At SXSW 2023, OpenAI's Greg Brockman and 23andMe's Anne Wojcicki dive into the potential for AI in healthcare

The health and medtech tracks at SXSW 2023 wrapped up earlier this week with a big focus on artificial intelligence, women's health in a post-Dobbs world and tackling health inequities.

The conference and festival, which takes over downtown Austin, Texas, for 10 days every year, had a big focus on cannabis and psychedelics this time around. Each topic had its own dedicated track with about 40 sessions total, highlighting how mainstream those two sectors have become.

Of course, the collapse of Silicon Valley Bank last Friday, which impacts many biotech, medtech and digital health startups, was a constant undercurrent of the conversations at this year's SXSW.

But there were plenty of other issues to dig into at the conference, with generative AI being a hot topic.

During a one-on-interview on stage, OpenAI’s co-founder and president Greg Brockman said he's excited about the potential for generative AI like ChatGPT to assist doctors with diagnosing diseases and illnesses.

"Medicine is definitely a very high-stakes area. We're very cautious with how people should use this kind of technology there," Brockman said.

Microsoft-backed OpenAI released ChatGPT late last year. ChatGPT is an AI language model, and it allows users to enter written prompts and receive new humanlike text or images and videos generated by the AI.

Brockman shared a story about how his wife, several years ago, suffered from pulsating pain in her abdomen. While doctors ruled out appendicitis, it took three months and visits with four different doctors, and multiple prescriptions for antibiotics, to get her condition correctly diagnosed, he said.

"I kid you not, I just typed in a couple of sentences of description into ChaptGPT that just said, No. 1, make sure it's not appendicitis and No. 2, ruptured ovarian cyst, and that's, in fact, what it was," Brockman said. "The kind of thing that I personally want in the medical field, I want something that I don't rely on. I don't want it to replace a doctor. I don't want it to tell me, 'Go take this super rare antibiotic.' But I think giving suggestions, giving you ideas; in writing, it's like the blank page problem. I think, for me, this is where generative AI can really shine. It's really about sort of unblocking you, giving you ideas and just giving you an assistant that is willing to do whatever you want, 24/7."

Later in the one-hour interview he added, "I think that the real story here in my mind is the amplification of what humans can do. I think that that will be true for knowledge work. It's like if you hire six assistants, and they're not perfect and they need to be trained up a little bit, but they're eager and they never sleep. They're there to help you. They're willing to do the drudge work. I think that that is going to be what writing will look like. I think that's what coding will look like. I think that's what sort of business communication will look like."

23andMe CEO sees huge potential for AI in disease prediction

There are big opportunities to harness genetic data and artificial intelligence tools to predict disease, according to Anne Wojcicki, co-founder and CEO of consumer genetic testing company 23andMe.

"Wouldn't it be great if you could show up at your clinician's office and your clinician walked in and said, 'Hello, here's what I see based on all this data about you. You are three years away from being diabetic' or 'Based on how you're living your life, you're going to be at higher risk for chronic kidney disease and you need to make these types of changes'? I think that one of the most exciting things is really being able to predict phenotypes, meaning like predict what health condition you're going to have or what trait you're potentially going to have," Wojcicki said during a keynote interview at the conference.

She added, "One of the things that I'm passionate about, and I think that taps in with what consumer demand is, is prevention. How do you not just better treat a disease, but how do you prevent it? I would say that most AI that I see in the healthcare system today is really about disease optimization or goes to things like optimizing payments."

23andMe launched 16 years ago offering at-home genetic testing kits for ancestry and for health.

The company, which went public a year ago, has since amassed a huge database of genetic data based on its 13 million users. 23andMe has pivoted its strategy to leverage its trove of data for research and to make and sell its own therapies. The company also is expanding its core consumer genetic testing into a new business line called its genomic health service. 

In 2021, 23andMe spent $400 million to buy Lemonaid Health, a virtual care and pharmacy provider, to integrate its personalized genetics service more deeply into primary care. 

Wojcicki said she is seeing a shift in physicians' perception of genetic data and the role it plays in providing more personalized care to patients.

23andMe released last the results of a survey that found 92% of doctors in the U.S. say genetics is an important part of a patient’s complete health picture.

"That's a huge shift for us. I think, suddenly, physicians see and they've heard enough stories that knowing a genetic piece of information about their patient could really lead to a different kind of outcome," she said.

The survey showed a significant shift in awareness of the importance of genetics in health. In 2018 only about three in ten doctors said they regularly saw patient cases involving genetics. In this latest survey, more than half, 51%, of primary care physicians surveyed said they encountered one or more clinical cases a week where genetics plays a role. 

Sixty-two percent of doctors today say that genetic testing can help them provide more personalized care. Most people surveyed (62%) said they wanted advice from their doctors that was tailored to them personally.

"There's a whole new area in the world of pharmacogenomics, which is how you can see how your genome interacts with medications that you can take. One of the most important areas for that is depression, which we've obviously seen a huge rise in from the pandemic," Wojcicki said. "There's this huge opportunity to help people get a better first-line medication for them based on their genetics. I do think that a lot of clinicians now are starting to see this. So the other data point that was interesting was like actually having patients saying they want personalization."

The very high price of health inequities

Health inequities related to race, socioeconomic status and sex/gender could create up to $1 trillion in avoidable healthcare spending annually by 2040, according to Deloitte's projections.

In the U.S., $320 billion per year in healthcare spending is attributed to health inequities, according to Deloitte researchers. 

"This is waste in the system. This isn't us going from poor care to great care. We're talking about bridging the gap between what is poor care to the average care," said Andy Davis, principal for Deloitte Consulting LLP’s Health Care practice, during a panel discussion on health equity strategies.

The average nonwhite individual 45 and older goes in 60% of the time to get their colorectal screening while the average white person goes in 65% of the time, he noted.

"How do you actually bridge that gap? That 5% [gap]? You'd want everyone to get this 100% of the time but that 5% represents late-stage cancer diagnoses for those patients who don't go and get it. And that's the $320 billion in waste," Davis said.

Jay Bhatt, D.O., a physician executive and executive director of the Deloitte Center for Health Solutions and the Deloitte Health Equity Institute, practices medicine at a community health center in Chicago's Southside as a primary care internist.

"What I'm seeing now is more people wanting support and services for the first time. That's the impact that I think the economy is having but also that the social ills of the nation show up in my office, in the clinic," Bhatt said. "Health inequities are America's chronic condition. We've just put a Band-Aid on this issue and not thought about it through addressing the system structures, policies and environments that impact the issue."

Health inequities are not new, Bhatt noted, "It was the [COVID-19] pandemic, the murder of George Floyd and the social unrest that has illuminated this in that it's not just a moral imperative, but an economic imperative [to address it]."

"Health equity can't be a side hustle. It's got to be embedded into the core of business strategy and operations and mindset and innovation," Bhatt said.

With the rise of "consumerism" in healthcare, patients now have the ability to be in control of their own healthcare, the panelists said. But for that to work for all patients, it requires them to trust the system, be engaged and have equal access, the healthcare leaders said.

Kameron Matthews, chief health officer at Cityblock Health, said the startup is working to build trust and open up access for marginalized populations with complex needs.

"Our model is one that is purposefully 'in the gray,'" Matthews said. "We are either a primary care provider for our patients, or we offer what's called 'primary care wraparound', where they may have a primary care provider elsewhere in the community, usually at an FQHC, and we are then through really one-stop-shop means offering other services. We're not only wrapping around the member and offering behavioral health, clinical pharmacy social services but we're also assisting that primary care doctor."

Operating with a value-based care model rather than traditional fee-for-service enables Cityblock Health to focus on social drivers of health and whole-person care, she noted.

The real cost of health inequity is that marginalized, vulnerable patient populations don't trust the healthcare system and have often been traumatized by the system, she said.

"We need to earn that trust back. We need to earn the right to engage with them. That's actually a major focus of our care model even before our docs connect with members, we have an entire team that's actually part of the primary care team that is focused on trust and engagement," Matthews said. "We are multimodal, so that means we're going into the home, we're providing virtual care, we're doing it in our clinics, we're doing it on park benches, and in the community purposefully. We're not just taking care of them as patients, we're taking care of them as people."

How healthcare is making inroads in underserved markets

As competition in primary care heats up, retail pharmacies and healthcare startups see a ripe opportunity to reach consumers who are falling through the cracks of the traditional healthcare system.

“The biggest opportunity for healthcare innovation and for businesses like ours is to play an additional extension and partner role," said John Driscoll, executive vice president and president of U.S. Healthcare at Walgreens, during a panel at SXSW 2023. "There's a big opportunity not just to provide that extra capacity but also do so in a more patient-centered, consumer way, leveraging data and technology and some of the skills that retail brings, which are convenience and trust that sometimes healthcare lacks." Read the full story here.

New battlegrounds over reproductive rights

Data privacy and access to online information about abortion care have become the next big battlegrounds in the fight over reproductive health in a post-Dobbs world.

"There's a reason why we're having a panel on this at South by Southwest this year, which is we live in a world today where we look at the type of evidence that can be used in prosecutions or that women have to worry about when you're thinking about accessing reproductive care. There's a big angle based on the sheer amount of information that we share with our phones and other technology in the course of our daily lives," said Alexandra Reeve Givens, president and CEO of the Center for Democracy and Technology, while speaking on a panel at the SXSW 2023 conference this weekend. Read the full story here.

How tech is helping patients tackle the burden of diabetes

One in 10 Americans live with diabetes, making millions of tiny decisions to keep themselves alive. Singer and performing artist Nick Jonas took the stage at SXSW to talk about his personal journey living with Type 1 diabetes.

Jonas, who was diagnosed at the age of 13, said diabetes care has significantly advanced and the use of continuous glucose monitors (CGM) has improved his quality of life.

"When I was first diagnosed, it was about finger sticks all the time and injections and I'm very fortunate to have that diabetes care, but it's come such a long way. I think those strides are continuing. I'm grateful that we have this technology that makes my life, whether I'm busy or not, easier for me to just be present, kind of in the moment. The technology enables me to make decisions in real-time to live my best life and be as present as I want to be in my work and with my family and as a friend."

Jonas was joined on stage by Thomas Grace, M.D., medical director of the Blanchard Valley Diabetes Center; Jake Leach, chief operating officer at medical device company Dexcom; Colorado state legislator Leslie Herod; and Pastor Mireya Martinez, who has Type 2 diabetes.

"Speaking for my patients who come through the clinic or even for myself, I will tell you that that is one blessing from this [CGM] technology is the confidence that you get in treating and managing your disease," Grace said. "A continuous glucose monitor really is like a mirror that you have to look at all the time when that data is getting pushed to you and you're able to make decisions again in real time that you wouldn't normally have been able to adjust to or make in the past. So it really has been a game changer to have that data available right at your fingertips or easy swipe on your phone to be able to see your glucose reading."

In 2021, it is estimated that 537 million people have diabetes, and this number is projected to reach 643 million by 2030 and 783 million by 2045, according to the National Institutes of Health.

The increase in global health expenditure due to diabetes has grown from $232 billion in 2007 to $966 billion in 2021 for adults aged 20 to 79 years—a 316% increase over 15 years, according to the Journal of Health Economics and Outcomes Research. 

The Centers for Medicare & Medicaid Services made a decision to permanently eliminate the requirement of the four-time-daily fingerstick in order to qualify for coverage of a CGM. One out of five people on Medicare have diabetes, and the elimination of the fingerstick requirement means Medicare beneficiaries with diabetes will have easier access to this critical technology, according to the American Diabetes Association."

That's the largest single decision for access that we've seen in the history of CGM but that still only opens up CGM to about a total of 5 million people in the United States," Dexcom's Leach said. "We're working with payers, governments and private insurance and payers to make sure people get access to the technology they need."

Even for the most resourced patients in America, the burden of diabetes still looms large over their heads. Patients without access to the best of the best in tools and treatments face even greater challenges to manage their conditions, the panelists said.

"The truth of the matter is we know that health disparities exist in our society, even today. Technology is helping to reduce that but we have communities, especially the African American community, that is disproportionately impacted by diabetes and by the negative health outcomes when it's untreated," Herod said.

There need to be more efforts to increase awareness and education about tools like CGM in certain populations, the panelists said. And there needs to be expanded health insurance coverage for the devices to make it more affordable for patients, they said.

"There are still a few states where Medicaid doesn't cover CGM. That was mind-boggling to me. There are still a few states here in the United States where patients with Type 1 diabetes don't have access to CGM," Grace said. "In Ohio, we just got Medicaid coverage for people with Type 2 diabetes, regardless of medications. So it doesn't matter if you're on insulin or just oral medications, Medicaid patients can now, every single one of them, can get CGM right at the pharmacy."