Zen⚡️Chu ⛑🏴‍☠️🇺🇸

OpenEvidence started as the place clinicians go to find clinical evidence. Now they're becoming the place medical societies go to CREATE it - that's a whole new moat for winning the AI CDS market. My 5 thoughts... First, the gist of what OpenEvidence announced: → The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) and OpenEvidence have partnered to keep clinical practice guidelines current using AI-augmented literature surveillance → OpenEvidence built a custom methodology with AAO-HNSF that systematically compares existing guideline recommendations against current medical literature. → The system flags specific recommendations for review when new evidence either supports revising the existing guidelines or reaffirms it. → AAO-HNSF has already applied this to several of its existing clinical practice guidelines. The goal is to make it easier and faster for societies to keep guidelines up-to-date. My 5 thoughts on this strategy and what it means for the AI CDS industry: 1/ OpenEvidence has strengthened its market position by going beyond simply licensing clinical content from medical societies and journals. By creating a way to add value to medical societies directly, and thus create some dependency for medical societies on OE, it incentivizes those societies to encourage their members to choose OE over other tools. 2/ This is awesome for clinical guideline maintenance. Many clinical practice guidelines become outdated because too many years can go by without a review or updates simply because doing a review is very time and labour intensive. It’s increasingly difficult because the pace of research outpaces our ability to incorporate them into guidelines. By reducing friction to making such updates, we will see guideline updates skyrocket. 3/ In the past, some clinicians may have minimized the value of guidelines because they could be quickly out of date. But if these tools can truly make guidelines more current, the clinician community will be even more willing to use them. This will lead to better patient care. 4/ This puts OE on a potential path to expansion beyond simply evidence search and curation and into opportunities of evidence generation itself. OE is starting by helping to update guidelines, but what if OE creates AI tools to suggest and draft not yet developed, brand new guidelines in the first place? That seems inevitable and the smart thing to do. 5/ This illustrates one of the powerful things about startups. OE has the freedom and courage to try new stuff like this very easily - how do the large incumbents move quickly enough to not just catch up but lead the way on product innovation? Unlike a big entrenched EHR, it’s hard to see how CDS products - even legacy ones - have much of a moat.

People think AI and biology and optics are SO separate. That what we are doing is SO wild. No, it’s actually following the history of all three fields. In 1957 Marvin Minsky patented the confocal microscope. Marvin Minsky, father of artificial intelligence. He wanted to see inside dense brain tissue. Conventional microscopes were useless. Too much scatter and blur and absolute garbage signal to noise. So he built a system that used a pinhole to block out-of-focus light and let you optically slice through neural tissue layer by layer. He showed it to people, like with most brilliant things, they initially didn’t care. The images were faint and scan-based and didn’t look sharp enough on the display. He later said he should’ve just used a smaller screen lol. So he dropped it and pivoted fully into AI. Decided studying the brain’s wiring was less relevant to him than studying its logic. The microscope sat ignored for 30 years. Then lasers made confocal scanning practical and it became one of the most important instruments in all of cell biology. Here’s what people miss though. AI didn’t come from just pure theory and math. AI came from biology and observation of biology. Neural networks are literally named after neurons. Perceptrons were modeled on how the brain processes signals. The entire field exists because people were trying to understand living systems and said “what if we could build something that learns like that.” Biology created AI. Not the other way around. And biology will never stop mattering. You can build the most sophisticated model in the world but if you’re training it on dead cell snapshots and bulk averages you’re just getting really good at being wrong. The data has to come from, be inspired by, life as we (barely!) understand it. That’s where optics changes everything. When you can actually watch a living cell make decisions in real time, label-free, at the molecular level… you’re not inferring biology anymore. You’re seeing it. That’s a whole different dimension of data that no amount of compute can hallucinate into existence. The guy who literally made AI also built one of biology’s most important instruments. the problem demanded it. He didn’t care what “field” it was. I don’t care what field you call my work either. It’s about the discovery and the solution to the problem I guess all i am saying is: he needed to see something so he built the thing that let him see it. Because, why the fuck not? (I agree with my whole heart and career.) The boundaries between these fields have never been real. The problems are real. The tools follow.

Whether the next president is a Republican or a Democrat, can we have someone with at least a little class next time? Because this is embarrassing.

Getting asked so I'll pull it here: What about other major allied health professionals ALL other major allied health professionals account for about 6% of total healthcare spending That includes a long list: Pharmacists and pharmacy techs Physical and occupation therapists Social Workers (all types) Speech/language therapists Respiratory therapists Mental health / Substance Abuse counselors Psychologists About 3.3 million people $300 billiion 6% of healthcare spending

If you don't transmute your anger into courageous action, it will manifest as intense apathy, depression, escapism, or disease, and you will constantly feel like you're wasting your incarnation. Don't suppress it. Use it to create motion.

@mnedoszytko So impressed with your postvisit.ai and congrats on taking 3rd place /13,000 recent hackathon @AnthropicAI

New media businesses are not easy. But because it’s my own thing, I get to set our policies. So for a few years now, I have been sharing a portion of our paid subscriber revenue to nonprofits & charities. I welcome submissions from readers on where we should donate next.

Incorrect. Harvard did not pioneer this. Juan Carlos Izpisua Belmonte is the key pioneer for the first widely cited paper showing partial reprogramming had anti-aging effects in vivo. That 2016 Cell paper reported that short-term cyclic OSKM expression ameliorated age-associated hallmarks and extended lifespan in a mouse model of premature aging.[pubmed.ncbi.nlm.nih +1]

The HPV vaccine Gardasil is one of great successes of modern medicine and is on the way to ELIMINATING cervical cancer in countries from Sweden to Australia! HHS Secretary RFK Jr : it kills people 🤡🤡

For agentic systems founders and dev tools founders: People do not want to pay for raw markdown and they shouldn't have to. But they may pay for orchestration, hosting, updates, collaboration, portability, analytics, and managed execution. These can be great businesses.

The war in the Strait of Hormuz will reach your local pharmacy within six weeks. Not because your pharmacist follows geopolitics. Because the active pharmaceutical ingredients in roughly half of America’s generic prescriptions begin as petrochemical derivatives manufactured in India, and India’s petrochemical industry begins as crude oil that transited 21 miles of water that closed on March 4. Nearly 70 percent of the active ingredients in US generic drugs are produced in India. India imports approximately 40 percent of its crude oil through the Strait of Hormuz. The crude feeds refineries that produce naphtha. The naphtha feeds petrochemical crackers that produce intermediates. The intermediates feed pharmaceutical plants in Gujarat, Maharashtra, and Hyderabad that produce the API, the active pharmaceutical ingredient, that is shipped to contract manufacturers in the United States, Europe, and across Asia. The chain from the strait to the tablet is six steps long. Every step requires the one before it. CNBC reported that the Hormuz closure puts America’s generic drug supply at risk. Fierce Pharma warned of longer-term effects on US manufacturing and generics. Think Global Health mapped the pharmaceutical supply chains most vulnerable to disruption. The consensus across trade publications, health policy analysts, and industry executives is identical: four to six weeks of current inventory exists in the pipeline. After that, shortages begin with the most complex formulations first. Cancer drugs are the highest risk. Biologics requiring cold-chain storage have the shortest shelf life and the longest replenishment cycle. Clinical trial medications depend on uninterrupted supply chains that are now interrupted. Insulin analogues, antivirals, and cardiac medications all contain intermediates sourced from Indian manufacturers whose input costs are rising with every day the strait remains closed. Air cargo is the emergency bypass. But air freight rates from India have climbed 200 to 350 percent on some routes since the war began, according to logistics tracking firms. Gulf air capacity is down 79 percent because airports in the UAE, Kuwait, and Qatar have been damaged or operate under restricted conditions. The Suez Canal route adds 10 to 14 days to maritime shipping times. The Cape of Good Hope route adds 21 to 28 days. Both alternatives assume the Red Sea remains navigable, which the Houthi threat has complicated since 2024. The World Health Organisation reported a 70 percent funding gap for its operational response in the region. Medical supply chains to Iran itself have been devastated, with hospitals reporting shortages of surgical supplies, blood products, and anaesthetics. But the downstream pharmaceutical effect extends far beyond the war zone. Every Indian manufacturer that pays more for crude pays more for naphtha, pays more for intermediates, and passes the cost forward into API prices that American generic drug companies absorb until they cannot absorb any further. The molecule does not know it is a medicine. The strait does not know it is a pharmacy. The petrochemical derivative that becomes a blood pressure tablet transits the same water as the petrochemical derivative that becomes a fertiliser pellet. Both are trapped. Both have shelf lives. Both have planting windows or prescription refill cycles that do not negotiate with blockades. Six weeks. Then the pharmacy starts calling patients about substitutions. open.substack.com/pub/shanakaans…

🚨Someone just open sourced a computer that works when the entire internet goes down. It's called Project N.O.M.A.D. A self-contained offline survival server with AI, Wikipedia, maps, medical references, and full education courses. No internet. No cloud. No subscription. It just works. Here's what's packed inside: → A local AI assistant powered by Ollama (works fully offline) → All of Wikipedia, downloadable and searchable → Offline maps of any region you choose → Medical references and survival guides → Full Khan Academy courses with progress tracking → Encryption and data analysis tools via CyberChef → Document upload with semantic search (local RAG) Here's the wildest part: A solar panel, a battery, a mini PC, and a WiFi access point. That's it. That's your entire off-grid knowledge station. 15 to 65 watts of power. Works from a cabin, an RV, a sailboat, or a bunker. Companies sell "prepper drives" with static PDFs for $185. This gives you a full AI brain, an entire encyclopedia, and real courses for free. One command to install. 100% Open Source. Apache 2.0 License.

@eringriffith Oh my.. Delve team are very rapidly, in the past ten minutes taking down pages and news articles they were hosting but I saved this fun one here: web.archive.org/web/2025072214…

Delve, a YC-backed compliance startup that raised $32 million, has been accused of systematically faking SOC 2, ISO 27001, HIPAA, and GDPR compliance reports for hundreds of clients. According to a detailed Substack investigation by DeepDelver, a leaked Google spreadsheet containing links to hundreds of confidential draft audit reports revealed that Delve generates auditor conclusions before any auditor reviews evidence, uses the same template across 99.8% of reports, and relies on Indian certification mills operating through empty US shells instead of the "US-based CPA firms" they advertise. Here's the breakdown: > 493 out of 494 leaked SOC 2 reports allegedly contain identical boilerplate text, including the same grammatical errors and nonsensical sentences, with only a company name, logo, org chart, and signature swapped in > Auditor conclusions and test procedures are reportedly pre-written in draft reports before clients even provide their company description, which would violate AICPA independence rules requiring auditors to independently design tests and form conclusions > All 259 Type II reports claim zero security incidents, zero personnel changes, zero customer terminations, and zero cyber incidents during the observation period, with identical "unable to test" conclusions across every client > Delve's "US-based auditors" are actually Accorp and Gradient, described as Indian certification mills operating through US shell entities. 99%+ of clients reportedly went through one of these two firms over the past 6 months > The platform allegedly publishes fully populated trust pages claiming vulnerability scanning, pentesting, and data recovery simulations before any compliance work has been done > Delve pre-fabricates board meeting minutes, risk assessments, security incident simulations, and employee evidence that clients can adopt with a single click, according to the author > Most "integrations" are just containers for manual screenshots with no actual API connections. The author describes the platform as a "SOC 2 template pack with a thin SaaS wrapper" > When the leak was exposed, CEO Karun Kaushik emailed clients calling the allegations "falsified claims" from an "AI-generated email" and stated no sensitive data was accessed, while the reports themselves contained private signatures and confidential architecture diagrams > Companies relying on these reports could face criminal liability under HIPAA and fines up to 4% of global revenue under GDPR for compliance violations they believed were resolved > When clients threaten to leave, Delve reportedly pairs them with an external vCISO for manual off-platform work, which the author argues proves their own platform can't deliver real compliance > Delve's sales price dropped from $15,000 to $6,000 with ISO 27001 and a penetration test thrown in when a client mentioned considering a competitor

I'm refreshing some of the slides in my healthcare 101 ​course​, and one of the things that always surprises me is how many two-way negotiators there are in healthcare. > Pharmaceutical Benefits Managers (PBMs) negotiate on behalf of their health insurance clients, but get rebates from pharma companies that they're negotiating against. > Group Purchasing Organizations (GPOs) for medical devices/supplies negotiate prices on behalf of hospitals, but their adminfee is usually a % of the total order that's paid by...the ​vendors​? > Benefits brokers negotiate on behalf of the employers to get better health insurance rates from carriers, but...get paid commission by the carrier? This dynamic exists in other industries, but I think is particularly prevalent in healthcare because 1) Consolidation means that a handful of two-way negotiators basically negotiate for everyone. It's hard for a new "non conflicted" competitor to come in because they'll lack the negotiating power of the existing player. 2) Because no one knows the prices for anything, it's hard to create accountability for decision makers around specific cost-savings they need to achieve. So might as well just picked the tried-and-true vendor, switching is a ton of work on the decision maker. A bunch of expensive wine, dine, and redlines for internal champions probably helps. 3) The buyer very rarely directly feels the pain of this two way negotiation. Usually the cost ends up getting passed to someone else (e.g. patients or the government) or it's felt indirectly through things like worse benefit design, fewer drugs covered, etc.

Proteins can now talk. Introducing BioReason-Pro, the first reasoning model for protein function. A thread🧵

Is "textbook performance" enough for medical AI? The first independent stress test of ChatGPT Health is out in @NatureMedicine. The Good: Near-perfect triage for textbook stroke and anaphylaxis. The Bad: A 51.6% under-triage rate for true emergencies. But there’s a massive elephant in the room: How fair is a safety study without a human control group? More analysis at link in comments.

Amazing interview w @ShivdevRao on where @AbridgeHQ physicians and patients are taking health Ai

I am a US citizen & Surgeon who took care of the Boston Maraton Bombing victims in 2013. I paid for 7 years to own a small apartment in downtown #Beirut for my 3 kids to enjoy summers there. Today, #Israel reduced my dream home to rubble, with american weapons, paid by my taxes.

What if we could engineer T cells in the body, making CAR T vs cancer, autoimmune diseases, and other applications far more practical, much less expensive? A step forward today via genome editing T cells nature.com/articles/d4158… nature.com/articles/s4158…