HealthCommentary

Exploring Human Potential

Healthy Women Mean a Healthy Democracy.

Posted on | June 17, 2024 | No Comments

Mike Magee

When he assumed the role on June 13, 2023, Jesse M. Ehrenfeld, MD, MPH focused on inequities in health care as a top priority for his year in office. In a memorable opening that day in Chicago, the Wisconsin anesthesiologist shared a personal mission with 700 AMA delegates centered on his then 4 year old son. Ethan was born 10 weeks premature at 2 lbs 7 oz.

“Watching my son cling to life, I was struck by the painful reality that, even though I was a physician and now, a father, neither I, nor my husband, could donate blood simply because we are gay. Discriminatory policies—policies rooted in stigma, not science—barred us from doing the most humane of acts, donating our blood.”

As the AMA’s 178th president, Dr. Ehrenfeld used that story as a jumping off point to share his priorities as their new President. He pledged that day to seek justice and equity, highlighting:

“Black women are at least three times as likely as white women to die as a result of their pregnancy.

“Black men are 50% more likely to die following elective surgery.

“LGBTQ+ teens and young adults suffer higher rates of mental health challenges that often go undiagnosed.”

He also warned, in the shadow of the Dobbs decision on June 24, 2022, of  “… discouraging trends related to health outcomes—maternal mortality rates in the U.S. are more than double those of other well-resourced nations, for instance—and are becoming more prevalent.”

But when it came to the politics of reproductive health access, he chose his words carefully and took a quieter tone with the audience of politically savvy doctors from red and blue states.

“Certain aspects of the country’s political climate have become dangerously polarized. Politicians and judges are making decisions about health care formerly reserved for patients and physicians and patients…” he said.

This statement, coming one year after Dobbs, clearly did not mirror, in intensity, the words of his predecessor, Jack Resneck Jr.,MD, who wrote on the day of the decision, “The American Medical Association is deeply disturbed by the U.S. Supreme Court’s decision to overturn nearly a half century of precedent protecting patients’ right to critical reproductive health care…In alignment with our long-held position that the early termination of a pregnancy is a medical matter between the patient and physician, subject only to the physician’s clinical judgment and the patient’s informed consent, the AMA condemns the high court’s interpretation in this case.”

That sentiment was reinforced by the nation’s 25,000 OBGYNs, 60% of whom are women. Their association (ACOG) wrote, “Today’s decision is a direct blow to bodily autonomy, reproductive health, patient safety, and health equity in the United States. Reversing the constitutional protection for safe, legal abortion established by the Supreme Court nearly 50 years ago exposes pregnant people to arbitrary state-based restrictions, regulations, and bans that will leave many people unable to access needed medical care.” 

Statements on behalf of the American Nurses Association, and the organizational arms for both physicians associates (PAs) and nurse practitioners (NPs) were equally forthright.

There are 4.2 million nurses, over 1 million doctors, and over 1/2 million PAs and NPs in the US. And as the latest US Census Report headlined, “Your health care is in women’s hands. Women hold 76% of all health care jobs.” This includes 90% of all nursing positions, 66% of PAs, and 55% of all current Medical School slots.

Not surprisingly, as women numbers have risen, traditional oaths for the caring professions have reflected changing priorities. For example, the women majority 2022 entering class of Penn State’s College of Medicine for the first time gave top billing in their professional oath to patients, not to the gods: “By all that I hold highest, I promise my patients competence, integrity, candor, personal commitment to their best interest, compassion, and absolute discretion, and confidentiality within the law.”

Seven years earlier, the American Nurses Association (ANA), created a formal Code of Ethics, which largely supplanted the 1893 Nightingale Pledge, with a four pillared Code which celebrated Autonomy (patient self-determination), Beneficence (kindness and charity), Justice,(fairness) and Nonmaleficence (do no harm), as anchors to Nursing’s 9 Provisions (or Pledges) that commit to: compassion and respect, patient-focus, advocacy, active decision making, self-health, ethical environment, scholarly pursuit, collaborative teamwork, professional integrity and social justice.

During Dr. Ehrenfeld’s one-year tenure following the Dobbs decision women’s access to health care deteriorated in red state after red state, a point reflected in clear losses for Republications on statewide initiatives supporting abortion access from Kansas to Kentucky, and Vermont to Michigan. But as the Kaiser Family Foundation reported this year, “As of April 2024, 14 states have implemented abortion bans, 11 states have placed gestational limits on abortion between 6 and 22 weeks…” Add to this that 1 in 5 current OB residents say they have decided to steer away from restrictive red states when they pursue practice opportunities on graduation.

And still, red states embracing MAGA’s marriage to White Nationalists seem to have doubled down on everything from restricting access to medication abortion and contraception, to book banning, to limiting  LBGTQ+ rights and promoting prayer in public schools in the hopes of achieving a Christian Nationalist society.

Which brings us to the fast approaching 2024 Presidential debate. Women’s reproductive autonomy will be well represented. It is arguably the premier equity and justice issue before us, central to both America’s patients and their caring health professionals. But let’s not forget it is also central to the health of our democracy.

John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.” 

What other form of government is there that so closely aligns with the aspirational pledges and oaths of our doctors, nurses, and body politic?

What Are The Alitos Afraid Of?

Posted on | June 12, 2024 | 2 Comments

Mike Magee

What’s up with the Alitos these days? Justice Sam weighed in with a tip of the hat toward “godliness,” while a seemingly unhinged flag-flying Martha-Ann invited the world inside their marriage, declaring “He never controls me.” Good to know.

Making it clear that her visceral reaction to a neighbor’s PRIDE flag was faith-based, she revealed a short-fuse and a long memory. As she said, “I want a Sacred Heart of Jesus flag because I have to look across the lagoon at the pride flag for the next month. I said (to Sam), ‘When you are free of this nonsense, I’m putting it up.’”

Harvard sociologist, Robert Putnam, and his co-author, Notre-Dame political scientist David Campbell, made it clear in 2010 that something was up with gender and religion in their publication, “American Grace: How Religion Divides and Unites Us.” In two sweeping surveys reported in the book, they revealed a change in attitudes that began to gain steam in 1970. To their surprise, “By 2006, majorities of every religious tradition except Mormons had come to favor women clergy. Nearly three-quarters of Americans said that women have too little influence in religion, a view that is widely shared across virtually all religious traditions and by both men and women.”

A recent AEI survey this year that catalogued religious affiliation of Boomers (1946-1964), Gen X (1965-1980), Millennials (1981-1996), and Gen Z (1997-2012) showed that women (in much greater numbers than men) apparently have had just about enough when it comes to religious subjugation. Only 14% of the baby boomer women were self-described religious “nones,” while 34% of Millennials and a whooping 39% of Gen Z’s were turning their backs on male-led religions. On top of that, nearly 2/3 of Gen Z women said “Churches do not treat men and women equally.”

The problem, experts say, tracks back to the concept of “complementarianism”, a belief that the Bible supports strictly different roles for men and women, and that “wives should submit to their husbands.”  It’s part of the rationale behind the Southern Baptist Convention’s vote yesterday to oppose in vitro fertlization  (IVF). Too little submission apparently.

Subjugation of women historically has taken many forms. The most recent has been the elimination of health care access with the Dobbs decision and reversal of Roe v. Wade. But placing a lid on women’s autonomy has a rich history in America. Take for example divorce.  It was outlawed in most states south of the Mason-Dixon line until the mid-19th century. As legal historian Lawrence Friedman explained, “Essentially husband and wife were one flesh; but the man was the owner of that flesh.”

In 1847, Wisconsin newspaperman and editor of the Racine Argus, Marshall Mason Strong, warned in an editorial that the “domestic sphere” was under attack with men being “degraded, the wife unsexed, and children uncared for.” Strong lamented the loss of women’s “finer sensibilities” with ‘every trait of loveliness blotted out.”

Two centuries later, the majority of women are having none of it, delivering political defeat after political defeat to religious conservatives after the Dobbs decision.  That decision was the culmination of a carefully planned and executed conservative takeover of the Supreme Court with Justice Alito in the lead. His intent, according to Yale legal scholar Neil S. Siegel, was to protect “Americans who hold traditionalist conservative beliefs about speech, religion, guns, crime, race, gender, sexuality and the family. These Americans were previously majorities in the real or imagined past, but they increasingly find themselves in the minority.”

What do the  Alitos fear most? They fear that traditionalists like themselves will be “branded as bigots.” Justice Alito said as much in his dissent in Obergefell v. Hodges (same sex marriage). He wrote with some sense of drama “Those who cling to old beliefs will be able to whisper their thoughts in the recesses of their homes. If they repeat those views in public, they will risk being labeled as bigots and treated as such by governments, employers, and schools.” 

His campaign to “protect majorities-turned-minorities” was also on full view five months before the 2016 Presidential election in his dissent when the Court declined to hear the case of a Washington State pharmacist who refused to fill prescribed contraceptives on religious grounds. Stormans, Inc. v. Wiesman, left standing according to Alito, was “likely to make a pharmacist unemployable if he or she objects on religious grounds to dispensing certain prescription medications…[i]f this is a sign of how religious liberty claims will be treated in the years ahead, those who value religious freedom have cause for great concern.”

AEI has little good news to offer the Alitos. The survey’s conclusion is rather stark: “None of this is good news for America’s places of worship. Many of these young women are gone for good. Studies consistently show that people who leave religion rarely come back, even if they hold on to some of their formative beliefs and practices. The decline in religious participation and membership has provoked a good deal of concern and consternation, but these latest trends represent a four-alarm warning.”

And therein lies the problem. The actions of the Alito’s this past week simply dig the hole deeper, as they await a reckoning with their demographic fate. For the Alitos, “the moment has revealed the man (and the woman).”

“Mr. Trump, I was Superman. You are no Superman!”

Posted on | June 3, 2024 | 2 Comments

With Christopher Reeve/ Sept.25, 2002

Mike Magee

As we approach the 20th anniversary of the death of Christopher Reeve, I’m drawn back to the evening of September 25, 2002, and a private conversation in a back room off the ballroom of the Marriott Marquis Hotel. As we awaited the ceremonial beginnings of the Christopher Reeve Paralysis Foundation Benefit Gala that evening, he said, “What I didn’t expect was that in this country, home of ‘Truth, Justice and the American way,’ hope would be determined by politics.”

That sentiment was, no doubt, fresh in his mind, having just appeared in his book, “Nothing Is Impossible: Reflections On A New Life” (Random House), a week earlier. And it was top of mind last week while (with millions of other Americans) I awaited a verdict in the New York trial of Donald Trump.

A month earlier, Smithsonian Magazine had run a feature on the first issue of the Superman comic book. The original copy of the 1938 “Action Comics No. 1” had just sold for $6 million at auction. A large part of that value tracked back to Chris Reeve himself – the enduring image and voice of Superman – a genuine American hero.

The famous slogan, “Truth, Justice, and the American Way”, however did not appear in that first publication. It surfaced later, in the early 1940’s comic books , written by Jerry Siegel and Joe Shuster, “to cheer on American military efforts in World War II.” Its use waxed and waned over the next three decades until 1978. That’s when the Richard Donner film “Superman: The Movie” was released starring Christopher Reeve. As the Superman Homepage News  acknowledges, it was thanks to Reeve’s performance that “the ‘Truth, Justice and The American Way’ motto was really cemented in popular culture for generations to come.”

In a controversial move, at the DC FanDome on October 21, 2021, DC Publisher Jim Lee announced that Superman’s motto “Truth, Justice and the American Way” would be evolving. “The American Way” would now be replaced by “a Better Tomorrow.” A press statement elaborated that the move was made “to better reflect the storylines that we are telling across DC and to honor Superman’s incredible legacy of over 80 years of building a better world.” Rolling Stone was given a slightly different spin by DC Comics which said, “Superman has long been a symbol of hope who inspires people from around the world, and it is that optimism and hope that powers him forward.”

Whether commercial, philosophical or political in motivation, now two years later, as Trump self declares his own “Superman-status” its  worth contrasting two very different versions of “the American way.” As NewYork Magazine reported in 2012, “Among the many laughably unrealistic images in the Donald Trump NFT collection, one stood out: the illustration of the former president in the classic Superman pose, ripping open his dress shirt to reveal a superhero costume underneath. Trump used this image, which was animated to show lasers shooting out of his eyes, to tease a ‘major announcement’ on December 15, which turned out to be a collection of 45,000 digital trading cards. ‘America needs a superhero!’ Trump proclaimed.”

Mirroring VP candidate Lloyd Bentsen’s reply to VP Dan Quayle’s comparison of himself to JFK (“Senator, I served with Jack Kennedy. I knew Jack Kennedy. Jack Kennedy was a friend of mine. Senator, you’re no Jack Kennedy.”), Christopher Reeve (were he with us today) could easily reply to our criminally convicted former president, “Mr. Trump, I was Superman. You are no Superman!”

And yet, Superman’s slogan is very much “in play.” Trump counselor Kellyanne Conway took a wrecking ball to its first word, “truth”, when she claimed the legitimacy of “alternate facts” on a Meet the Press interview in 2017. As for “justice,” the Washington Post, on June 2nd, ran this headline: “Trump’s attacks on US justice system after his conviction could be used by autocrats, say experts.” And that leaves only “The American Way?”

James Madison, in Federalist No. 51, wrote, “Justice is the end (the anchor) of government. It is the end of civil society. It ever has been, and ever will be pursued until it is obtained, or until liberty be lost in the pursuit.”

Historian John J. Patrick has made a compelling argument that democracy is the American way and is “a never ending quest to narrow the gap between lofty ideals and flawed realities…” But using Professor Patrick’s measures, Trump’s “American Way” is miles apart from Christopher Reeve’s ideal as we knew it. 

Trump’s destructive actions, borrowing from Professor Patrick, include:

“Governing ineptly because the most able persons are not selected to rule.”

“Making unwise decisions in government by pandering to public opinion.”

“Eroding political and social authority and unity by encouraging criticism and dissent.”

“Encouraging abuse or disregard of unpopular persons or opinions.”

“Failing to achieve its ideals or to adhere to its basic principles.”

Twenty years ago, at the height of an election season, on October 10, 2004, Christopher Reeve died peacefully with loving family members at his side. He never felt sorry for himself or blamed anyone. As he said, “Some people are walking around with full use of their bodies and they’re more paralyzed than I am.”

As for being a hero himself, his insights were prescient and highly relevant to the current threat to our democracy. He said, “What makes Superman a hero is not that he has power, but that he has the wisdom and the maturity to use the power wisely.”

 

“Justice delayed is justice denied . . . but not forever.”

Posted on | May 29, 2024 | Comments Off on “Justice delayed is justice denied . . . but not forever.”

Mike Magee

The date was March 16, 1868. The speaker was a British statesman and former Prime Minister, William Evert Gladstone. In a dispute that day, during vigorous debate in Parliament, Gladstone, in response to supportive cheers from colleagues said , “But above all, if we be just men, we shall go forward in the name of truth and right, and bear this in mind, that when the case is ripe and the hour has come, justice delayed is justice denied.”

These words ring loud and clear this week for millions of Americans, as they await a verdict in the criminal trial of Donald Trump in New York. Whatever one’s political persuasion, most agree that the presiding judge, Juan Merchan, has been highly competent and efficient in orchestrating the historic trial and avoiding over-reacting to Trump’s labeling the judge “corrupt” and “conflicted.”

Judge Merchant has been a Justice of the New York Supreme Court since 2009. An experienced and balanced jurist, he has earned the respect of defense attorneys like New York lawyer Ron Kuby who described him as “a serious jurist, smart and even tempered…a no-nonsense judge…always in control of the courtroom.”

Contrast this with the evaluations of Judge Aileen M. Cannon who recently issued a “curious order” indefinitely delaying a date for Tump’s classified document case after holding seven public hearings during the past 10 months. Her performance has caused legal analyst Alan Feuer, who has covered criminal justice for the New York Times since 1999, to comment, “The portrait that has emerged so far is that of an industrious but inexperienced and often insecure judge whose reluctance to rule decisively even on minor matters has permitted one of the country’s most important criminal cases to become bogged down in a logjam of unresolved issues.”

Needless to say, the contrast between the two judges is stark. The only thing they seem to have in common is that both were born in Columbia. Personalities and loyalties aside, each will forever be tied to Trump, and their ability to deliver or delay justice. This is because the majority view of Americans is that “fairness” and the “rule of law”  require “timely and efficient justice systems.”

What friends of Judge Cannon must consider is whether “justice delayed or disrupted on one dimension may still find its resolution in another.” That is to say, her actions one way or another, have consequences, and could send the Trump narrative down any number of alleys that place the former President (and his family members) in even greater jeopardy. Witness for example the life journey of O.J. Simpson following his acquittal for the murder of Nicole Brown Simpson. Or Harvey Weinstein, freed on a technicality, only to be retrialed as more of his victims surface.

Purposeful delays in justice can boomerang on defendants. For example, the former President succeeded in stonewalling release of his tax returns for over a decade. But time ran out in 2024 when the IRS announced that he had “claimed massive financial losses twice” (in 2008 and 2012) and owed the government over $100 million. And that was just on a single holding – a Chicago skyscraper. Then there was the 2023 battery and defamation conviction for the 1990’s rape of E. Jean Carroll. The $5 million dollar judgement against him took nearly three decades to snare him in justice’s web. And in that same year, New York attorney general Letitia James convinced Justice Arthur Engoron that the Trump Organization was guilty of massive real estate fraud, and effectively revoked the license to operate New York based properties.

What we as a society are currently witnessing is that timely resolutions are central to maintaining “public trust.” People must move on with their lives, and can only do so if social order and public confidence in justice is maintained. Trump’s success with a strategy of delay seems to be waning. The current trials remind us that continuous improvement will always be the order of the day for our legal system. Access, efficiency, equity, and timely justice for all. 

And should he somehow wiggle his way out of the current downtown New York holding cell, he and his protectors will soon enough learn that “Justice delayed is justice denied . . . but not forever.”

AI Can Talk, But Can It Think?

Posted on | May 22, 2024 | Comments Off on AI Can Talk, But Can It Think?

Mike Magee

OpenAI says its new GPT-4o is “a step towards much more natural human-computer interaction,” and is capable of responding to your inquiry “with an average 320 millisecond (delay) which is similar to a human response time.” So it can speak human, but can it think human?

The “concept of cognition”  has been a scholarly football for the past two decades, centered primarily on “Darwin’s claim that other species share the same ‘mental powers’ as humans, but to different degrees.” But how about genAI powered machines? Do they think?

The first academician to attempt to define the word “cognition” was Ulric Neisser in the first ever textbook of cognitive psychology in 1967. He wrote that “the term ‘cognition’ refers to all the processes by which the sensory input is transformed, reduced, elaborated, stored, recovered, and used. It is concerned with these processes even when they operate in the absence of relevant stimulation…”

The word cognition is derived from “Latin cognoscere ‘to get to know, recognize,’ from assimilated form of com ‘together’ + gnoscere ‘to know’ …” 

Knowledge and recognition would not seem to be highly charged terms. And yet, in the years following Neisser’s publication there has been a progressively intense, and sometimes heated debate between psychologists and neuroscientists over the definition of cognition.

The focal point of the disagreement has (until recently) revolved around whether the behaviors observed in non-human species are “cognitive” in the human sense of the word. The discourse in recent years had bled over into the fringes to include the belief by some that plants “think” even though they are not in possession of a nervous system, or the belief that ants communicating with each other in a colony are an example of “distributed cognition.”

What scholars in the field do seem to agree on is that no suitable definition for cognition exists that will satisfy all. But most agree that the term encompasses “thinking, reasoning, perceiving, imagining, and remembering.” Tim Bayne PhD, a Melbourne based professor of Philosophy adds to this that these various qualities must be able to be “systematically recombined with each other,” and not be simply triggered by some provocative stimulus.

Allen Newell PhD, a professor of computer science at Carnegie Mellon, sought to bridge the gap between human and machine when it came to cognition when he published a paper in 1958 that proposed “a description of a theory of problem-solving in terms of information processes amenable for use in a digital computer.”

Machines have a leg up in the company of some evolutionary biologists who believe that true cognition involves acquiring new information from various sources and combining it in new and unique ways. 

Developmental psychologists carry their own unique insights from observing and studying the evolution of cognition in young children. What exactly is evolving in their young minds, and how does it differ, but eventual lead to adult cognition? And what about the explosion of screen time?

Pediatric researchers, confronted with AI obsessed youngsters and worried parents are coming at it from the opposite direction. With 95% of 13 to 17 year olds now using social media platforms, machines are a developmental force, according to the American Academy of Child and Adolescent Psychiatry. The machine has risen in status and influence from a side line assistant coach to an on-field teammate. 

Scholars admit “It is unclear at what point a child may be developmentally ready to engage with these machines.” At the same time, they are forced to admit that the technology tidal waves leave few alternatives. “Conversely, it is likely that completely shielding children from these technologies may stunt their readiness for a technological world.”

Bence P Ölveczky, an evolutionary biologist from Harvard, is pretty certain what cognition is and is not. He says it “requires learning; isn’t a reflex; depends on internally generated brain dynamics; needs access to stored models and relationships; and relies on spatial maps.”

Thomas Suddendorf PhD, a research psychologist from New Zealand, who specializes in early childhood and animal cognition, takes a more fluid and nuanced approach. He says, “Cognitive psychology distinguishes intentional and unintentional, conscious and unconscious, effortful and automatic, slow and fast processes (for example), and humans deploy these in diverse domains from foresight to communication, and from theory-of-mind to morality.”

Perhaps the last word on this should go to Descartes. He believed that humans mastery of thoughts and feelings separated them from animals which he considered to be “mere machines.” 

Were he with us today, and witnessing generative AI’s insatiable appetite for data, its’ hidden recesses of learning, the speed and power of its insurgency, and human uncertainty how to turn the thing off, perhaps his judgement of these machines would be less disparaging; more akin to Mira Murati, OpenAI’s chief technology officer, who announced with some degree of understatement this month, “We are looking at the future of the interaction between ourselves and machines.”

May 17, 2024 Address at Presidents College/U. of Hartford: “Artificial Intelligence (AI) and The Future of American Medicine.

Posted on | May 18, 2024 | Comments Off on May 17, 2024 Address at Presidents College/U. of Hartford: “Artificial Intelligence (AI) and The Future of American Medicine.

Artificial Intelligence (AI) and the Future of American Medicine

Link here: https://www.healthcommentary.org/about/artificial-intelligence-ai-and-the-future-of-medicine/

GPT-4o: “From babble to concordance to inclusivity…”

Posted on | May 14, 2024 | 3 Comments

Mike Magee

If you follow my weekly commentary on HealthCommentary.org or THCB, you may have noticed over the past 6 months that I appear to be obsessed with mAI, or Artificial Intelligence intrusion into the health sector space.

So today, let me share a secret. My deep dive has been part of a long preparation for a lecture (“AI Meets Medicine”) I will deliver this Friday, May 17, at 2:30 PM in Hartford, CT. If you are in the area, it is open to the public. You can register to attend HERE.

The image above is a portion of one of 80 slides I will cover over the 90 minute presentation on a topic that is massive, revolutionary, transformational and complex. It is also a moving target, as illustrated in the final row above which I added this morning. 

The addition was forced by Mira Murati, OpenAI’s chief technology officer, who announced from a perch in San Francisco yesterday that, “We are looking at the future of the interaction between ourselves and machines.”

The new application, designed for both computers and smart phones, is GPT-4o. Unlike prior members of the GPT family, which distinguished themselves by their self-learning generative capabilities and an insatiable thirst for data, this new application is not so much focused on the search space, but instead creates a “personal assistant” that is speedy and conversant in text, audio and image (“multimodal”).

OpenAI says this is “a step towards much more natural human-computer interaction,” and is capable of responding to your inquiry “with an average 320 millisecond (delay) which is similar to a human response time.” And they are fast to reinforce that this is just the beginning, stating on their website this morning “With GPT-4o, we trained a single new model end-to-end across text, vision, and audio, meaning that all inputs and outputs are processed by the same neural network. Because GPT-4o is our first model combining all of these modalities, we are still just scratching the surface of exploring what the model can do and its limitations.”

It is useful to remind that this whole AI movement, in Medicine and every other sector is about language. And as experts in language remind us, “Language and speech in the academic world are complex fields that go beyond paleoanthropology and primatology,” requiring a working knowledge of “Phonetics, Anatomy, Acoustics and Human Development, Syntax, Lexicon, Gesture, Phonological Representations, Syllabic Organization, Speech Perception, and Neuromuscular Control.”

The notion of instantaneous, multimodal communication with machines has seemingly come of nowhere but is actually the product of nearly a century of imaginative, creative and disciplined discovery by information technologists and human speech experts, who have only recently fully converged with each other. As paleolithic archeologist, Paul Pettit, PhD, puts it, “There is now a great deal of support for the notion that symbolic creativity was part of our cognitive repertoire as we began dispersing from Africa.” That is to say, “Your multimodal computer imagery is part of a conversation begun a long time ago in ancient rock drawings.”

Throughout history, language has been a species accelerant, a secret power that has allowed us to dominate and rise quickly (for better or worse) to the position of “masters of the universe.”  The shorthand: We humans have moved “From babble to concordance to inclusivity…”

GPT-4o is just the latest advance, but is notable not because it emphasizes the capacity for “self-learning” which the New York Times correctly bannered as “Exciting and Scary,” but because it is focused on speed and efficiency in the effort to now compete on even playing field with human to human language. As OpenAI states, “GPT-4o is 2x faster, half the price, and has 5x higher (traffic) rate limits compared to GPT-4.” 

Practicality and usability are the words I’d chose. In the companies words, “Today, GPT-4o is much better than any existing model at understanding and discussing the images you share. For example, you can now take a picture of a menu in a different language and talk to GPT-4o to translate it, learn about the food’s history and significance, and get recommendations.”

In my lecture, I will cover a great deal of ground, as I attempt to provide historic context, relevant nomenclature and definitions of new terms, and the great potential (both good and bad) for applications in health care. As many others have said, “It’s complicated!”

But as this week’s announcement in San Francisco makes clear, the human-machine interface has blurred significantly. Or as Mira Murati put it, “You want to have the experience we’re having — where we can have this very natural dialogue.”

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