More than two-thirds of U.S. physicians have changed their minds about generative artificial intelligence and now view the technology as beneficial to health care. But as AI grows more powerful and prevalent in medicine, apprehensions remain high among medical professionals.

For the last 18 months, I’ve examined the potential uses and misuses of generative AI in medicine — research that culminated in my new book, “ChatGPT, MD.” Over that time, I’ve seen the fears of clinicians evolve — from worries over AI’s reliability and, consequently, patient safety, to a new set of fears: Who will be held liable when something goes wrong?

Technology experts have grown increasingly optimistic that next generations of AI technology will prove reliable and safe for patients, especially under expert human oversight. As evidence, recall that Google’s first medical AI model, Med-PaLM, achieved a mere “passing score” (60 percent) on the U.S. medical licensing exam in late 2022. Five months later, its successor, Med-PaLM 2, scored at an “expert” doctor level (85 percent).

Since then, numerous studies have shown that generative AI increasingly outperforms medical professionals in various tasks. These include diagnosis, treatment decisions, data analysis and even empathy.

Despite these advancements, errors in medicine can and will occur, regardless of whether the expertise comes from human clinicians or advanced AI technologies.

Legal experts anticipate that as AI tools become more integrated into health care, determining liability will come down to whether errors result from AI decisions, human oversight or a combination of both.

For instance, if doctors use a generative AI tool in their offices for diagnosing or treating a patient and something goes wrong, the physician would likely be held liable, especially if it’s deemed that clinical judgment should have overridden the AI’s recommendations.

But the scenarios get more complex when generative AI is used without direct physician oversight. As an example, who is liable when patients rely on generative AI’s medical advice without consulting a doctor? Or what if a clinician encourages a patient to use an at-home AI tool for help with interpreting wearable device data, and the AI’s advice leads to a serious health issue?

In a working paper, legal scholars from the University of Michigan, Penn State and Harvard explored these challenges, noting: “Demonstrating the cause of an injury is already often hard in the medical context, where outcomes are frequently probabilistic rather than deterministic. Adding in AI models that are often non intuitive and sometimes inscrutable will likely make causation even more challenging to demonstrate.”

To get a better handle on the risks posed to clinicians when using AI, I spoke with Michelle Mello, professor of law and health policy at Stanford University and lead author of ” Understanding Liability Risk from Using Health Care Artificial Intelligence Tools.”

Her analysis, based on hundreds of tort cases, suggests that current legal precedents around software liability could be adapted to include AI. However, she points out that direct case law on any type of AI model remains “very sparse.” And when it comes to liability implications of using generative AI, specifically, there’s no public record of such cases being litigated.

So, for medical professionals worried about the risks of implementing AI, Mello offers reassurances mixed with warnings.

“At the end of the day, it has almost always been the case that the physician is on the hook when things go wrong in patient care,” she noted, but added: “As long as physicians are using this to inform a decision with other information and not acting like a robot, deciding purely based on the output, I suspect they’ll have a fairly strong defense against most of the claims that might relate to their use of GPTs.”

To minimize the risk, Mello said AI should be implemented as a supportive tool to enhance (not replace) clinical decisions. She also urges health care professionals to negotiate terms of service with major AI developers like Nvidia, OpenAI and Google, whose current disclaimers deny any liability for medical harm.

While concerns about the use of generative AI in health care are understandable, it’s critical to weigh these fears against the existing flaws in medical practice.

Each year, misdiagnoses lead to 371,000 American deaths while another 424,000 patients suffer permanent disabilities. Meanwhile, more than 250,000 deaths occur due to avoidable medical errors in the United States. Half a million people die annually from poorly managed chronic diseases, leading to preventable heart attacks, strokes, cancers, kidney failures and amputations.

Our nation’s health care professionals don’t have the time available in their daily practice to address the totality of patient needs. The demand for medical care is higher than ever at a time when health insurers — with their restrictive policies and bureaucratic requirements — make it harder than ever to provide excellent care.

It is imperative for policymakers, legal experts and health care professionals to collaborate on a framework that promotes the safe and effective use of AI. As part of their work, they’ll need to address concerns over liability. But they must recognize that the risks of not using generative AI to improve care will far outweigh the dangers posed by the technology itself. Only then can our nation reduce the enormous human toll resulting from our current medical failures.

Pearl, the author of “ChatGPT, MD,” teaches at both the Stanford University School of Medicine and the Stanford Graduate School of Business. He is a former CEO of The Permanente Medical Group. He wrote this column for The Fulcrum, a nonprofit, nonpartisan news platform covering efforts to fix our governing systems.

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Capping its inaugural season, Minnesota’s professional women’s hockey team skated past Boston to take home the first-ever Walter Cup — the league equivalent of the Stanley Cup, which has proved elusive for the Wild for the past quarter-century. How best to mark the championship glory?

The women’s team — which came together so hurriedly the league has yet to christen a name — announced a victory celebration to be held from 5 to 7 p.m. Friday at Rice Park, by the statue of Olympic coach Herb Brooks at 317 Washington St.

But could there also be a secondary event in the offing?

“Championship = Parade,” wrote St. Paul Mayor Melvin Carter on Wednesday night on the platform currently known as X and previously known as Twitter, using his personal account. “Them’s the rules.”

The mayor, who did not disclose further details, was no less proud on his professional X account: “We are the State of Hockey; it’s only right that the inaugural Walter Cup resides here. Congratulations @PWHL_Minnesota on a championship finish of an extraordinary season! #WeWonTheCup.”

While mounting security costs have derailed some street festivities over the years, St. Paul hasn’t been shy about throwing together an impromptu parade when a special sporting occasion merits. When renowned St. Paul gymnast Sunisa Lee took home a gold medal in the women’s all-around event at the Tokyo Olympics in 2021, the city greeted her with a parade down White Bear Avenue that drew some 20,000 to 25,000 well-wishers, many of them Hmong fans who had come from at least as far away as Arkansas to celebrate.

The inaugural Walter Cup championship of the Professional Women’s Hockey League skated to a finish Wednesday when Minnesota blanked out Boston with a 3-0 win at Tsongas Center in Lowell, Mass. By 9 p.m. Wednesday, the team was marketing pre-orders for championship t-shirts, sweatshirts, hats, hockey pucks and neck chains.

So when and where will the celebratory parade be held?

Wrote the mayor on social media Wednesday night: “Stay tuned.”

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Israel stands accused of genocide as it fights to destroy Hamas in response to Hamas’ savage terrorist attack last October. Is the world’s only Jewish state being held to a different standard? Many Israelis believe this to be true, and they are, undeniably, right. It doesn’t, however, make all criticism of the war in Gaza either unfair or antisemitic.

It’s surely true, to name one example, that the appalling death toll in Gaza — now estimated by the Hamas-led health authority at about 36,000 — cannot alone explain the scale and depth of the international outcry it has caused. Where were the campus protesters and genocide claims when at least 10 times that number of ethnic Tigrayans were killed or deliberately starved to death by the Ethiopian and Eritrean governments in a war that ended only last year?

Equally indisputable is that prosecutors at the International Criminal Court have set a precedent by recommending arrest warrants on war crimes charges for Prime Minister Benjamin Netanyahu and Defense Minister Yoav Gallant. If the court approves that request, it will be the first time since the ICC’s inception in 2002 that it has targeted the sitting leaders of a democracy, even though other democracies have, of course, done some very bad things. Invading Iraq on a lie, at the cost of hundreds of thousands dead, would be one candidate.

The ICC warrants sought against Hamas are equally unprecedented; never before has the court indicted terrorists for war crimes. Many Israelis are furious at the idea that their elected leaders should be equated with terrorists in this way, no matter how much they may dislike Netanyahu. All of the above is accurate, but it also entirely misses the point. And that’s in no small part, I think, because those same Israelis are seeing a different war unfold on their TV screens and news pages than the daily horror show of broken Palestinian children that’s seen outside the country.

On Monday, news organizations around the world (as well as Israel’s own leftist Haaretz) led their news pages with an IDF strike on Rafah that set refugee tents on fire, killing 45 people, according to initial reports from the Hamas-controlled Gaza health authority. Yet neither Israel Today nor Yedioth Ahronoth (Latest News), which together account for about half of all Israeli news readership, had that story on their home pages for much of the day — even after the prime minister acknowledged the IDF had made a “tragic mistake.” Instead, they headlined on the long-term threat posed by Hamas, on newly released footage of the Oct. 7 massacres, a further twist in Netanyahu’s trials on corruption charges, or on rockets fired from Lebanon (an evacuated home was hit).

This sanitized account of the IDF’s continuing effort to eliminate Hamas is either missing or glossing over undeniable facts. The first is that Gaza is being leveled. You can argue as to why and who is to blame, but it has happened. The 2,000- and 1,000-pound bombs that the U.S. only recently stopped sending Israel cause fatalities within a radius of about 360 meters (1,181 feet), making high rates of collateral damage inevitable in a densely populated urban area such as Gaza. Israel has used these bombs liberally, which is a choice.

Equally undeniable is that the unfolding IDF assault in Rafah has blocked the main aid crossing to Gaza, undoing recent improvements in the quantities of food and other aid that had been making it into the territory. People will go hungry as a result. Israeli officials say they’re doing their best and point to aid theft by Hamas. Yet the decision to resist opening more crossing points, and to not crack down on Jewish extremists who blocked or destroyed aid on its way into Gaza, suggest the government is, at a minimum, recklessly negligent in ensuring the provision of basic necessities to Gaza’s civilian population.

None of this proves the legal charge of genocide, a crime that requires not a certain number of casualties or weapon types, but the intent to wipe a group of people out in the place where they live. When 8,000 unarmed men and boys were executed by Serb forces in the Bosnian town of Srebrenica in 1995, it was ruled a genocide because the intent to exterminate a whole class of people in that particular location was so clear.

Israel’s National Security Minister Itamar Ben Gvir and Finance Minister Bezalel Smotrich have provided South Africa with fodder for its genocide case against Israel at the International Court of Justice — which hears state-on-state complaints — by calling to remove Palestinians from Gaza, at the same time IDF actions are making it uninhabitable. It isn’t enough to say these men aren’t in the war cabinet; Netanyahu depends on them to stay in power, and Israelis should be concerned they are being led by extremists toward a crime they would not condone.

Of course, Israel is a special case. It will always be singled out, often unfairly and for malign reasons. No other conflict, after all, takes place on the Holy Land, a patch of desert claimed as a spiritual home by three major religions and fought over for centuries. No other nation was formed as a refuge from pogroms. Few others have such a controversial modern history, in which Arabs and Jews have fought multiple wars aimed at removing one or the other people from the land, a contest that remains unresolved after 70 years. Fewer still have resulted in a permanent, unstable refugee status, accompanied by de facto military occupation and aggressive settlement.

But the arrest warrants, campus protests and genocide accusations were not inevitable. These were the direct results of the Netanyahu government’s policies, pushed into hyperdrive since he scraped back into power with the help of ultra-right parties in December 2022.

Double standards should not be Israel’s big concern here. The question for Israelis should be how they want to be led, how they retrieve the remaining hostages in Gaza alive, and how they win the war. That victory won’t come the day Hamas commander Yahya Sinwar is killed in a Rafah tunnel, but when Israelis can live in security, which will depend on addressing the Palestinian despair Hamas feeds on. This is the goal by which Israelis should judge their own leaders, as well as the claims of outsiders.

Marc Champion is a Bloomberg Opinion columnist covering Europe, Russia and the Middle East. He was previously Istanbul bureau chief for the Wall Street Journal.

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It’s a Thursday morning at Keys Café and Bakery in Roseville.

Regulars know what this means: The Breakfast Boyz are here again.

During this particular breakfast rush, the “Boyz” of a certain age are gathered around several tables that have been pushed together in the back of the café. They’re eating French toast, drinking coffee, joking around and making conversation like they’ve known each other all their lives. Because, many of them have known each other all their lives — some as brothers, others through growing up and attending school in and around Roseville and the Como neighborhood of St. Paul, several through the world of business. New friends have come along, too. These days the chatter has expanded from kids and jobs to include grandchildren, retirement and health issues as well as current affairs and other topics of the day.

One thing in their lives has remained constant, though: this regular gathering of fraternal friends.

“These guys never miss a Thursday,” said server LeAnn Kopic.

In April, the Breakfast Boyz celebrated their 30th anniversary of meeting up for breakfast at Keys on Thursdays.

“It’s a small-town story in the cities,” said 73-year-old Bob Cardinal of Roseville, one of the Boyz.

The Great Get-Together

In 1994, Bill Clinton was president, O.J. Simpson was facing murder charges and “Friends” was a new television sitcom. In Minnesota, regular gate admission to the Minnesota State Fair was $5, where it cost $3 to park and Grandstand tickets started at $8 to see Wynonna Judd sing (with Tim McGraw opening).

These days, friends can stay connected every moment of every day through texting, group chats, social media and email. But in 1994, people wouldn’t even understand that sentence: Texting wasn’t a thing, the internet hadn’t yet gone mainstream and most of us didn’t have email or cellphones. It was the year that Jeff Bezos started Amazon in his garage; Google wouldn’t be founded until 1998.

We mostly communicated with our friends by picking up the landline or meeting up in person — like the Boyz did.

But how did the Boyz start their breakfast club at Keys?

Recollections may vary.

The original group met for breakfast as an offshoot of gatherings with their wives, someone said. One member recalled that the Boyz set a breakfast date after they kept running into each other at funerals; another said the ritual began thanks to a conversation they had after seeing each other at the State Fair. One recalls it starting up after they happened to see their friends at Keys. Actually, someone said, they started meeting earlier at Perkins.

The Boyz all agree, though, that they looked forward to breakfast with friends.

“We had so much fun, we really cracked each other up, we saw the value right from the beginning,” recalled Mick Detviler of St. Paul, now 73. “We said, ‘We should do this all the time.’”

Detviler recalls that Connie — their regular server from 1994 to 2020 — was key in getting them to start meeting weekly at Keys.

“We knew Connie from before, she used to work at Patrick McGovern’s with Pat, the guy who owns it who is also a Como boy,” Detviler said.

Connie reminded Detviler of Flo, that feisty and funny waitress on the vintage television sitcom “Alice.”

“Just like Flo, Connie could dish it right back,” Detviler said. “I think the guys loved it. When we talked about getting together more often, Connie said, ‘I’m here on Thursdays, I’ll have the table set for you.’”

‘A true blessing’

In the early years, when the Boyz had less flexibility in their schedules, they still managed to juggle work and family and other obligations to keep Thursday mornings free for this great get-together. If their kids were off from school, they sometimes tagged along. Other special guests still stop by, like friends back in town who know where to find the Boyz if it’s a Thursday morning.

As the years rolled along and membership grew, the breakfast club provided a space and place to network as well as reminisce and talk politics, religion and other hot topics. From the kitchen to the board room, from places of business to the classroom, from the expertise of law to the skill set of marketing and publishing, their careers were varied. There’s even a (past) Vulcan among them.

Each week, the Boyz estimate that there might be between 10 and 25 at breakfast — the gathering grows and shrinks “like an accordion,” Cardinal said.

On the Thursday that the Pioneer Press stopped by, Jerry Hammer — the retired CEO of the State Fair and perhaps the group’s most well-known member, also known as Bob Hammer’s little brother — was not able to attend, but we caught up with the 69-year-old St. Paul resident by phone later.

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“I’ve known these guys literally most of my life, it’s such a joy,” said Hammer of the tradition. “It’s a constant that keeps you grounded. I’d go to Australia to give presentations on the Fair, get home and get back to Keys with the Boyz.”

The men, mostly in their 60s and 70s now, see coming to breakfast on Thursdays as a ritual that is as sacred as attending the State Fair every summer.

“This has been a highlight of my life,” said original member Steve Burwell, 74, of Roseville. “A true blessing.”

“It’s just a good bunch of guys,” Cardinal said.

It’s not limited to breakfast, though: The guys have started meeting up for lunch once a month. You’ll find them across the street at the House of Wong.

“We call it Wing Wednesdays,” Detviler said.

By the numbers

A sign celebrating 30 years honors longtime server Connie and shows the Breakfast Boyz have consumed more than 21,000 breakfasts and 70,000 cups of coffee since their first meeting on April 18, 1994, at Keys Cafe and Bakery in Roseville. (John Autey / Pioneer Press)

Over 30 years, a lot of coffee has been consumed on Thursday mornings.

Just how much?

Burwell, the statistician of the group, also known as “The Great Calculator,” recently ran the numbers for 30 years of weekly breakfasts. Over the span of three decades, the Boyz have:

Met for breakfast once a week for 1,560 weeks.
Ordered 21,490 meals.
Consumed 70,249 cups of coffee (or 2,911 gallons).

As for dollars spent, it’s more challenging to tabulate.

“Everyone gets their own tab,” Detviler said.

But the Great Calculator, at our request, ran those ballpark numbers and came up with a conservative estimate of $211,032.

Now that’s a lot of support for one local business!

Pandemic tailgating

It also wasn’t easy to keep meeting during the pandemic. Remember, restaurants were closed for awhile. Then, seating was outside or limited.

The Boyz, though, still gathered here on Thursdays — even if they couldn’t do so inside the restaurant.

“They tailgated,” recalled server Wendy Olson.

The Boyz dined at the picnic tables the restaurant set up in the parking lot — but they missed their regular routine inside.

“Even during the shutdown,” said Kopic, their regular server, “they’d be looking in the windows.”

Their longtime server, Connie, retired during the pandemic, like so many people did. But Kopic has the routine down now.

“She can go around the table and know what everyone wants without anyone saying anything,” Cardinal said.

The Boyz also lost a friend, Jim “Ole” Olson, during 2020 — although not to COVID-19. Even during his final months, as Olson dealt with health issues, he kept coming for breakfast on Thursdays. That included his birthday celebration (your birthday is a big deal if you are one of the Boyz).

“You think I’m going to pass up free cake?” his friends recall him saying.

A photo of the late Jimmy Olson and his U.S. Navy Seabee hat looks over the shoulders of Mike Miller, left rear, and Bob Hammer, right rear, as the Breakfast Boyz meet at Keys Cafe and Bakery in Roseville on Thursday, April 25, 2024. (John Autey / Pioneer Press)

Olson passed away at age 70 on Dec. 3, 2020. In a way, he is still part of Thursdays. During the gathering in April, his photo was displayed here, overlooking his table of friends.

“He’s like our patron saint,” Detviler said.

Same place, next week

In 2024, it’s easy to stay in touch with friends without meeting up in person — maybe too easy, maybe too isolating. The Boyz could certainly start a group chat on their phones now, or get some face time via FaceTime. It wouldn’t be the same, though.

There’s no bacon or fellowship with that kind of tradition.

So the breakfast club continues. It’s as comforting as a bowl of oatmeal at this point.

“They all know someone will be here every Thursday,” said Jeannie Hunn, the owner of the café.

Today, the Boyz will gather as usual.

“We look forward to it every week,” said Detviler.

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