Healthcare 2026: AI Doctors, GLP-1s, and Insurance Defection

对吧？

Right?

第一，他们能做以前医保计划能做的事——比如因为已有病症拒保。

One, they can do things that plans used to be able to do pre Affordable Care Act, deny people based on preexisting conditions.

对吧？

Right?

所以他们的风险群体整体上好得多，对吧？

So their risk pool is much better, right, as a whole.

而且也不用像保险公司那样，被要求保留大量资本金以防出事。

And also, don't have the same regulatory requirements of, hey, we have to have a bunch of capital on your book so you don't go and solve it.

这种情况是存在的，对吧？

This happens, right?

所以你们的合规要求更低，合规成本自然也更低。

So your regulatory pay your regulatory requirements are lower, so your cost for compliance and all that is lower too.

这其实是个挺有意思的模式：你要是住院了，收到账单，拿给大伙儿看，然后大家就一起凑钱帮你付。

But it's like an interesting model where you're like, hey, if I go to the hospital, I get a bill and I show this to the people and then they all contribute to it.

但问题是，你得指望大家真愿意掏钱，不然就玩完了。

But the downside is you gotta better you better hope that people are actually down and will pay for it.

我觉得这产品对某些人来说还挺特别的——我说‘特别’，不是说认同它的理念，只是觉得……

And I do think it's an interesting product for people who are and when I say interesting, I don't mean, like, ideologically agree with it, but I do just think

它其实是在推荐这个东西。

it's recommending it.

我不是在推荐它，但我认为它多少碰到了一个中间地带：你看，

I'm not recommending it, but I do think this is it probably addresses this middle ground a little bit where it's like, hey.

我现在的医保太差了，该报的都不报，还贵得要命。

Like, the health insurance I currently have sucks, and it's not covering the things I wanted to cover anyway, and it's really expensive.

我早就赌上一把了，反正也不知道保险到底会不会赔我，很多人都是这样。

I'm already gambling on whether or not the insurance is gonna cover me or not, which was the case for a lot of people.

他们说：‘我买了这保险，结果去医院一报，人家拒赔。’

They're like, you know, they I'm buying this, so then I go and they deny my claim.

是啊。

Yeah.

这种事情本来就有可能发生。

They're already there's a chance of that happening.

那我还不如试试这个别的办法。

I might as well try this other thing.

如果我身体好，能参保，保费还能便宜点。

And if I can get in because I'm a healthier person, I pay less for it.

所以我觉得，很多人在理念上其实也认同这一点。

So I think there's a lot of people that also just ideologically agree with that premise.

是的。

Yeah.

这反而给那些处于中间地带的人提供了一种可能。

So that I think becomes sort of potential for people in that middle Zone.

对。

Yeah.

但现在的体系根本没为这种情况做好准备，因为很多人还得自己去挑医疗服务，对吧。

But the infrastructure is not built for that because a lot of those people, again, have to go and shop for their own care Yeah.

还得去跟医院谈价，这类事儿，有些医疗分摊组织还真提供帮忙谈价的服务。

Negotiate the bill, all this kind of stuff, which and some of these health sharing ministries offer services to help you negotiate and all this kind of stuff.

但这本质上是一种完全不同的医疗消费模式。

But it's just also a very different model of health care consumption.

这里头其实还涉及一种文化转变——人们得主动去跟医生谈价格，而且愿意这么做。

Like it's there's also some cultural change that happens here where people have to go and are willing to, like, negotiate prices with providers.

这事儿现在还不常见。

That is not a normalized thing.

也许以后会变得普遍起来，那……

Maybe that becomes more normal, That

这说得通。

makes sense.

挺有意思的。

It's interesting.

你会报名参加一个

Would you sign up for a

医疗共享事工吗？

health sharing ministry?

我啊……

I

我不太确定自己会不会加入。

don't know if I would.

其实我不希望咱们的医疗体系分裂成两个完全不同的群体。

Actually, so I don't want our health care system to splinter into two groups.

就是一部分人有能力放弃常规医保，直接自费看病，靠自己这套方式打理医疗开支，剩下的人却只能困在现有的医疗体系里，只能靠慈善救助，说白了就是自己掏腰包填医疗系统的窟窿。

One group that can afford to defect from health insurance, go cash pay, and run their own healthcare stack that way, and then folks that are effectively cycling through our existing healthcare system, relying on charity care effectively out of pocket for the health system to pay for it.

我今年花了点时间研究不同国家的医疗市场。

I spent a little bit of time this year studying different healthcare markets.

比如墨西哥就在一定程度上是这种情况，当然两者不能完全对标，但墨西哥确实是富人有一套专属医疗体系，穷人又是另一套。

Mexico as an example has that to some extent, it's not a perfect parallel, there's one system for the rich and another system for the poor.

这就是我最担心会出现的坏局面了。

So that would be the that would be the downside case that I would worry about here.

当然。

Sure.

其实呢，我觉得美国医疗体系的核心问题就是风险池太多了，对吧？

There is also I mean, so for one, I think the core problem with US healthcare is just like we have too many risk pools, right?

你只能二选一。

You kind of have to choose one or the other.

总想着搞个折中，比如一部分自费，一部分用保险。

Like having this, hey, maybe we're a little cash pay, Maybe we're a little bit pay a little bit insurance.

有些人靠雇主提供的保险。

Some people are in employer insurance.

有些人是医保（联邦医疗保险）。

Oh, some people are Medicare.

这才是真正的问题所在。

That's kind of the core problem.

对吧？

Right?

我们得选其中一个方向。

We have to move to one or the other.

对吧？

Right?

比如奥巴马医改，本来的想法是把所有人都纳入个人医保市场，让大家统一在这儿买保险。

So, you know, for the ACA, the idea was we'll move everyone theoretically to this individual exchange, and everyone will buy from that.

至少大伙儿都在同一个风险池里了。

That's at least they're all in the risk pool.

对吧？

Right?

那样就更像德国了。

And that looks more like Germany.

是的。

Yeah.

你也可以完全走自费路线，所有人都自掏腰包，就专注这一块。

You could also do totally cash pay, right, where it's like everyone is cash pay and you're just focused on that.

这看起来更像印度，或者像新加坡那样，把门诊和住院分开来搞。

That looks maybe more like an India, for example, or like a Singapore if you're doing it through out splitting outpatient and inpatient out.

对吧？

Right?

但你必须二选一。

But you have to pick one or the other.

像美国这种半吊子的中间路线——

Like, this in between Americans

就是喜欢选择多。

love choice.

我们就是爱选择多。

We love choice.

谁都想要有多个选项。

Everyone wants to have an option.

我们愿意为选择多付钱。

We pay for the choice.

选择反而是最糟的方式。

Choice is like the worst way.

现在根本是在最差的选项里挑一个。

It's choosing between the worst options now.

但反过来，还有一个意识形态的问题：你真觉得人应该能花钱买更好的医疗服务吗？

But also on the flip side, there's, again, like, the ideological question of do you believe that you should be able to pay for better care?

是的。

Yeah.

对吧？

Right?

我觉得这个问题让很多人特别不舒服，因为他们内心根本没法接受：‘人居然真能花钱请更好的医生？’

And I think a lot it may that question makes a lot of people really uncomfortable because it's like they cannot reconcile internally that, oh, people should be able to pay for better doctors.

如果你不认同这点，也没关系，但结果就是，一旦所有人都只能用同一个医疗系统，私下总会冒出另一个平行系统，让人绕开它——不管怎样都能买到更好的服务。

Well, if you don't want that, and that's fine, what ends up happening is that if everyone gets access to one care system, then there will emerge a parallel system that allows them to do that no matter what, right?

因为有人会说：‘我出钱，直接找最好的医生，现金支付’，哪怕官方系统已经存在，这些好医生也会溜走。

Because they'll be they'll say, hey, I'll pay for the best doctors, cash, even if there is an existing one, and those doctors will exit, right?

这其实就是现在所谓的会员制医疗、私人医疗在发生的事，对吧？

And that's kind of what's happening today with a concierge medicine and all this kind of stuff, right?

大家都说，希望全科医生能照顾到每个人。

Everyone's, hey, we want primary care physicians to be able to see everyone.

这不就是所谓的平等主义嘛，诸如此类的说法。

It's like the great equalizer, all this kind of stuff.

可突然间，有人就说：我愿意花大价钱，就为让你别管别人，专心照顾我。

And then suddenly people are like, I will pay a lot of money for you to just not do that and then come just take care of me.

对吧？

Right?

没错。

Yeah.

事实上，这种事早就已经在发生了。

The reality is that's kind of already happening.

我想不到任何一个国家，哪怕是像英国这样的全民医疗体系，能完全避免这种情况。

I can't think of a single system even in socialized medicine countries like The UK.

人们还是会买私人保险，就是为了能早点看上医生，诸如此类的事。

People still get private insurance and to to see see docs with lower wait times, all this kind of stuff.

我觉得，根本不可能有个系统能完全杜绝花钱买更好医疗服务的可能性。

Like, I don't think it's possible to actually have a system where you can't pay for better care.

这事儿就是会自然发生。

It just happens.

只要不 outright 禁止，它迟早会形成一个市场，不管你怎么搞。

It'll just emerge as an economy no matter what unless you unless you ban it, right?

当然，你也可以禁，但那也会带来一堆别的问题。

Which like you can do, but that has its own sort of downsides to it too.

比如加拿大，就是个没法搞双轨制的例子。

Like Canada, for example, is an example of not being able to parallel system.

结果就出问题了，有人会说：‘我要是得了复杂病，干脆直接去美国看。’

And that has its own issues where people are like, hey, if I have a complex care thing, I'm gonna come to The US.

所以我也说不准，但我觉得咱们得接受一个现实：不管你怎么做，最后大概率还是会变成——有人愿意花钱买更好的医疗服务。

So I don't know, like, we gotta get comfortable with the idea that I think you have to you will probably no matter what end up with a system where people pay for better care.

你可以用特别绕的方式做，也可以直接明明白白地做，或者干脆尊重大家愿意为哪些服务多花钱的选择。比如在印度这样的国家，人们就可以花钱享受更好的医疗条件，对吧？

You can either do that in a really convoluted way or just do that in a straightforward way or do that in a way where you're more comfortable with what they choose to pay for, So for example, in countries like India and stuff, can pay for better amenities, right?

就是 nicer 的待遇啊，各种好东西。

Like the nice rewards and all this kind of stuff.

这么说，可能反而更容易让人接受。

Like, maybe that's a more palatable way to do that, basically.

是的。

Yeah.

对，这挺有意思的。

Yeah, it's interesting.

如果真这么发展下去，比例到底是15%、18%还是12%还不确定，但从Reddit上的讨论来看——这可是我的亲身观察。

Where is the so if this plays out and TBD, if it's 15% or 18% or 12%, but it's clear that per the Reddit threads, That's which is my truth.

这确实是我的看法。

That's my truth.

人都在往外面跑。

People are defecting.

是的。

Yeah.

这对初创公司会有什么连锁影响？

What are the ripple effects for startups?

如果你打算创业，显然那些主动健康管理类的初创公司会有机会，因为大家更愿意自费消费，但还有别的吗？

If you're trying to start something, obviously the proactive health startups have an opportunity here, more cash pay spend, but what else?

对，我觉得针对这群人，医疗导航的方式也会完全不同，确实如此。

Yeah, I think also just like care navigation looks very different for this group of people, Totally.

你得认真想想，你这事到底有多严重，值不值得花大价钱去看医生，特别是你自己掏钱的时候，对吧？

I think you have to really think about, is this thing I'm doing serious enough that I need to go see a higher cost medical practitioner if you're paying out of pocket, right?

这种初步筛选的步骤，跟以前完全不一样了。

That triaging step is really different.

所以我觉得，帮人们搞清楚‘我该去哪儿看这个病’特别重要。

So I do think that helping people figure out like, hey, where do I go for this?

还有，这事儿到底严不严重，非得跑一趟不可吗？

And is this actually serious enough that I need to go?

这本质上就变成了一种完全不同的产品类型。

Becomes a whole separate type of product to build basically.

跟有保险的人不一样，你得帮他们一步步搞定保险、医疗网络、报销这些事儿。

Compared to someone who have insurance, you're really navigating them through their insurance, directory, coverage, whatever it is.

所以我觉得这完全是两码事。

So I think that looks very different.

我觉得另一个连锁反应是，会冒出一堆人想以超低价格提供医疗服务。

I think another ripple effect too is there's gonna be, I think, lot of people that try to deliver care at, like, hyper lower costs.

对吧？

Right?

比如那个Doctronic，犹他州的那个试点项目，我记得他们开药续方只要四美元一次。

So the Doctronic, you know, the pilot in Utah is a good example where I I remember correctly, they're doing prescription refills at $4 a pop.

而不是一块五？

Instead of $1.50?

对。

Yes.

是的。

Yeah.

这其实还挺便宜的。

Which, you know, that is actually pretty that is relatively affordable.

你需要续个处方。

You need a prescription refill.

对。

Yeah.

这样一条路就能解决，不用再专门跑一趟看医生。

That is like one route can go rather than having to do a totally net new visit to the doctor.

对吧？

Right?

我觉得这类服务会越来越多。

So I do think you'll see more of this, hey.

我们怎么把成本压到极致低？

How do we bring costs, like, an extremely low level?

很明显，得靠AI、科技，还有这些玩意儿。

Obviously, using AI, using tech, using all this kind of stuff.

另一个有意思的想法是，能不能跟现有的医疗机构搞点新式的合作，专门针对那些自费看病的病人？

And then the other one, which, like, I think is a little interesting to think about is, you know, can you do some form of novel contracting with the existing providers for when they see people who are coming in as cash pay?

是的。

Yeah.

对吧？

Right?

因为说实话，医疗机构到时候真挺难办的，对吧？

Because the reality is the providers are gonna be in a tough spot, right?

有人上门自费，结果付不起钱。

Where someone comes in, they have to pay cash, they don't.

比如说，有人跑急诊做了特别贵的检查，做完就走人，医院去追着要钱，最后根本要不到，对吧？

Like, you know, the if they come into the emergency room, they do some really expensive stuff, people leave, they chase them down for the money and then they don't get it, right?

所以这种情况下，医疗机构真的挺被动的。

So the provider is in a tough spot when that happens.

能不能给自费患者提供个特别简单的打包价之类的？比如，嘿，你是自费的，这是我们的价格。

Can you offer really easy like bundled payments or whatever it is to people to be like, hey, you're a cash pay person.

这是我们的收费标准。

Here's what our rate is.

直接来就行，别折腾了。

This and come through and get it.

现在你想查个自费价，得绕一大圈，特别麻烦。

Right now, if you wanted to figure out the cash pay rate for something, you like have to go through a really weird convoluted process to do this.

你得打电话问，说自己是自费患者，然后还得像砍价一样扯皮。

You call in, you'll say you're a self pay patient, and kinda like haggling.

我感觉我就像在……

I feel like I'm like the in the in

印度市场里讨价还价。

an Indian market.

你懂我意思吧？

You know what I mean?

我就觉得

I'm just

咱们这儿来回砍价，搞得跟闹着玩儿似的。

like, we're haggling back and forth, and we're just like, what's up?

咱们到底要往哪儿走啊？

Where are we gonna be?

不如干脆给大家整得明明白白的，听好了。

But to maybe just make it really easy for everyone, like, hey.

这是打包价。

Here's the bundle.

包含哪些服务都列在这儿了。

Here are the services included.

你直接来就行。

You can come for this.

尤其是那些价格高点的项目，比如你没保险又非做不可，我们就给你明码标价，该怎么弄、花多少钱，一清二楚。

And that's gonna especially be true for things like somewhat higher cost procedures and stuff like that, where it's like, if you're uninsured and you do really need that thing, here's how we can do it and here's the cost we'll pay.

这听起来反而有点像医疗旅游的模式，大家都慕名过来求医。

It looks more like the medical tourism market where people are coming.

没错，就是这个意思。

Exactly.

只不过这是本土化的医疗旅游而已。

But it's a local version of that.

就像有人专门跑到美国来，就想在梅奥诊所接受治疗一样。

But people are coming to The US and they want to get the procedure at Mayo Clinic.

他们是自费掏钱的。

They're paying out of pocket.

都没录入我们的系统里。

They're not in our system.

其实国内也能有这样的服务模式。

There could be a domestic option like that.

现在就有现成的做法，只不过得把流程简化一下，

It exists today, but just make it easier,

这事儿现在做起来太难了

It's lower very hard to do

确实。

that today.

那这可能算一个方向。

So maybe that's one.

那咱们跳着聊几个更相关的预测吧。

Okay, so we're going to jump around across some of the predictions just to hit ones that are more relevant.

如果消费者开始自己主导医疗、更多自费、不再依赖传统体系，那一个趋势就是筛查诊断和居家采样会火起来。

If consumers are defecting, coordinating more of their care and spending more out of pocket, one prediction is that screening diagnostics and at home sample collection becomes the hot area.

你具体说说这个逻辑。

So lay out the case there.

你看Lil Jon都在做结肠癌筛查的广告了，大家把粪便样本寄遍全美，简直离谱。

So Lil Jon is doing colon cancer screening commercials, People are shipping their poop around the country, like, just crazy.

对。

Yeah.

这事儿只跟医疗健康有关。

It's only for health care.

根本没关系。

Not even relevant.

他们就是这么干的。

They're just doing it.

你知道的，查完邮件记得洗手。

You know, check your wash your hands after you check the mail.

你详细说说这个。

Lay out that.

你为啥觉得这会成真？

Why do you think that's gonna happen?

我的意思是，说清楚点，我觉得不是因为没保险的人变多了才这样。

Well, I mean, to be clear, I don't think it's because the uninsured thing happened.

对。

Sure.

但我觉得诊断这个领域特别有意思，却一直被严重忽视。

I but I think that diagnostics is, I feel like, such an interesting area that is, like, very underinvested in.

对啊。

Yeah.

你懂的吧？

You know?

我觉得跟自费医疗有关的一点是，你跟医生和病人聊的时候，会发现大家对这事的看法根本对不上——他们压根没法达成共识。

I think maybe one thing to tie to the uninsured maybe not uninsured, but cash pay rather, is that I think this is one of the areas that a lot of people when you talk to doctors and you talk to patients, this is one thing that I feel like there is a somewhat irreconcilable difference here that they just can't think about.

就是，大家都希望有人能定期关注自己的健康状况。

Like, the people wanna be monitored in some capacity.

但很多医生会说：你可以监测啊，但就算监测了，我们也做不了啥。

And a lot of the doctors will be like, well, you could be monitored, but there's not much we can do even if you get monitored.

对吧？

Right?

毕竟，监测了也不会改变你的治疗方案。

Like, it's not like your care pathway is going to change doing that.

但很多人就是希望有人能盯着自己。

But But a lot of people just, like, wanna be monitored.

对吧？

Right?

因为他们觉得有人在关心自己，每个环节都被重视，诸如此类的。

Because they feel like someone is looking out for them and they're being considered at all points and blah blah blah.

所以我觉得大家确实想要这种服务，尤其是自费的客户。

So I think that people want that, and especially in the cash pay.

你看长寿医学这一块就特别明显。

And you see this with the longevity medicine and all this kind of stuff.

他们真正想要的，很大程度上就是定期被监测。

Like, a big component of what they want is just like being monitored.

对吧？

Right?

就算查不出啥问题，至少咱们确认过一遍了，你说是吧？

Even if it says nothing, it's just at least we checked, you know?

所以我真的觉得，人们对这种服务的需求特别高。

So I do think that the appetite for that is really high.

我觉得，随着越来越多采用AI原生的医疗模式，这一点会变得至关重要。

I think as you move to more of these AI native care models, that becomes a really core part.

对吧？

Right?

从被动治疗转向主动预防，关键在于用什么数据来告诉你该采取行动了，对吧？

The shift from reactive care to proactive care really has to come from what is the data source that's going to tell you that something has to be done, right?

我觉得这得靠一些筛查和诊断手段来实现。

And I think that is going to come from some form of screening diagnostics, etcetera.

我们之前聊过一点AI开药的事儿。

You know, we talked a little bit about the AI, about AI prescribing, for example.

我觉得比这更进一步、也更有趣的，是AI能自动安排化验或随访，甚至在医生还没来得及看之前就先一步处理了。

I think the next level above that, which will be interesting is like AI ordering things like labs or follow ups that you might need pre the doctor actually needing to look at it.

对吧？

Right?

我觉得这也会成为其中一部分。

And I think that is going to be sort of a part of this.

但总的来说，诊断领域现在也出现了更有趣的市场策略——我们发现有个很大的自费市场，这些人就想被持续监测，同时他们又在等更正规的实验室检测或FDA审批流程。

But in general, like I think diagnostics also are seeing a more interesting go to market strategy too, which is, hey, we basically see a big cash pay market that was just wanting to be monitored while in the meantime, we go through a more legit, you know, lab developed tests or FDA approval route.

但确实存在一种需求，想用这些新检测手段来监测一些平时不常关注的指标。

But there's this appetite here for these like new tests to just be monitored on different metrics that maybe are not typically monitored.

而且人们确实有这种意愿。

And they see this appetite from people to do that.

比如，如果你家族有某种疾病的遗传风险，但又不完全符合临床指南里推荐用药的标准，人们还是会自己想办法去查，而且他们也愿意掏钱。

Like, especially for example, if you have, you know, some family risk of something, right, but you don't quite fit really neatly into guidelines around like that you need to be prescribed this thing, people are gonna find alternative routes to doing that and they have money to do that too.

他们愿意为此买单。

They're gonna pay for it.

比如冠状动脉钙化CT扫描，这就是个很好的例子，但偏偏很难做得到。

Coronary, you know, calcium CT scans, like, great example of this, where like, for some reason it's really hard to get that.

而且，研究证据和临床指南之间，还存在巨大的时间差。

And also, there's still a huge lag between like evidence and sorry, research and then care guidelines.

对吧？

Right?

很多时候，从有潜力的新技术到真正成为普遍临床标准，中间能拖上十年以上。

So the lag is like ten plus years in a lot of cases between what's interesting and what actually makes it into, hey, we're doing this for all patients and all this kind of stuff.

但人们愿意花钱避开这种等待。

But people are willing to pay to to escape that.

你做过吗？

Have you done it?

钙扫描？

The calcium scan?

我没做过，老兄。

I'm not, dude.

但你要是个三十来岁的南亚人，那你突然就得认真考虑这个问题了。

But I'm like, you know, if you're a 30 year old brown person, like, you're suddenly in a risk category that you have to be thinking about this.

我就是你刚说的那种典型例子——胆固醇略高，南亚男性，风险因素全占了。

Is it I'm a perfect example of what you just described, which is slightly high on the border cholesterol, South Asian male, so I have risk factors.

心血管事件。

Cannon event.

对，就是这样。

Yeah, exactly.

我医生说，你绝对不需要做钙化CT扫描。

And so my doctor was like, you definitely don't need a calcium CT scan.

但我就是想知道。

I wanted to know.

我现在就想找医生问问。

I wanted doctors now.

开玩笑的。

Just kidding.

但我还是去做了。

But I did it anyways.

挺好的。

Cool.

你查出来结果怎么样？

What'd you find out?

是零，挺好的。

It was a zero, which is good.

明白了。

Okay.

但我就是想弄清楚这个。

But I wanted to know that.

对。

Yeah.

知道这个真不错。

That's good to know.

没错。

Exactly.

我觉得咱们社会得想明白一件事，现在的医疗系统老想搞一套标准化的治疗方案，对吧？

Like, I I think the tough thing I think the thing that we have to figure out as a society a little bit is that the existing healthcare system really wants to be like, hey, here they really wanna create standardized care for people, right?

还要搞一套标准化指南，让医疗水平在平均层面上对所有人都有效，对吧？

And standardized guidelines to make medicine also good at the median level for everybody, right?

但与此同时，大家又希望在医疗决策上能有更多的自主权。

But at the same time, people want more agency in their healthcare in some capacity.

对吧？

Right?

没人愿意被告诉：‘你先等等看吧。’

They wanna feel no one wants to be told like, hey, just wait and see.

他们就是不想听这种话。

They just don't wanna be told that.

其实有很多低风险的事情，我们可以直接让普通人自己去尝试、去体验。

And there are probably a lot more lower risk things that we can just let people try and do and see.

我觉得这可能就是为什么现在像休伯曼方案这类东西这么火，还有那些……

I think this is one of the reason for example that protocols are so popular right now, like Huberman protocols and Yeah.

各种方案都特别受欢迎。

Period of protocols.

你知道，这些方案的核心其实就是那套老生常谈：吃好、睡好，就是平常听到的那些建议。

You know, the core the core thing of what these protocols are saying is eat well, sleep well, you know, the normal advice you get.

但

But

关键是它被包装了。

It's branded.

没错，是被包装了，但……

Well, it's branded, but

而且它还给人一种清单感，好像你真得按部就班地去做点什么才行。

also it gives people like what seems like a task list that they should actively be doing to like Yeah.

让你觉得在好好管理健康，还给你推荐一堆补充剂，让你感觉真的在行动。

Be good at their health and gives them, like, supplements to feel like they're doing something.

对。

Yeah.

至于你到底做没做，其实没那么重要，重要的是，这种能自己做主的感觉。

And whether or not they're doing it is sort of irrelevant, but the feeling of having agency in those situations, I think, is actually the important part.

测试也是同样的道理。

So the same with the testing.

人们就是想觉得自己能掌控一点局面。

People just wanna feel like they're in control a little bit.

我觉得这里头其实有个矛盾：一方面，有些病人干脆放任自流，直到症状严重了才去做筛查和诊断，结果反而给医疗系统添了更大压力。

And, you know, I think there's some tension here about, okay, there's clearly a line of, like, where patients are just, like, YOLO ing until screening tests and diagnostics that then end up with, like, more pressure on the health care system.

比如你做核磁共振，突然发现一堆意外的结节。

Like, you find incident delomas in your MRI.

然后就得别人来收拾烂摊子，一堆后续问题跟着来。

Now someone else gotta deal with it, all this kind of stuff.

但我认为，人们还是想要更多主动权——比如当你觉得当前的治疗方案不太靠谱时，至少想做个检查，亲眼看看情况。

But I think people want more agency and getting a test done where you're like, I just don't feel good about what my care plan is today.

我就想查一查，图个安心。

I just like to see and test.

不管好坏吧，至少我觉得，这种主动参与，才是未来医疗的走向。

It's just for better or worse, just like I'm be a part of health care going forward.

我觉得你说得对。

I think that's right.

而且我觉得这还会引发另一个争论：监管机构到底该允许这些检测和AI应用说什么？

And I think that creates another debate, which is what do regulators allow these tests and AI applications to say?

对。

Yeah.

我觉得很多医疗界的人会说，这些检测其实也提供不了什么真正有用或值得关注的信息。

I think a lot of these things, the medical establishment will say, Well, it's not really going to tell you anything that actionable or that interesting.

但这些东西往往都是从边缘开始的。

But these things start on the fringe.

我的看法是，我觉得这是件好事。

My take is that I think it's a good thing.

它们都是从边缘开始，

They start on

然后慢慢变得主流。

the fringe and then they get more mainstream.

说实话，我们现在美国的医疗体系，供给严重不足。

I think the reality is that the healthcare system that we have today in The US is drastically supply constrained.

2300万美国人从事医疗行业，可还是排长队。

So 23,000,000 Americans work in healthcare, yet we've got long wait times.

这些数据你肯定都听过。

You've heard all the statistics.

一亿多人找不到全科医生，能约上的话，等四十天以上都是常事，诸如此类。

100,000,000 people plus don't have access to a primary care doc, forty day plus wait times to see a doc if you can, etcetera, etcetera.

这种种麻烦让人抓狂，需求就像喷泉一样四处乱窜，往各种地方涌去。

And so all that friction is frustrating and the demand exhaust shoots off somewhere and it's shooting off to all these places.

而且

And

你说得对，人们都想有自主权，这种自主性自然会往别处跑。

to your point, people want agencies, so that agency is going to go somewhere.

那它到底往哪儿跑了呢？

And where is it shooting off?

都跑到大语言模型那儿去了。

It shoots off at LLMs.

你看到OpenAI那份报告了吗？全球每周有两亿三千万人用ChatGPT问健康问题，每天四千万人次。

So you saw the OpenAI report, two thirty million people around the world using ChatGPT for health related questions each week, 40,000,000 a day.

太离谱了，真是太离谱了。

It's crazy, It's crazy.

它都取代医生了。

It's replaced Doctor.

还有谷歌，还有好多别的东西。

Google and many other things.

现在好多人都在用主动健康管理工具，比如健康会员服务、Aura和Whoop这些可穿戴设备，随便你说哪个。

The proactive health tools are being adopted by a bunch of people, the health memberships, the wearables like Aura and Whoop, name your thing.

这不挺合理的吗？

And that makes sense, right?

大家确实想自己动手管健康，但还是有监管上的障碍，我觉得特别有意思，挺好奇接下来会怎么发展——至少几周前，设备还分两大类。

People want to do stuff with that, but there's still regulatory friction that I find interesting and I'm kind of curious to see how it plays out this which is at least as of a few weeks ago and prior to that, there were two buckets for a device.

FDA要么说这是个健康类产品，完全不能做任何医疗宣称；要么就认定它是医疗器械，想说什么都行，但得走一遍漫长复杂的审批流程。

FDA either said it's a wellness product and it can't make any medical claims at all, or it's a medical device and you can make all the claims you want, but you've got to go through a long regulatory approval process.

对，没错。

Yep, yep.

这明显更有利于大公司，那些老牌医疗科技巨头，初创公司根本玩不转。

That as we know largely favors the incumbents, the big med tech companies, really hard for startups.

所以相对而言，真正冒出来的设备其实没几个——按理说，本该有更多才对。

So there's not that many on a relative basis devices that have emerged relative to, I think, what could have been possible.

是啊。

Yeah.

我就拿我的Oura戒指举个例子。

I'm touching my Oura Ring as an example.

Oura的Tom，还有他们的投资人，我觉得他之前在《华尔街日报》写了一篇特别棒的评论，说应该搞个第三类分类。

So Tom at Oura, investors there, but I think he wrote this amazing op ed in the Wall Street Journal that basically said there should be a third category.

这个第三类叫‘数字健康筛查工具’——它不直接给你诊断结果，但能提醒你身体里有几处值得关注的地方，建议你去跟医生聊聊。

And that third category is digital health screeners, which is there's something in between that's not necessarily going to give you direct medical diagnosis, but will show you a couple things that you probably want to know about your body and you might want to talk to your doctor about.

他在文章里举的例子我觉得挺好的，比如设备能推测出一些高血压的早期信号，提醒你：‘你可能该去跟医生聊聊高血压的事了。’

So the examples that he gave in the article that I thought were good were maybe there's a couple early indicators of high blood pressure that it can infer and tell you to say, Hey, you might want to talk to your doc about hypertension.

我记得以前看过一个数据，超过百分之四十的成年人已经被诊断出高血压之类的，简直太离谱了，这真是个普遍又难搞的慢性病。

And I think, I can't remember the last statistic, but forty percent plus of adults are diagnosed with hypertension or something So crazy like it's a real chronic condition that's challenging.

文章里还提到另一个例子：某些睡眠异常可能预示着睡眠呼吸暂停。

The other one that they give in the article is, hey, there's some sleep irregularities that are probably predictive of sleep apnea.

赶紧去问问医生吧。

Talk to your doctor.

没错，完全同意。

Yeah, totally.

对吧？

Right?

咱们干脆就别管它了。

Like we should just let that go.

我觉得关键在于，中间其实有个灰色地带——你可以收集大量数据，然后直接丢给大语言模型处理。

And I think that's the There's obviously something in the middle where you could get all this data and then just drop it into your LLM.

反正大家早就这么做了。

People are doing it anyways.

我把所有医疗数据都丢进聊天机器人，让它帮我分析。

I drop all my medical data into counsel and pick

挑一个就行。

the one.

未来就是这样。

And that's where it's going.

FDA之前说过一些话，暗示他们打算——

FDA said some things that suggested that they're gonna- They

明摆着在暗示，心照不宣。

gave the hint, hint, wink, wink.

是啊，他们确实打算放宽一些可穿戴设备的限制，但这只是开始。

Yeah, they're gonna roll back some of these things on wearables, but wearables is just the start.

对吧？

Right?

现在你想想AI医生应用，它们能说啥、能干啥。

Now you get into AI doctor applications and what can they say, what can they do.

你觉得这事儿咋样？

So what do you think of that?

我的意思是，归根结底，作为社会，我们该允许病人自己承担多大风险？

I mean, again, I think the question is, as a society, how much risk do you think that patients should be allowed to take on themselves?

对。

Yeah.

对吧？

Right?

比如AI开药这事，可能就是个好例子。

Like, the AI prescribing thing maybe is a good example here.

对吧？

Right?

诊断的问题咱们待会儿再聊。

And we'll come back to the diagnostics for a sec.

但你觉得，一个人应该有权花四块钱，让AI医生直接给你开常见药吗？

But do you think that a person should be able to say, hey, I wanna be able to pay $4 to see the AI doctor who's gonna auto prescribe me via these common meds?

它有时候可能会出错。

It might get it wrong sometimes.

一旦出错，受伤害的就是你自己。

And if it does, then it'll harm me.

你也可以选择多花点钱，找一个更靠谱、准确率更高的医生，这样出错的概率更低，比如开错药之类的风险也更小，随便你怎么说。

Or I can choose to pay a higher amount and see a doctor that maybe has more sort of like higher accuracy or whatever it is and lower chance of me doing risk of having an adverse event or whatever, like getting prescribed the wrong thing, whoever.

作为个人，你该不该有这个选择权？

Should I be able to make should I be allowed as a person to make that choice?

你是想选那个便宜但更容易出错的AI医生，还是不选？

That like, want the AI doc that maybe gets it wrong more often, but it's cheaper or not?

筛查类的可穿戴设备应该也是同样的道理吧？

Probably same thing for screening diagnostic wearables, right?

它可能从你的数据里发现一些有意思的东西，但同时也会有相当高的假阳性率。

Where it's like, hey, here's the thing that might find some interesting stuff in your data, but also it's gonna have a false positive rate of this much.

对吧？

Right?

你可以自己选。

And you can choose that.

不过这里有个问题，假阳性结果带来的负担，最终会落到去看医生的人、医疗系统或者急诊室头上。

Now I will say the issue here a little bit is that the burden of the false positive rate then falls on the doctor you go and see or the health system or the emergency room.

所以我觉得这确实是个值得认真考虑的问题：当这种设备大规模普及后，一旦出现假阳性，受影响的可能是数百万人。

So I think that is like a real consideration we have to think about is like when people have these devices at scale, suddenly the risk of when false positive rates happen, it's gonna be millions of people.

对吧？

Right?

这可不是闹着玩的。

That's no joke.

对吧？

Right?

但与此同时，我觉得我们正在错过大量特别有价值的数据，本该好好利用的。

But also at the same time, I think we're missing a lot of really interesting data that we should be doing more things with.

比如说，我最近跟不少长期戴连续血糖监测仪的人聊过。

For example, I think, you know, I've been talking to a bunch of people that have been wearing CGMs for a while.

对。

Mhmm.

他们当中很多人其实有各种各样的情况，表面上看像糖尿病，但根本不是一回事。

And a lot of them, I think, for example, have different pathologies of what traditionally looks like diabetes.

比如糖尿病这个说法太笼统了，背后可能藏着好几种完全不同的生理机制，只是都被归到一个名字底下。

Like, for example, I think diabetes is this, like, broad category, but there's probably multiple underlying things that are actually happening that are actually different forms of diabetes, for example.

睡眠问题、失眠这些也是一样，肯定不止一种原因。

Probably same thing with, like, sleep, insomnia, all this kind of stuff.

但要分辨这些差异，光靠普通检查根本不够，得有大量连续的数据，才能看出它跟健康状态到底有什么不同——这我觉得特别关键。

There's probably underlying multiple pathologies, but it's hard to tell that if unless you have a more massive stream of data that is coming that can help you tell, like, how that's changing and how that's changing from a healthy baseline, which I think is really important.

对吧？

Right?

今天我就戴着那个口腔环，作为一个健康人。

I am wearing the oral ring today as a healthy person.

等我生病的时候，它就能捕捉到我从健康状态到生病状态之间的变化。

As I develop a disease, it's going to catch things that change from my healthy baseline to, like, being a sicker person.

这些变化以及它们自然发展的过程——其实就是自然病程研究——特别重要。

And those changes and how that naturally progresses, like natural history study basically, is really important.

我觉得如果我们有更多人戴这种设备，就能把这种方法用在更多疾病上。

And I think we probably can do that for more diseases if we had more people wearing this kind of stuff.

所以

So

这简直就是真实世界数据的终极梦想。

This is the real world data dream.

没错。

It is.

真的。

Really.

这

This is

这不就是我们所有人都想要的吗？

what we all wanted.

对。

Yeah.

我觉得问题在于，真实世界的数据一直以来更偏向于制药公司的应用场景。

And I think and I think the problem is real world data has always been focused a little bit more on like pharma use cases.

我觉得还有很多普通人其实就想知道自己是不是有类似这种奇怪睡眠模式的人。

Think I there are a lot of people that are also just like, I kinda wanna know if there's other people like me who have this sort of weird sleep pattern.

是的。

Yes.

那他们都在做什么？

And what does that what are they doing?

这说明了什么？

What does that mean?

你知道吧？

You know?

我觉得这是个特别开放、还没人深入探索的领域。如果有人在听的话，我觉得基于这些理念建立一个以患者为中心的生物样本库，真的很有意思。

That's I think a really open unexplored space that people have not quite, you know, I think if anyone is listening to this, I think building a patient first biobank on these concepts, think is really interesting.

人们真的很想知道，那些和自己长相相似、生物标志物也类似的人，是怎么应对这种情况、怎么生活的。

People really do wanna know how people that look like them or have biomarkers that look like them, deal with that or operate in world.

他们的治疗经历是怎样的？哪怕去掉了所有身份信息，这类数据也值得了解。

What does their care journey look like even if you de identify it or all this kind of stuff?

知道有人和你一样有奇怪的睡眠模式，吃了某种剂量的镁，结果真的有效，这很有帮助。当我们细分人群时，你会发现他们和你特别像。

It's useful to know, hey, this person who had this weird sleep pattern took this magnesium dosage and it actually seemed to work for them and they actually, you know, when we sub cohort the populations, they look very similar to you.

所以，也许你也该试试。

So maybe you should try it.

对吧？

Right?

是的。

Yeah.

这确实还没人好好研究过。

That's very unexplored.

我觉得可穿戴设备这些东西，正是实现这一点的好办法。

And I think wearables and all this kind of stuff is a way to do that.

但前提是得有办法把这类数据系统化地收集起来，你说对吧？

But we can only do that if there is some, you know, way to capture that data in a structured way, basically, right?

得找个折中的办法才能做到。

And you need a middle path to do that.

这正好能引出我们接下来要聊的话题。

So that's a good transition to talk about.

你之前提了大概三个关于医疗AI的预测。

You had three or so predictions around healthcare AI.

第一个是关于州政府和联邦政府在关键监管上的冲突。

And your first one was around state governments clashing with the federal government on key regulations.

你可以从几个角度聊聊，但咱们先聚焦在AI上。

Talk about it across a few dimensions, but let's zoom in on AI.

州政府和联邦政府会在公共卫生指南、疫苗建议、AI监管、保险法细节这些方面产生分歧。

So state governments will clash with the federal government on public health guidelines, vaccine recommendations, AI regulation, insurance law nuances.

以上所有。

All of the above.

对，咱们聊聊这个。

Yeah, let's talk about that.

说到AI，我觉得这个挺有意思的。

So on AI specifically, think this is interesting.

去年，伊利诺伊州、内华达州，还有其他几个州，要么禁止，要么限制AI心理聊天机器人使用。

Last year, we had Illinois and Nevada and a couple other states either ban or restrict AI therapy chatbot usage.

就在上周——你写那篇文章之后——犹他州刚启动了一个试点项目，允许AI开处方药。

Basically last week, so since you wrote your piece, we literally had Utah doing the pilot around AI being allowed to prescribe medications.

目前范围很窄，只涉及190种低风险药物，比如哮喘吸入器这类。

It's very narrow on 190 low risk medications, your asthma inhaler, things like that.

先从低风险的开始，以后再慢慢扩展。

Low risk stuff to start, but can expand.

然后特朗普总统去年12月签了一项行政令，意思就是：我们要搞一个全国统一的框架，让大家更容易遵守。

And then President Trump signed an executive order in December saying, that effectively said, hey, we're gonna do a national framework and we'll make it easy for folks to follow.

听起来你觉得2026年会更乱一些。

It sounds like you think it's gonna be more chaotic in 2026.

肯定的。

Definitely.

再多说说。

Say more.

我的意思是，我觉得有好几方面吧。

I mean, I think it's I mean, I think there's a couple things.

对吧？

Right?

一方面，美国确实正在兴起一股反AI的潮流，这其实挺正常，大家担心失业，也担心那些影响自己生活的决定是由AI做的——比如，可能有个AI在背后做选择，结果反而对你不利。

One part is there is definitely an anti AI sort of movement that is happening in The US, which is sort of expected and natural, and people are worried about job loss, and they're worried about how decisions are being made that affect their lives because, like, maybe there's an AI on the other end that is choosing things that are, you know, anti helping them.

对吧？

Right?

所以我能理解这种反AI情绪，它迟早会影响政策。

So I understand, like, where that's coming from and that anti AI movement will inevitably impact policy.

而且你待在哪个州，那个州的监管机构就会站在其中一方。

And depending on which state you're in, you're going to have a regulator in that state side with one side or the other.

对吧？

Right?

举个例子，就像Waymo那样。

Maybe like analog here is actually like Waymo's.

对吧？

Right?

Waymo现在只在几个州运营。

Waymo's are in a few states.

最早是从加州开始的。

They started in California.

我每次来这儿都超爱坐Waymo，真的特别棒。

They are super like I love riding in a Waymo every time I come here.

各州对要不要让Waymo进来，看法差得可远了，对吧？

States have very different opinions on whether they should allow Waymo's into their own state, right?

不管是他们担心得拿出多少证据来证明安全性才敢上线，还是知道一旦推广开来，会带来大规模的失业。

Whether it's they care about how much they have to prove safety wise before they roll out or they, you know, there's they know there's gonna be widespread job loss when they come in.

我觉得其他领域的AI也会走同样的路。

And I think AI for other things is just gonna follow the same trend.

对吧？

Right?

所以问题在于，各州其实不太清楚该怎么下手。

And so I think the issue is that, like, states don't quite know what to do.

我觉得咱们都明白，AI也存在不少滥用的情况，比如深度伪造啊、各种奇怪的用途，这些我们都得提防，对吧？

Like, I think we can all acknowledge that there's a lot of like also bad AI use cases that we need to watch out for using deepfakes and weird ways and a lot of this kind of stuff, right?

所以总的来说，大家其实都在琢磨：怎么在控制AI潜在风险的同时，又不挡住它带来的巨大好处？

So as a whole, I think people are trying to figure out how do we regulate the downside risk of AI while also enabling the like upside potential that we can see, right?

也许现在这样各州各自试点、看看哪些管用哪些不行，最后再搞出一个全国性的框架，反倒不是坏事。

And maybe it's actually not a bad thing that we're running a bunch of state by state experiments to see like what works and what doesn't and then create a more national framework to do this.

不过 downside 是，就像医疗行业一样，每个州的合规要求都不一样，搞得产品得改来改去，进一个新州的成本也天差地别。

The downside though, is then you have to you know, healthcare has always been really annoying about having different compliance rules for every state, which means your product looks very different and the cost to go in a new state is very different.

这确实挺麻烦的，但也许我们真该在各地试试不同的办法。

That's gonna be annoying, but actually, maybe we should be running different experiments here.

每个州都会不一样，毕竟各自的医疗需求也不同。

And each state is gonna, you know, it's gonna look different depending on their own health care needs as a state.

对吧？

Right?

比如你这儿农村人口多，看病特别难，那肯定得赶紧想办法，让这些人至少有个家庭医生。

If you have a really large rural population, for example, that really struggles to get access to care, you're probably gonna lean more heavily into, hey, we need to get these people don't have a PCP.

得给他们点实际的帮助。

We need to get them something.

对吧？

Right?

要是你这儿医疗资源竞争激烈，那情况可能就不同了，看病方便得很，根本不用操心。

If you have a very competitive provider network, maybe that's actually not the case, and care accessibility is fine and all that.

所以我觉得，各州其实都在琢磨：怎么在控制风险的同时抓住机会，但问题是，大家对这事儿的理解根本不一样。

So I think that'll I think it just really I think that states are trying to figure out like how do we protect the downsides while getting the upsides, but they just don't they all have a different opinion on what that means.

比如有些州，他们就是不希望保险公司用AI来拒赔。

Like some states, for example, you know, they really don't want insurance companies to use AI to deny claims.

对吧？

Right?

他们觉得这事儿特别糟糕，诸如此类的。

They're like, they think that's like really bad, blah blah blah.

他们反而更愿意让人来拒赔。

They'd rather have humans deny this.

没错。

Yeah.

可问题是，他们怎么去监管呢？

Which which also at the same time, almost like, how are they even gonna monitor?

要是人用ChatGPT来判断理赔然后拒掉，这跟用AI有啥区别？

If a human is using ChatGPT Yeah.

说到底，真的不一样吗？

To lead the claim and then deny it, is it really any different?

是啊，当然。

Yeah, sure.

我不是特别确定，说实话我也不清楚。

Not to be clear, but I don't know.

咱们走着瞧吧。

We'll see.

肯定会有些州搞出些有趣的实验来。

It'll be some fun, fun state experiments.

对，我觉得你说得对。

Yeah, I think that's right.

从竞争力的角度，还有为了让所有创新想法都能冒出来——毕竟最终受益的是消费者——我觉得必须得有个全国统一的框架。

I think from a competitiveness standpoint and from getting all the innovative ideas out there, which ultimately benefits the consumer, I think you've got to have a national framework.

没错。

Sure.

因为如果每个州都有不同的监管规则，搞得特别复杂，那只会让现有大公司占便宜，他们有庞大的法律团队，能搞懂所有规定，还能据此运营和扩张。

Because if you have a lot of regulatory complexity with different rules in every states, it favors the incumbents who have the armies of legal teams that can interpret all those things and operationalize and scale in that way.

你想让大科技和小科技站在同一条起跑线上。

You want to level the playing field for big tech and little tech.

但另一方面，你也希望有实验的空间。

On the other hand, you want the experimentation.

我觉得当技术发展这么快的时候，你希望监管能跟上，但你根本不知道什么才是正确的做法。

I think when the technology is moving so fast, you want regulation to catch up, but you really don't know what the right answer is.

所以像你所说的，让不同州根据各自的人口结构和城乡分布来试点，确实很有启发性。

And so it's instructive to have different states experiment for their unique population mix and rural to urban mix as you described.

所以对我来说，关键问题是：我们有没有足够的数据基础设施，能从这些实验中学到东西？

And so I think the question for me is do we have the right data infrastructure to learn from all that stuff?

比如处方药这个例子就挺有意思的。

So like the prescription example is an interesting one.

好，明白了。

Okay, great.

你知道的，处方药续药，4美元就能搞定，不用花150美元。

You know, you can refill a prescription for $4 instead of $150 Sure.

咱们看看这招管不管用，好处和坏处分别是什么。

Let's see if that works and let's see the upsides and downsides of it.

从这个州的试点项目里，咱们能学到不少东西。

We're going to learn a lot from that state pilot.

没错。

Sure.

但这只是其中一个例子。

But that's just one example.

咱们得让五十个不同的例子都试试看。

We want 50 different examples to play out.

这正是我担心的地方。

And that's the thing that I worry about.

是的。

Yeah.

我的意思是，如果我们

I mean, you know If we

就等国家层面吧。

wait just for National, basically.

对。

Yeah.

我的意思是，其实也有种观点认为，我记得乔纳森·斯洛特金写过一篇特别棒的评论，说Waymo的技术已经好到某种程度，要是到处推广反而不道德了。

I mean, there's an argument to be made also that I I thought actually that I think Jonathan Slotkin wrote like a great op ed about Waymo's seem to have proven that, like, they're so good that actually would be unethical Yes.

不该全面铺开。

Not roll it out everywhere.

太厉害了。

So good.

对吧？

Right?

我觉得如果我们能这么做就好了：这个试点项目效果这么好，我们就该赶紧推广到全国各地。

And I think if you can if we can do something around the in the lines of, hey, this pilot or this thing looks so good, we really just gotta boost it everywhere.

对。

Yeah.

我觉得联邦政府其实可以换种思路，别一上来就搞一刀切的规矩。

I think that can actually be maybe a different way the federal government thinks about things rather than be like, hey, we're gonna set blanket rules.

对。

Yeah.

不如让各地自己先试自己的方案。

It can be like, all these places should test their own things out.

要是哪个地方的效果真不错，那就……

If something looks like it's working Yes.

把它的做法推广到全国。

Then we make that the rule for everyone else.

然后赶紧把那些功能或项目推给所有人。

And then like, speed run getting people getting those getting that whatever, getting those features or programs out to everybody.

没错。

Yes.

别老想着先搞个‘这玩意儿行得通’的官方认证。

Rather than be like, hey, we need to create a yes, it's working.

不用上来就规定死

No, it's working.

给所有州统一套一套规则

Rule set for every state.

对

Yeah.

不如就让各州自己先试点测试，管用了再全国推广

Just be like, go run your own pilots and tests and then let's get it up.

《纽约时报》那篇讲Waymo的文章，对，没错

The New York Times article around Waymo Yeah.

就是个绝佳的例子

Is a perfect example.

而且有意思的是，文章里提到医疗健康和生命科学行业早就有这套逻辑了：如果你在做临床试验，期间疗效已经明明白白摆在那了，再继续试验就不符合伦理了——因为你还给对照组用安慰剂，这会坑到他们的

And actually, ironically, it it pointed to healthcare and life sciences as an industry that already has this framework, which is if you're running a clinical trial and the evidence is as clear as day, at some point it becomes unethical to continue the trial because you're giving the placebo to the control arm and it's causing them.

你懂的，就是会害到那群人

And you know it's them.

那这里到底是什么样的框架呢？

And so what is the framework like that here?

我觉得这个值得重点关注。

I think this is going to be one to watch.

这跟医疗AI领域的知识产权争议密切相关。

That relates to IP and all the IP debates around HealthCare AI.

对。

Yeah.

没错。

Yeah.

你说过，医疗AI领域的知识产权界限会逐渐明确，会出现丰厚的版权和授权交易。

So you said intellectual property lines will be drawn in HealthCare AI with lucrative copyright and licensing deals.

没错。

Yeah.

这张照片，我们一会儿放出来给大伙儿看看，画的是大鸟把你勒得喘不过气。

This photo, which we'll put it up for the people out there with big birds strangling you.

你知道吗，有时候我老婆闯进来，看到我正在工作，这次她看见我输出了一张埃尔莫把我勒住的图。

Know, sometimes my wife walks in on me doing my work, and in this case, she's seeing me, like, output an image of Elmo choking me out.

她还问，这真的就是我们家的饭钱来源？

And she's this is, like, really what's putting food on the table.

没错。

Exactly.

她都在怀疑你到底有没有正经工作。

She's wondering if you have a real job.

是啊。

Yeah.

对啊。

Yeah.

所以说，这事儿真是疯了。

So so, I mean but it's crazy.

那你给大家说说，AI整体上到底是怎么回事。

So so lay that out, lay out that case for AI overall.

当然。

Sure.

那些纷繁的版权纠纷和诉讼都闹得沸沸扬扬，那在医疗领域具体会是什么情况？

All the drama deals and litigations that And happened last then what does it look like in healthcare specifically?

我的意思是，从基础模型的角度来看，最大的问题一直是：当AI服务在复述、输出内容，或者以从未被允许的方式使用知识产权时，版权到底该怎么界定？

Yeah, mean, the foundation model side, the big issue has always been like, does copyright look like in an era where, you know, the AI service regurgitating or spitting out things or like using IP in ways it was never supposed to be.

这就跟埃尔莫勒死我一样。

It's like Elmo choking me out.

对吧？

Right?

没错。

Yeah.

现在呢，一堆诉讼和合作同时在发生，不同的基础模型被允许使用各大公司的知识产权。

And now there's a bunch of lawsuits slash partnerships that have been happening where different foundation models now are allowed to use the IP from different companies.

我觉得迪士尼投资了OpenAI。

So I think Disney invested in OpenAI.