Envisioning AI that expands civil rights

Presented by Better Medicare Alliance: The ideas and innovators shaping health care

Dec 22, 2023 View in browser   By Daniel Payne, Erin Schumaker and Carmen Paun Presented by PROGRAMMING NOTE: We’ll be off next week for the holidays but back to our normal schedule on Tuesday, Jan. 2. TECH MAZE Pulse oximeters have provided flawed readings for people with darker skin. | AP Civil rights advocates want to ensure the use of artificial intelligence in health care doesn’t perpetuate – or exacerbate – the biases in the data it’s trained on. To that end, the Lawyers' Committee for Civil Rights Under Law is pitching legislation it’s drafted: the Online Civil Rights Act. What’s in it? The bill addresses AI use in health care, as well as other contexts. It would: — make discrimination in an algorithm illegal — mandate evaluation of algorithms before and after they’re put to use — require AI creators and users to deploy it safely — create data protection and AI transparency requirements — establish more oversight through government and the courts The Biden administration — which is working on implementing an October executive order aimed at laying the groundwork for regulation — should proceed, said David Brody, managing attorney at the Lawyers' Committee’s Digital Justice Initiative, but that work should be supported by additional authority from Congress. The laws governing the technology need to be revisited, he said, because many were written before the scope and power of today’s AI had evolved. What’s next? Should Congress pass the legislation — in part or whole — AI could be a force for good, Brody said. “We believe a well-designed algorithm … can expand equal treatment,” he said. More than a dozen congressional offices have reached out to discuss the proposed bill, according to Brody. A message from Better Medicare Alliance: We support policy solutions to strengthen Medicare Advantage and improve the beneficiary experience. Our policy priorities include modernizing prior authorization, establishing marketing guidance clarity, and improving provider directories. Learn more about Better Medicare Alliance's recommendations for Medicare Advantage priorities.   WELCOME TO FUTURE PULSE Longwood Gardens, Kennett Square, Pa. | Shawn Zeller/POLITICO This is where we explore the ideas and innovators shaping health care. Merry Christmas and happy new year, Future Pulse readers! We'll see you in 2024. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Ruth Reader at rreader@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Chelsea Cirruzzo talks with POLITICO health care reporter Daniel Payne about the ways artificial intelligence is already used across the medical landscape and how regulators are responding. Listen to today’s Pulse Check podcast   A message from Better Medicare Alliance:   CHECKUP Nsomma Alilonu, a medical student who worked on the AI Patient Actor project, with Thomas Thesen | Katie Lenhart/Dartmouth Picture a mashup of ChatGPT and the language app Duolingo — but for medical students learning to interview patients. Meet "AI Patient Actor," a teaching-tool-in-progress that Thomas Thesen, a cognitive neuroscientist, is testing on second-year students at Dartmouth's Geisel School of Medicine. In med school, students practice by interviewing actors playing patients. It helps the students learn to make diagnoses and hone their soft skills, like building rapport, counseling and motivation techniques, and learning to ask open-ended questions. Why it matters: Actors are expensive. In rural New Hampshire, where Dartmouth is located, it can be hard to recruit Spanish-speaking ones to roleplay with students who will treat Spanish speakers after graduation. And since opportunities to practice with real humans are infrequent, students get nervous about them. Then came the advent of ChatGPT, the bot that can answer questions. "That's when I got the idea for my teaching, to use this to teach students how to do patient interviewing, clinical diagnoses, differential diagnoses, and then also to give them individualized feedback," Thesen told Erin. How the AI Patient Actor works: Students can pull up the app and type or ask questions aloud in English, Spanish, German or Swahili. "Hi, I'm Dr. X. What brings you to the clinic today?" The ChatGPT4-powered app responds. Instead of referencing ChatGPT's entire knowledge base, the tool is constrained to a patient template created by medical educators. Students continue the conversation, probing for information, ordering tests and exams (with laboratory results provided by the app), until they've landed on a diagnosis and course of treatment. Then the app evaluates their performance and offers feedback. What's next? This is the first semester that Thesen's rolled out the platform in his neuroscience and neurology course, so it hasn't been evaluated. He wants to see: — Did the app behave like a real patient? — Did it stick to the script? — Did it have biases? Thesen said he also wants to know if students who use it develop better interviewing and clinical reasoning skills. Whatever the results, he said he’s not planning to lay off the actors. "It's not taking something away. It's not replacing something. It's adding something,” he said. A message from Better Medicare Alliance: More and more seniors are choosing Medicare Advantage than ever before, including in rural communities. In 2023, 40% of all eligible Medicare beneficiaries in rural counties were enrolled in an MA plan—nearly four times the share in 2010. As rural Medicare Advantage enrollment grows, the program is making care more affordable for rural communities because Americans in rural areas are more likely to face financial challenges than those in urban areas. Medicare Advantage covers all of the same services as Fee-For-Service (FFS) Medicare, but offers additional cost protections, including an annual cap on out-of-pocket expenses and additional benefits that support beneficiaries' overall health, like dental and vision. Ultimately, beneficiaries save $2,400/year on average compared to FFS Medicare beneficiaries. Read about our proposed solutions for improving and maintaining care for seniors.   AROUND THE NATION The soft taco with chicken is the low-cal option. | Getty Images Knowing how many calories are in a taco didn’t prompt enthusiasts of the delectable finger food to cut back much, according to a new study looking at calorie labeling in Taco Bell restaurants across the country. Why it matters: Congress ordered fast food chains to post calorie counts on their menus when it passed Obamacare in 2010. After some fits and starts, the Food and Drug Administration mandated the labels in 2018. The study, by researchers at New York University, looked at the number of calories people ordered per transaction in Taco Bell restaurants that put the number of calories on menus before the Obamacare provision took effect. The researchers then compared those with transactions at Taco Bell restaurants that didn’t provide the calorie information at the time. Noshers’ choice: People ordered meals with about 25 fewer calories in Taco Bells that posted calorie information compared to Taco Bells that didn’t display the number. Researchers considered other factors, such as eating habits in the communities, in evaluating the results, said Pasquale Rummo, associate professor in the Department of Population Health at NYU Grossman School of Medicine. Takeaway: People are entitled to know how many calories they’re consuming, Rummo told Carmen, adding that 25 calories a meal adds up over time. Rummo said the menu labeling rules don’t require enough transparency about what’s in the food we’re buying. “Knowing things like added sugar content of what you're ordering, which is not mandatory for reporting and many restaurants don't report it, it's probably more valuable,” he said. Rummo praised the Sweet Truth Act that New York City Mayor Eric Adams signed in November requiring restaurants with 15 or more locations to put a warning label about added sugar on their fare if it surpasses the FDA’s recommended amounts. Businesses must comply by this time next year. Diets high in sugar can lead to health problems, including obesity, diabetes and heart disease.   Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker   Follow us

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