knew I was going to be a media mogul. But go ahead. Go ahead. Yeah, I don't think you did. Because I remember I was there, if you recall. I did. I think that, you know, the future is going to happen whether we want it to or not.

42:05And you're going to change. And obviously, the tools are going to change, like you say. I mean, the ability to do things now is so much more. You know, we had to go to the card catalog and look up things. And now it's at your fingertips. Everything, not just, you know, well, everything's available at your fingertips. Yeah. Louie, do you know what a card catalog is? I'm going to stop your uncle-ing here. Louie, do you know what a card catalog is? I plead to fifth. You don't know what a card catalog is. See, he doesn't know, Jeff. He doesn't know what a Rolodex is. He doesn't know what a rotary phone is.

42:36Oh, I know that one. I know that one. I know that one because I've seen a toy one. He does. Yes, he has. Many years ago, I tell the story when I showed them a payphone and they were both flummoxed by the entire experience when they were kids and we were in Los Angeles. Anyway, this is fascinating. Thank you, Uncle Jeff. Louis, do whatever you want, but you do need to get a job. Anyway, one more quick break and we'll be back for predictions.

43:06Support for the show comes from Odoo. Running a business is hard enough, and you don't need to make it harder with a dozen different apps that don't talk to each other. One for sales, another for inventory, a separate one for accounting. Before you know it, you find yourself drowning in software and processes instead of focusing on what matters, growing your business. This is where Odoo comes in. It's the only business software you'll ever need. Odoo is an all-in-one, fully integrated platform that handles everything. That means CRM accounting, inventory, e-commerce, HR, and more. No more app overload.

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44:10Support for the show comes from Odoo. Running a business is hard enough, and you don't need to make it harder with a dozen different apps that don't talk to each other. One for sales, another for inventory, a separate one for accounting. Before you know it, you find yourself drowning in software and processes instead of focusing on what matters, growing your business. This is where Odoo comes in. It's the only business software you'll ever need. Odoo is an all-in-one, fully integrated platform that handles everything. That means CRM accounting, inventory, e-commerce, HR, and more. No more app overload.

44:39No more juggling logins. Just one seamless system that makes work easier. And the best part is that Odoo replaces multiple expensive platforms for a fraction of the cost. It's built to grow with your business, whether you're just starting out or you're already scaling up. Plus, it's easy to use, customizable, and designed to streamline every process. It's time to put the clutter aside and focus on what really matters, running your business. Thousands of businesses have made the switch, so why not you? Try Odoo for free at odoo.com. That's O-D-O-O dot com.

45:17Okay, we're going to do some predictions. I am going to start to give you an idea. I told you guys you had to be prepared, and I'm guessing, Louie, you are not, but you're going to have to come up with some really soon. One I want to note is this story I think everyone should read, and I'll tell you why it's a prediction. The Washington Post has a fascinating story of a Michigan sex educator named Heather Alberta, who lives in a conservative county and came under fire for what she was putting out as a sex educator there. It's an insane story, and it tells me something I've been predicting a lot.

45:48All this anti-trans attacks and everything else is all about a larger picture of the strides that gay and lesbians, LGBTQ plus people have made. It's not just about trans, it's about the whole situation. I find it personally threatening. And with four kids, and although my two older kids are now adults, it still reminds me how terrifying it was, and it will continue to be. So I think this is their end game. This is where they're going. And everything they say now, what they are trying to do, is just gaslighting for what they really want, which is to end rights for people that are not straight and probably white, especially in this county.

46:34And the other prediction I have, I've been predicting the writer's strike will end probably sometime in October. Hollywood Studios have made public their latest offer to writers. They're really interesting offers. concessions offered include guaranteed minimum length of employment, controls around use of AI and wage and residual increases. I don't know if it's enough. The union is saying it's not, but it's pretty attractive to a lot of people I've been talking to. It's much further down the pike. When Scott returns in September, we'll be chatting with actor and writer Joseph Gordon-Levitt to get his take on all of it.

47:06He recently wrote an interesting op-ed about the use of AI in Hollywood and how he thinks compensation should work. So we'll see, but But maybe by then or sometime in October, this may be settled. All right, Jeff, you start with your prediction. One of the things I have to say, I do the anesthesia for a lot of trans people having surgery. Number one, minors do not have this kind of surgery. It's particularly bottom surgery. And if they do have top surgery, they have to be emancipated minors. So this whole trope about that the right is professing that these guys are having gender-altering surgery is just not true.

47:46Adults, that's for adults. And I work with a lot of these adults, and I have to say they are among the most kind people that I work with, and they're very aware of what they're doing. It's a big deal to make this commitment, and you don't do this on a whim. These are people who are uncomfortable in their bodies from a very young age. And it has taken a lot of time and effort and psychological preparation and support from their families. And I think that we need to be kind to people like that because they're suffering and they have the technology and the wherewithal now to do something about it.

48:22So it's evil to vilify these people. And that's all I just want to say about that. and the doctors who perform this surgery, I think, are heroes. So let's do the predictions. So number one, I think, you know, interestingly, wearable technology has really taken off with the Apple Watch. And I think every week I have a patient who says that they have diagnosed atrial fibrillation with their Apple Watch and they're getting ablations now because of it. So I think we're going to see that more and more modalities. I think we're going to see things like, in addition to heart rate activity and O2SAT, We'll possibly see glucose monitoring continuously, transcutaneous CO2 monitoring, and that will allow people to basically real-time have a record for their physicians.

49:08The other thing, I think we're going to see a big increase in genetic and genomic-type testing. And the difference is genetic is what you're born with. Let's say if you have the BRCA1 gene, if you have cancer, that will allow us to screen people who are at risk and then be able to do early interventions. Genomic testing is for things like colon testing for cancer. There's changes in the DNA of cells that are affected by cancer, and we're going to see a lot more of that for a variety of illnesses. And we'll see more of this kind of genomic testing. And I think we're going to be able to design as based on this what are called bespoke drugs, drugs that will allow individuals to be treated based upon their genomics and their genetics, which is great.

49:52As well, I think that in the next several years, we're going to see a lot more physician's assistants, registered nurse first assistants going to be providing care and medicine. And there is a doctor shortage. There's a severe anesthesiologist shortage. And obviously, we need to do something about that. And then all this will allow people to do data group sourcing and to improve medical care and decrease medical errors like drug errors, as I said before. So that's my prediction. And I'm really, really rosy about the future of medicine. Those are good. And by the way, just, you know, Dr. Jeffrey Swisher and Kara Swisher are working on a book together, which will include a lot of these things, aren't we, Jeffrey Swisher?

50:30We're excited. We like working together. We have a very nice brother and sister. We have another brother, David, who we love too, but he is not going to be working on the book. Well, he might be. You never know. We can recruit him. We can recruit him. He might be. We can write the foreword. Maybe. I don't know. I don't know. He's busy. He's a smart guy. He is. He's fantastic. He is. If I have to say, he's probably got the highest IQ of us combined. I agree. He might. I agree. He might be the smartest of you three. I think he is. He is. Yes. All right. Louis, we're going to end up with you with a prediction, please.

51:01Yeah. Okay. My prediction is a bit more political, but I think that within my lifetime, at least, that we will see a huge change in our political dynamic relating to parties in this country. I think our system of two parties worked really well in the 20th century era of bipolarity between the United States and the Soviet Union. After the collapse of the Soviet Union, we entered a period of unipolarity in which the United States was the only world power. And we were able to reign free. America's number one top dog. But then as we enter this state of multipolarity within the world, as there are multiple major powers emerging with the BRICS nations, the U.S.

51:39and Western nations competing, I think that that's going to have a domestic effect as well. Our parties are more ideologically splintered than ever, not amongst, not only in contrast of each other, but within the ranks of themselves. You see the Republicans splitting between Trumpism and conservatism, this huge dynamic between the right and conservative, maintaining the status quo or moving the pendulum to the right. And I think within the Democrats, there's a lot of disagreement over active progressivism, passive progressivism, and non-action. And I think that that is going to have a huge effect to, quote, Noam Chomsky.

52:13There's only one party in this nation, the big business party with two factions. And the current system is not good for business. So I think that we will either see a challenge to that business and the big business party and see a true emergence of genuine political parties advocating for individuals, or business will be changed. And there will be a change to either the Republican, the Democrat, or both or neither. and the big business party is going to establish itself once again. So we'll see. Wow. All right. Wow. Louis Swisher. I'm impressed, Louis. Money well spent on college. Yay. I love it.

52:52I bet you're thinking for yourself. Oh, my God. This is what we learn at our leftist, elitist institutions. You should be proud, Kara. My work is done. This flaming libtard is ready to vote. Actually, Louis has a lot of different. He's not a flaming libtard. No, I am. Oh, I am. Oh, I am. You're a very analytical thinker is one thing I appreciate about you. But I think one more thing that I think we often forget is humanism. We are all individuals of this nation and we all affect each other better or for worse. And I know at the end of the day, we're all going to die together. So we might as well try to get along together as we're alive.

53:28Oh, I love you, Louis Swisher. Can I just say you're the best? Also, we want to have a shout out to our amazing, your amazing brother, Alex Swisher, who's going to be starting here at University of Michigan. At the last minute, he kind of wanted to be on, but he resisted it coming on. But we would love to have him on at some point. He's also a great thinker and a really great kid. And so we're excited to focus on him the rest of the day. Correct, Louis Swisher? I am excited to go have lunch with that kid. He's excellent. Wait till you ask him about politics. He's not a kid anymore. He ain't no kid no more.

53:59No. And we are all, apparently, we're all going to convert here in California for Christmas, right? Yes, we shall. We shall. We'll see you then. So, Louis, I went out to Walmart the other day and I bought one of those artificial Christmas trees. And, yep, I'm going to do that. The person asked me if I was going to put it up myself. And I said, ew, no, that would hurt. I'm going to put it up in the living room. Ba-da-bum.

54:32Oh, my God. Oh, I'm never inviting you back. Yeah, you got to have those. Yeah, yeah, yeah. No, no. Sorry. I have to go make a friend of mine who's a proctologist feel better because his wife just left him and it absolutely wrecked him. Ba-dum-bum. Oh. And with that, okay, we're ending the show right now because this is very embarrassing for me as a person. Okay. Louis had a high note. And then Jeff, you bring it right down. No, no, no, no. Jeff, Jeff reminded me, reminded us who we were. That's in the spirit of Scott. I miss Scott. Hi, Scott. And thank God for George Hahn. I think he was fantastic, too.

55:15All right. OK, Louis and Jeff, that is the show. Thank you so much. I'm so thrilled. And I'm excited to go out to launch Louis in a second. We'll be back on Tuesday with more Pivot. I'm going to read us out. Today's show was produced by Lara Naiman, Zoe Marcus, and Taylor Griffin. Ernie Enderjot engineered this episode. Make sure you subscribe to the show wherever you listen to podcasts. Thanks for listening to Pivot from New York Magazine and Vox Media. We'll be back next week for another breakdown of all things tech and business. Thanks, boys. All right. Thanks. Thank you.

55:52Support for the show comes from Odoo. Running a business is hard enough, and you don't need to make it harder with a dozen different apps that don't talk to each other. One for sales, another for inventory, a separate one for accounting. Before you know it, you find yourself drowning in software and processes instead of focusing on what matters, growing your business. This is where Odoo comes in. It's the only business software you'll ever need. Odoo is an all-in-one, fully integrated platform that handles everything. That means CRM accounting, inventory, e-commerce, HR, and more. No more app overload.

56:21No more juggling logins. Just one seamless system that makes work easier. And the best part is that Odoo replaces multiple expensive platforms for a fraction of the cost. It's built to grow with your business, whether you're just starting out or you're already scaling up. Plus, it's easy to use, customizable, and designed to streamline every process. It's time to put the clutter aside and focus on what really matters, running your business. Thousands of businesses have made the switch, so why not you? Try Odoo for free at odoo.com. That's O-D-O-O dot com.

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