GOP Debate, AI in Medicine and the Right Wing's New Favorite Song with Co-Hosts Louie Swisher and Dr. Jeffrey Swisher

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Hi, everyone.

This is Pivot from New York Magazine and the Vox Media Podcast Network.

I'm Kara Swisher.

As Scott 3 August continues and it's going rather well, my co-hosts today are two of my favorite people, my son Louis Swisher and my brother, Dr.

Jeffrey Swisher.

Say hello, boys.

Hi, Kara.

Hi, Mom.

Hey, Louie.

Hey, Jeff.

Hi, mom.

How's it going?

It's going good.

I'm glad to be back.

I know.

I'm glad you're back, too.

I'm so thrilled you're here.

Explain where we are, Louie.

Well, we are currently in a very beautiful old house in Ann Arbor, Michigan, here to drop off my charmingly lovely little brother at Michigan.

It's going to be a big year for him.

I'm very excited.

Yeah.

And where are you headed?

Oh, me?

May voy al sur.

I'm going to Argentina.

I'm very excited.

Yeah, you're leaving your mother.

You're leaving your mother to go to Argentina for the year.

Are you excited?

Yes, I am very excited.

I'm very excited.

I think it's going to be a great adventure.

Why are you going to Argentina?

Explain for the people why.

I am going to Argentina because I am studying inter-American politics and all the terrible things our government did in Latin America over the past 100 years.

And I'm also a student of fascism, according to my grades last semester, a grade A fascist.

So I am very excited to learn more about fascism within the American or Latin American context and try to apply those lessons here to the United States.

Yeah, Kara, don't cry for Louis for Argentina, okay?

Because, you know, anyway, that's a joke.

God, you're not going to be Scott Galloway.

Don't try to be a bad Scott Galloway.

I'm not trying to be Scott, but Louie, I got a question.

Is Alex going to be in one of those super high-rise dorms when he goes to Michigan for his housing?

No, I don't actually think so.

I heard he's, I don't know the exact name of his dorm, but I remember when I came here a month ago for his orientation tour, we went to his dining hall, and apparently it's the best one, which is good for him because he's a black hole of consumption.

Yeah, there's some advice I want to give him about high-rise dorms.

Do not have sex in elevators because it's wrong on so many levels.

Just kidding.

Oh, my God.

Yeah, this is the theme of today's episode.

So it begins.

All right, dad jokes.

No, no, these two were last night.

Last night they were trading dirty jokes.

One of the functions of my brother is to be the obnoxious dad joke guy for my sons.

And it's worked out rather well for all of them, except for me.

Last night was the bottom of the barrel of all these jokes they were telling.

Somebody's got to do it, Kara.

It's a hard job, but somebody's got to do it.

It is.

I am a student of the uncle, and I am ready to carry the torch of the terrible jokes.

Okay, please don't.

Please don't.

This is a bad, I should have never introduced you.

Let me ask you a question, Louis, before we get to our big stories.

College is going well, I think, for you.

You're liking college?

I am.

Yeah.

My sophomore year was a lot better than my freshman year.

that was quite a year you had the pandemic yeah yeah yeah yeah yeah you took a year off people I've talked about that yeah gap years on a scale of one to ten how influenced have you been by Scott Galloway by Scott Galloway oh there's not a moment I go without his influence I think I carry it with me I carry the algebra of happiness on me every day I read it I quote it like the Bible you do I think Scott is excellent I really I think he's a lovely man who does a lovely podcast with my lovely mother and

is just a really exciting, bright light to be around.

While that light can sometimes burn a bit hot, I think sometimes we need that in our lives.

So, yeah.

Yeah, we do.

You were excited about his book about men, right?

You wanted to talk to him.

You had some thoughts.

It's interesting.

I mean, modern, as this, as a son of women, I get asked all the time about modern masculinity and the collapse of masculinity and, you know, yada, yada, yada.

And I'm just like, buddy, it's just changing.

The one constant has changed.

So why don't we just all get on board with this training?

You know, it doesn't, you know, and also like my life doesn't necessarily need to affect your life.

So, yep, that's right.

Mind your own business so you won't be mind and mind, Sank.

That's a great song, great song.

Hank Williams, go listen to him.

Anyway, today we'll talk about the first GOP primary debate of the 2024 election, the pros and cons of artificial intelligence in medicine, and the song that seemingly came out of nowhere to light up the charts.

But first, in my latest episode of On with Kara Swisher, I talked to Ronan Farrow about his new piece on Elon Musk.

Farrow details Musk's isolation and how his use of ketamine and other drugs may be impacting his decisions.

Let's listen to a clip.

Ambien, ketamine, weed are all substances that can be taken legally and safely, and you might have varying views on how healthy each of these things are, but there's certainly a valid defense of a healthy use of all of them.

Nevertheless, this picture that emerges when you talk about

him with people who are close to him and even care about him is of a person who's under tremendous stress.

You know, maybe grapples with, you know, I'm not going to diagnose the guy and say depression, but certainly he's talked about sadness, loneliness, right?

And, you know, those kinds of substances in excess can be ones where you

would be concerned if someone is in bad shape emotionally and using them to excess again

in sensitive contexts like launching rockets.

What a cocktail.

I know, right?

We'll get to your thoughts on drugs in a second, Louis.

But Jeff, talk about this because let's just say first, alleged use of these drugs.

He's talked about his use of Ambien.

He's talked about

his problems with opiates.

He's tweeted about it.

And many people, you know, the Wall Street Journal had a story about this.

He talks, he doesn't shy away from talking about this issue.

Okay.

Yeah.

I mean, Elon's always had sly references to drug culture.

I mean, the whole thing on the price of Twitter stock, 440 and 420.

And

I mean, 420, I'm sorry, 420

in marijuana and smoking on, I guess, was Joe Rogan.

Was he smoking a joint on a show?

And so

the thing about this, he's always sort of been kind of an edgelord, and that's kind of how he sees himself, I think.

And my concern is that that kind of behavior seems to be getting worse over time.

And of course, I mean, obviously, I read the article in the New Yorker by Ronin, which was fantastic and extremely comprehensive.

And I actually saw it today, I guess, on Twitter or not on X.

Elon basically said Ronin was the enemy of the people.

It's a little concerning.

So the drugs that purportedly he's using, ketamine, is a dissociative anesthetic.

I use ketamine almost on a daily basis in my patients, and it's a very effective drug.

And ketamine is now, a lot of research is being done on ketamine, its use in depression in smaller doses.

But in higher doses, ketamine is a very powerful dissociative anesthetic, which is what I use it for, for patients.

And it could be problematic because obviously judgment can be impaired

and it can create issues.

And so ketamine combined with a benzodiazepine like ambien, or I use midazolam, which is a shorter acting amnestic agent.

It takes the edge off ketamine and I'm using it in lower doses and intravenously.

I don't know whether Elon is using it intravenously or orally or intramuscularly, but obviously in higher doses, it's got more significant effects.

Can there be an abuse of it just the way there can be abuse of opiates?

Yes, of course.

I mean,

there's types of abuse.

Opiate abuse is different.

Opiate addiction is different than I would think ketamine addiction is.

There are

opiate receptors in the body that are naturally occurring,

and opiates are addictive physiologically as well as psychologically.

I think ketamine is probably more addictive from a psychological standpoint than a physical standpoint.

I don't know of ketamine withdrawal, for instance, whereas you can have severe opiate withdrawal.

And also, there's a threshold effect of ketamine to a point.

I mean, at some point, you become, you go to sleep.

It can be used as an induction agent to make someone fall asleep.

So I don't know about long-term effects, but it could certainly impair your judgment.

Impair your judgment.

Louis, how do you look at this when you hear about these things?

I don't know.

I've always viewed him with kind of a cautionary glance because

I don't trust him.

I think that he has an agenda based in his companies that he wants them to do well, as well as his personal agenda as an edgelord trying to instigate conflict among people and like stir the pot.

And I think that,

you know, to quote the great Timothy Leary, it's all about mindset and setting.

And I think if somebody is a, you know, a corporate figure who has a lot of responsibility on them and continues to add responsibility by purchasing companies that used to be called Twitter or engaging in missions to space, I think there becomes, you know, kind of a scale.

And do you want to balance your recreation or do you want to, you know, have these debts and dues that you owe to the people that you're employing, to the people that are on your board, to the people that are believing in this idea that you're creating.

And, you know, you're not a teenager in the basement, you know, and it's, it's fine to experiment and to change consciousness.

I'm an advocate for that.

I think it can open a lot of, you know, thinking channels and ways of getting to understand yourself and the world around you.

But still, you have to look at it with a bit of realism and realize that, you know, Elon, you're much bigger than you are.

And, you know, it's...

I think these drugs might be having an impact on his business and on his, I guess, his empire.

The one thing I have to say, the take-home message that I took from reading Ronan Farah's article is just how powerful Elon Musk is in so many aspects of our life.

I mean,

the part about Ukraine was chilling.

I mean,

at a decision that he makes to flip the switch off of Starlink, it could result in thousands and thousands of deaths almost instantaneously.

That was chilling to me.

In addition, so you think about it, not just Twitter, Tesla.

I mean, how many thousands and thousands of vehicles are driving around with software he developed with which I have a Tesla?

And I have to say, I do not necessarily trust the self-driving aspect of that car.

So, Louis, would you, does it impact what you would buy?

I certainly think it does to some extent.

I mean, I'm a big fan of the Mini Cooper.

I've been driving since 2018.

I don't think I'm going to drive any other car.

But

I, you know, it's, Tesla has a huge impact.

And I think that,

yeah, Elon also has a huge impact as an individual.

You know, there's like the corporate side and there's the personal side.

And he seems to be trying to separate those and still be the fun uncle on the internet kind of guy, but it's really not.

And it's not fun.

And it's not funny.

I like that you use the word uncle because he thinks he's young.

Did you like the cage match?

You wanted to go.

You and your brother wanted to go, which I was horrified.

Hell, I'd love to watch billionaires beat each other up.

That sounds like a great afternoon.

But, you know, your mother wanted to go as well.

She wants us to come with me.

I think she'd have a great time.

Yeah.

But,

yeah,

I think that it's kind of a distraction.

I think that it's just trying to put up a big PR event to get us to talk about something else other than the responsibilities that both Elon Musk and Mark Zuckerberg face in the 21st century.

And they'd rather have us talk about them fighting than talk about

it.

All right, I'm going to bring up another thing.

The right has a new anthem,

Rich Men North of Richmond by country singer Oliver Anthony, has attracted praise from people like Marjorie Taylor Greene, Carrie Lake, and Matt Walsh.

The song is based around complaints about political elites, taxes, and obese welfare recipients.

The song has so much traction, it debuted at number one on the Billboard Hot 100.

Anthony is the first artist to ever top the charts with no prior chart history.

Of note, the artist has a playlist of conspiracy theory videos on his YouTube account.

Let's listen to a clip.

I've been selling my soul, working all day,

overtime hours for bullshit pay, so I can sit out here and waste my life away.

Drag back home and drown my troubles away.

It's a damn shame.

First, you, Louie, what do you think of the song?

What do you think of it?

Moreover, he's no Dixon Dallas, but I think that

it's definitely

Dixon Dallas is a hit maker.

That's all I'm going to say.

But this song is a, is a, is a low and slow.

He's hot on Reddit.

He's hot.

He's just all over the internet.

He loves to make gay country songs, and they're just absolute hits.

I don't know how he does it, but catchy songs, bops.

Okay.

Everybody, check Dixon Downs.

Yeah, Dixon Downs.

He's good looking.

That's a great one.

Every day we spend together, I fall more into him.

That boy, he takes my breath away.

I can't find the words to say.

So I wrote this little note.

Kiss it, sill it so you know.

I've got some time.

If you've

What do you think of this guy?

This song, when I first heard it, I heard it like kind of a working man's anthem at first.

And then I listened to it again, and I kind of heard the dog whistle.

And then I listened to it again, and I really heard the dog whistle.

So I think that within this message of a man who's trying to, in a sense, vocate his frustrations with the modern complex and modern situation and get back to a day that was simpler that he can better recognize when things were easier.

I think within that, he's pushing an agenda perpetuating stereotypes like the welfare queen and disregarding basic elements of our,

you know, the commonality that we all share.

Because I think within that message is a cry of pain that a lot of Americans feel.

But then with that pain, he's kind of poking at others and tearing others down rather than just, you know, asking the real question of

why are we all hurting like this?

And what can we all do together?

You know, and I think you made a good point talking about the rich men north of Richmond.

Let me ask you one more question then, Jeff.

I'd love, because you're a musician.

You listen to a lot of music, Louis.

Do you think this guy has talent

as a singer?

I don't really listen to this kind of music.

I mean,

but yeah, he's got a nice voice.

He can play the guitar.

So, all right.

So a couple of things.

I mean, I think I love his dobro, and I think the dobro is the type of guitar he's playing.

It's a nice sound.

I like the...

the melodic transition.

I like his switch.

His bridges are good.

I think he's a good singer.

He's fine.

I mean, it's a little yelly, a little Mumford Brothers yelly for me, and that's not my favorite kind of music.

But I mean, the thing about the song lyrically, it's all over the map.

I mean, let's just from the beginning,

selling his soul for shitty pay, check.

Okay, number two, the world is changing.

Yes, it is.

Check.

And then he goes into drug overdoses, which is a horrible problem.

People burying themselves six feet in the ground.

And then, of course, taxes.

Nobody likes taxes.

So I think the song would have been

better if he had just kind of stuck to a few themes.

And some people are hate listening to it.

And, you know, there's a bunch of these things like the sound of freedom.

There's definitely

a want for this content.

People like Ben Shapiro are doing a lot of programming and children's programming.

And I think this is fine.

This is great.

And it's always been here.

I think many years ago when Louis was a kid, remember Vegetales, Louis?

Oh, yeah.

Oh, yeah.

I thought they were fine.

Yeah.

Yeah.

There's definitely some

subliminal messaging, yeah, yeah.

When you look at them now, you're like, whoa, by the way, there's rich, there's rich men south of Richmond.

I don't know.

The one thing that kind of confuses me, though, is that why, whenever people get angry at the government, and you know, I'm not, I'm not trying to speak too blank in term here, but like people get so pissed off at the federal government when it is, in fact, the state and local government has the biggest effect on your day-to-day life.

Um, I don't know why, you know, there's not a song about the Richmond at the Capitol House, you know, rather than just in DC and why the focus is on this lovely place where I've spent seven years, where a lot happens and there's a lot of influence.

But in reality, it's the politicians that live within your zip code that have a larger effect on your life.

All right, stop talking sense, Louis Swisher.

All right, let's get to our first big story.

The first debate in the 2024 Republican primary is happening this week in Milwaukee.

We're recording ahead of time, so by the time you listen to this, the dust will have settled or it'll just be dustier.

Eight candidates qualified qualified for the debate, including Ron DeSantis, Mike Pence, Chris Christie, and Vivek Ramaswamy.

Sadly, my guest co-host, Will Hurd, did not make the cut and he's pissed about it.

He said he did.

One candidate not in attendance, the frontrunner, Donald Trump, who announced that he would be skipping the debate, citing recent polls that showed him leading in the field by allendary numbers.

That's according to Trump.

Trump is saying busy, however, doing an interview with Tucker Carlson that will be posted on Twitter on debate night, of course, surrendering in Georgia and also surrendering in Georgia with a bond set at $200,000.

That's that's for Thursday.

I think I know the answer.

Will either of you be watching this debate?

Let's start with you, Jeff.

No, actually, I'm going out to a birthday dinner.

I am going to record it, though, because I do want to watch it.

Why do you want to watch it?

Well, it's interesting.

I think the

issue, the elephant in the room, is the fact that Donald Trump is not there.

And I really would like to see these guys develop some spine about Donald Trump.

I mean, listen, the man is found liable for rape.

He should have been disqualified in the last election.

He made fun of disabled people to access Hollywood tape.

Would have knocked anybody out.

I mean, Kara, we're old enough to remember when Mike Dukakis

was pilloried for wearing a helmet that was too big in a tank, when Jimmy Carter was pilloried because a rabbit chased him in a rowboat.

And when

what's his name was

the guy, the yell, you know, the famous yell that knocked him out.

Oh, yes, Howard.

Howard.

Howard Dean.

Yeah, Howard Dean, when he got knocked out i mean trump any one of the things that trump has done should have made him literally not qualified to run for president but it didn't let's just the voters love him and i understood some voters love him uh i would like i would like them to discuss though the fact that this man is eminently not qualified by character by experience by uh by actions etc and he had a failed presidency and i think that's something that they should discuss well they're not going to well you don't know that they might they might obviously chris Christie will.

Louie, do you want to watch?

We're going to watch the debate, aren't we?

Yeah, I'm pretty eager to watch this debate.

I am always a fan of these debates.

Why?

Tell me why.

Well, they're damn entertaining first and foremost.

I mean, it's going to be a bit less entertaining now that the big guy's not there, but to some extent, yeah, I agree with Uncle Jeff that I think this is going to be an opportunity for the candidates to finally distance themselves and to find themselves other than Donald Trump.

Will they do that?

I don't know.

I think probably they will

toe the line and

just continue to kiss his ass and beat down Ron DeSantimonius as he is their leading contender.

Do these debates matter?

Yes and no, because

what is said on that stage necessarily doesn't matter.

I mean, they're just...

talking.

They could be lying.

They could be making false promises.

They could be leading us in other ways.

But the impact of these debates surely matters.

I mean, go back to the first one, Nixon versus Kennedy.

Huge debate.

Swung the election in the way of Kennedy in a huge way, and not necessarily because of what they said, but how they looked on stage.

And I think the fact that Donald Trump is not on that stage is going to be a very interesting look.

I don't think it's going to hurt him that much that he's not there on that stage, but I think it's not going to help the other candidates that much either, because honestly, I don't know.

I don't know if they're going to be able to swim without that big guy.

What are you looking for?

As you, you voted, you voted in the last presidential election, right?

Did you vote?

I did not vote in the midterms because I was lazy, but I did vote in the 2020 election.

Yes.

So this is, as a younger person, I'm sorry to put it all on you as a younger person, you think this is important to listen to what they want to do, correct?

To hear them out.

Yeah, I think it's definitely important to take any opportunities to hear what these people who want to run our country say.

Because not only, I mean, even if they don't run the country, what they say and who follows them really can tell us a lot about how the country feels.

I think that

the most interesting thing for this debate, though, for me at least, is going to be

how Fox News moderates it.

If Fox News, because I remember earlier this year with the CNN Donald Trump Town Hall, I was furious at the screen because,

can I talk about CNN for a second on here?

Because I thought that they were just trying to cover their ass.

They only, that poor woman on stage, I mean, she's very good reporter, very, very,

that night, she might have had the toughest job in America.

But

I thought that CNN was only really covering Donald or trying to check back on Donald when CNN could be held legally liable, as in when he, whenever he lied about the presidential election.

But when he talked about how there was going to be an abortion ban or something like that, or how abortions are allowed up until when the baby was born, there was no checkback.

There was no rebuttal against Donald for these lies he was spreading on national television.

And I'm not, and Donald's not going to be at this debate, but I just want to see how Fox News conducts themselves and how they moderate this debate and how they allow people to speak, how they allow people to ask questions, how they allow people to challenge each other.

I think that's going to be very revealing of the way this organization is going and of the coverage climate of this election.

Louis raises a really good point about the CNN town hall with Trump.

It wasn't a debate.

It was a town hall.

The fact that, you know, unchecked lies, like Louis raises the abortion issue.

I mean, I tweeted about this, real

live tweeted about this, that thing when it was going on, and about this persistent lie that is not

immediately countered when people make this thing about abortion to the time of birth or even after birth.

I mean, that's just insane.

Listen, let me tell you, as a physician, that does not happen.

It's not a thing.

Okay.

And yet it's made a thing and then it becomes a cultural meme and as if it is a thing.

And they really need to fact check more carefully.

Yeah, I would agree.

Now, Trump made it clear he doesn't care about this debate and is trying to divert eyeballs over to X or Twitter with his Tucker Carlson interview.

Watching that, Louis, are you going to watch that over there?

Tucker pisses me off.

I can't watch him.

I mean,

it's very hard to remain calm for me when I watch him because he reminds me of somebody who is losing an argument and changes the point, changes the topic because he doesn't have an argument.

I mean, and he does it in such a way that you think you're losing, but that's a form of gaslighting.

And I don't appreciate that.

I've encountered arguers like that out there in the world, and I used to just walk away.

Walk away.

All right, Jeff, what about you?

I can't take Tucker Carlson seriously.

He's an overprivileged individual who grew up with an amazing, you know, Swanson fortune.

Yeah, he's a rich man north of Richmond.

He's a very rich man north of Richmond.

And he's just hard for me to take.

He's just so smarmy and

he's a clown.

I can't take him seriously.

Don't be watching.

Trump's done a lot of interviews.

We've been seeing, now, let me shift over.

We've been seeing and hearing more about Vivek Ramaswani in the last few days, thanks to rising poll numbers and some profiles in The Atlantic, where he featured some controversial 9-11 and January 6 comments.

He posted a video on Twitter of his debate trap, a shirtless workout on a tennis court.

He has a very whippy forehand, although not bad.

What do you think of this guy?

Or do you have any thoughts whatsoever?

Yeah, he's slick.

He's very slick.

He's a good public speaker.

He's actually not a bad rapper.

I listened to his rap.

I mean, I'm not a connoisseur of rap, but he's not bad.

I mean, I certainly couldn't do that.

But, I mean, clearly he lies like he breathes.

And he's been caught in several lies.

on the news yesterday.

I was listening to

what's her name?

The reporter.

Yeah.

Caitlin Collins.

Caitlin Collins, yeah, who's very good.

And

he's just, he's a slicker version of Trump.

Louis, is there any other Republicans you're looking at?

Are there any Republicans you think are interesting?

Chris Christie intrigues me a little bit.

I mean, he's kind of like the guy at the House Party who yells we should calm down when the kitchen's already on fire.

You know, you could have said that earlier, buddy, but I guess fine, you're saying it now.

I think Chris Christie makes an interesting point about attacking Donald Trump.

I think he's very late to doing it, and I think that doesn't necessarily make him, it doesn't clear his record for, you know, holding toe and kissing ass.

But I think that it's going to be interesting to see how he, with Dot, without Donald on the stage, how he directs that passion towards the other players.

I think he's going to call out the other candidates on the stage.

And basically, he's going to be going to be the person who's going to be the anti-Trump.

And if he can bring those other people with him, I I mean, Pence has been toeing the line with that,

you know, since he's, you know, after he was almost hung at the Capitol.

Yeah, I mean, I think that, you know, hopefully Christie will bring it to that point where the other candidates can actually start, you know, the emperor has no clothes type of activity.

So is it going to work, either of you, or is it just Trump's the candidate?

It's not going to work.

No, Trump's the candidate.

I mean, unfortunately, it's, he's just, yeah.

Yep.

Let's go on a quick break when we come back.

By the way, everyone should vote for Louis Swisher in 20 years.

Just FYI is going to be.

Don't do that.

He's got my vote.

Yes.

You would be an amazing candidate.

And I would be like your mom in the background.

I might be dead by now.

Kara putting the nepo in nepotism.

Yay.

Anyway, let's go on a quick break.

When we come back, I'll be asking my brother, the doctor, to weigh in on the benefits and dangers of AI in medicine.

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Louis and Jeff, we're back with our second big story.

Artificial intelligence seems to have infiltrated all aspects of society these days, and medicine is no exception.

Hospitals are now pouring hundreds of millions of dollars into AI software and education, and companies like Amazon, Microsoft, and Google are entering the healthcare space with AI tools to transcribe doctor-patient conversations, quickly provide doctors with medical knowledge, and more.

But in spite of all the innovations and investments, a Pew Research Center study earlier this year revealed that 60% of Americans would feel uncomfortable if their clinician relied on AI to diagnose or recommend treatments, and 33% think it would lead to worse outcomes for patients.

I'm going to, Louis, I will have some questions for you.

I'm going to focus on Jeff here.

You're on the front lines of all this, and you've told me various things of how you use AI in your work.

I'd like your overall thoughts and then some specifics.

And I have some questions.

So, AI obviously is going to be a big player in the future in medicine.

It is to some extent, but the true power of AI has not been realized in medicine yet.

And it's going to come in a variety of forms, and I'll just kind of briefly go over it.

So let's just say the New England Journal, which is one of the flagship publications for medicine, has a new website.

It's ai.nejm.org.

And they're going to have submissions about how AI can be used in medicine because, frankly, most doctors don't really know how AI is going to be used in medicine.

It's a very small number of people

who are very aware of how AI is going to be used.

But let me just point out some of the the big ways it's going to be used.

Number one is data management, integration of clinical data,

note writing.

I mean, when you generate a medical note, you often recreate the wheel every single time you write a note.

And already with electronic medical records, that's being done to some extent with a lot of copy and paste.

But AI is going to do it in a much more organic way

in terms of note writing, as well as interviewing patients.

It will listen to your interview with a patient.

And just like a scribe does now in a hospital, the AI will listen to the interview and will transcribe what's going on.

And it will allow you to memorialize a care plan for a patient, their hospital course, any information that happens, their history.

And it gives you a cohesive patient map about that individual in a way where it can utilize the strengths of AI and make things like medical errors and drugs and medical errors and procedures and medical errors in not having an adequate history.

It's going to fix, hopefully fix that.

That's the biggest strength of it.

Secondly, people don't think about it, but insurance integration is going to be helped by AI.

Because right now, how we bill for medical insurance in this country is insane.

But AI will hopefully help streamline that.

It will allow doctors to bill more efficiently, and it will also lead to cost savings.

So that's a very big part of AI.

And the third is actual care management.

And this is where someone like me, who's a person on the front lines, comes in, is it will allow me to have a vast medical database that allows me to look at the everything that's in medicine you know in terms of uh you know even rare things pattern recognition uh people like radiologists and pathologists are gonna you know they run the both the risk of being made obsolete um and uh but also i think mostly it's gonna be like you know you think about a hammer a carpenter uses a hammer which is a tool right now imagine that the next tool is a nail gun and then the next one is a laser guided nail gun.

These kind of things allow better use of tools and allow physicians to basically use their skills in order to use a thing like AI to provide better care for a patient.

So for someone like me who's an anesthesiologist, I do, my specialty is liver transplantation, solid organ transplantation.

And in a liver transplant, you have a very sick, often a very sick patient with a wide variety of medical problems in a very challenging situation.

where an entire liver is being removed from a patient and their circulation and their blood pressure and their cardiac output and their vascular resistance changes on a dime

due to what the surgeon's doing.

And I have to deal with that, blood loss, coagulability, all these kind of things.

And in an AI situation, let's just take a patient with what's known as vasaplegia, where they're not responding to the typical drugs that I use to raise blood pressure.

Well, an AI algorithm can help me decide based upon a series of data, what is the best course of action to take in a given situation in real time, which I can choose to accept or not, but it helps me think on my feet.

Yeah.

So it gives you more, it's like a smart person in your ear, right?

Exactly, right.

It's exactly like a smart person in your ear.

It can't supplant what I do.

I mean, I mean, an AI is not going to innovate my difficult to innovate patient, but it can certainly give me ideas in real time on the fly.

Which is helpful to you.

We talked about the makings of a great business plan for you.

Scott and I were talking a second opinion AI for doctors.

Right, right.

Are you off and running with that?

I am.

Actually, so I did a seed round.

I raised about a billion dollars in a seed round, and I actually already sold it to Google for $200 billion.

So I'm rivaling Elon Musk as a name.

Thanksgiving on you, Jeff.

Thanksgiving.

I am a full-time physician and chairman of a department.

In addition to doing all the other things I do, I don't have time to do that.

But

are doctors getting more innovative?

I was talking to one of my doctors who you know who helped me, and he's got two companies going.

Is it time for doctors to be more innovative?

Yeah, I wish I had the time to do that.

just don't.

I mean, I think, you know, I'll be 65 in two years and I'll retire and then I'll do it.

Then you'll do it because doctors have been innovative, but this is sort of opening up a lot of things.

Are there things AI shouldn't be used for?

I mentioned the stat about people's concerned about AI diagnoses, even if they're correct.

Because I know this is a big shock to people, but doctors don't know everything, as I say to you all the time,

is the problem.

They don't.

They definitely don't.

So, no, AI, you have to, like every tool, every tool has the ability to use it correctly or incorrectly.

And a doctor, like any tool that we use, regardless of what it is, I mean, you have to be able to know some background.

I mean, look at the case of that lawyer who used an AI argument in a court, and it turned out that every single one of the cases that he cited was made up by AI.

That's concerning, right?

You know, and AI has, it looks like it's degenerated in its ability to do things for some reason, like mathematical calculations.

So, you have to constantly, you know,

trust but verify, I think is the best way to say it.

What about the ethical considerations?

Senator Mark Warner wrote to Google CEO Sundar Pachai a few weeks ago, voicing his concern about possible ethical issues, as well as, as you said, on proven technology with the company's

MedPalm2 tool.

Well, I think people need to know that what they're talking to is a bot and not a human being.

I think that's unethical to pass off a person as a human being when, in fact, they're not.

And I think that we have to be careful about that.

And the other thing too is they have to make a disclaimer that this thing that they're dealing with is not a real person.

It's not a physician and therefore everything should be verified by a physician beforehand.

And I mean, to that point, you know, just like self-driving, you know, do I trust it?

Sort of, but not 100%.

Louis, how do you feel comfortable knowing your doctor was using AI for diagnosis?

Well, I really enjoyed what Jeff was saying earlier about just having it as like another tool on your tool belt.

I think that is a very good use of this.

And you see that across industries in the legal industry, I mean, legal aids are

shaking in their boots right now because that is a very AIable job.

And I think that using this technology in combination with human talent is a very excellent usage.

When we rely entirely on the robot, that's when things become a bit questionable.

And I think there is probably an inherent distrust of machines from humans because they're not like us.

They are other.

They are, we don't, we don't see ourselves in them and therefore can't completely trust them.

So when you're, when you're thinking about it, like when you're thinking about jobs, you're going to go in the job market, presumably, I hope so, in the next couple of years.

You cook.

When I think of it, someone asked me, what would you like Louis to do?

And I said, oh, he can do whatever he wants, but I would like him to be cooking because you can't AI that.

It's not AIable.

Cooking is not except for looking up recipes, like that kind of thing.

It's a hands-on job.

Well, it is, though, but it is.

But it is.

It is.

Okay, how?

Well, I think, I mean, it depends.

I mean, you have people who love to eat Trader Joe's frozen meals, meals, and then you have people who like to cook themselves dinner every night.

And the former is very, you know, AIable.

It's very easy for a machine to crank out frozen meals in a standard package and standard, you know, standard measurements and stuff like that.

But there is a human element that people enjoy.

And I certainly do.

And I think as the world increasingly becomes more automated, increasingly becomes more influenced by computers and AI, I think we might

lose touch with that human element and desire it a bit more.

You see that nowadays even where in like, you know, for, you know, if you have the money, like in DC, you can sign up for a farm to deliver your milk to your door.

You know, that's real old school, is it?

But like the

there is a desire to go back to more simpler human-to-human, hand-to-hand contact and commerce and connection.

Do you think about that when you're thinking about jobs?

I mean, I don't know if you're thinking about what you're going to do after college, but do you, is that worrisome to a lot of young people?

Is that everything is going to be replaced?

Because it's, you know, that's that's sort of the trope.

Yeah, I think.

So, how do you think about it?

Well, I think about it

recognizing the fact that I actually can't really think about it.

I can't predict the future.

I don't know what's going to happen.

I would say that most of the jobs that exist today, you could not have predicted 30 years ago.

So, the world is going to change and

new jobs are going to go away, certainly, but new jobs are going to emerge and new things are going to emerge to do.

I personally, as someone who's culinarily inclined, likes to write, is a student of ideas I think that the the realms I occupy are not particularly threatened by automation and AI but

I think for a lot of people it is and I think there will be like I think there'll be a mixture of combination with AI and machinery as there has been for a while now

there'll also be replacement but there will also be an emergence of entirely new sectors and entirely new professions that we simply just can't fathom now so I'm not too worried worried.

I know, but I'm not, I don't want to speak for all young people, you know, but do people your age worry about jobs right now?

Is that a big thing they think about, or is it just

yeah, a lot of my friends are going into their senior year of college, and a lot of them are facing that existential crisis of what do I do now?

I think that's a normal thing for people in that transitionary period to experience.

But I think with the, you know, the worry the world is changing politically, economically, culturally,

these questions are even more relevant than ever.

And I don't have the answers, so I can't provide any comfort, but

it might be all right.

So Louis, let me give you some uncle advice and experience here.

So, you know, when I graduated college in 1982, I was an international relations major, and medicine was the last thing on my mind.

I took exactly three classes as an undergraduate in science, human sexuality, oceans, and G01.

That was it.

So, as you know, after my

year of taking off and living up at Lake Tahoe, I decided I was going to be a doctor for a lot of reasons.

And you can go to my sub stack and read about why if you want to.

The thing is, you don't know what the future is going to bring.

And

Kara will probably say the same thing, you know, when she walked into the Washington Post, into Ben Bradley's office and said, you know, no, I would not.

I always knew I was going to be a media mogul, but go ahead.

Go ahead.

Yeah, I don't think you did because I remember I was there, if you recall.

I think that, you know, the future is going going to happen whether we want it to or not.

And you're going to change.

And obviously the tools are going to change, like you say.

I mean, the ability to do things now is so much more.

We had to go to the card catalog and look up things.

And now it's at your fingertips.

Everything,

not just, you know,

well, everything's available at your fingertips.

Yeah.

Louis, do you know what a card catalog is?

I'm going to stop your uncling here.

Louie, do you know what a card catalog is?

I plead to fifth.

I plead.

You don't know what a card catalog is.

See?

He doesn't know, Jeff.

He doesn't know what a Rolodex is.

He doesn't know what a Rotary phone is.

No, I know that one.

I know that one.

I know that one because I've seen a toy one.

He does.

Yes, he has.

Many years ago, I told a story when I showed them a payphone and they were both flummoxed by the entire experience when they were kids and we were in Los Angeles.

Anyway, this is fascinating.

Thank you, Uncle Jeff.

Louie, do whatever you want, but you do need to get a job.

Anyway, one more quick break, and we'll be back for predictions.

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Okay, we're going to do some predictions.

I am going to start to give you an idea.

I told you guys you had to be prepared, and I'm guessing, Louie, you are not, but you're going to have to come up with some really soon.

One

I want to note is this story I think everyone should read, and I'll tell you why it's a prediction.

The Washington Post has a fascinating story of a Michigan sex educator named Heather Alberta, who lives in a conservative county and came under fire for what she was putting out as a sex educator.

They are, it's an insane story, and it tells me something I've been predicting a lot: all this anti-trans attacks and everything else is all about a larger picture of

the strides that gay and lesbians, LGBTQ plus people have made.

It's not just about trans, it's about the whole the whole situation.

I find it personally threatening

and with

four kids.

And although my two older kids are now adults, it still

reminds me how terrifying it was and it will continue to be.

So I think this is their end end game.

This is where they're going and everything they say now, what they are trying to do is

just gaslighting for what they really want, which is to end rights for

people that are not straight and probably white,

especially in this county.

And the other prediction I have, I've been predicting the writer's strike will end probably sometime in October.

Hollywood Studios have made public their latest offer to writers.

They're really interesting offers.

Concessions offered include guaranteed minimum length of employment, controls around use of AI, and wage and residual increases.

I don't know if it's enough.

The union is saying it's not, but it's pretty attractive to a lot of people I've been talking to.

It's much further down the pike.

When Scott returns in September, we'll be chatting with actor and writer Joseph Gordon-Levitt to get his take on all of it.

He recently wrote an interesting op-ed about the use of AI in Hollywood and how he thinks compensation should work.

So we'll see, but maybe by then or sometime in October, this may be settled.

All right, Jeff, you start with your prediction.

One of the things things I have to say, I do the anesthesia for a lot of trans people having surgery.

Number one, minors do not have this kind of surgery, it's particularly bottom surgery.

And if they do have top surgery, they have to be emancipated minors.

So this whole trope about that

the right is

professing that these guys are having gender altering surgery is just not true.

Adults, that's for adults.

And I work with a lot of these adults, and I have to say, they are among the most kind people that I work with, and they're very aware of what they're doing.

It's a big deal to make this to make this commitment.

And you don't do this on a whim.

These are people who are uncomfortable in their bodies from a very young age.

And it has taken a lot of time and effort and psychological preparation and support from their families.

And I think that we need to be kind to people like that because they're suffering and they have the technology and the wherewithal now to do something about it.

So,

it's evil to vilify these people.

And that's all I just want to say about that.

And the doctors who perform this surgery, I think, are heroes.

So, let's do the predictions.

So, number one, I think, you know, interestingly, wearable technology has really taken off with the Apple Watch.

And I think every week I have a patient who says that they have diagnosed atrial fibrillation with their Apple Watch, and they're getting ablations now because of it.

So, I think we're going to see that more and more modalities.

I think we're going to see things like, in addition to heart rate activity in O2SAT, we'll possibly see glucose monitoring continuously, transcutaneous CO2 monitoring, and that will allow people to basically real-time have a record for their physicians.

The other thing, I think we're going to see a big increase in

genetic and genomic type testing.

And the difference is genetic is what you're born with.

Let's say if you have the BRCA1 gene, if you have cancer, that will allow us to screen people who are at risk and then be able to do early interventions.

Genomic testing is for things like colon testing for cancer.

There's changes in the DNA of cells that are affected by cancer, and we're going to see a lot more of that for a variety of illnesses.

And we'll see more of this kind of genomic testing.

And I think we're going to be able to design, as based on this, what are called bespoke drugs, drugs that will allow individuals to be treated based upon their genomics and their genetics, which is great.

As well, I think that in the next several years, we're going to see a lot more physicians' assistants, registered nurse-first assistants going to be providing care and medicine.

And there is a doctor shortage, there's a severe anesthesiologist shortage.

And obviously, we need to do something about that.

And then all this will allow people to do data group sourcing and to improve medical care and decrease medical errors, like drug errors, as I said before.

So that's my prediction.

I'm really, really rosy about the future of medicine.

Those are good.

And by the way, Justino, Dr.

Jeffrey Swisher and Kara Swisher are working on a book together, which will include a lot of these things, aren't we, Jeffrey Swisher?

We're excited.

We like working together.

We're a very nice brother and sister.

We have another brother, David, who we love too, but he is not going to be working on the book.

Well, he might be.

He will never know.

We can recruit him.

We can recruit him.

He might be.

We can write the foreword.

Maybe.

I don't know.

I don't know.

He's busy.

He's a smart guy.

He is.

He's fantastic.

He is.

If I have to say, he's probably got the highest IQ of us combined.

I agree.

He might.

I agree.

He might be the smartest of you three.

I think he is.

He is.

Yes.

All right.

Louis, we're going to end up with you with a prediction, please.

Yeah.

Okay.

My prediction is a bit more political, but I think that within my lifetime, at least, that we will see a huge change in our political dynamic relating to parties in this country.

I think our system of two parties worked really well in the 20th century era of bipolarity between the United States and the Soviet Union.

After the collapse of the Soviet Union, we entered a period of unipolarity in which the United States was the only world power, and we were able to reign free America's number one top dog.

But then as we enter this state of multipolarity within the world, as there are multiple major powers emerging with the BRICS nations, the U.S.

and Western nations competing, I think that that's going to have a domestic effect as well.

Our parties are more ideologically splintered than ever, not amongst, not only in contrast of each other, but within the ranks of themselves.

You see the Republicans splitting between Trumpism and conservatism, this huge dynamic between the right and conservative, maintaining the status quo or moving the pendulum to the right.

And I think within the Democrats, there's a lot of disagreement over.

active progressivism, passive progressivism, and non-action.

And I think that that is going to have a huge effect to, quote, Noan Chomsky.

There's only one party in this nation, the big business party with two factions.

And the current system is not good for business.

So I think that we will either see a challenge to that business and the big business party and see a true emergence of genuine political parties advocating for individuals, or business will be changed.

And there will be a change to either the Republican, the Democrat, or both or neither.

And the big business party is going to establish itself once again.

So we'll see.

Wow.

All right.

Wow.

I'm impressed, Louie.

Money well spent on college.

Yay.

I love it.

But you're thinking for yourself.

Oh, my God.

This is what we learn in our leftist, elitist institutions.

You should be proud, Kara.

My work is done.

This flaming lip tard's ready to vote.

Actually, Louis has a lot of different things.

He's not a flaming lip tard.

No, I think he's.

Oh, I am.

Oh, I am.

You're a very analytical thinker.

It's one thing I appreciate about you.

But I think one more thing that I think we often forget is humanism.

We are all individuals of this nation, and we all affect each other better or for worse.

And, you know, at the end of the day, we're all going to die together.

So we might as well try to get along together as we're alive.

Oh, I love you, Louis Swisher.

Can I just say you're the best?

Also, we want to have a shout out to our amazing, your amazing brother, Alex Wisher, who's going to be starting here at University of Michigan.

At the last minute, he kind of wanted to be on, but he did resist it coming on.

But we would love to have him on at some point.

He's also a great thinker and a really great kid.

And so we're excited to focus on him him the rest of the day, correct?

Louis Swisher?

I am excited to go have lunch with that kid.

He is excellent.

Wait till you ask him about politics.

He's not a kid anymore.

He ain't no kid no more.

No.

And we are all, apparently, we're all going to converge here in California for Christmas, right?

Yes, we shall.

We shall.

We'll see you there anyway.

Louis, I went out to Walmart the other day and I bought one of those artificial Christmas trees.

And

yep, I'm going to

do that.

The person asked asked me if

I was going to put it up myself.

And I said, you, no, that would hurt.

I'm going to put it up in the living room.

Ba-dum-bum.

Oh, my God.

Oh, I'm never inviting you back.

Yeah, you got to have those.

Yeah, yeah.

No.

No.

Sorry, sorry.

I have to go make a friend of mine who's a proctologist feel better because

his wife just left them and it absolutely wrecked them.

but um bum oh

and with that okay we're ending the show right now because this is very embarrassing for me as a person okay louis had a high note and then jeff you bring it right down no no no no jeff jeff reminded me reminded us who we were that's in in in in the spirit of scott i i miss scott hi scott and i and thank god for george hahn i i think he was fantastic too all right okay louis and jeff that is the show thank you so much i'm so thrilled and I'm excited to go out to launch Louie in a second.

We'll be back on Tuesday with more Pivot.

I'm going to read us out.

Today's show was produced by Lara Naaman, Zoe Marcus, and Taylor Griffin.

Ernie Enderdott engineered this episode.

Make sure you subscribe to the show wherever you listen to podcasts.

Thanks for listening to Pivot from New York Magazine and Vox Media.

We'll be back next week for another breakdown of all things tech and business.

Thanks, boys.

All right.

Thanks.

Thank you.

This month on Explain It to Me, we're talking about all things wellness.

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Collagen smoothies and cold plunges, Pilates classes and fitness trackers.

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Why do we want that so badly?

And is all this money really making us healthier and happier?

That's this month on Explain It To Me, presented by Pureleaf.

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