
Joyce Lee, MD, MPH Checking out https://xitter.cf/t.co/57VYyyxDPm @ACMIO @umichmedicine #tableau #hit #ai #learninghealthsystems #HealthDesign
Ann Arbor, MI
Joined October 2008
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"Without data you aren't doing improvement. You're having a nice time together." -Michael Seid @ImproveCareNow
Doctor as Designer retweeted
MIT published a brutally honest report on what AI is doing to students.
A committee of professors and students spent five months studying how AI changed learning on campus, and the findings read like a warning to every university on the planet.
Study groups are disappearing. Office hours are emptying out. Problem sets and take-home exams no longer prove anything, because AI can produce credible solutions to almost any written assignment in the undergraduate curriculum. Students who lean on chatbots lose mastery and confidence, and some slip into what the report calls cognitive surrender, reaching for AI at the first hint of struggle.
The numbers are rough. 46 percent of surveyed MIT undergrads use LLMs daily. 90 percent worry about their own overreliance. Undergrads who feel AI makes them replaceable now outnumber those who feel it makes them capable.
The committee's answer surprised me. They refused to fight AI with surveillance. The report calls AI detectors unreliable, says lockdown browsers feel like spying, and warns that policing students builds a classroom atmosphere of mutual distrust.
Instead, MIT wants to rebuild education around the things AI can't replace. That means oral exams, semester portfolios, in-person project work, and a required social component in every subject. The report even floats the idea of rethinking grades entirely, since without a GPA to optimize, much of the incentive to cheat with AI evaporates.
The committee warns professors against replacing undergrad research assistants with AI agents just because they're cheaper, because a university exists to grow people, not output.
The most famous tech school on earth admitted the machines broke its way of teaching. Its answer is more humans, not more software.
Thanks to Diego Ize-Ludlow @drdiegoendo for his provocative talk about obesity care in different "systems".
Doctor as Designer retweeted
Satya Nadella just warned every company using AI: you are paying twice. Once with money. Again with something far more valuable.
He published an article introducing something called the Reverse Information Paradox.
And it changes how you think about every AI tool your company uses.
Nobel laureate Kenneth Arrow described the original paradox: a seller risks giving away knowledge just to sell it. Nadella says AI flips this completely.
In the AI age, the buyer gives away knowledge just to use what they bought.
Every time your team uses Claude or GPT at work, every prompt reveals what you are building. Every correction teaches the model what good looks like inside your company. Every eval shows what you value. Every trace exposes your workflow.
The model provider learns more about you with every interaction. You learn almost nothing about what they are learning in return. Your corrections are distilled institutional know-how. The kind a competitor could never buy.
And it leaks trace by trace, correction by correction, without you noticing.
His line: "You can offload a task. You can offload a job. But you can never offload your learning."
If the model provider disappears tomorrow, do you still own the intelligence your team built on top of it? Your evals. Your memory. Your traces. Your workflows. Or did all of that compound inside someone else's infrastructure?
In the cloud era, companies accumulated data. In the AI era, they accumulate learning. Right now, most of that learning is compounding inside the model provider. Not inside the company paying for it.
The CEO pushing AI harder than anyone just told you to protect your knowledge from the very tools he is selling you. That should tell you everything.
“This is a place where people are undone, and it’s also a place where people are remade”
kqed.org/news/12090227/what-…
The world is changing very quickly
Publishers Are Preparing to Opt Out of Google Search adweek.com/media/publishers-…
Doctor as Designer retweeted
There is a process that I have used, and still use, to reignite life...
Create two timelines—6 months and 12 months—and list up to five things you dream of having (including, but not limited to, material wants: house, car, clothing, etc.), being (be a great cook, be fluent in Chinese, etc.), and doing (visiting Thailand, tracing your roots overseas, racing ostriches, etc.) in that order.
If you have difficulty identifying what you want in some categories, as most will, consider what you hate or fear in each and write down the opposite.
Do not limit yourself, and do not concern yourself with how these things will be accomplished. For now, it’s unimportant. This is an exercise in reversing repression.
Be sure not to judge or fool yourself. If you really want a Ferrari, don’t put down solving world hunger out of guilt. For some, the dream will be fame, for others fortune or prestige. All people have their vices and insecurities. If something will improve your feeling of self-worth, put it down.
Drawing a blank? In that case, consider these questions:
1) What would you do, day to day, if you had $100 million in the bank?
2) What would make you most excited to wake up in the morning to another day?
Don’t rush—think about it for a few minutes.
If still blocked, fill in the five “doing” spots with the following:
— one place to visit
— one thing to do before you die (a memory of a lifetime)
— one thing to do daily
— one thing to do weekly
— one thing you’ve always wanted to learn
What does “being” entail doing?
Convert each “being” into a “doing” to make it actionable. Identify an action that would characterize this state of being or a task that would mean you had achieved it. People find it easier to brainstorm “being” first, but this column is just a temporary holding spot for “doing” actions.
Here are a few examples:
1) Great cook —> make Christmas dinner without help
2) Fluent in Chinese —> have a five-minute conversation with a Chinese co-worker
Determine three steps for each of the dreams in just the 6-month timeline and take the first step now.
Define three steps for each dream that will get you closer to its actualization.
Set actions—simple, well-defined actions—for now, tomorrow (complete before 11 A.M.) and the day after (again completed before 11 A.M.). Once you have three steps for each of the four goals, complete the three actions in the “now” column.
Do it now. Each should be simple enough to do in five minutes or less. If not, rachet it down. If it’s the middle of the night and you can’t call someone, do something else now, such as send an e-mail, and set the call for first thing tomorrow.
If the next stage is some form of research, get in touch with someone who knows the answer instead of spending too much time in books or online, which can turn into paralysis by analysis.
The best first step, the one I recommend, is finding someone who’s done it and ask for advice on how to do the same.
Americans keep poisoning themselves with semaglutide, other weight loss drugs cardiovascularbusiness.com/t…
Doctor as Designer retweeted
As engineering, product, design, DS, etc. melt into a new kind of role, I was reflecting on what roles might look like in the future. For example, when I look at the Claude Code team I see what I think is five archetypes:
1. Prototyper: comes up with brand new ideas; churns out many ideas, most of which don't ship
2. Builder: quickly turns a prototype/idea into production-grade product/infra
3. Sweeper: cleans up the UI, simplifies the code and system, unships, optimizes performance
4. Grower: takes a product that has been built and iterates on it to improve Product-Market Fit
5. Maintainer: owns a mature system to make it secure, reliable, fast, and efficient as it scales
Many people span across 2 roles, and sometimes 3 roles. I also notice that these roles are not really tied to job function -- eg. across Anthropic, some designers match category 1, some 2, some 3; same for engineers, PM, DS.
A healthy team needs a mix of these, depending on the product:
- A product that is new and pre-PMF needs people that are strong at 1+2+3
- A product that is growing and has found PMF needs 2+3+4 and some 5
- A product that has strong PMF needs 3+4+5 and some 2
Maybe product roles of the future will look more like this, and less like the domain-specific roles of today?
Doctor as Designer retweeted
I'm a cardiologist. For months I've been telling you that inflammation is the fire behind heart disease — not just cholesterol. That we've been treating the smoke while the fire kept burning.
Penn Medicine just built the fire extinguisher.
They took the most powerful immune technology in cancer medicine — CAR T-cell therapy — and flipped it. Instead of engineering killer cells to destroy tumors, they engineered regulatory T cells to suppress the chronic arterial inflammation that causes heart attacks.
Published in Circulation. The results stopped me cold.
In CAR T cancer therapy, doctors extract your T cells, genetically engineer them to recognize a specific target, and infuse them back into your body as precision-guided missiles. It has cured previously terminal blood cancers. The technology won its developers a Nobel Prize.
The Penn team asked a question no one had asked before: what if we aimed this at the arteries?
They engineered regulatory T cells — Tregs, the immune cells whose job is to calm inflammation rather than cause it — to specifically target oxidized LDL. OxLDL is the molecule that starts the entire atherosclerotic cascade. It infiltrates your artery wall, triggers macrophages to gorge on it and become foam cells, releases inflammatory cytokines, recruits more immune cells, and builds the plaque that eventually ruptures and causes a heart attack.
OxLDL is the match that lights the fire. These engineered CAR Tregs are designed to find that match and snuff it out — at the arterial wall itself.
The results in mouse models of atherosclerosis:
Blocked macrophage foam cell formation — the cellular process that builds plaque. Dramatically reduced arterial wall inflammation. Prevented over 70% of plaque buildup compared to untreated controls. And critically — preserved normal immune function everywhere else.
That last point is essential. Previous anti-inflammatory approaches to atherosclerosis failed because they suppressed the entire immune system — leaving patients vulnerable to infections and other complications. Colchicine works modestly. Canakinumab in the CANTOS trial reduced events but increased fatal infections. The immune system is a sledgehammer. You can't just turn it down globally.
CAR Tregs solve this by being targeted. They don't suppress your whole immune system. They patrol your arteries specifically, calming the inflammation at the exact site where it's causing damage — and leaving the rest of your immunity intact.
One infusion. Targeted. Precise. The cells do the work.
Lead author Robert Schwab of Penn Medicine put it directly: "If we can get the immune system to see OxLDL and provoke an anti-inflammatory response, it would reduce inflammation and essentially stop the pathogenesis in its tracks."
Senior author Avery Posey: "Our study shows for the first time how CAR T cell technology could be used to treat the underlying cause of the most common form of heart disease — the leading cause of death worldwide."
As a cardiologist who has spent twenty years treating the downstream consequences of arterial inflammation — the stents, the bypasses, the cardiac rehab, the second heart attacks — I need you to understand what this represents.
Every treatment I currently have manages the damage after the fire has burned. Statins lower the fuel supply. Blood pressure meds reduce the mechanical stress. Stents prop open arteries that have already narrowed. These save lives. I use them daily.
But none of them put out the fire itself.
CAR Tregs are engineered to extinguish the inflammation at its source — inside the artery wall — before the plaque builds, before the vessel narrows, before the rupture, before the heart attack.
This is the shift from managing disease to correcting the biological process that causes it. At the cellular level. With living medicine.
This was demonstrated in mice, not humans. The leap from mouse models to human cardiovascular trials is enormous and filled with failures. Manufacturing CAR T cells is currently expensive — roughly $400,000 per treatment in cancer. Scaling this for a disease that affects billions would require a manufacturing revolution. Long-term safety of engineered immune cells patrolling human arteries for years or decades is completely unknown. Human trials are likely years away.
But 70% plaque reduction. With preserved immune function. Targeting the exact inflammatory mechanism I've been writing about for months. Published in Circulation — the flagship journal of the American Heart Association.
The trajectory is unmistakable.
Gene editing to permanently lower cholesterol. Personalized mRNA vaccines to hunt cancer. GLP-1 drugs rewiring metabolism. Cellular reprogramming to reverse aging. And now — living immune cells engineered to extinguish the inflammation that causes the number one killer on earth.
Every one of these treats the root cause instead of managing the downstream damage. Every one of them was impossible a decade ago. Every one of them is in trials or approaching trials right now.
I've held dying hearts in my hands in the cath lab at 3 AM. Hearts that were destroyed by inflammation I could see but couldn't stop.
The day I can infuse a patient with cells engineered to stop that inflammation before it ever builds the plaque — that's the day cardiology changes forever.
We're not there yet. But the fire extinguisher just passed its first test.
Wow this is incredible. What a fascinating and life changing loophole in pharmaceutical manufacturing
Doctor as Designer retweeted
Story from NYT on saving life by AI
As a cardiologist, I appreciate the human story here but let’s be precise about what’s actually happening.
A well-trained physician would have caught this ECG finding and ordered the echo. What we’re often calling ‘AI breakthroughs’ in cardiology are really gap-fillers for under-resourced or under-trained systems, valuable in that context, but not paradigm-shifting for centers with strong clinical care.
The hype cycle around AI in medicine risks overpromising to patients and undervaluing the clinicians already doing this work every day. 🩺 🫀
@nytimes @DKThomp
- 45yo patient complains of difficulty breathing
- X-ray and ECG don't point to clear diagnosis
- he's sent home
- AI-enabled scan detects severe heart damage
- follow-up echocardiogram shows severe heart problems
- doctors perform heart transplant, conclude he might have died suddenly
Great story.
Unlike many promises in AI and medicine—many of which are either over-sold or hard to evaluate, bc AI-enabled drug discoveries can take years for clinical trials to establish efficacy—AI-enhanced diagnostics feels like more of a right-here/right-now phenomenon. The success stories are rare enough for now that most of them get written up in Nature and the NYT, but I think this is a great early frontier for AI and medicine, despite the risks of false positives, over-scanning, over-spending on safe edge cases, etc
Doctor as Designer retweeted
A Japanese immunologist spent 20 years proving that the chemicals trees release into the air walk into your bloodstream, hunt down your stress hormones, and arm your immune system in ways no therapist or pharmaceutical has ever matched, and most of the data has been sitting in Japanese medical journals for two decades waiting to be translated.
His name is Qing Li.
He is a clinical professor at Nippon Medical School in Tokyo and the president of the Japanese Society of Forest Medicine. The Japanese government has been funding his research since 2004, and the body of work he has produced is the reason forest bathing is now an officially prescribed clinical therapy in Japan and Korea.
The story actually starts in 1982, when the Japanese Ministry of Agriculture, Forestry and Fisheries coined the term shinrin-yoku to describe the practice of slow, mindful walking in a forest. They did it for a practical reason.
Japan was urbanizing fast, stress-related illness was climbing, and the country had thousands of square kilometers of forest sitting unused. The idea was to give people a reason to walk into the trees... They had no idea what was actually happening to the human body during those walks until Qing Li ran the first proper experiment in 2005.
He took twelve healthy adult men on a three-day, two-night trip to a forest park. They walked for a few hours each day. Nothing strenuous. No prescribed routes or breathing exercises. They simply walked slowly through the trees, breathing the air, looking at the forest.
Li drew blood and urine samples before the trip, on the second day, on the third day, on day seven after returning home, and again on day thirty.
The numbers that came back from the lab were not what anyone expected.
The activity of a specific type of immune cell called the natural killer cell, which is the cell your body uses to hunt down cancer cells and virus-infected cells before they can spread, had jumped by roughly 50 percent during the forest trip. The actual number of natural killer cells circulating in the bloodstream had increased significantly.
Three different anti-cancer proteins that those cells produce, called perforin, granzymes, and granulysin, had all risen sharply. And the effect did not disappear when the men went home. The immune boost was still measurable on day seven and was still partially present on day thirty.
Two hours a day in a forest had upgraded the immune system for a full month.
Li ran the same experiment with women a year later and found nearly identical results. Then he ran it with a control group who took a three-day trip through an urban area with the same amount of walking, the same hotel quality, and the same diet.
The urban group showed no measurable change in natural killer cell activity at all. The forest was doing the work, not the vacation.
The mechanism turned out to be a class of airborne molecules called phytoncides. Trees produce these compounds to defend themselves against insects, bacteria, and fungi. Pine, cedar, oak, and cypress trees release them in particularly large amounts, especially in warmer weather and after rainfall.
When you walk through a forest, you are inhaling those molecules into your lungs and absorbing them through your skin, and once inside your body they appear to directly stimulate the production and activity of the very immune cells Li was measuring in his lab.
Roughly 50 percent of the health benefit of a forest walk, according to Li's data, comes from the chemistry of the air itself. The other half comes from what the forest is doing to your nervous system.
This is where it stops being only about the immune system and starts being about stress.
A separate Japanese research team measured cortisol, the body's main stress hormone, in 84 participants across 35 different forest sites. They drew samples before and after a 30-minute walk in each forest and compared them to control walks in matched urban environments. The cortisol levels of the people who walked in the forest were lower than the cortisol levels of the people who walked in the city by a significant margin. Their heart rates were lower. Their blood pressure was lower.
The activity of their parasympathetic nervous system, which is the part responsible for rest and recovery, had gone up. The activity of their sympathetic nervous system, which is the part that drives fight or flight, had gone down.
Then a researcher at the University of Michigan named MaryCarol Hunter ran the cleanest version of this experiment ever done. She recruited participants from a city and told them to take a nature pill three times a week for eight weeks.
They were free to choose the time, the place, and the duration of the nature experience, as long as it was outside, in daylight, and free of phones, conversations, and aerobic exercise. They sent her saliva samples before and after each session so she could measure cortisol changes accurately and rule out the normal daily drop in stress hormones that happens to everyone.
The result was that participants experienced a 21.3 percent drop in cortisol per hour spent in nature, with the biggest payoff happening between minutes 20 and 30 of the walk.
After that, the cortisol kept dropping, but more slowly. The threshold dose for measurable stress relief was just 20 minutes outside in something that looked and felt like nature.
What none of this means is that nature is a substitute for therapy or for medication when someone genuinely needs them. Therapy treats different things than a walk does, and Li himself has been careful in interviews to call forest bathing a complementary intervention rather than a replacement for clinical care.
But what the research has settled is that the human body has a physiological response to being among trees that operates on the same biological systems modern medicine is trying to reach with drugs and clinical protocols, and that response is fast, measurable, and free.
The strangest part of Li's work is the implication he keeps repeating in interviews. The average person now spends more than 90 percent of their life indoors. Their cortisol stays elevated. Their natural killer cells stay sluggish.
Their parasympathetic nervous system rarely gets a chance to take over. The system that was tuned by millions of years of life under a canopy of trees is being asked to run permanently inside a box made of drywall and screens.
Your body has not forgotten what it is supposed to do in a forest. It is waiting for you to walk into one.



















