AI and the Decline and Fall of Human Intelligence


When my daughter Alex was in third grade she had the reigning Marin County (California) Teacher of Year. Her name escapes me (I’ll blame it on the chemo brain). The parents of all the kids in this Tiburon classroom were beside themselves with praise for her. Me … not so much. A big one thing I had a problem with was she encouraged the students to use calculators in her class. Her reason was that it would be good practice for real life – where no one did math long hand anymore. Well, I do.

Now I still use a calculator, but daily I make every effort to do math problems in my head. Percentages, grocery bill estimates, gas mileage … anything and everything. it’s something I’ve always done and probably always will. It’s cerebral exercise, and it’s something I’ve encouraged my daughter to do also. On road trips as a grade-schooler, she’d have to look at the mileage, take in account our speed, and determine when we’d get to the next stop. I don’t know if she liked it … but she did it anyway.

Now I don’t mean to sound like a Luddite. On the contrary, I self-taught myself how to program in college on FORTRAN 77 on my college’s IBM 360/370 (how many of you remember FORTRAN or a 360/370). I’d sneak in to the computer center at night and drop off my boxes of punch cards. I wasn’t so bright that I used a terminal like the other nocturnal geeks in training though. I used punch cards … and for a many months carried around my three boxes of 1400 cards.

I bought my first Mac in 1985 and I was transferring data online before there was an online. My first email address was at the Well in the San Francisco. In fact I gave Well email addresses for Christmas presents. Alexandria was raised on a Mac, and instead of going to college when she graduated high school … she went to Apple.

That said, I didn’t like the idea of supplanting the exercise of the brain for the exercise the fingers hitting the calculator buttons. And the excuse: “they’ll need to learn how to use a calculator in real life when they’re older” is lame. What they’ll need to learn is how to use their brain. And considering who this country elected as president – we’re in short supply of those that either can or will.

Now I’m not blaming calculators and their use in grade school for the clown in the White House and utter disintegration of the democracy before our very eyes … but then maybe I should. Maybe we should look it as a symptom … a touchstone of sorts, emblematic of how we view intellectual development in this country. I get the whole “recognizing the value of tools” thing. But unless the foundation is built for which the tools are to be used (and hopefully complement) – we’re building a skyscraper or citizens’ equivalent of it – on a landfill.

Continue reading

The Health Care System Needs to Rethink How It Treats People of Color After This


Over Memorial Day weekend 13 years ago, my younger brother, Laith, died in an accident. He was 26 years old. Losing young people in their mid-20’s is particularly devastating because they are embarking on adulthood and their futures hold limitless hopes, dreams, and possibilities. For the survivors, no holiday brings the same joy as it did before. Someone is not there, and never will be.  

Wanda Cooper-Jones, the mother of Ahmaud Arbery, has endured unbearable pain. Gregory and Trevor McMichaels shot and killed her son while he was running down the road. They were not arrested and charged with a crime until 74 days later. A third man, William Bryan, stood by and recorded the murder of Ahmaud Arbery on his cellphone for more than 4 minutes. 74 days passed before he was charged with committing a crime. The gruesome facts of this story have enraged me because I know a little something about the unrelenting grief associated with unexpected death. 

My brother’s death was accidental, which made me incredibly sad. Wanda Cooper-Jones’ son was ruthlessly lynched and then this week George Floyd was killed in broad daylight by a police officer in Minneapolis, both of which make me unspeakably angry. 

Enough is enough. This nation must stop tolerating lynching of black men and women.  While racism is difficult to discuss, it is also necessary, valuable, and essential in order to bring about change. My previous column addressed white privilege and ever since, readers have been asking, “What now?” 

Now, we need to become allies to people and communities of color.   

But what does it mean exactly to be an ally?   

Continue reading

Medical Decision-Making in the Time of Coronavirus


I was recently speaking with a friend of mine, a pulmonologist at a large academic medical center in the Midwest, about his COVID-19 experience. I was especially interested, in the context of iterative experimentation, to learn how his hospital was working on improving the care of COVID-19 patients, especially those in the ICU, which he oversees.

It’s a real problem, he said. On the one hand, there are specific initiatives he’s trying to evaluate, in a classic, controlled fashion, so he can figure out if the intervention is effective and should become part of the standard of care.

That’s the goal.

In reality, however, here’s what he says is actually happening: most of the front-line doctors are hearing about the very latest approaches, generally from social media (such as Twitter or medical podcasts), and are trying to immediately apply these methods to their patients. As a result, the care patients receive depends (to some degree) on the specific physician involved, as well as the extent to which that physician has been influenced by other opinionated doctors.

At a recent Boston innovation conference (discussed here), Dr. Paul Biddinger, an emergency medicine physician who leads emergency preparedness at the Massachusetts General Hospital, made a remarkably similar observation. He praised the “unprecedented information sharing” associated with the COVID crisis. But he also expressed concern about the “practicing by anecdote,” and more generally the “temptation to fall off what have been the time-proven methodologies of science.”

Continue reading