医疗保健2026：AI医生、GLP-1药物与保险脱退

我不是在推荐它，但我确实认为它可能在一定程度上解决了这个中间地带的问题，就像是，嘿。

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.

比如，我目前的医疗保险很糟糕，它并没有覆盖我想要的保障内容，而且价格非常昂贵。

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.

我已经在赌保险公司是否会理赔了，这对很多人来说都是如此。

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.

他们就像是，你知道，我买了这个保险，然后我去理赔时他们却拒绝了我的索赔。

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

是的。

Yeah.

这种情况是有可能发生的。

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

我不妨试试这个其他方案。

I might as well try this other thing.

如果我因为比较健康而能加入，那我支付的费用就会更少。

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

所以我认为有很多人从意识形态上也认同这个前提。

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

是的。

Yeah.

因此，我认为这为那些处于中间地带的人提供了一定的可能性。

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

但基础设施并没有为这种情况做好准备，因为很多这样的人仍然需要自己去寻找医疗服务，是的。

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.

谈判账单，处理所有这些事情，而一些健康共享组织确实提供帮助你谈判等服务。

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.

比如，这里也发生了一些文化上的变化，人们必须愿意与医疗服务提供者协商价格。

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.

这并不是一种被普遍接受的做法。

That is not a normalized thing.

也许这会变得更为普遍，那

Maybe that becomes more normal, That

这说得通。

makes sense.

很有趣。

It's interesting.

你会加入医疗共享组织吗？

Would you sign up for a health sharing ministry?

我不确定我是否会加入。

I don't know if I would.

实际上，我不希望我们的医疗体系分裂成两部分。

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

一部分人有能力脱离医疗保险，选择现金支付，并自行管理他们的医疗体系，而另一部分人则被迫继续依赖现有的医疗系统，依靠慈善救助或自费支付，让医疗系统为其买单。

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.

今年我花了一些时间研究不同的医疗市场。

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

以墨西哥为例，在某种程度上就存在这种情况，虽然不是完全平行，但确实存在一个为富人服务的系统和一个为穷人服务的系统。

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

所以这将是这里我担心的不利情况。

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

确实如此。

Sure.

另外我的意思是，首先，我认为美国医疗的核心问题在于我们有太多的风险池，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?

你基本上必须二选一。

You kind of have to choose one or the other.

就像这样，嘿，也许我们部分自费，也许我们部分自费部分保险。

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

有些人有雇主提供的保险。

Some people are in employer insurance.

哦，有些人有医疗保险。

Oh, some people are Medicare.

这正是核心问题。

That's kind of the core problem.

对吧？

Right?

我们必须在两者之间选一个。

We have to move to one or the other.

对吧？

Right?

所以，对于《平价医疗法案》，其初衷是理论上让所有人都进入这个个人保险交易所，所有人都从那里购买保险。

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

至少他们都属于同一个风险池。

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

对吧？

Right?

这看起来更像德国。

And that looks more like Germany.

是的

Yeah.

你也可以完全采用现金支付，也就是所有人都现金支付，你只专注于这一点。

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

这看起来可能更像印度，或者如果你把门诊和住院分开处理，也像新加坡。

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?

但你必须选择其一。

But you have to pick one or the other.

像这种介于中间的美国模式

Like this in between Americans

喜欢选择。

love choice.

我们喜欢选择。

We love choice.

每个人都希望拥有选择权。

Everyone wants to have an option.

我们为选择付费。

We pay for the choice.

选择是最糟糕的方式。

Choice is like the worst way.

现在是在最糟糕的选项之间做选择。

It's choosing between the worst options now.

但另一方面，同样存在一个意识形态问题：你是否相信你应该能为更好的医疗付费？

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?

我认为这个问题让很多人感到非常不安，因为他们内心无法接受：人们应该能为更好的医生付费。

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.

好吧，如果你不想要那样，那也没问题，最终会发生的是，如果所有人都能使用一个医疗体系，那么无论如何都会出现一个并行的体系来允许他们这样做，对吧？

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?

因为他们会说，嘿，即使已经有现成的医疗体系，我也愿意花钱请最好的医生，现金支付，然后那些医生就会退出，对吧？

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?

这有点像今天正在发生的礼宾医疗之类的事情，对吧？

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

大家都在说，嘿，我们希望初级保健医生能够为所有人看病。

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

这就像是一种伟大的平衡器，诸如此类的说法。

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

然后突然间人们会说，我愿意付很多钱，只要你别那样做，只管来照顾我。

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?

是的。

Yeah.

事实上，这种情况已经发生了。

The reality is that's kind of already happening.

我想不出任何一个系统，即使在像英国这样的全民医疗国家，人们仍然会购买私人保险，以便更快地看医生，诸如此类的情况。

I can't think of a single system, even in socialized medicine countries like The UK, people still get private insurance and to to see see docs with lower wait times, all this kind of stuff.

我认为，不可能存在一个完全无法付费获得更好医疗服务的系统。

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

这种情况就是会发生。

It just happens.

无论怎样，它都会作为一种经济现象自然出现，除非你明令禁止，对吧？

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

你可以这么做，但这也会带来它自身的弊端。

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

比如加拿大，就是一个无法形成平行体系的例子。

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

这带来了自身的问题，比如人们会说：如果我需要复杂的治疗，我会去美国。

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.

所以我不知道，我觉得我们必须接受这个想法：无论怎样，最终很可能都会形成一个人们为更好的医疗服务付费的体系。

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.

你要么以一种非常迂回的方式实现这一点，要么直接了当地做，或者以一种你对他们选择付费内容更自在的方式来做。比如在印度等国家，人们可以付费获得更好的设施，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?

比如更好的待遇和诸如此类的东西。

Like the nice rewards and all this kind of stuff.

也许这是一种更容易让人接受的方式，基本上就是这样。

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

是的。

Yeah.

是的，这很有趣。

Yeah, it's interesting.

所以如果这种情况持续下去，具体比例待定——可能是15%、18%或12%，但根据Reddit上的讨论来看（这是我的真实感受，我的真实看法），很明显人们正在流失。

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, which is truth, that's my truth, that's my truth, people are defecting.

没错。

Yeah.

这对初创企业会产生哪些连锁反应？

What are the ripple effects for startups?

如果你想要创业，显然主动健康类初创公司在这里有机会，会有更多现金支付支出，但还有什么呢？

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

是的，我也认为对于这群人来说，护理导航看起来会非常不同。完全同意。

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

我认为你必须认真思考，如果自掏腰包的话，我现在的情况是否严重到需要去看收费更高的医疗从业者，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?

这个分诊步骤确实很不一样。

That triaging step is really different.

所以我确实认为帮助人们搞清楚，比如，嘿，我该去哪里处理这个问题？

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

以及这个问题是否真的严重到需要我去就诊？

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

基本上就变成了另一种需要开发的产品类型。

Becomes a whole separate type of product to build basically.

与有保险的人相比，你实际上是在帮他们 navigating 他们的保险、目录、保障范围等等。

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

所以我觉得这看起来非常不同。

So I think that looks very different.

我认为另一个连锁影响是，会有很多人试图以极低的成本提供医疗服务。

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Doctronic，犹他州的那个试点项目就是个很好的例子，我记得他们每次处方续药收费4美元。

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

而不是1.5美元？

Instead of $1.50?

是的。

Yes.

对。

Yeah.

这实际上相当实惠。

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

你需要续开处方。

You need a prescription refill.

是的。

Yeah.

这可以作为一种途径，而无需完全重新预约医生就诊。

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

对吧？

Right?

所以我认为你会看到更多这样的做法。

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

我们如何把成本降到极低的水平？

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

显然，要利用人工智能、技术以及所有这些手段。

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

另一个我觉得有点意思的想法是，能否与现有医疗服务提供方达成某种新型合约，针对那些自费就诊的患者？

And then the other one, which, like, I think is a little interesting to think about is, 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?

因为现实情况是，医疗服务提供方会陷入困境，对吧？

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

当有人来就诊，他们需要支付现金，但他们没有支付。

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

比如，你知道，如果他们进了急诊室，做了一些非常昂贵的治疗，人走了之后医院追着要钱，结果却收不到钱，对吧？

Like, you know, 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?

所以当这种情况发生时，医疗服务提供者就陷入了困境。

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

你能提供非常简便的打包支付方案之类的服务吗？对自费病人说：嘿，你是自费病人。

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

这是我们的费率。

Here's what our rate is.

然后过来完成支付。

This and come through and get it.

现在，如果你想了解某项目的自费费率，你得经历一个非常复杂繁琐的过程。

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.

你得打电话过去，说明你是自费病人，然后有点像讨价还价。

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

我感觉自己像是在印度市场里一样。

I feel like I'm like in the Indian market.

你明白我的意思吗？

You know what I mean?

我就觉得，我们来回讨价还价，然后就在想，怎么回事？

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

我们到底会怎么样？

Where are we gonna be?

但为了让大家更容易理解，这里有一个打包方案，包含的服务有这些，你可以来享受这项服务。

But to maybe just make it really easy for everyone, here's hey, the bundle, here are the services included, you can come for this.

对于一些成本较高的手术和类似项目，这一点尤其重要，如果你没有保险并且确实需要这些服务，我们可以告诉你如何操作以及具体费用。

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.

这看起来更像医疗旅游市场，人们会专程前来。

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

没错。

Exactly.

但这是本地化的版本。

But it's a local version of that.

但人们会来到美国，希望在梅奥诊所接受治疗。

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

是的。

Yes.

他们自费支付。

They're paying out of pocket.

他们不在我们的系统中。

They're not in our system.

是的。

Yeah.

可能有一种国内的类似选择。

There could be a domestic option like that.

这种模式今天已经存在，但只需让它更简便一些，

It exists today, but it just make it easier,

今天要这样做非常困难。

It's lower very hard to do that today.

对。

Yeah.

所以也许这就是其中一个方案。

So maybe that's one.

好的。

Okay.

所以我们会在一些预测中跳着讲，只挑更相关的部分。

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

如果消费者正在流失，更多地协调他们的护理并增加自付支出，那么一个预测是筛查诊断和居家样本采集将成为热门领域。

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.

是的。

Yeah.

那么请详细阐述一下这个情况。

So lay out the case there.

所以Lil Jon正在做结肠癌筛查的广告。

So Lil Jon is doing colon cancer screening commercials.

人们在全国各地寄送自己的粪便样本。

People are shipping their poop around the country.

这太疯狂了。

It's crazy.

甚至他们就这么做了。

Not even They're just doing it.

寄完邮件后要洗手。

Wash your hands after you check the mail.

解释一下这个。

Lay out that.

你为什么觉得这会发生？

Why do you think that's gonna happen?

我的意思是，明确一点，我不认为这是因为没有保险的情况发生的。

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

当然。

Sure.

但我认为诊断领域是一个非常有趣且投资不足的领域。

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

我认为，或许可以和无保险人群联系起来，但更准确地说是自费人群，我觉得这是一个很多人——当你和医生、患者交谈时——会发现存在某种根本性分歧的领域，他们根本无法达成共识。

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.

比如，人们希望在某种程度上接受监测。

Like, the people wanna be monitored in some capacity.

很多医生会说，你可以被监测，但即使你被监测了，我们也做不了多少事。

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?

你的治疗方案在那期间并不会改变。

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

但很多人就是想要被监测。

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

对吧？

Right?

因为他们觉得有人在关注他们，他们在每一个环节都被重视，诸如此类。

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

所以我认为人们想要这种服务，尤其是在自费医疗中。

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

你在长寿医学和这类领域中也能看到这种现象。

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

他们想要的一个重要组成部分其实就是被监测。

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

对吧？

Right?

即使结果显示一切正常，但至少我们检查过了，你明白吗？

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

所以我确实认为这方面的需求非常高。

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

我认为随着我们转向更多这类AI原生的护理模式，这将成为非常核心的部分，对吧？

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

从被动护理转向主动护理，关键必须在于确定哪些数据源能告诉你需要采取行动，对吗？

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?

我认为这将来自于某种形式的筛查诊断等等。

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

你知道，我们之前稍微讨论过AI，比如AI开处方这方面。

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

我认为更有意思的下一阶段是，AI能够预先订购像化验或随访这样的项目，甚至在医生需要查看之前就完成，对吧？

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, right?

而且我认为这将成为其中的一部分。

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

但总的来说，我觉得诊断领域也出现了更有趣的市场策略，也就是说，我们发现有一个庞大的自费市场，他们只是希望被监测，同时我们可能会走更正规的路线，比如实验室开发的测试或FDA批准的途径。

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, maybe we go through a more legit, you know, lab developed tests or FDA approval route.

但市场对这些新测试有需求，它们应该根据一些通常不被监测的不同指标来进行监控。

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

他们看到了人们对此的强烈需求。

And they see this appetite from people to do that.

比如说，如果你有某种家族遗传风险，但又不太符合相关指南中需要开具特定药物的标准，人们就会寻找替代途径来实现这一点，而且他们也有足够的资金。

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.

他们会愿意为此付费。

They're gonna pay for it.

冠状动脉钙化CT扫描就是一个很好的例子，不知为何，这项检查真的很难获得。

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，证据与研究之间，以及临床指南之间仍然存在巨大的滞后，对吧？

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

在很多情况下，从有趣的研究发现到真正被应用于所有患者的临床实践，这个滞后长达十年以上。

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.

但人们愿意花钱来规避这种滞后。

But people are willing to pay to to escape that.

你做过吗？

Have you done it?

钙化扫描？

The calcium scamp?

我没有，老兄。

I'm not, dude.

但如果你是一个30岁的棕色人种，那你突然就进入了需要关注这个问题的风险类别。

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.

我就是你刚才描述的完美例子：胆固醇略高，南亚男性，所以

I'm a perfect example of what you just described, is slightly high on the border cholesterol, South Asian male, so

我有风险因素。

I have risk factors.

心血管事件。

Cannon event.

是的，没错。

Yeah, exactly.

所以我的医生说，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.

谁知道呢？

What does one know?

医生懂什么？

What do doctors know?

开玩笑的。

Just kidding.

但我还是做了。

But I did it anyways.

不错。

Cool.

你发现了什么？

What'd you find out?

结果是零，这很好。

It was a zero, which is good.

好的。

Okay.

但我

But I

我想知道这个。

wanted to know that.

是的。

Yeah.

这很好到

That's good to

知道了。

know.

没错。

Exactly.

就像，我觉得我们社会需要弄明白的一个难题是，现有的医疗体系真的很想做到，嘿，他们真的想为人们提供标准化的医疗服务，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?

并且制定标准化指南，让医疗在平均水平上对每个人也都很好，对吧？

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

但同时，人们也希望在医疗保健方面拥有更多自主权，对吧？

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

他们不想听到别人说，嘿，等着看吧。

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

他们就是不想听到这种话。

They just don't wanna be told that.

而且可能还有很多风险更低的事情，我们可以让人们尝试去做、去观察。

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

我认为这就是为什么像休伯曼协议这样的协议现在如此流行的原因之一，是的。

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

协议的周期。

Period of protocols.

你知道，这些协议的核心内容就是吃好、睡好，也就是你常听到的那些常规建议。

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.

但是

But

这是有品牌效应的。

It's branded.

这是有品牌效应的，但

Well, it's branded, but

它还给人提供了一张看似明确的任务清单，让他们积极去做，是的。

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

从而改善自己的健康状况，并提供一些补充剂，让他们感觉真的在采取行动。

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

是的。

Yeah.

而他们是否真的在做其实并不重要，但我觉得在这些情况下拥有掌控感才是关键部分。

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.

所以测试也是一样的道理。

So it's the same with the testing.

人们只是想要感觉自己稍微能掌控局面。

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

而且，你知道，我觉得这里存在一些矛盾，一方面，很明显有些患者就是抱着'活在当下'的心态，直到筛查测试和诊断结果出来，结果给医疗系统带来更大压力。

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，你在核磁共振检查中发现了意外瘤。

Like, you find incident delomas in your MRI.

现在得由别人来处理这件事，诸如此类的情况。

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

但我认为人们想要更多自主权，去做个检查，当你觉得对目前的护理方案不太满意时。

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.

我只是喜欢去观察和检测。

I just like to see and test.

不管好坏，我都想成为未来医疗的一部分。

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

我觉得这是对的。

I think that's right.

我认为这引发了另一个争论，即监管机构允许这些检测和人工智能应用宣称什么？

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

是的。

Yeah.

我认为很多这类东西，医疗界会说，它其实并不会告诉你任何切实可行或有趣的信息。

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.

是的。

Yeah.

但这些事物往往始于边缘。

But these things start on the fringe.

我的看法是，我认为这是件好事。

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

它们从边缘开始，然后逐渐走向主流。

They start on the fringe and then they get more mainstream.

我认为现实是，我们今天在美国所拥有的医疗体系严重受到供给限制。

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

所以，有2300万美国人从事医疗行业，但我们仍然面临漫长的等待时间。

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

你已经听过所有这些统计数据了。

You've heard all the statistics.

一亿多人无法获得初级保健医生，即使能约到，等待时间也超过四十天，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.

因此，所有这些摩擦令人沮丧，需求的激增四处蔓延，正流向各个方向。

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

说到你的观点，人们想要的是自主性，这种自主性会流向某个地方。

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

它流向哪里了？

And where is it shooting off?

它流向了大语言模型。

It shoots off at LLMs.

你看过OpenAI的报告吧，每周有两亿三千万人 worldwide 使用ChatGPT咨询健康相关问题，每天四千万人。

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.

这太疯狂了，太疯狂了。

It's crazy, It's crazy.

它已经取代了医生。

It's replaced Doctor.

还有谷歌和其他许多东西。

Google and many other things.

主动健康管理工具正被大量人群采用，比如健康会员服务、可穿戴设备如Aura和Whoop，等等。

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

这很合理，对吧？

And that makes sense, right?

人们想利用它做些什么，但我发现仍然存在监管摩擦，这很有趣，我很好奇想看看它会如何发展，至少在几周前以及更早之前，设备被分为两类。

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要么说它是健康产品，完全不能做任何医疗声明，要么说它是医疗设备，你可以随意做声明，但必须经过漫长的监管审批流程。

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.

是的，没错。

Yep, yep.

正如我们所知，这很大程度上有利于现有的大型医疗科技公司，对初创企业来说确实很困难。

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

所以相对而言，出现的设备数量并不多，我认为相比可能达到的规模要少得多。

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

是的。

Yeah.

我正以我的Oura Ring为例进行说明。

I'm touching my Oura Ring as an example.

所以Oura的汤姆，那里的投资者，但我认为他在《华尔街日报》上发表了一篇精彩的观点文章，基本上提出了应该有第三类别的观点。

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.

而这第三类别就是数字健康筛查器，它介于两者之间，不一定能直接提供医疗诊断，但会向你展示一些你可能想了解的关于身体的信息，或许你会想和医生讨论。

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.

他在文章中举的例子我觉得很好，比如它可能能推断出高血压的几个早期迹象，并告诉你：嘿，你可能需要和医生谈谈高血压的问题。

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.

而且我记得，虽然记不清具体数据了，但超过40%的成年人被诊断出患有高血压之类的，这太疯狂了，真是一种具有挑战性的慢性病。

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.

文章中提到的另一个例子是，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.

请咨询你的医生。

Talk to your doctor.

是的，完全同意。

Yeah, totally.

对吧？

Right?

就像我们应该放手让它去。

Like we should just let that go.

我认为这中间显然存在某种方式，你可以获取所有这些数据，然后直接输入到你的大型语言模型中。

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.

反正人们已经在这么做了。

People are doing it anyways.

我把我的所有医疗数据都输入到模型中进行分析

I drop all my medical data into counsel and pick

就是这个。

the one.

这就是未来的发展方向。

And that's where it's going.

FDA发表了一些言论，暗示他们将会——他们

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

给出了暗示，使眼色，心照不宣。

gave the hint, hint, wink, wink.

是的，他们将会对可穿戴设备的某些规定进行回调，但可穿戴设备只是开始。

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

对吧？

Right?

现在你进入AI医生应用，它们能说什么，能做什么。

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

你觉得怎么样？

So what do you think of that?

我的意思是，再次强调，问题在于，作为社会，我们认为患者应该被允许承担多大的风险？

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开药这件事可能就是个很好的例子。

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

对吧？

Right?

我们稍后再回到诊断这个话题。

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

但你认为一个人是否应该有权说，嘿，我想花4美元去看AI医生，让它通过常见药物自动给我开处方？

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?

它有时可能会出错。

It might get it wrong sometimes.

如果它出错了，那就会伤害到我。

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

或者我可以选择支付更高的费用去看一个可能准确率更高、或者说是降低不良事件风险的医生，比如避免被开错药之类的情况。

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，我是否应该被允许做出这样的选择：我想要那个可能更容易出错但更便宜的AI医生，还是不想要。

Should I be able to make should I be allowed as a person to make that choice that, like, I want the AI doc that maybe gets it wrong more often, but it's cheaper or not.

对于筛查诊断类的可穿戴设备来说，可能也是同样的情况，对吧？

Probably same thing for screening diagnostic wearables, right?

这就像说，这里有个东西可能会从你的数据中发现一些有趣的信息，但它也会有这么高的假阳性率，对吧？

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, right?

而你可以选择这个。

And you can choose that.

不过我要说的是，这里的问题在于，假阳性率带来的负担会落在你去看的医生、医疗系统或急诊室身上。

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.

所以我认为这是我们不得不认真考虑的一个现实问题：当这些设备大规模普及时，一旦出现假阳性，可能会波及数百万人。

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, like it's gonna be millions of people.

对吧？

Right?

这可不是开玩笑的。

That's no joke.

对吧？

Right?

但与此同时，我认为我们正在错过大量非常有趣的数据，本该更多地加以利用。

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.

例如，我觉得，你知道，我一直在和一些长期佩戴连续血糖监测仪的人交流。

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

嗯哼。

Mhmm.

他们中很多人，我认为，比如，有着不同于传统糖尿病表现的病理特征。

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

就像，比如说，我觉得糖尿病是一个宽泛的类别，但可能实际上存在多种不同的潜在问题，它们其实是不同形式的糖尿病。

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、失眠这类情况可能也是同样的道理。

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

很可能存在多种潜在的病理状况，但除非你拥有更庞大的数据流来帮助判断这些变化以及它们如何偏离健康基线，否则很难确定——我认为这一点非常重要。

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?

我今天戴着口腔监测环，作为一个健康的人。

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

随着我患上疾病，它会捕捉到从我的健康基线变化到更像病人的状态。

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

而这些变化及其自然进展，基本上就是自然史研究，真的非常重要。

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

我认为如果有更多人佩戴这类设备，我们或许能为更多疾病做到这一点。

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

所以这就是真实世界数据的梦想。

So This is the real world data dream.

确实如此。

It is.

真的。

Really.

这正是我们都想要的。

This is what we all wanted.

是的。

Yeah.

我认为问题在于真实世界数据一直以来都更侧重于制药行业的应用场景。

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

我觉得还有很多人只是单纯想知道，是否有其他像我一样拥有这种奇怪睡眠模式的人。

I think 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.

那他们是怎么做的呢？

And what does that what are they doing?

这是什么意思？

What does that mean?

你知道吗？

You know?

我认为这是一个非常开放、尚未探索的领域，人们还没有完全……我想如果有听众正在听，我认为基于这些概念建立一个以患者为先的生物样本库会非常有趣。

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, I think is really interesting.

人们确实想知道与自己相似或拥有相似生物标志物的人是如何应对这种情况或在世界上生活的。

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.

即使去标识化，他们的医疗旅程是什么样的呢？

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

知道这一点很有用，比如，有个人也有这种奇怪的睡眠模式，他服用了这种剂量的镁，结果确实对他有效。

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.

实际上，当我们对人群进行亚群分组时，他们和你非常相似。

They actually, you know, when we sub cohort the populations, they look very similar to you.

所以你也许可以试试。

So maybe you should try it.

对吧？

Right?

是的。

Yeah.

这还是一片非常未被探索的领域。

That's very unexplored.

我认为可穿戴设备和其他这类技术就是实现这一点的方式。

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

但如果我们不能以某种结构化的方式捕捉这些数据，就只能做到这一步了，对吧？

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

你需要一条中间路径来实现这一点。

And you need a middle path to do that.

这正好是一个很好的过渡话题。

So that's a good transition to talk about.

你之前提出了大约三个关于医疗人工智能的预测。

You had three or so predictions around healthcare AI.

你的第一个预测是关于州政府与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.

从几个维度谈谈这个问题，但让我们聚焦在人工智能上。

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

州政府将在公共卫生指南、疫苗建议、人工智能监管、保险法细节等方面与联邦政府发生冲突。

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

以上所有方面。

All of the above.

好的，我们来谈谈这个。

Yeah, let's talk about that.

具体到人工智能方面，我觉得这很有意思。

So on AI specifically, think this is interesting.

去年伊利诺伊州、内华达州和其他几个州要么禁止要么限制了人工智能治疗聊天机器人的使用。

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

基本上就在上周，也就是你写完文章之后，我们确实看到犹他州正在试点允许人工智能开处方药。

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

它非常局限于190种低风险药物，比如你的哮喘吸入器等。

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

从低风险内容开始，但可以扩展。

Low risk stuff to start, but can expand.

然后特朗普总统在12月签署了一项行政命令，实际上是在说，嘿，我们将制定一个全国性框架，让民众更容易遵循。

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.

听起来你认为2026年情况会更混乱。

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

确实如此。

Definitely.

请多说说。

Say more.

我的意思是，我认为有几件事需要考虑。

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

对吧？

Right?

一方面，美国确实存在一种反人工智能的运动，这在某种程度上是预料之中且自然的，人们担心失业问题，也担心那些影响他们生活的决策是如何做出的，因为可能另一端的人工智能正在做出不利于他们的选择。

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?

所以我理解这种情绪的由来，而这种反人工智能运动将不可避免地影响政策。

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

根据你所在的州，该州的监管机构会支持其中一方或另一方，对吧？

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, right?

也许这里的类比实际上是Waymo，对吧？

Maybe like analog here is actually like Waymo's, right?

Waymo已经在几个州运营了。

Waymo's are in a few states.

它们最初是在加利福尼亚州启动的。

They started in California.

每次我来这里，我都超爱乘坐Waymo。

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

各州对于是否允许Waymo进入本州有着非常不同的看法，对吧？

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

无论是他们关心在推出前需要证明多少安全性，还是他们知道Waymo进入后会导致大规模失业。

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

我认为其他领域的AI也会遵循同样的趋势，对吧？

And I think AI for other things is just gonna follow the same trend, right?

所以我认为问题在于各州还不太清楚该如何应对。

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

我认为我们都承认，有很多不良的人工智能应用案例需要我们警惕，比如深度伪造和各种奇怪的手段，以及这类事情，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，我认为人们正在努力探索如何监管人工智能的负面风险，同时又能发挥我们看到的积极潜力，对吗？

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?

也许我们进行各州实验来观察哪些有效、哪些无效，然后制定更全国性的框架来做这件事，实际上并不是坏事。

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.

不过缺点是，就像医疗保健一样，每个州都有不同的合规规则总是很烦人，这意味着你的产品看起来会非常不同，进入新州的成本也大不相同。

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.

这会很烦人，但实际上，也许我们应该在这里进行不同的实验。

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

每个州都会，你知道的，根据他们自身的医疗需求，情况会有所不同。

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?

比如说，如果你有大量农村人口很难获得医疗服务，你可能会更倾向于强调：我们需要帮助这些没有家庭医生的人。

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.

我们需要为他们提供一些东西。

We need to get them something.

对吧？

Right?

如果你有一个竞争非常激烈的医疗服务网络，也许情况并非如此，医疗服务的可及性也没问题等等。

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

所以我认为，各州其实是在努力思考如何在获得好处的同时防范风险，只是他们对具体怎么做有着不同的看法。

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，他们真的不希望保险公司使用人工智能来拒绝理赔。

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

对吧？

Right?

他们觉得那样很糟糕，诸如此类的。

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

他们宁愿让人来拒绝理赔。

They'd rather have humans deny claims.

是的，

Yeah.

与此同时，他们又该如何进行监控呢？

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

如果一个人使用ChatGBT来处理索赔然后拒绝它，这真的有什么区别吗？

If a human is using ChatGBT to lead the claim and then deny it, is it really any different?

没错，

Yeah,

当然。

sure.

不太清楚，但不知道呢，我们会看到一些有趣的州内实验。

Not too clear, but I don't know, we'll see Be some fun home state experiments.

是的，我觉得说得对。

Yeah, think that's right.

我认为从竞争力和让所有创新想法得以实现的角度来看——这最终对消费者有利——必须有一个国家层面的框架。

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.

当然。

Sure.

因为如果你在每个州都有大量监管复杂性，不同的规则会有利于那些拥有庞大法律团队、能够解读并以这种方式运营和扩展的现有企业。

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 operationalize and scale in that way.

你希望为大科技公司和小科技公司创造一个公平的竞争环境。

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

另一方面，你也希望有实验的空间。

On the other hand, you want the experimentation.

当技术发展如此迅速时，你希望监管能跟上，但你真的不知道什么是正确的答案。

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

因此，正如你所描述的，让不同州根据其独特的人口构成和城乡比例进行实验是有启发性的。

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，问题在于我们是否有合适的数据基础设施来从这一切中学习？

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

比如处方的例子就是一个有趣的案例。

So like the prescription example is an interesting one.

好的，太好了。

Okay, great.

你知道，你可以花4美元而不是150美元来续配处方药。让我们看看这是否可行，以及它的利弊。

You know, you can refill a prescription for $4 instead of $150 Let's see if that works and let's see the upsides and downsides of it.

我们将从那个州的试点项目中学到很多。

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

当然。

Sure.

但这只是一个例子。

But that's just one example.

我们希望看到50个不同的例子展开。

We want 50 different examples to play out.

这就是我担心的事情。

That's the thing that I worry about.

是的，我是说，你知道如果我们

Yeah, I mean, you know If we

只是等待全国范围内的，基本上。

wait just for national, basically.

是的。

Yeah.

我的意思是，也有一种观点认为，我觉得乔纳森·斯洛特金写过一篇很棒的评论文章，指出Waymo似乎已经证明了他们如此出色，以至于不全面推广反而是不道德的。

I mean, there's an argument to be made also that 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 to not roll it out everywhere.

太棒了。

So good.

对吧？

Right?

我认为，如果我们能做点类似的事情，比如：这个试点项目或这个举措看起来太好了，我们真的必须全面推广。

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.

是的。

Yeah.

我认为这实际上可以成为联邦政府思考问题的另一种方式，而不是说：我们要制定一刀切的规则。

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

是的。

Yeah.

可以是这样的，所有地方都应该测试他们自己的东西。

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

如果某些东西看起来运作良好，是的。

If something looks like it's working Yes.

然后我们就把它定为适用于所有人的规则。

Then we make that the rule for everyone else.

然后就像，快速推进让人们获得那些功能或项目，让所有人都能用上。

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

是的。

Yes.

而不是说，嘿，我们需要创造一个——是的，它确实有效。

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

不，它确实有效。

No, it's working.

为每个州制定规则集。

Rule set for every state.

是的。

Yeah.

就像这样，去运行你们自己的试点和测试，然后我们就把它推广开来。

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

《纽约时报》关于Waymo的文章就是一个完美的例子。

The New York Times article around Waymo is a perfect example.

而实际上，讽刺的是，它指向了医疗保健和生命科学行业，这个行业已经有了这样的框架：如果你正在进行临床试验，证据已经非常明确，那么继续试验就会变得不道德，因为你给对照组使用了安慰剂

And actually, ironically, it pointed to healthcare and life sciences as a 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

并且这正在对他们造成伤害。

and it's causing them.

知道这正在伤害他们。

Know it's harming them.

那么这里的框架是什么样的呢？

And so what is the framework like that here?

我认为这将是一个值得关注的案例。

I think this is going to be one to watch.

这与知识产权以及医疗AI领域的所有知识产权争议有关。

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

你说过，医疗AI领域的知识产权界限将会明确，并且会出现利润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.

是的。

Yeah.

这张照片，我们会放出来给那些被大鸟勒住的人看。

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

有时候我妻子走进来，看到我在工作，这次她看到我输出了一张埃尔莫勒住我的图片。

You 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.

是的。

Yeah.

这真的是在养家糊口的东西吗？

Is this really what's putting food on the table?

是的，没错。

Yeah, exactly.

她在怀疑你是不是有份正经工作。

She's wondering if you have a real job.

对对对。

Yeah, yeah, yeah.

我的意思是，但这太疯狂了。

I mean, but it's crazy.

那么请详细阐述一下，全面分析人工智能领域的案例，包括去年发生的所有戏剧性事件、交易和诉讼。

So lay that out, lay out that case for AI overall, all the drama, deals, and litigations that happened last year.

那么在医疗保健领域具体又是什么情况呢？

And then what does it look like in healthcare specifically?

是的。

Yeah.

我的意思是，在基础模型方面，核心问题一直是：在人工智能服务会复述、输出内容或以从未预期的方式使用知识产权的时代，版权会呈现怎样的形态。

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

就像艾尔莫在掐我脖子，对吧？

It's like Elmo choking me out, right?

现在出现了一系列诉讼和合作，不同的基础模型现在被允许使用不同公司的知识产权。

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

所以我想迪士尼投资了OpenAI，对吧？

So I think Disney invested in OpenAI, right?

现在大概可以在其中使用他们的知识产权了。

And now presumably can use their IP within it.

所以，你知道，你可以清楚地看到这些界限正在被划定，Anthropic就曾面临一个重大案件，起诉那些写了很多书之类的人。

So, you know, you clearly see these lines being drawn and Anthropic had a huge case against people who have written a bunch of books and all this kind of stuff.

所以这个问题正在解决中，对吧？

So that's being figured out, right?

医疗保健领域有太多受版权保护的内容。

Healthcare has so many copyrighted things.

例如疾病量表、CBT代码，这么多受版权保护的东西可能是所有行业中被付费墙保护得最严密、最昂贵的PDF文件了。

Disease scales, for example, CBT codes, so many of these copyrighted things probably is the most behind a paywall expensive PDFs that exist of any industry somehow.

是的

Yeah.

但我们在付费墙领域是市场领导者吗？

But there's Are we the market leader in paywalls?

我们一定是。

We must.

这真的很令人难过。

That's really sad.

我们一定是。

We must be.

公平地说，如果你想使用这些内容，就必须支付费用。

Fair So if you want to use any of those things, you gotta pay a fee.

你得付钱了。

You gotta pay the piper.

对吧？

Right?

只要我们处在一个必须使用这些标准或类似体系的环境中，许多医疗人工智能应用就有必要与这些知识产权所有者建立授权合作关系，对吧？

As long as we are in a system where you have to use those standards or whatever, it it behooves a lot of these a lot of the healthcare AI applications to create licensing partnerships with these people who own the IP, right?

所以现实中这种情况很可能会发生。

So that'll probably happen realistically.

是的。

Yeah.

我认为可能有一个更有趣的问题，我前几天在网上发过这个观点，结果被吐槽了，但我认为这是一个有趣的思维实验：我认为协议就是知识产权。

I think maybe a more interesting one, and I sort of posted this online the other day and kinda got roasted, but I think it's an interesting thought experiment is I think protocols are IP.

嗯。

Mhmm.

对吧？

Right?

我认为彼得·阿蒂亚的长寿协议就是知识产权。

I think that the Peter Atia longevity protocol is IP.

我一直有个问题，如果你是彼得·阿蒂亚，对吧？

And I think one question has always been like, okay, if you are a Peter Atia, right?

顺便说一下，我不认识彼得·阿蒂亚，但嘿，如果你在听的话。

By way, I don't know Peter Atia, but hey, man, if you're listening.

告诉我你对此有什么看法。

Let me know let me know what you think.

我会买下它。

Would buy not die.

我会购买彼得·阿蒂亚的方案。

I would buy the Peter Atia protocol.

是的。

Yeah.

因为你知道，要成为他的客户，他收费非常高，但要是能把这个方案开放出来就好了。

Because I can't you know, his to be on his client list, he charges a really high fee, but make that available.

对。

Yeah.

比如，如果有一个经过彼得·阿蒂亚训练的智能代理，能在患者初诊、剂量调整等环节实施这些方案，那么你就可以只去看普通医生，但医生会配套使用彼得·阿蒂亚的方案，帮你完成在他在诊所里通常能做的一切。

Like, also, if there's a Peter Attia trained agent that is implementing the protocols at the you know, patient intake level, at the, dose escalation level, whatever, then you can potentially just see a regular doctor that has a wraparound of the Peter Attia protocols that, you know, helps you do all the things that you normally would at his clinic, essentially.

对吧？

Right?

你支付的价格可能比普通诊所低。

You pay maybe a lower price than the normal clinic.

对不对？

Right?

但我认为这会成为一个有趣的点，嘿。

But I think that becomes an interesting thing of, hey.

我想创建自己的治疗方案，这些方案可能略微超出循证医学指南的范围，然后让其他诊所实施。

I wanna create my own protocols that I think are maybe slightly outside evidence based medicine guidelines and then gets implemented at other clinics.

对吧？

Right?

但很多诊所可能会通过人工智能代理或其他方式来实际执行这些方案。

But a lot of those clinics might implement it in the form of AI agents or other ways to actually execute that.

所以是的。

So Yeah.