For docs, the pocketbook trumps AI

The ideas and innovators shaping health care
Jan 16, 2024 View in browser
 
Future Pulse

By Daniel Payne, Carmen Paun, Erin Schumaker and Ruth Reader

POLICY PUZZLE

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The AMA's lobbying is focused more on Medicare reimbursement than on AI policy at the moment. | ANDY JACOBSOHN/AFP via Getty Images

The leading doctors’ group is increasingly concerned about AI in health care — but it isn’t talking about it much with lawmakers at the moment.

The American Medical Association, released its principles for overseeing the new artificial intelligence in health care in November.

It called for a “whole of government” approach to mitigate risks the tools pose to patients and consumers.

But seeing those principles enacted into law isn’t the group’s lobbying priority at the moment, AMA President Jesse Ehrenfeld told Daniel.

Why’s that? The group is fixated on convincing lawmakers to rescind a 3.4 percent cut to Medicare reimbursements that took effect Jan. 1.

“This is what we are focused on because it is so urgent,” Ehrenfeld said.

Why it matters: AI is advancing quickly in health care as diagnostic and administrative tools, sometimes unregulated. Unvetted systems could pose risks to patients if they reinforce bias in the data that undergirds the systems.

But that problem is mainly theoretical, and health care interests consider it a lower priority than pocketbook issues like how much Medicare pays.

Little concrete regulatory or legislative action has been taken other than new rules requiring more transparency from the developers of AI systems that the Department of Health and Human Services finalized last month.

Rep. Greg Murphy (R-N.C.), a member of the GOP Doctors Caucus, wrote in a recent letter to FDA Commissioner Robert Califf that “no serious effort has been made by either body to pass comprehensive legislation.”

 

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INNOVATORS

This undated fluorescence-colored microscope image made available by the National Institutes of Health in September 2016 shows a culture of human breast cancer cells.

Researchers used AI to pinpoint 2,000 molecules that could bind against the most mutated protein in Parkinson's disease. | Ewa Krawczyk/National Cancer Institute via AP

A science competition organized by Conscience, a Canadian-funded nonprofit, has led to the identification by AI of seven promising molecules to treat the version of Parkinson’s disease linked to family history.

How it worked: Nearly two dozen academic and commercial organizations with computational chemistry or AI expertise pinpointed 2,000 molecules that could bind against the most mutated protein in that type of Parkinson’s.

A lab at the University of Toronto’s Structural Genomics Consortium tested the molecules and validated seven, according to Conscience. An independent evaluation committee assessed the experimental data to find the most convincing results. The process took two years.

Why it matters: The competition compared dozens of computational methods against the same target protein, showing which AI algorithms are best at identifying potential molecules that could work.

That’s critical because there aren’t yet any benchmarks for which AI algorithms work well in drug discovery, Ryan Merkley, Conscience’s CEO, told Carmen.

“There’s a perception out there that, in the same way you can say ‘draw me a picture of a dog on a beach on a sunset’ and ChatGPT will produce the whole thing, that some will say, ‘create me the format of a drug that will cure pediatric cancer,’ and that that will happen.”

But that’s far from today’s reality, Merkley said.

The only thing AI can do now is point experts to areas where they can dig for potential new drugs, he said. “We need ways to know how good AI is at making those recommendations,” Merkley added.

All the data generated by the competition, including the chemical structures of the molecules tested and associated computational methods, are available online.

What’s next? Merkley hopes that by using open data and developing benchmarks for AI algorithms used in drug discovery, Conscience can contribute to finding affordable drugs for rare diseases or areas where there’s a market failure, such as antibiotics.

The competition to identify potential compounds against Parkinson’s was funded by the Michael J. Fox Foundation for Parkinson’s Research.

Other competitions underway focus on developing drugs for Covid-19, finding ways to improve cancer treatments and exploring a hormone receptor that plays a role in obesity.

 

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AROUND THE AGENCIES

An aerial view showing a harvesting machine collecting corn in a field in Baradero, Argentina, on March 30, 2023.

Distance from medical facilities contributes to the relatively poor health outcomes in rural America. | Luis Robayo/AFP via Getty Images

"Living in rural America shouldn't be a risk factor for dying earlier for most diseases."

Dr. Bon Ku, ARPA-H program manager

There's a stark disparity between health in rural and urban areas, with rural Americans more likely to develop lung cancer and to die from heart disease, respiratory disease, cancer and stroke.

The Advanced Research Projects Agency for Health's latest program aims to address that problem by boosting hospital-level care in remote areas.

The program's focus, on early detection of diseases like cancer, and expanding access to care, feeds into President Joe Biden's cancer moonshot goal of reducing the cancer death rate by half over 25 years. Hitting that goal is possible, recent research found, but only if gains are made in prevention, early detection and access to high-quality cancer care in underserved communities.

How it works: The Platform Accelerating Rural Access to Distributed & InteGrated Medical care, or PARADIGM program, aims to develop mobile health units to act as the arm of rural hospitals, offering virtual visits and advanced imaging tests, like CT scans, MRIs, ultrasounds and lab testing in remote locations.

"We should be able to deliver these essential services in a vehicle technology platform that's able to replicate the services delivered in a hospital,” said Dr. Bon Ku, the program manager.

What’s next? Future demonstrations will investigate whether the mobile units go directly to patients' homes or operate out of convenient local locations, like retail store parking lots or fire departments.

In addition to the mobile units, the program plans to develop mini CT-scanners and get hospitals and insurers to help pay for it.

"This is going to cost the health systems money, but this is going to be able to augment their services and enable them to see more patients in a more cost-efficient manner," Ku said.

 

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