Robert Pearl: Why ChatGPT’s ‘memory’ will be a health care game changer

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OpenAI generated massive media interest with the announcement that its signature product, ChatGPT, is gaining memory. The new feature enables the generative artificial intelligence system to “carry what it learns between chats, allowing it to provide more relevant responses,” according to the company.

As Congress holds hearings and regulators rumble with apprehension, the media coverage so far has generally overlooked the biggest part of this announcement, which has direct ties to American health care:

The development of memory-powered AI is a pivotal step toward transforming U.S. medicine.

Although there are many technological and regulatory hurdles to clear — and fears around privacy and security to mitigate — this development has the potential to make health care more personalized, patient-centric and affordable. These improvements — alongside the potential pitfalls of AI-empowered health care — are the subject of my upcoming book, “ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine.”

Here are three ways generative AI’s improved memory will transform patient care:

More accurate diagnoses

For over a decade, clinicians have wanted to precisely tailor care to each patient’s unique health profile, including their genetic makeup and personal health preferences. But too much has stood in the way.

One major challenge is the sheer volume of knowledge required to customize medical care. The human genome consists of approximately 3 billion base pairs of DNA, which if typed out as letters would fill about 200 New York City phone books. What’s more, medical knowledge doubles every 73 days, making it almost impossible for any human to keep up with all the innovative medical findings and updated guidelines for helping patients.

A third hurdle is technological. With the average patient consulting 19 different doctors throughout their lifetime, an individual’s electronic medical records are often dispersed across numerous medical offices and health systems. The lack of interoperability among EMR systems compounds this issue, preventing clinicians –and, by extension, generative AI — from accessing a patient’s complete medical history.

Currently, ChatGPT’s ” context window” (how many words it can recall before losing its memory), falls well short of the nearly 17,000 words found in the average patient’s medical record.

However, generative AI systems are predicted to become 30 times more powerful within the next five years, dramatically expanding their data retention capabilities and enhancing their reliability. This, combined with OpenAI’s specialized plug-ins (known as GPTs), offers promising opportunities. Initially, generative AI might access a limited set of patient data through platforms like My Chart, which can be used on personal computers or smartphones. Eventually, however, generative AI will enable patients to consolidate their digital medical records from various health care providers.

This will create a comprehensive, personalized health record, serving as a reliable resource for both patients and their health care teams.

With this information stored in an AI’s memory, patients will be able to input their symptoms and receive specific diagnostic and treatment suggestions.

For people who are uncertain about the significance or urgency of new symptoms, the AI will provide reliable advice. And for patients with rare or complex conditions, it will offer invaluable second opinions. Advanced diagnostic ability, alongside comprehensive health care information, will be instrumental in reducing the 400,000 annual deaths attributed to misdiagnoses.

Fewer complications from chronic disease

Chronic diseases like diabetes, hypertension, obesity and asthma affect six in 10 U.S. adults. Complications from these diseases account for 1.7 million deaths each year.

Unlike acute illnesses that appear suddenly and usually are resolved quickly, chronic conditions persist over time, impacting tens of millions of Americans every single day.

Doctors care for these conditions in an episodic fashion, which is far from optimal. Patients with chronic diseases typically see their physician every three to four months, providing doctors with only a snapshot of their health status. As a result, chronic diseases aren’t controlled as well as they should be, which leads to life-threatening, and preventable, complications.

At a national level, hypertension is adequately controlled just 60 percent of the time, and effective blood sugar management in type 2 diabetes is achieved less than half the time. Data from the Centers for Disease Control and Prevention indicate that proper disease prevention and management approaches would reduce the risk of kidney failure, heart attacks and strokes by 30 percent to 50 percent.

Applying these percentages to the U.S. death toll from chronic disease complications, these CDC estimates indicate that more than half a million lives could be saved annually.

Generative AI, once connected to home wearable devices, can update patients about their health status and suggest medication adjustments or lifestyle changes. It can also remind them about necessary screenings and even facilitate testing appointments and transportation, thereby improving disease management, reducing complications and maximizing health outcomes.

Safer hospitals

Generative AI with memory will radically improve inpatient care, as well. Once it’s integrated with bedside monitors and able to remember a patient’s clinical status over time, the AI system will be able to immediately alert professionals when a problem arises, so they can intervene.

Additionally, video monitoring systems powered by AI could oversee the delivery of medical care, pinpointing any departures from established best practices. This real-time oversight would provide immediate alerts to caregivers, preventing medication mishaps and reducing the risk of infection.

These two uses of AI technology would help reduce the staggering 250,000 deaths each year attributed to preventable medical errors.

While ChatGPT and similar technologies hold immense potential, today’s generative AI tools still require clinician supervision. But looking ahead, the exponential growth of generative AI’s capabilities (doubling every year) points to a transformative future for the practice of medicine.

Now is the time for both clinicians and patients to become comfortable using generative AI. And it is an opportunity for regulators and elected officials to advance, not stifle its potential. With memory and GPTs, the doctor’s AI toolkit is quickly filling up.

Robert Pearl is a clinical professor of plastic surgery at the Stanford University School of Medicine and is on the faculty of 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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‘Carefluencers’ are helping older loved ones, and posting about it

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On the east side of San Jose, California, there is an abuela who seems to have more grandchildren than she can count.

Mardonia Galeana holds her grandson Yosimar Reyes hands, in San Jose, Calif., on March 18, 2024. Reyes has cared for his grandmother since the start of the COVID-19 pandemic. (Carolyn Fong/The New York Times)

“A lot of people see me and they hug me,” Mardonia Galeana, 89, said in Spanish. “I don’t even know them, but sometimes they ask me for a blessing on the street and I do the best I can on their forehead.”

Her likeness has been featured in a painting in the San José Museum of Art and in a mural in the city’s mission district. But it’s her online presence that has captivated the thousands of people who have come across the photos and videos posted by her grandson Yosimar Reyes.

“Seeing your Abuela smiling and having a good time truly warms my heart,” one user commented beneath a video of Galeana enjoying herself at a senior center while others danced to a track by merengue singer Elvis Crespo.

Reyes has been chronicling moments in his grandmother’s life on a private Instagram account followed by more than 21,000 people. His posts have shown a trip they took to New Orleans, their strolls with his dog, Chulito, around the San Jose Flea Market, and occasional doctor visits.

Although Reyes calls himself Galeana’s “personal stylist,” he is first and foremost her caregiver — driving her to appointments, managing her medications, making sure she has a roof over her head.

“I take pride in the fact that I care for and dress my grandma,” Reyes, 35, said. “That she’s not going to be out here in a muumuu. Her nails are also poppin’ and it’s a big self-esteem boost for her.”

Francesca Falzarano, an assistant professor at the University of Southern California Leonard Davis School of Gerontology, has a term for the growing number of people like Reyes who share behind-the-scenes looks at the daily realities of providing round-the-clock care for older loved ones.

“In my research lab, we call them ‘carefluencers,’” Falzarano said. “Social media is really the only way a lot of these people are able to access support, education and a sense of belonging.”

Reyes, a poet and artist, was raised by his grandparents and came with them to the United States from Guerrero, Mexico, in the early 1990s. “Even as a kid, I was already a caregiver,” he said. “I had to translate documents and help my grandparents navigate this country because they were older and didn’t speak English.”

Reyes, who was named the 2024 Santa Clara County poet laureate, said he has occasionally found himself overwhelmed since he fully undertook the role of caring for his grandmother during the COVID-19 pandemic.

“I’m trying to build a career as an artist and as a writer, but then I still have to go home and have to take care of somebody,” said Reyes, who has described his experience as a caregiver in poems like “Abuela Gets a Fever.” “Some days, I’m emotionally depleted. And if she’s having a bad day, I have to make sure that I’m not reactionary.”

Mardonia Galeana poses with her grandson, Yosimar Reyes, outside their home in San Jose, Calif., on March 18, 2024. On TikTok and Instagram, people are sharing what it’s like to take care of relatives who have reached their final years. (Carolyn Fong/The New York Times)

As the population ages, Reyes’ experience is likely to become more common. According to the Centers for Disease Control and Prevention, the number of unpaid caregivers in the United States increased to about 53 million in 2020 from 43.5 million in 2015.

Chris Punsalan of Las Vegas, who became a caregiver for his grandmother Anicia Manipon eight years ago, has shared his experiences with her on YouTube, Instagram and TikTok.

“I decided to document us because I felt it was important,” Punsalan, 30, said. “It’s not only for me to be able to look back on, but I also slowly realized that it was very helpful for people who have been through a somewhat similar situation.”

Punsalan, who has over 2 million followers on TikTok, has created content out of tending to his grandmother’s bedsores, cooking her breakfast and sharing the products he uses to tend to her needs. Since Manipon’s death in January, he realized that his social media accounts have done more than provide information and comfort for other family caregivers.

“During her funeral, my cousin said something that really struck a chord with me,” Punsalan recalled. “He said, ‘Whenever I miss my grandmother, I have a library of videos to remember her by.’”

Jacquelyn Revere, an aspiring TV writer in Los Angeles, began posting about her experiences after she became the main caregiver for her mother and grandmother in 2016. She said she found comfort while trying to help others in her position through social media, and the number of people following her on TikTok grew to more than 650,000.

“When I was posting my mom, it’s not like I felt like I had to — it actually became fun,” said Revere, 37. “Social media brought so much validation with people saying, ‘You’re doing such a good job,’ and it became a place of refuge.”

Revere’s grandmother died in 2017; her mother died in 2022.

“Many of my caregiver friends are people who I’ve met on social media,” Revere said. “We’ve really created a community that’s very close knit, because it’s hard to understand the weight of this role if you’ve never had it.”

Mardonia Galeana poses for grandson Yosimar Reyes outside their home in San Jose, Calif., on March 18, 2024. On TikTok and Instagram, people are sharing what it’s like to take care of relatives who have reached their final years. (Carolyn Fong/The New York Times)

While posting a get-ready-with-me-and-Grandma video on TikTok may bring caregivers a sense of community, some viewers can’t shake the feeling that such content might be exploitative. Is a vulnerable older relative in a position to consent to appear in a video, when the person recording it is responsible for administering her medication?

“That is so heartbreaking,” one user commented on a TikTok video of an older woman struggling to eat. “I wish you all would have the dignity to stop posting these messages.”

But according to Falzarano, the benefits of caregivers’ sharing their experiences outweigh the risks. “It’s really contributing to the greater awareness and visibility of chronic illness in caregiving,” she said.

Falzarano, 32, whose research is focused on dementia, family caregiving and technology for older adults, also noted that while there are a variety of resources readily available for expecting parents, the same could not be necessarily said for those grappling with the end of life.

“We all have this universal experience where we’ll need to provide care or need to be cared for at some point,” Falzarano said. “Why not start thinking about it now?”

Galeana, who will turn 90 in December, hasn’t been able to return to the home in Mexico that she and her grandson left behind more than three decades ago. With no clear pathway to U.S. citizenship, the two have built a forever home of sorts online.

“She’s old and she’s been through so much, from poverty in Mexico to all that we’ve experienced in the United States,” Reyes said. “My goal now is to make sure that she’s happy and not always talking about how sad her life was. And people love her here and know her as the abuelita. It’s beautiful.”

Whether it’s being recognized at the market or having flowers or care packages sent to her home by strangers who have encountered her online, she has become a local celebrity.

“As a little girl, I wanted to be an artist,” Galeana said in Spanish. “I would dance and sing and want to be on the movie theater screen. But it never happened.”

But later that week, after Reyes had fixed her hair and done her makeup, she was ready to be the star of a video that would be seen by thousands.

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Readers and writers: Two mysteries and something a little lighter

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Here are two crime/mysteries and a light-hearted novel about art and wealth for your TBR list.

(Courtesy of the author)

“Ashes, Ashes”: by Fredrick Soukup (Vine Leaves Press, $17.99)

I was a boy who left Miss Bonnie’s place to revisit the house of my childhood torture. And before that I was a boy who didn’t know I needed to revisit the house of my childhood torture, because I didn’t know quite that it was torture. And before that I was a boy who didn’t know how much I’d someday love and hate Miss Bonnie, because I didn’t know her from any pack-a-day in the county. And before that I was a boy up in that cold grey garage loft, one of many probably, being tortured and not knowing it. These things happen. — from “Ashes, Ashes”

Fredrick Soukup (Courtesy of the author)

Foster mother Miss Bonnie’s body is found in her home and the story is that she hanged herself. Dorian, one of her “boys,” is grown up and scratching out a living in northern Minnesota. He hasn’t been back to Miss Bonnie’s home in the town of Sibley, near Brainerd, since he left years earlier. But he wants to pay his respects to the woman who loved him and her other foster kids. Returning to the now-dilapidated house he finds Heath, one of his foster “brothers,” living there alone. Darian looks at the tin ceiling and knows there was no way Miss Bonnie would have been able to kill herself with a rope. The cops in this town where everybody knows everybody are hiding something.

But who killed Miss Bonnie and why? That’s the heart of this richly layered and complicated psychological novel, which holds mysteries within mysteries and lies in lies. It’s the story of trauma experienced by kids in the foster system, even those with caring substitute mothers, as well as the pains of social class.

The story moves back and forth in time, covering about 20 years in the lives of a big cast of characters, especially in the voices of Dorian and Heath, Emma and Monica. Emma has known Dorian for years and although she is married with children, she emails him almost day, discussing her life to the extent her messages become a sort-of journal. Dorian never responds but he reads every word and she knows it. Monica is the girl young Heath wants to run away with. When she is expecting his baby, she breaks the fragile and angry boy’s heart.

This is a novel that needs to be read slowly and carefully because it’s easy to lose track of the characters’ relationships. And although there is violence and abuse in the story, the conclusion is so perfect it could break your heart.

Soukup, who lives in St. Paul, is a graduate of St. John’s University. His debut novel, “Bliss,” was a finalist for a 2021 Minnesota Book Award and received an independent publishers bronze medal in the Great Lakes Fiction category. His second novel, “Blood Up North,” won the NYC Big Book Award for Literary Fiction.

“Ashes, Ashes” was inspired by the years when the author’s parents took care of more than 60 foster children at their home in northern Minnesota. Soukup will introduce his novel at 6 pm. Friday, April 19, at Next Chapter Booksellers, 38 S. Snelling Ave., St. Paul.

(Courtesy of the author)

“Doorman Wanted”: by Glenn R. Miller (Koehler Books, $28.95 hardcover, $19.19 paperback)

I do mean it in a positive way. You’re not like the other doormen I’ve encountered. I can’t put my finger on it. It’s the way you carry yourself. It’s different, certainly, from the current collection at L’Hermitage.” — from “Doorman Wanted”

Glenn R. Miller (Courtesy of the author)

What could be more fun than a peek into the lives of wealthy folks who live in an Upper East Side apartment building?  We meet the residents through the eyes of Franklin Hanratty, the polite, helpful doorman who talks like a P.J. Wodehouse character. But Franklin isn’t who he’s pretending to be. He’s Henry Franken, heir to a fortune, whose secret is that he owns the building where he works.

Henry knows everything that goes on in the building, including the room number of sweet Wendy. All the tenants love him but his boss, Charlotte, does not. Even when Henry sorts out a crazy traffic jam in front of the building involving two stuck delivery trucks, ditzy, self-promoting Charlotte takes credit for his work.

Nobody knows that when Henry goes home for the evening he walks down an alley and re-enters the building through a back door into a private elevator that takes him to his home — the luxurious owner’s penthouse. Meanwhile, Charlotte and the residents are becoming increasingly agitated because this mysterious owner never seems to be around.

When Henry goes against the rules and gives free morning coffee to homeless street artists Terry and Tomata he finds himself in the world of talented men and women who just haven’t made it as artists. Terry and Tomata are beguiling characters, almost a comedy act as they philosophize about art and their place in society. Every Saturday Henry meets with his lawyer/godmother, who’d been his father’s best friend. She urges him to stop pretending, reveal his status as building owner, and get on with his life. But Henry has always been ambivalent about having so much money and he doesn’t know what to do with it. So he remains a doorman.

In a hilarious chapter Harry and his artist friends are recruited by Wendy to give advice on packaging of a high-priced protein bar. The artists show their skills and explain why the proposed packaging is the wrong color and the picture on it is not accurate. Unfortunately, Wendy’s boss is appalled by these rag-tag artists and fires Wendy.

Eventually Henry’s involvement with the artists, whose living space is in Central Park, helps him discover what he can do with his wealth with the help of Wendy.

The author, who lives in Minneapolis, began his career by working on television soap operas and game shows at NBC in Burbank, Calif. He has served as a CBS-affiliate news producer as well as executive speechwriter and creative director at production agencies in the Twin Cities. A teacher at the Loft Literary Center in Minneapolis, he is married to former Loft director Jocelyn Hale. Miller has also served on the boards of independent publishers Graywolf Press and Coffee House  House Press and is former president of Friends of the Minneapolis Public Library.

(Courtesy of the author)

“Murder in the Tea Leaves”: by Laura Childs (Berkley Prime Crime, $28.99)

Theodosia shouted at the top of her lungs, pounded on the door, and finally resorted to kicking it with all her might. The door didn’t shatter, budge, or break. She was locked in the attic with nothing but the remains of a mystery — the bizarre tale of a woman’s strange imprisonment. — from “Murder in the Tea Leaves”

Minnesotan Gerry Schmitt, who writes as Laura Childs (Courtesy of the author)

Theodosia Browning, owner of the Indigo Tea Shop in Charleston, S.C., takes on Hollywood in Laura Childs’ 27th tea shop cozy. Theo is providing snacks for the crew of a horror film being produced in an abandoned old mansion when the lights go out and the director’s body is lifted off his metal chair, sparks flying all around him. So begins Theo’s investigation into who would kill the director by wiring electricity to a chair. There is no shortage of suspects, as usual. Among them are the new director who seemed to step into the role a little too smoothly, the head script writer, the film’s female star and the head electrician. When one of Theo’s friends is shot in her antique shop, Theo risks her life and that of Drayton, her tea sommelier, during a late-night confrontation with the bad guys in the city’s harbor.

As with all tea shop mysteries by Childs (pen name for Minnesotan Gerry Schmitt), Theo’s charming shop is a main character as she, Drayton and chef Haley orchestrate meals and themed events such as Vintage and Poetry teas. What goes on at the tea shop is as interesting as the mystery, showing Theo’s smarts as a small-business owner. Childs does a terrific job of evoking the sounds and smells of old Charleston, its stately mansions and its long history. And we can count on her being protected by Earl Grey, her big dog. Now if only Theo could spend some quality time with her boyfriend Riley, a detective who keeps telling her to stop investigating or she’ll get hurt. But an intrepid and brave sleuth never listens to that kind of advice. (The book includes 12 of Haley’s recipes, from Ham and Sweet Potato Casserole to Double-Chocolate Scones and Waldorf Tea Sandwiches.)

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In new shared studio, opening soon in Marine on St. Croix, artists Emily Anderson and Katy Helen aim to connect with nature — and neighbors

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Last winter, mosaic artist Katy Helen sent a serendipitous email.

She had moved her family to Marine on St. Croix over the summer, after nearly a decade and a half in California. For much of her time there, she’d created her intricately tiled surfboards in an independent studio, and now, back in her home state, she wanted a shared creative space.

She found a building that could house a studio — the old Marine Cafe space on Judd Street — but needed a partner.

As she asked around, one name kept popping up: the landscape painter Emily Anderson. They’d never met, but Helen invited her to coffee.

They hit it off immediately. Both artists’ work is deeply inspired by nature and particularly water; they’re both moms and both previously lived in California and both have similar business models and ideas of what makes for a positive work environment.

And both artists were feeling the isolation that comes from working alone in a studio and shipping finished work to customers they may only rarely, if ever, meet in person. Anderson, who used to run the HWY North Gift Shop & Gallery in town, particularly missed being able to invite community members into her creative space.

What if they built their own shared studio?

“We went from ‘Hi, nice to meet you’ to ‘Should we partner on this?’ by the end of coffee,” Helen said.

Marine Village Art Studios is set to open on June 1 and 2, during Art Opener, an open-studio event across the St. Croix Valley.

Following the studios’ grand opening, Helen and Anderson plan to have additional open studio days throughout the summer and fall, and you can stop in any time by making an appointment with either artist.

The building’s interior is unrecognizable from its former life as the Marine Cafe: It’s bright and airy; the bold red walls are gone, as are the wall shelves (and ceilings) full of antique trinkets and bike parts. The kitchen equipment was removed — except for a large sink, helpful for artists — and plenty of kitchen grease was scrubbed away.

“It’s just so good to have excitement and new energy, and it seemed like the perfect way to have a storefront that’s welcoming to the community, where we can have events and invite people to see what we’re doing,” Anderson said. “It seemed like everything was perfectly timed.”

As they get closer to settling into their new creative spaces, their art is evolving, too.

Anderson is experimenting with larger compositions, which she said “is exciting and also scary.”

As for Helen, one of the first major purchases she made when she moved back to Minnesota was a canoe, and she’s been paddling at William O’Brien State Park. In California, the mosaics she’d create on surfboards were rooted in the nearby Pacific coast, but here, inspiration comes from the river.

A work-in-progress: She commissioned a smaller handmade wooden canoe, which she split lengthwise — so each side can be mounted on a wall — and is tiling it.

“And I’ve recognized scenes from William O’Brien in Emily’s paintings,” Helen said. “That’s one of the first Minnesota-inspired directions I’ve taken here, is doing art on canoes. It’s fun to see, now, how…the art is connecting to the place.”

Marine Village Art Studios: 41 Judd St., Marine on St Croix; open periodically and via appointment; marinevillagestudios.com

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