New MIT digital health initiative: MIT Initiative
This is an extraordinary article: in length (it is very long) and in breadth (it covers the universe, beginning with first principles), and in quality (it is lay person readable).
The article is actually one article of four. Here is the first, all about Elon Musk:
Great story. No silver bullets here. Just process improvements.
The death rate from coronary heart disease has dropped 38 percent in a decade. One reason is that hospitals, rich and poor, have streamlined emergency treatment.
Notes on Gawker
This aggregation of blog sites like gawker.com and lifehacker.com has a few underlying themes:
Examples are: gawker.com and lifehacker.com
Nick Denton is the founder (2002, after selling First Tuesday, a networking site for technologists). He is well known as an early proselytizer of Facebook. He is an Oxford graduate son of a Professor of Economics and a psychotherapist.
He started out as a “sweat shop for free lance bloggers” and now is a bit more civilized.
Reputation is one of being relentlessly transparent, and ruining many lives in the process.
They are mega controversial – they posted a video of Hulk Hogan havingg sex with a good friend’s wife, for example.
a ton of their traffic (approx 25%) comes from Facebook
Has a bunch of cool writers like Tom Scocca and Neetzam Zimmerman (viral internet guru)
NYT describes Gawker as having “an unwavering commitment to truth telling” or, less generously, “a relentless cynicism”
Article in Sunday NYT, June 14, 2015
Gawker Media is an online media company and blog network, founded and owned by Nick Denton and based in New York City. It is considered to be one of the most visible and successful blog-oriented media companies. Incorporated in the Cayman Islands As of March 2012, it is the parent company for eight different weblogs: Gawker.com, Deadspin, Lifehacker, Gizmodo, io9, Kotaku, Jalopnik, and Jezebel. All Gawker articles are licensed on a Creative Commons attribution-NonCommercial license. 
1 Revenue and traffic
2.1 Sourcecode breach
2.2 2011 redesign and traffic loss
2.3 Leaked script
2.4 Collective action
3 List of Gawker Media weblogs
3.2 Licensed Australian weblogs
3.3 Weblogs formerly owned by Gawker
4 See also
6 External links
Revenue and traffic
While Denton does not go into detail over Gawker Media’s finances, he has downplayed the profit potential of blogs, declaring that “[b]logs are likely to be better for readers than for capitalists. While I love the medium, I’ve always been skeptical about the value of blogs as businesses”, on his personal site.
In an article in the February 20, 2006 issue of New York Magazine, Jossip founder David Hauslaib estimated Gawker.com’s annual advertising revenue to be at least $1 million, and possibly over $2 million a year. Combined with low operating costs—mostly web hosting fees and writer salaries—Denton was believed to be turning a healthy profit by 2006. In 2009, the corporation was estimated to be worth $300 million, with $60 million in advertising revenues and more than $30 million in operating profit.
Gawker Media was originally incorporated in Budapest, Hungary, where a small company facility is still maintained. The company was headquartered at Nick Denton’s personal residence in the New York neighborhood of SoHo, and it remained there until 2008. That year he created a new base of operations in Nolita in Manhattan.
On April 14, 2008, Gawker.com announced that Gawker Media had sold three sites: Idolator, Gridskipper, and Wonkette.
In a fall 2008 memo, Denton announced the layoff of “19 of our 133 editorial positions” at Valleywag, Consumerist, Fleshbot and other sites, and the hiring of 10 new employees for the most commercially successful sites—Gizmodo, Kotaku, Lifehacker, and Gawker—and others which were deemed to promise similar commercial success (Jezebel, io9, Deadspin, and Jalopnik). Denton also announced the suspension of a bonus payment scheme based on pageviews, by which Gawker had paid $50,000 a month on the average to its staff, citing a need to generate advertising revenue as opposed to increasing traffic. He explained these decisions by referring to the 2008 credit crisis, but stated that the company was still profitable. In September 2008, Gawker reported 274 million pageviews.
On November 12, 2008, Gawker announced that Valleywag would fold into Gawker.com. The Consumerist was sold to Consumers Union, who took over the site on January 1, 2009. 
On February 22, 2009, Gawker announced that Defamer.com would fold into Gawker.com.
In October 2009, Gawker Media websites were infected with malware in the form of fake Suzuki advertisements. The exploits infected unprotected users with spyware and crashed infected computer’s browsers. The network apologized by stating “Sorry About That. Our ad sales team fell for a malware scam. Sorry if it crashed your computer”. Gawker shared the correspondence between the scammers and Gawker via Business Insider.
On February 15, 2010, Gawker announced it had acquired CityFile, an online directory of celebrities and media personalities. Gawker’s Editor-in-Chief Gabriel Snyder announced that he was being replaced by CityFile editor Remy Stern.
On December 11, 2010, the Gawker group’s 1.3 million commenter accounts and their entire website source code was released by a hacker group named Gnosis. Gawker issued an advisory notice stating: “Our user databases appear to have been compromised. The passwords were encrypted. But simple ones may be vulnerable to a brute-force attack. You should change your Gawker password and on any other sites on which you’ve used the same passwords”. Gawker was found to be using DES-based crypt(3) password hashes with 12 bits of salt. Security researchers found that password-cracking software “John the Ripper” was able to quickly crack over 50% of the passwords from those records with crackable password hashes. Followers of Twitter accounts set up with the same email and password were spammed with advertisements. The Gnosis group notes that with the source code to the Gawker content management system they obtained, it will be easier to develop new exploits.
2011 redesign and traffic loss
As part of a planned overhaul of all Gawker Media sites, on 1 February, 2011, some Gawker sites underwent a major design change as part of the larger roll-out. Most notable was the absence of heretofore present Twitter and StumbleUpon sharing buttons. Nick Denton explained that Facebook had been by far the biggest contributor to the sites’ traffic and that the other buttons cluttered the interface. This decision lasted three weeks, after which the buttons were reinstated, and more added.
On 7 February, 2011, the redesign was rolled out to the remainder of the Gawker sites. The launch was troubled due to server issues. Kotaku.com and io9.com failed to load, displaying links but no main content, and opening different posts in different tabs didn’t work, either.  The new look emphasised images and de-emphasised the reverse chronological ordering of posts that was typical of blogs. The biggest change was the two-panel layout, consisting of one big story, and a list of headlines on the right. This was seen as an effort to increase the engagement of site visitors, by making the user experience more like that of television. The site redesign also allowed for users to create their own discussion pages, on Gawker’s Kinja. Many commenters largely disliked the new design, which was in part attributed to lack of familiarity.
Rex Sorgatz, designer of Mediaite and CMO of Vyou, issued a bet that the redesigns would fail to bring in traffic, and Nick Denton took him up on it. The measure was the number of page views by October recorded on Quantcast. Pageviews after the redesign declined significantly—Gawker’s sites saw an 80% decrease in overall traffic immediately after the change and a 50% decrease over two weeks—with many users either leaving the site or viewing international versions of the site, which hadn’t switched to the new layout. On 28 February, 2011, faced with declining traffic, Gawker sites allowed for visitors to choose between the new design and the old design for viewing the sites. Sorgatz was eventually determined to be the winner of the bet, as at the end of September, 2011, Gawker had only 500 million monthly views, not the 510 million it had had prior to the redesign. However, on 5 October, 2011, site traffic returned to its pre-redesign numbers, and as of February 2012, site traffic had increased by 10 million over the previous year, according to Quantcast. As of March 23, 2012, commenting on any Gawker site required signing in with a Twitter, Facebook, or Google account.
In January 2014, Quentin Tarantino filed a copyright lawsuit against Gawker Media for distribution of his 146-page script for The Hateful Eight. He claimed to have given the script to one of six few trusted colleagues, including Bruce Dern, Tim Roth, and Michael Madsen. Due to the spreading of his script, Tarantino told the media that he wouldn’t continue with the movie. “Gawker Media has made a business of predatory journalism, violating people’s rights to make a buck,” Tarantino said in his lawsuit. “This time they went too far. Rather than merely publishing a news story reporting that Plaintiff’s screenplay may have been circulating in Hollywood without his permission, Gawker Media crossed the journalistic line by promoting itself to the public as the first source to read the entire Screenplay illegally.”
On 22 June, 2013, unpaid interns brought a Fair Labor Standards Act action against Gawker Media and founder Nick Denton. As plaintiffs, the interns claimed that their work at sites io9.com, Kotaku.com, Lifehacker.com and Gawker.TV was “central to Gawker’s business model as an Internet publisher,” and that Gawker’s failure to pay them minimum wage for their work therefore violated the FLSA and state labor laws. Although some interns had been paid, the court granted conditional certification of the collective action.
In October 2014, a federal judge ruled that notices could be sent to unpaid interns throughout the company who could potentially want to join the lawsuit.
List of Gawker Media weblogs[
• Cink – Hungarian
• Deadspin – Sports
• The Concourse – Music, food, sports-related pop culture
• Screamer – Deadspin’s soccer hub
• The Stacks
• Adequate Man
• Gawker.com – New York City media and gossip, tabloid
• Valleywag – San Francisco, Silicon Valley and tech gossip
• Morning After
• Gawker Review of Books
• True Stories
• The Vane
• Fortress America
• Black Bag
• Gizmodo – Gadget and technology lifestyle
• Sploid – News, futuristic ideas and tech
• Indefinitely Wild – Adventure Travel in the Outdoors with Wiley
• Field Guide
• White Noise
• io9 – Science/Science Fiction
• Observation Deck
• True Crime
• Jalopnik – Cars and automotive culture
• Buyer’s Guide
• Opposite Lock
• Foxtrot Alpha
• Truck Yeah – Trucks and truck culture
• Car Buying
• Code 3
• Black Flag
• Jezebel – Celebrity, Sex, Fashion for women
• Thats What She Said
• The Muse
• The Powder Room
• I Thee Dread
• Kotaku – Video games and East Asian pop culture
• The Bests
• Talk Amongst Yourselves
• Pocket Monster
• Lifehacker – Productivity tips
• After Hours
• Two Cents
• Shop Talk
Licensed Australian weblogs
• Gizmodo Australia – Gadgets and technology
• Kotaku Australia – Games and gaming industry coverage
• Lifehacker Australia – Tips, tricks, tutorials, hacks, downloads and guides
Weblogs formerly owned by Gawker
• Consumerist – Consumer advocate: Now owned by Consumer Reports
• Fleshbot – Pornography: Now owned by editor Lux Alptraum
• Gawker Artists – Contemporary/Rising Art Registry 
• Gawker.TV – Television and online video
• Gridskipper – Travel: Now owned by Curbed Network
• Idolator – Music: Now owned by BuzzMedia
• Oddjack – Gambling
• Screenhead – Online video: Now unrelated film site
• Wonkette – Washington D.C. gossip and politics: Now independent
• Weblogs, Inc.
1 ^ Gawker Media. Using Gawker Media Content
2 ^ Penenberg, Adam L. “Can Bloggers Strike It Rich?” Wired. September 22, 2005.
3 ^ Denton, Nick. “Nano Wars” March 8, 2005.[dead link]
4 ^ Thompson, Clive. “Blogs to Riches – The Haves and Have-Nots of the Blogging Boom” New York Magazine. February 20, 2006.
5 ^ Carr, David. “A Blog Mogul Turns Bearish on Blogs”, New York Times, July 3, 2006
6 ^ Pareene, Alex. “Memo: Gawker Sells Three Sites” April 14, 2008.
1 Jump up ^ Gawker Media is the Goldman Sachs of the Internet, The Awl, July 27, 2009
2 Jump up ^ Gardner, Eric (February 19, 2014) “Gawker to Quentin Tarantino: We’re Safely Based in the Cayman Islands”, Hollywood Reporter. (Retrieved 3-5-2014.)
3 Jump up ^ McIntyre, Douglas A. (2009-11-10). “The Twenty-Five Most Valuable Blogs In America”. 24/7 Wall St. Retrieved 2009-11-10.
4 Jump up ^ McGrath, Ben (18 October 2010). “Search and Destroy: Nick Denton’s blog empire”. The New Yorker (Condé Nast): 50–61. Retrieved 2011-01-21.
5 ^ Jump up to: a b c Owen Thomas: Valleywag cuts 60 percent of staff Valleywag, 3 October 2008
6 Jump up ^ “Defamer Folds Into Gawker; Editors to Pursue Careers in Bearded Hip-Hop”. gawker.com. 2009-02-22. Retrieved 2009-03-23. |first1= missing |last1= in Authors list (help)
7 Jump up ^ Popken, Ben (2009-10-27). “Gawker Duped By Malware Gang, Serves Up Infected Suzuki Ads”. The Consumerist. Retrieved 2010-04-27.
8 Jump up ^ Blodget, Henry (2009-10-26). “Gawker Scammed By Malware Crew Pretending To Be Suzuki”. Business Insider. Retrieved 2010-04-27.
9 Jump up ^ Techshrimp
10 Jump up ^ “Gawker website Hacked by Gnosis ; Gnosis says they are not 4chan or Anonymous”. TechShrimp. 2010-12-12. Retrieved 2010-12-12.
11 Jump up ^ “Commenting Accounts Compromised — Change Your Passwords”. Lifehacker. 2010-11-12. Retrieved 2010-12-12.
12 ^ Jump up to: a b “Brief Analysis of the Gawker Password Dump”. Duo Security. 2010-12-13. Retrieved 2010-12-18.
13 Jump up ^ “Acai Berry spam attack connected with Gawker password hack, says Twitter | Naked Security”. Nakedsecurity.sophos.com. Retrieved 2012-11-15.
14 Jump up ^ “Gnosis on Gawker Hack, Web Security”. Geekosystem. 2010-12-13. Retrieved 2012-11-15.
15 Jump up ^ Salmon, Felix (2010-12-1). “The new Gawker Media”. Retrieved 2014-10-21. Check date values in: |date= (help)
16 Jump up ^ Peterson, Latoya (2011-02-08). “How Gawker’s redesign subverts the scannable culture of the Internet it helped create”. Retrieved 2014-10-21.
17 Jump up ^ McCarthy, Caroline (2011-02-01). “Twitter buttons disappear from Gawker redesign”. Retrieved 2014-10-21.
18 Jump up ^ Jeffries, Adrianne (2011-02-25). “gawker redesign Gawker’s Ban on ‘Shiny Bauble’ Share Buttons Lasted One Week”. Retrieved 2014-10-21.
19 ^ Jump up to: a b Covert, James (2011-02-08). “Gawker Web redesign met with Bronx cheers”. Retrieved 2014-10-21.
20 ^ Jump up to: a b Romenesko, Jim (2014-02-28). “Denton: Gawker’s redesign more bruising than it needed to be”. Retrieved 2014-10-21.
21 Jump up ^ LaCapria, Kim (2011-02-07). “Are you digging on the Gawker Media extreme makeover?”.
22 Jump up ^ Mims, Christopher (2011-02-11). “Gawker.com’s Redesign is the Future of Gawker–Period”. Retrieved 2014-10-21.
23 Jump up ^ Ellis, Justin (2011-02-12). “Jalopnik redesign shows how Gawker Media plans to open up blogging to its readers”. Retrieved 2014-10-21.
24 Jump up ^ Leach, Anna (2011-03-29). “Rage against the redesign”. Retrieved 2014-10-21.
25 Jump up ^ Garber, Megan (2011-02-07). ““It just feels inevitable”: Nick Denton on Gawker Media sites’ long-in-the-works new layout”. Retrieved 2014-10-21.
26 Jump up ^ Observer Staff (2011-02-07). “Nick Denton Bets Cash Gawker Redesign Boosts Pageviews”. Retrieved 2014-10-21.
27 Jump up ^ “Gawker’s Traffic Numbers Are Worse Than Anyone Anticipated – Nicholas Jackson”. The Atlantic. 2012-11-06. Retrieved 2012-11-15.
28 Jump up ^ Schonfeld, Erick (2011-02-17). “Gawker’s Gulp Moment: Big Redesign Is Driving People Away”. Retrieved 2014-10-21.
29 Jump up ^ De Rosa, Anthony (2011-03-03). “The rise and fall of Gawker media”. Retrieved 2014-10-21.
30 Jump up ^ “Gawker.com Site Info”. Alexa.com. 2011-11-01. Retrieved 2012-11-15.
31 Jump up ^ Stableford, Dylan (2014-02-28). “Gawker Admits Redesign Mistakes, Rolls Out Fixes”. Retrieved 2014-10-21.
32 Jump up ^ Alvarez, Alex (2011-03-01). “Nick Denton Admits Gawker’s Redesign Wasn’t All They’d Hoped It Be”. Retrieved 2014-10-21.
33 Jump up ^ Davis, Noah (2011-10-05). “Nick Denton Loses Bet That The Gawker Redesign Wouldn’t Hurt Traffic”. Retrieved 2014-10-23.
34 Jump up ^ Olanoff, Drew (2012-02-02). “Remember that Gawker redesign? A year’s worth of data says it worked”. Retrieved 2014-10-21.
35 Jump up ^ “Transitioning Your Commenting Account: The FAQ”. Lifehacker.com. 2012-03-23. Retrieved 2012-11-15.
36 Jump up ^ Quentin Tarantino sues Gawker over Hateful Eight script leak – Arts & Entertainment – CBC News
37 Jump up ^ Gettell, Oliver (January 22, 2014). “Quentin Tarnatino mothballs ‘Hateful Eight’ after script leak”. Los Angeles Times. Tribune Company. Retrieved January 27, 2014.
38 Jump up ^ Gardner, Eriq (27 January 2014). “Quentin Tarantino Suing Gawker Over Leaked ‘Hateful Eight’ Script (Exclusive)”. Hollywood Reporter. Retrieved 27 January 2014.
39 Jump up ^ Shotwell, James (27 January 2014). “QUENTIN TARANTINO SUING GAWKER FOR SHARING LEAKED ‘HATEFUL EIGHT’ SCRIPT”. Under the Gun Review. Retrieved 27 January 2014.
40 Jump up ^ O’Connell, Sean (27 January 2014). “Quentin Tarantino Sues Gawker Over The Hateful Eight Script Leak”. Cinema Blend. Retrieved 27 January 2014.
41 Jump up ^ Smythe, Christie (2013-06-22). “Gawker’s Unpaid Interns Sue After Fox Searchlight Ruling”. Retrieved 2014-10-21.
42 Jump up ^ Gardner, Eriq. “Gawker Hit With Class Action Lawsuit by Former Interns”. Retrieved 2014-10-21.
43 Jump up ^ Smith, Allen (2014-08-20). “Gawker Faces Collective Action by Unpaid Interns”. Retrieved 2014-10-21.
44 Jump up ^ The HR Specialist: New York Employment Law (2014-10-19). “Gawker is latest target of unpaid intern class action”. Retrieved 2014-10-21.
• Gawker Media
• Tom Zeller, Jr.. “A Blog Revolution? Get a Grip”, New York Times, May 8, 2005 (registration required)
• Vanessa Grigoriadis, “Everybody Sucks: Gawker and the rage of the creative underclass, New York magazine, October 22, 2007
• v t e
• Gawker.com Gizmodo Kotaku Jalopnik Lifehacker Deadspin Jezebel io9 Valleywag
Nick Denton sites
Sold by Gawker
• Fleshbot Idolator Wonkette Consumerist
• Charlie Jane Anders Ana Marie Cox Brian Crecente Nick Denton George Dvorsky Emily Gould Maura Johnston Brian Lam David Lat Will Leitch Annalee Newitz Alex Pareene Max Read Tim Rogers Peter Rojas Elizabeth Spiers Owen Thomas Gina Trapani Ray Wert Neetzan Zimmerman
From Business Insider
Apple’s plan to take over your entire home will start in these two categories
EUGENE KIM JUN. 2, 2015, 3:31 PM 202
The first batch of products built on top of Apple’s HomeKit — a framework that helps develop iPhone-controlled home appliances — are finally out. The products range from a lighting dimmer and an air quality monitor to an energy consumption tracker and a door locks controller.
The first HomeKit-based products show which categories will lead the way for the broader shift to a connected-home: home-energy equipment and home safety and security systems. According to BI Intelligence, most of the connected-home devices will first be built in these two areas, as they are fairly cheap and easy to install – making them more accessible for average homeowners.
Smart home-energy devices, such as the Nest thermostat, are expected to grow at a compound annual rate of 74% between 2014 and 2019, while home safety and security systems, led by companies like Dropcam, are set to see a 77% compound annual growth rate by 2019. And with the number of households with broadband internet connections expected to reach 1.2 billion globally, connected-home devices will only continue to grow.
Refer to: April 2015 Blog Post on Apple, J&J, and Watson
IBM says each person generates one million gigabytes of health-related data across his or her lifetime, the equivalent of more than 300 million books. IBM launched the new Watson Health business unit to help patients, physicians, researchers and insurers use data to achieve better health and wellness for all.
IBM’s Dr. Watson Will See You…Someday
The game-show-winning AI struggles to find the answers in health care
By Brandon Keim
Posted 29 May 2015 | 8:00 GMT
Four years ago, Neil Mehta was among the 15 million people who watched Ken Jennings and Brad Rutter—the world’s greatest “Jeopardy!” players—lose to an IBM-designed collection of circuits and algorithms called Watson.
“Jeopardy!” is a television game show in which the host challenges contestants with answers for which they must then supply the questions—a task that involves some seriously complicated cognition. Artificial-intelligence experts described Watson’s triumph as even more extraordinary than IBM supercomputer Deep Blue’s history-making 1997 defeat of chess grandmaster Garry Kasparov.
To an AI aficionado, Watson was a tour de force of language analysis and machine reasoning. To Mehta, a physician and professor at the world-renowned Cleveland Clinic, Watson was a question unto itself: What might be possible were Watson’s powers turned to medicine? “I love technology, and I was rooting for Watson,” says Mehta. “I knew that the world was changing. And if not Watson, then something like it, with artificial intelligence, was needed to help us.”
Mehta wasn’t the first doctor to dream of a computer coming to his rescue. There’s a rich history of medical AIs, from Internist-1—a 1970s-era program that encoded the expertise of internal-medicine guru Jack Myers and gave rise to the popular Quick Medical Reference program—to contemporary software like Isabel and DXplain, which can outperform human doctors in making diagnoses. Even taken-for-granted ubiquities like PubMed literature searches and automated patient-alert systems demonstrate forms of intelligence.
Powerful as those programs may be, though, they’re not always considered smart. Watson, with its ability to process natural language, make inferences, and learn from mistakes, embodied something much more sophisticated. It also arrived at an opportune time: Health care, particularly in the United States, was finally experiencing a digital overhaul.
These days, clinical findings, research databases, and journal articles are all available in machine-readable form, making them that much easier to feed to a computer. And federal mandates have made electronic medical records nearly universal. Therefore, software is more tightly integrated than ever into medicine, and there’s a sense that making health care more effective and less expensive requires improved programming.
So it’s no wonder that shortly after Watson’s “Jeopardy!” triumph, IBM announced that it would make Watson available for medical applications. The tech press buzzed in anticipation of “Dr. Watson.” What was medicine, after all, but a series of logical inferences based on data? Four years later, however, the predicted revolution has yet to occur. “They are making some headway,” says Robert Wachter, a specialist in hospital medicine at the University of California, San Francisco, and author of The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age (McGraw-Hill, 2015). “But in terms of a transformative technology that is changing the world, I don’t think anyone would say Watson is doing that today.”
Where’s the delay? It’s in our own minds, mostly. IBM’s extraordinary AI has matured in powerful ways, and the appearance that things are going slowly reflects mostly on our own unrealistic expectations of instant disruption in a world of Uber and Airbnb. Improving health care represents a profound challenge, and “going to medical school,” as so many headlines have quipped of Watson, takes time.
Impressive as that original “Jeopardy!”-blitzing Watson was, in medical contexts such an automaton is not really useful. After all, that version of Watson was fine-tuned specifically for one trivia game. It couldn’t play The Settlers of Catan, much less make useful recommendations about a 68-year-old man with diabetes and heart palpitations. “ ‘Watson, given my medical record, which is hundreds of pages long, what is wrong with me?’ That’s a question,” says Watson software engineer Mike Barborak. “But it wasn’t a good question for Watson to answer.”
Watson’s engine was powerful, but it needed to be adapted for medicine and, within that broad field, to specific disciplines and tasks. Watson is not a singular program; rather, in the words of Watson research director Eric Brown, it’s a “collection of cognitive-computing technologies that are combined and instantiated in different ways for each of the solutions.”
So there are many different Watsons now being applied to medicine. Some of the first could be found at the Cleveland Clinic, Memorial Sloan Kettering Cancer Center, MD Anderson Cancer Center, and insurance company WellPoint (now called Anthem), each of which started working with IBM to develop its own health-care-adapted version of Watson about three years ago. Two years later, as the hardware shrank from room-size to small enough for a server rack, another round of companies signed on to collaborate with IBM. Among these are Welltok, makers of personal health advisory software; @Point of Care, which is trying to customize treatments for multiple sclerosis; and Modernizing Medicine, which uses Watson to analyze hundreds of thousands of patient records and build treatment models so doctors can see how similar cases have been handled.
Watson’s training is an arduous process, bringing together computer scientists and clinicians to assemble a reference database, enter case studies, and ask thousands of questions. When the program makes mistakes, it self-adjusts. This is what’s known as machine learning, although Watson doesn’t learn alone. Researchers also evaluate the answers and manually tweak Watson’s underlying algorithms to generate better output.
Here there’s a gulf between medicine as something that can be extrapolated in a straightforward manner from textbooks, journal articles, and clinical guidelines, and the much more complicated challenge of also codifying how a good doctor thinks. To some extent those thought processes—weighing evidence, sifting through thousands of potentially important pieces of data and alighting on a few, handling uncertainty, employing the elusive but essential quality of insight—are amenable to machine learning, but much handcrafting is also involved.
It’s slow going, especially as each iteration of Watson needs to be tested with new questions. There’s a certain irony: While modern AI researchers tend to look down on earlier medical AIs like Internist-1 as primitive rules-based attempts to codify expertise, today’s medical Watsons are trying to do something similar, albeit in a far more sophisticated way.
Expectations have also been altered in another respect. Watson’s text-processing powers (its “Jeopardy!” database contained some 200 million pages of text) seemed to make it an ideal tool for handling the rapid growth of medical literature, which doubles in size every five years or so. But a big pool of information isn’t always better. Sometimes, as when modeling the decisions of top lung-cancer specialists at Memorial Sloan Kettering, there aren’t yet journal articles or clinical guidelines with the right answers. The way to arrive at them is by watching doctors practice. And even when relevant data do exist, they are often most useful when presented in smaller expert-curated sets.
Another issue is data quality. WatsonPaths, which Mehta has been developing at the Cleveland Clinic, is the closest thing yet to that archetypal Dr. Watson, but it can work only if the AI can make sense of a patient’s records. As of now, electronic medical records are often an arcane collection of error-riddled data originally structured with hospital administration in mind rather than patient care.
Mehta’s other project, then, is the Watson Electronic Medical Records Assistant, in which the computer is trained to distill those records into something doctors and the program itself might actually use. “That has been a challenge,” says Mehta. “We are not there yet.”
The issues with electronic records underscore the fact that each Watson, whatever its theoretical potential, is deployed in the all-too-human—and often all-too-inhuman—reality of modern health care. Watson can’t make up for the shortage in primary-care physicians or restore the crucial doctor-patient bond lost in an era of 5-minute office visits.
Most fundamentally, Watson alone can’t change the fee-for-service reimbursement structure, common in the United States, which makes the quantity of care—the number of tests, treatments, and specialist visits—more profitable than bottom-line quality. “It’s not just a technology problem,” says Wachter. “It’s a social, clinical, policy, ethical, and institutional problem.”
Watson can’t address all those issues, but it might, perhaps, ameliorate some of them. Better medical-record processing could make for extra minutes with patients instead of extra screens. And helping doctors to analyze hospital and research data could make it easier for them to practice effective evidence-based medicine.
While its “Jeopardy!” triumph was “a great shot in the arm” for the field, says Mark Musen, a professor of medical informatics at Stanford, IBM is just one of many companies and institutions in the medical-AI space. Indeed, mention of Watson sometimes raises hackles within that community. It’s a response rooted partly in competitiveness, but also in a sense that attention to Watson has obscured the accomplishments of others.
Take the AI that Massachusetts General Hospital developed called QPID (Queriable Patient Inference Dossier), which analyzes medical records and was used in more than 3.5 million patient encounters last year. Diagnostic programs like DXplain and Isabel are already endorsed by the American Medical Association, and startup company Enlitic is working on its own diagnostics. The American Society of Clinical Oncology built its big-data-informed CancerLinQ program as a demonstration of what the Institute of Medicine, part of the U.S. National Academies, called a “learning health system.” Former Watson developer Marty Kohn is now at Sentrian, designing programs to analyze data generated from home-based health-monitoring apps.
Meanwhile, IBM is making its own improvements. In addition to refinements in learning techniques, Watson’s programmers have recently added speech recognition and visual-pattern analysis to their toolbox. Future versions might, like the fictional HAL 9000 of sci-fi fame, see and hear. They might also collaborate: Innovations in individual deployments could eventually be shared across the platform, turning the multiplicity of Watsons into a giant laboratory for developing new tools.
How will all this shake out? When will AI transform medicine, or at least help improve it in significant ways? It’s too soon to say. Medical AI is about where personal computers were in the 1970s, when IBM was just beginning to work on desktop computers, Bill Gates was writing Altair BASIC, and a couple of guys named Steve were messing around in a California garage. The application of artificial intelligence to health care will, similarly, take years to mature. But it could blossom into something big.
This article originally appeared in print as “Dr. Watson Will See You… Someday.”
An abridged version of this article appeared in the June 2015 issue of IEEE Spectrum.