Artificial Intelligence medicine coming to America!

Medical Doctors will always be Doctors! Artificial Intelligence will only be another tool enabling physicians to better treat the sick! Oh yeah…It will save all a boat load of money!

IBM's Watson is better at diagnosing cancer than human doctors

By IAN STEADMAN

WIRED

Monday 11 February 2013

IBM's Watson -- the language-fluent computer that beat the best human champions at a game of the US TV show Jeopardy! -- is being turned into a tool for medical diagnosis. Its ability to absorb and analyse vast quantities of data is, IBM claims, better than that of human doctors, and its deployment through the cloud could also reduce healthcare costs.

The first stages of a planned wider deployment, IBM's business agreement with the Memorial Sloan-Kettering Cancer Center in New York and American private healthcare company Wellpoint will see Watson available for rent to any hospital or clinic that wants to get its opinion on matters relating to oncology. Not only that, but it'll suggest the most affordable way of paying for it in America's excessively-complex healthcare market. The hope is it will improve diagnoses while reducing their costs at the same time.

Two years ago, IBM announced that Watson had "learned" the same amount of knowledge as the average second-year medical student. For the last year, IBM, Sloan-Kettering and Wellpoint have been working to teach Watson how to understand and accumulate complicated peer-reviewed medical knowledge relating to oncology. That's just lung, prostate and breast cancers to begin with, but with others to come in the next few years). Watson's ingestion of more than 600,000 pieces of medical evidence, more than two million pages from medical journals and the further ability to search through up to 1.5 million patient records for further information gives it a breadth of knowledge no human doctor can match.

According to Sloan-Kettering, only around 20 percent of the knowledge that human doctors use when diagnosing patients and deciding on treatments relies on trial-based evidence. It would take at least 160 hours of reading a week just to keep up with new medical knowledge as it's published, let alone consider its relevance or apply it practically. Watson's ability to absorb this information faster than any human should, in theory, fix a flaw in the current healthcare model. Wellpoint's Samuel Nessbaum has claimed that, in tests, Watson's successful diagnosis rate for lung cancer is 90 percent, compared to 50 percent for human doctors.

Sloan-Kettering's Dr Larry Norton said: "What Watson is going to enable us to do is take that wisdom and put it in a way that people who don't have that much experience in any individual disease can have a wise counsellor at their side at all times and use the intelligence and wisdom of the most experienced people to help guide decisions."

The attraction for Wellpoint in all this is that Watson should also reduce budgetary waste -- it claims that 30 percent of the $2.3 trillion (£1.46 trillion) spent on healthcare in the United States each year is wasted. Watson here becomes a tool for what's known as "utilisation management" -- management-speak for "working out how to do something the cheapest way possible".

Wellpoint's statement said: "Natural language processing leverages unstructured data, such as text-based treatment requests. Eighty percent of the world's total data is unstructured, and using traditional computing to handle it would consume a great deal of time and resources in the utilisation management process. The project also takes an early step into cognitive systems by enabling Watson to co-evolve with treatment guidelines, policies and medical best practices. The system has the ability to improve iteratively as payers and providers use it." In other words, Watson will get better the more it's used, both in working out how to cure people and how to cure them more cheaply.

When Watson was first devised, it (or is it "he"?) ran across several large machines at IBM's headquarters, but recently its physical size has been reduced hugely while its processing speed has been increase 240 percent. The idea now is that hospital, clinics and individual doctors can rent time with Watson over the cloud -- sending it information on a patient will, after seconds (or at most minutes), return a series of suggested treatment options. Crucially, a doctor can submit a query in standard English -- Watson can parse natural language, and doesn't rely on standardised inputs, giving it a more practical flexibility.

Watson's previous claim to fame came from it winning a special game of US gameshow Jeopardy! in 2011. For those unfamiliar, Jeopardy!'s format works like this: the answers are revealed on the gameboard and the contestants must phrase their responses as questions. Thus, for the clue "the ancient Lion of Nimrod went missing from this city's national museum in 2003" the correct reply is "what is Baghdad?". Clues are often based on puns or other word tricks, and while it's not quite on the level of a cryptic crossword, it's certainly the kind of linguistic challenge that would fox most language-literate computers.

Watson's ability to parse texts and grasp the underlying rules has had its drawbacks, though, as revealed last month when IBM research scientist Eric Brown admitted that he had tried giving Watson the Urban Dictionary as a dataset. While Watson was able to understand some of the, er, colourful slang that fills the site's pages, it also failed to understand the different between polite and offensive speech.

Watson's memory of the Urban Dictionary had to (regrettably) be wiped.

Can President Trump enable the Government to run a Pharmaceutical company (Successfully)?

This a good idea to lower the price of a single drug for a single disease. Problem is the government cannot “run” a successful business (government cannot even run the government correctly). If ever an American President was able to run business it is President Trump, but it would take years to fire the incompetent Bureaucrat populating the Hall of our Government!

Trump Can Lower Drug Prices By U.S. Government Purchase Of Drug Companies

John LaMattina, CONTRIBUTOR

FORBES     JAN 18, 2017 @ 08:04 AM

Major mergers in the biopharmaceutical industry are driven by a variety of factors, but the major one tends to be the acquisition of new assets to fuel growth of the acquiring company’s pipeline. I was personally involved in such processes a few times during my Pfizer tenure. When the possibility of a Warner-Lambert merger with American Home Products arose back in 1999, Pfizer stepped in and executed a hostile takeover with the express purpose of having sole access to what was becoming the biggest-selling drug of all time–Lipitor. Similarly, when Pfizer was facing a revenue gap in 2004, it acquired Pharmacia, not just for control of the COX-2 pain medication franchise, but also for a variety of other Pharmacia products that blended well with Pfizer’s drug portfolio.

Whenever a company is contemplating an acquisition or merger, it goes through extensive analyses to justify such a move first to its board of directors, then to its shareholders. These deals generally run into the tens of BIILIONS of dollars as one must pay not just the current value of the desired company but also a significant premium over that price in order to make the bid sufficiently attractive to the board and shareholders of the takeover target. To justify such an acquisition, the acquirer needs to show not only the long-term revenue potential of the desired products, but also ways to strip out costs–the dreaded “synergies” that arise from redundant efforts–as well as jettisoning specific assets that the acquiring company isn’t interested in retaining, such as major divisions (e.g., chemical or agricultural) or specific products. Such analyses can generally be used to justify paying the price necessary to close the deal.

Dr. Peter Bach of Memorial Sloan-Kettering Cancer Center, a longtime advocate of affordable drug pricing, and Dr. Mark Trusheim of MIT’s Center of Biomedical Innovation have taken the concept of biopharma acquisitions and applied it intriguingly into a plan, laid out in a post for FORBES, for the U.S. government to obtain access to important drugs. The drugs in question are the hepatitis C cures Harvoni and Sovaldi, both sold by Gilead. They propose a plan that not only saves the government money, but also would enable millions of patients who still have hepatitis C to get cured as soon as possible. These patients are currently caught in a bind because the high costs of these drugs--even at the rebated price of $42,000/patient for a course of treatment–is too much a burden for the government to bear all at once.

Essentially, Bach and Trusheim have done an analysis that any big company would do for a major acquisition. Gilead’s current market cap is about $100 billion. Taking into account the need for a 30% premium as well as the assumption of Gilead’s $26 billion debt, the price rises to $156 billion. However, the authors believe that divesting Gilead’s HIV franchise for $52 billion, other pipeline assets for another $10 billion, and divesting the ex-U.S. hepatitis C business for $17 billion, the cost of the deal is down to $77 billion. The government would also gain the $31 billion that Gilead has stashed in overseas cash and, with other savings, the cost comes down to about $40 billion, a price that amounts to a per patient cost of about $15,700 for wiping out hepatitis C, a disease that causes liver failure and liver cancer. As the authors say: “That’s a 63% savings, a no-brainer even before the corporate jet is sold.”

While this sounds pretty enticing, there are issues in trying to do this. For one thing, the government would become a competitor with U.S. businesses that, theoretically, the government would like to see thrive. Both AbbVie and Merck have drugs that compete with Gilead’s drugs. Bach and Trusheim believe that, since Gilead’s drugs amount to 80% of the hepatitis C business, the market has spoken as to their value. However, having the government as a competitor would damage AbbVie and Merck’s efforts and could force drug companies out of R&D in key fields threatened by potential government invasion.

The U.S. government would be challenged to execute such a plan. What agency would be responsible to analyze such deal opportunities? Who would manage it once it was acquired? After all, the drug would need to be manufactured, quality monitored, distributed, etc. The government could contract this work out, but it would add another layer of bureaucracy. Theoretically, the government could use this tactic for other drugs. I have no doubt that there are rare or orphan disease drugs currently sold by biotech companies much smaller than Gilead. Should the government become a procurer of such firms? Finally, my guess is that, if large pharma companies got wind of Gilead being in play, suitors with deep pockets might enter the bidding process for Gilead. Should the government be involved in such bidding wars?

Nevertheless, the Bach-Trusheim proposal in intriguing. Some will undoubtedly attack this plan as the beginnings of governmental nationalization of the biopharmaceutical industry. I don’t think that’s the case. Such a takeover of Gilead would mirror a similar takeover by a big company. The deal wouldn’t go through unless Gilead’s board and shareholders approved it, just like any other deal. Furthermore, my guess is that this sort of move may appeal to President Trump’s business sense. He’s looking to bring down drug prices and for different ways for the government to impact the process. This plan certainly does that.

After ObamaCare expect a better system! This one will work!

Here’s what happens after ObamaCare is gone

The American people will be better off! Develop programs that are affordable for those that want a choice, and give those with pre-existing conditions a separate program. Should work just fine!

By Michael Tanner NY Post

January 13, 2017 | 8:46pm

Republicans are wrestling with how to repeal and replace ObamaCare. It turns out that legislating is much more complex than campaigning. Still, ObamaCare as we know it is unlikely to be with us much longer.

So what happens after it’s gone? On Friday, we looked at some of the most likely provisions of any ObamaCare replacement. They would expand consumer choices, by expanding the use of health-savings accounts and allowing the purchase of health insurance across state lines.

Still, there are some people who would face challenges if the law were repealed. This includes those with low incomes and those with pre-existing health conditions.

ObamaCare did expand the number of Americans with health coverage by some 20 million people. Most of those, however, received coverage not through the program’s subsidies for private insurance but through the expansion of Medicaid.

There is ample evidence to suggest that Medicaid provides little if any benefit. One notable experiment in Oregon found no improvements in health outcomes from Medicaid enrollment. But regardless, repeal of ObamaCare is unlikely to have any short-term impact on Medicaid.

The same can’t be said for those Americans receiving subsidies to purchase insurance through ObamaCare’s exchanges. Those subsidies will almost certainly be cut back or eliminated, so some people could end up paying for the full cost of their premiums.

Of course, that also means less of a burden for taxpayers overall, since they were picking up the cost of those subsidies. Besides, even with subsidies, the rising cost of premiums under ObamaCare was leaving many Americans struggling to afford insurance.

There will undoubtedly be winners and losers, but by bringing down the cost of insurance, the Republican plans will leave most Americans better off.

The question of pre-existing conditions is a much tougher nut to crack. Pretty much all the problems with ObamaCare flow from the decision to require insurance to cover people with pre-existing conditions — that is, people who are already sick — without charging them more than healthy people.

Because insurers will lose money on those sick individuals, the cost has to be offset by enrolling young and healthy individuals, who pay premiums but require few benefits. Since the young and healthy are reluctant to buy insurance on their own, ObamaCare included the unpopular individual mandate in order to force them to do so.

A mandate meant the government had to define what qualified as insurance, hence the minimum benefits package and the elimination of low-cost catastrophic policies. People who liked their policies found out they couldn’t keep their policies. The dominoes fall.

The number of truly uninsurable people is actually quite small, and will decline further under Republican plans to reduce insurance costs and make it easier for people to keep their coverage if they lose their job.

Still, any replacement plan will have to include some provision to make sure health insurance — or at least health care — is available to people whose medical condition makes them otherwise uninsurable.

Some GOP plans preserve the pre-existing-conditions requirements as long as a person maintains continuous coverage, or signs up during a limited open-enrollment period.

But people would still game the system, jumping to more comprehensive plans or those with the best specialists after they become sick, knowing that insurers could not refuse them or increase their premiums. If Republicans simultaneously eliminate the mandate, this will only accelerate the adverse-selection death spiral already besetting ObamaCare.

The only workable answer is to take otherwise uninsurable people out of the traditional insurance market altogether and subsidize their coverage separately.

This may be done through the expansion and subsidy of state high-risk pools, much the way states handle auto insurance for high-risk drivers. Or sick individuals may be taken out of the insurance system altogether, with their health care paid for through a reformed Medicaid program.

However these changes play out, it’s important to realize that no one is going to have their health insurance suddenly snatched away. Some people may have to get their health care in different ways, and some, who can afford it, may have to pay more.

But the predictions that replacing ObamaCare will mean uninsured Americans dropping dead in the street are worth little more than fake news.