THE PROGNOSIS

The use of artificial intelligence is proliferating in American health care — outpacing the development of government regulation. 

From diagnosing patients to policing drug theft in hospitals, AI has crept into nearly every facet of the health-care system, eclipsing the use of machine intelligence in other industries. More than half of health-care insiders said the industry is ahead of other fields in AI adoption in a survey published in January by KPMG International Cooperatives. 

Meanwhile, U.S. lawmakers have yet to pass comprehensive legislation regulating the artificial technology's impact on a variety of industries and the personal data it mines to become smarter. Sen. Cory Booker (D-N.J.), Sen. Ron Wyden (D-Ore.) and Rep. Yvette D. Clarke (D-N.Y.) introduced bills in April to provide oversight by the Federal Trade Commission of personal data collected by AI, but none have progressed beyond committee. 

The European Union published its own AI regulatory proposals last week after European Commission President Ursula von der Leyen pushed for a coordinated European approach to AI in all industries including health care within 100 days of taking office in December, the Associated Press reported

However, some have critiqued the E.U. approach, saying it’s too broad for the specifics of certain AI programs. 

“While high-level approaches are valuable, they too often treat today’s AI as something independent and more novel than it really is. That can lead to distracting attempts at omnibus AI legislation, such as the” E.U. proposal, R. David Edelman, a researcher on AI policy at MIT’s Internet Policy Research Initiative, wrote in The Post.

Edelman instead suggested the European Parliament pass “20 or 30 new bills, grounded in existing law and addressing the benefits and risks of AI specific to every subsector of the economy.”

The White House released draft principles a month before the E.U. announcement in hopes of influencing the union's proposal, The Technology 202 reported. Trump's administration steered clear of heavy-handed regulation on private industry and suggested that federal agencies, such as the Food and Drug Administration, should take public input into account when regulating AI. 

AI is already being used in a variety of ways throughout the U.S. health-care system –  Google partnered with start-ups that want to use smart machines to help paralyzed patients walk and slow doctor burnout. One way hospitals are employing the data is to track alleged “diversion” of prescription medication by their owns staff, though using AI to police the problem offers its own host of risks.

With no government regulation of machine learning, AI companies offering such services have largely been left to regulate themselves. One is Kit Check, a Washington-based start-up that created Bluesight, an AI program that hospitals can use to monitor their employees and flag alleged workplace theft of controlled substances.

Kit Check’s client list is growing. More than 60 health systems and 100 hospitals already have implemented its AI program or are in the process of doing so, Kevin MacDonald, the company’s CEO and co-founder, told The Health 202. The company attributes its growth largely to the opioid crisis and evidence that in-hospital drug diversion is a “serious and urgent concern.”

Hospitals have made the news when nurses were under the influence or overdosed at work. MacDonald said AI can prevent those headlines.  

“Some of the hospitals that are using the system are doing it because they had a problem and they need to remedy that problem,” he said. “But there are others that are definitely in the camp of ‘we don’t want to be the next headline.’”

One Kit Check client, Massachusetts General Hospital, paid $2.3 million in 2015 to settle a Justice Department case alleging the hospital’s weak oversight allowed employees to divert drugs. Using AI technology is one way the hospital hopes it can address its history, said the hospital’s chief pharmacy officer, Christopher Fortier.

On the front end of the Bluesight interface, hospital administrators can see a list of their employees and a score assigned to them based on a variety of factors taken into account by AI. 

The program learns abnormal behaviors and flags risks such as drugs being removed from a dispensing cabinet without being put on a patient’s chart; how long it takes employees to administer medicine after it is dispensed; and the frequency such medicines are wasted, meaning thrown out  after being used or expired. When Kit Check engineers tried counting how many factors are measured by AI, they stopped after 50, senior product manager Samir Neyazi said. 

Though it might help hospitals ferret out alleged problem behavior more quickly, the approach holds a variety of risks, privacy experts said. One of them is the amount of data being used makes it impossible to be sure of how an AI algorithm makes its decisions, said Jenny Yang, a senior researcher at the Urban Institute, a Washington-based think tank.

In addition, AI mechanisms expose employees to their data being made available to a third party. 

Kit Check is trying to mitigate the risks by assembling diverse practices from the experts and following existing law governing health-care data. And hospitals can still refuse to tell Kit Check whether its algorithms are correct after an employee is flagged by the machine for suspicious behavior. Neyazi says that's the biggest hurdle in making sure the program learns from its mistakes.

AI is also facing criticism as a human resources tool, especially if it is being used in the hiring or firing process. Recruiting-technology firm HireVue, which more than 100 employers including Hilton Hotels and Unilever use, faced legal backlash after The Post reported on how the technology may be penalizing job candidates who don’t look or speak a certain way.

Concerned that substance abuse is a difficult disease to diagnose, Liz Stokes, a member of the American Nurses Association, said conclusions reached by AI technology should also be verified by humans. 

David Garraux, who represents employers in labor litigation, agreed, cautioning hospitals against using the findings of machine learning programs exclusively as a means of firing anyone. Garraux recommends not only establishing a framework for an investigative process but also a way of ensuring the data collected by the third-party vendor stays private. 

“Artificial intelligence is not something that should be used in a vacuum,” he said.

Garraux said state lawmakers have made more progress than federal ones on such issues, citing the commission New York’s legislature created this year to determine how AI should be regulated.

In May, the Illinois General Assembly became the first legislative body to pass a law imposing restrictions on employer use of artificial intelligence in hiring. 

“AI has evolved and developed so quickly over just the past few years that both employees and lawmakers are still reacting to its effect and its scope,” Garraux said.

AHH, OOF and OUCH

AHH: The contenders for the Democratic nomination for president appear to be following Donald Trump’s lead when it comes to health records. As a substitute for full reports on their health, the major candidates have relied “instead on the Trumpian physician testimonial,” our colleagues Matt Viser and Lenny Bernstein write. 

It appears the “sense of obligation and responsibility still attached to the pursuit of the presidency,” as described by former John McCain adviser Steve Schmidt, has disappeared. 

Three years ago, then-70-year-old Trump “became the oldest person to win the presidency after a campaign in which he released only a letter from his doctor attesting to his ‘astonishingly excellent’ health.” This time around, the four 70-or-older candidates – Sens. Elizabeth Warren (D-Mass.) and Bernie Sanders (I-Vt), former vice president Joe Biden and former New York mayor Mike Bloomberg -- have released similar letters from doctors or documents summarizing their health and fitness. Neither Sen. Amy Klobuchar (D-Minn.), 59, nor former South Bend, Ind., Mayor Pete Buttigieg, 38, has released health records.

“No law, of course, requires presidents to divulge intimate medical details, and previous occupants of the White House have not always done so. Woodrow Wilson kept it a secret when strokes paralyzed his left side. Franklin Roosevelt famously masked the effects of polio. And John F. Kennedy hid chronic back pain and Addison’s disease behind a front of youthful vitality,” Matt and Lenny write. “…In general, however, presidential candidates have felt an obligation to assure voters that they are physically up to the job and unlikely to make an early departure — an issue that weighs especially heavy this year.” 

OOF: In Loudoun County, Va., the concerns about youth vaping are being incorporated into a driver’s education program. Officials in the Northern Virginia school system worked with the sheriff’s office to add vaping information to a mandatory driving seminar, our Post colleague Hannah Natanson reports

Loudoun County Sheriff Mike Chapman called it a first for his office. 

“The department has never incorporated warnings about other forms of substance abuse into its driver’s education program, which it has offered in Loudoun County schools for at least as long as he has been sheriff. Chapman took the job in 2012,” Hannah reports. “The idea emerged from discussions Chapman held with staff members last summer, he said, shortly after Virginia enacted a law making it illegal for people under 21 to buy ‘nicotine vapor products,’ including e-cigarettes. The sheriff convenes senior officers for a chat every morning to discuss ‘what’s on people’s minds’ — and, in the weeks after the legislation took effect, one topic dominated.”

Ashley L. Merianos, an associate professor at the University of Cincinnati who studies public health education, called it a “novel way to go.” She told Hannah she had not heard of any other school districts including such warnings in driver’s education. 

OUCH: Walgreens pharmacy employees told consultants last year about making prescription mistakes as a result of high stress and “unreasonable” expectations. But company leaders asked the consultants working on a report not to mention those concerns in a presentation made at corporate offices, the New York Times’s Ellen Gabler reports in this investigation. 

Amy Bixler, the director of pharmacy and retail operations at Walgreens, told the consultants, for example, to remove a bullet point from the presentation that referenced employees dodging or ignoring “proper procedures to meet corporate metrics.” In another slide, details about “errors resulting from stress” were left off. 

The underlying issues related to staffing, stress and high expectations have reportedly affected pharmacies beyond just Walgreens. Last month, Ellen reported on the tumult at chain pharmacies that led to medication-related errors and put patients at risk. 

“Pharmacists in dozens of states have accused Walgreens, CVS and other major drugstore chains of putting the public at risk of medication errors because of understaffed and chaotic workplaces, The New York Times reported last month,” Ellen reports. “In letters to state pharmacy boards and in interviews with The Times, pharmacists said they struggled to keep up with an increasing number of tasks — filling prescriptions, giving flu shots, answering phones and tending the drive-through, to name a few — while racing to meet corporate performance metrics they characterized as excessive and unsafe.”

Walgreens spokesman Jim Cohn told the Times the company took “any concerns seriously to ensure the appropriate parties are aware and working to address them.”

But Ellen adds the pharmacy chains have pushed back on some complaints, and also suggested any errors were uncommon.

TRUMP TEMPERATURE

 — President Trump was not told that more than a dozen coronavirus-infected Americans would be flown home to the United States from Japan after they disembarked from the Diamond Princess cruise ship. 

Earlier this month, Trump and his administration’s coronavirus task force were informed that Americans who spent weeks quarantined aboard the luxury ship would be flown to the United States on two planes, but they believed patients with symptoms or who tested positive for the virus would stay in Japan, our Post colleagues Yasmeen Abutaleb and Josh Dawsey report. 

“Trump was briefed on the decision and agreed that healthy passengers should not be on the plane with sick ones, three senior administration officials said,” they write. “But the State Department and a top U.S. health official ultimately decided to bring back the 14 Americans who tested positive for the virus on the planes and place them in isolation. Trump learned of the decision only after the fact and was angry that he wasn’t consulted first, complaining that the decision could damage his administration’s handling of the response.” 

After finding out, Trump complained to acting chief of staff Mick Mulvaney, Domestic Policy Council Director Joseph Grogan and HHS Secretary Alex Azar, among other officials. He has held calls with top White House officials to insist he “should have been told, that it should have been his decision and that he did not agree with the decision that was made.” 

— The White House plans to soon call on Congress for emergency funds to address the outbreak, Politico’s Dan Diamond reports. 

“However, the amount could be significantly lower than some public health officials have argued is necessary — potentially as little as $1 billion, said two individuals, which could be rapidly exhausted by development of potential vaccines, widespread lab tests and numerous other investments,” he adds. 

The request, which is preliminary, follows weeks of reluctance to call for additional financial resources. 

— Meanwhile, there are concerns the coronavirus outbreak is edging closer to a pandemic. 

“There are outbreaks. There are epidemics. And there are pandemics, where epidemics become rampant in multiple countries and continents simultaneously,” our colleagues Carolyn Y. Johnson, Lena H. Sun, William Wan and Joel Achenbach report. “The novel coronavirus that causes the disease named covid-19 is on the verge of reaching that third, globe-shaking stage.” 

Officials from the World Health Organization are specifically sounding the alarm about the growing challenge to contain the virus. 

“The window of opportunity is still there, but the window of opportunity is narrowing,” WHO Director General Tedros Adhanom Ghebreyesus said Friday. “We need to act quickly before it closes completely.”

If the coronavirus becomes a pandemic, “a large proportion of the human population — a third, a half, two-thirds even — could become infected, although that doesn’t necessarily mean that all will become ill.” 

Another point to remember: “The word ‘pandemic’ evokes fear, but it describes how widespread an outbreak may be, not its deadliness,” our colleagues add. 

Europe
How the virus arrived in the country remains a mystery.
Chico Harlan

HEALTH ON THE HILL

Supporters of single-payer health care in part fueled Sanders's advantage in initial support among Nevada caucus-goers over the weekend, according to entrance poll results. 

The results found, as Post pollsters Scott Clement and Emily Guskin report, that 62 percent of voters said they support replacing all private health insurance with a single government plan for everyone – 48 percent of those voters supported Sanders. By comparison, 15 percent of them supported Warren, 11 percent supported Biden, 10 percent of that group supported Buttigieg and 6 percent supported Klobuchar.

The polls also found 44 percent of caucus-goers said health care was the most important issue in their vote. Of those caucus-goers, 38 percent supported Sanders. He won that demographic group by 19 percentage points – Warren was supported by 19 percent of that group. 

Sanders won the Saturday caucuses decisively. “Sanders’s advantage in Nevada was overwhelming, with substantial leads in nearly every demographic group, allowing him to set down a marker in the first state with a significant share of nonwhite voters,” our Post colleague Matt Viser reported. He also noted that despite the criticism from the powerful Culinary Union over his Medicare-for-all proposal, “he won in caucus sites filled with union members.” 

AGENCY ALERT

— The Food and Drug Administration gave the green light to the first non-statin pill to treat high cholesterol in almost two decades. 

“The drug, bempedoic acid, is the first in a new class of drugs to treat low-density-lipoprotein cholesterol, also called ‘bad’ cholesterol, which causes the buildup of fatty deposits in the arteries, reducing blood and oxygen flow,” our Post colleague Laurie McGinley reports

It’s the latest tool against the No. 1 killer in the United States and around the world: heart disease. 

The medication will be an additional therapy for patients who are taking as high a dose of statin medication as they can handle, but who still need to bring down their cholesterol levels. The medication can also help patients who are able to tolerate only low-dose statins, or who cannot take statins. 

Statins “can cause muscle aches and cramps, making it hard for some people to take the required dose, said Robert Rosenson, director of cardiometabolic disorders for Mount Sinai Hospital in New York. More than 10 percent of people taking high-dose statins had muscle pain, according to a 2005 study.” 

— And here are a few more good reads:

MEDICAL MISSIVES

Slowing growth of Covid-19 cases in China supports the emerging consensus that the Wuhan quarantine bought China and the world time to prepare.
Stat

OPIOID OPTICS

In rural Carter County, Tenn., health officials have embraced a strategy for stemming addiction: Teaching children as young as 6 how to administer Narcan, a nasal spray that can stop an opioid overdose from being fatal.
New York Times

INDUSTRY RX

Health
They organize summer camps for athletic training and encouragement and engineer novel ways to make prosthetics using recycled plastics and new technologies.
Kate Furby

STATE SCAN

Virginia Politics
The number of gun-control bills from newly empowered Democrats was “piling on,” one said.
Laura Vozzella

REPRODUCTIVE WARS

California disputed a Trump administration assertion that it is violating federal law by requiring insurers to cover abortion after federal officials threatened to withhold funding if the state doesn’t change its policy.
Wall Street Journal
Mississippi's law banning abortions at the detection of a fetal heartbeat -- as early as six weeks into pregnancy -- will remain blocked, a panel of circuit judges ruled on Thursday.
CNN

DAYBOOK

Coming Up

  • The Washington Post will host a live event on Wednesday featuring key government officials, academics and advocates discussing the plight of working families and low-income workers in the United States. 

SUGAR RUSH