This month's issue is focused on Health & Medicine.
AI’s touch on health care
Inside: Napa Insider · Ramona Faith Bungalow Kitchen · Pride Mountain Sick Days · For Love or Prenups How artificial intelligence connects with North Bay medicine
February 2024
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For all that is Sonoma County. For all that is you.
February 2024
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49 YEARS OF BUSINESS INTELLIGENCE
February 2024 • Volume 49 • Number 2
LEAD STORY 18 DR. AI WILL SEE YOU NOW! Judith M. Wilson How artificial intelligence is transforming the doctor’s office near you
WORK/LIFE 13 MEDS 15 RETAIL 17 HOUSING FEATURE STORIES 28 Calling in sick, 2024-style
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Jean Saylor Doppenberg
Diagnosing the new state sick-leave law 38 Throwing shade Janet Perry Planting trees brings a canopy of wellness benefits to a community 46 Prenups—to have and to hold… Vicki Larson Why more North Bay residents are wedded to pre-marriage financial agreements
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Helping grow your business isn’t just something we do... it’s all we do!
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COLUMNS 11
DEPARTMENTS 8 LETTERS 52 DINE WISE Jason Walsh Bungalow Kitchen by Michael Mina 56 GREAT TASTES Alexandra Russell Pride Mountain Vineyards in St. Helena 58 WHAT’S HAPPENING Upcoming North Bay events 61 BIZ SCENE North Coast Wine Industry Expo 63 ON THE MOVE New hires and promotions in the North Bay 64 BEYOND THE BOARDROOM Rosie Padilla Ramona Faith, CEO Healthy Petaluma
PUBLISHER’S FORUM Lawrence Amaturo It’s time to serve under-served young readers
27 TECH TALK Michael Duffy A prescription for losing weight 36 ONLY IN MARIN Bill Meagher 37 ECON 101 Robert Eyler A look at the national debt 45 NAPA INSIDER Christina Julian The down low on Up Valley 54 VINE WISE Adam Lee How to position your winery for a sale 55 IN THE KITCHEN John Ash
Hospice merger and City of Novato’s sell off
Grilled cheese sandwiches, the ultimate comfort food
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NorthBay biz (ISSN No. 1542-3549: USPS 097-770) is owned and published monthly (plus three bonus issues annually) by North Bay Media Group, LLC. Editorial offices are at 3392 Mendocino Ave., Santa Rosa, CA 95403 USA: (707) 528-4434. Sub- scription price is $35 per year. Periodicals Postage Paid at Santa Rosa, CA 95402 and at additional mailing offices. Copyright 2022, NorthBay biz. Reproduction of this issue in whole or in part is strictly forbidden without written permission by the publisher. POSTMASTER: Send address changes to NorthBay biz, 3392 Mendocino Ave., Santa Rosa, CA 95403 USA.
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Letters
Letters to the Editor A matter of inches ?
Editor: I have been inspired to respond to Bill Meagher’s article in the December issue of NorthBay biz [“A Sea Change Is Gonna Come”] about the looming catastrophe of rising water caused by climate change. He reports [based on projects from the Bay Conservation and Development Commission that Marin will see a] 12-inch to 32-inch sea level rise, $110 billion cost, 104,000 jobs lost plus another 85,000 jobs that will never happen, 13,000 housing units destroyed and another 70,000 that will not get built. Wow! This is awful and it’s all happening by 2050! We better do something fast and thankfully Bill and the BCDC are sounding the alarm. But 12 to 32 inches is a big range… Help me out here, Bill Meagher. You are a journalist so you should be able to check the data, methodology and resources, and not just quote Chairman Mao. How about a little curiosity? Are we looking at 3 inches or 8 or 12 inches or 32 inches? Will 189,000 jobs really disappear from Marin when storm tides are a few inches higher? What’s the rationale for that? How are those calculations made? What about all the new jobs building seawalls, levees and 63,000 new housing units to replace all the submerged ones? How about doing some real reporting and analysis rather than repeating dire warnings about flood-bombs? Mr. Walsh [editor], don’t you think your readers deserve better than this? Roger Hartley, Sonoma Editor’s Note: Thanks for writing Roger! We always appreciate a healthy dose of skepticism. But keep in mind that the role of journalists isn’t to assume we can quickly become experts on a subject merely by conducting some Google searches and reading some graphs (i.e. the dreaded “doing your own research” model). While we may conduct those exercises for basic background information and to develop working knowledge of context, we rightly still rely on information from authorities on complex subjects to provide accurate information and objective feedback, which we report to readers. Given that credible studies show between 98.7 and 100% of international scientists believe climate change is taking place and add to that the very real fact that sea levels have risen around 10 inches since the advent of the industrial revolution (late 19th century) with around half of that sea-level rise coming since 1980 (in other words, climate change due to humans burning fossil fuels is quickly accelerating), it’s reasonable for Meagher to report the scientific community consensus expectation that, based on the rate of acceleration and unless fossil-fuel burning is drastically curbed, sea levels will rise from around 1 to 3 feet by 2100. You’re correct that “projections aren’t data”—but they’re based on data. Rather than focusing on such questions as, “will sea levels rise 12 or 36 inches—which is it?!” (in an attempt to cast doubt on the projections and encourage inaction), Meagher, as a responsible journalist, looks at the big picture reality of climate change and asserts: “It would behoove we humans to do something about it.”—Jason Walsh, editor
Publisher
Lawrence Amaturo
Editor-in-Chief
Jason Walsh
Associate Editor
Rosie Padilla
Contributing Editor
Bill Meagher
Design Director
Anne Schenk
Administrative Assistant
Jodi Pasquini
Marketing Consultant
Lori Rooney
Writers Janet Perry Jason Walsh Jean Saylor Doppenberg Judith M. Wilson
Rosie Padilla Vicki Larson
Columnists Adam Lee Alexandra Russell Bill Meagher Christina Julian Jason Walsh John Ash Michael E. Duffy Robert Eyler
Photographers Duncan Garrett
For more recent NorthBay biz issues, check out northbaybiz.com . Email comments, complaints and witty observations to jwalsh@northbaybiz.com. Please include name, address and phone number. Letters will be edited for length and clarity.
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NorthBaybiz 9
Books Are Portable Magic
Remember being read to as a child? My mother read aloud to me, and one of my favorite books was Charlotte’s Web by E.B. White. But what I remember most was the sound of her voice, the rhythm of the words and what it
felt like leaning into her, while she read aloud to me. The pages of those books she read transported us to faraway places—real and imaginary—and taught me about life and opened my mind to all the possibilities. So when I became a mother, I began reading to my kids.And now I’m reading to my grandchildren every chance I get. As for my mom, now a great-grandmother, she still takes great joy in reading to the kids whenever she visits. Remember to take time every chance you get—eat, play, read. Reading helps build language and thinking skills, develops a child’s imagination and empathy for others, achieve better in school, and it’s a great way to spend time together. And best of all, reading aloud to your child makes memories that will stay with you for a lifetime.That’s what my mother was doing years ago when she took the time to read aloud to me.
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Publisher’s Forum
Student success is showing recovery signals. But there’s still miles of ground to cover to merely get us back to where we stood pre-pandemic.
Under-served students need help now more than ever By Lawrence Amaturo
R eaders of this column may remember hearing of my great concern as the 2020 COVID social policies spread across the country as quickly as the disease itself. In an “abundance of caution,” all schools in California abruptly shut down, children were sent home, grading policies were relaxed and the state education decision makers called all the shots. As someone who changed masks daily and personally hand-washed all grocery packaging before presenting food to my family at the very start of the outbreak, I recognize that caution was, indeed, a necessary action. My surgeon brother-in-law in New
pandemic have “upended U.S. education.” Millions of students lost significant ground, despite billions of taxpayer money thrown at the problem. Here are some of the most damaging statistics: a) From 2019 to 2022, math scores for third through eighth grades plunged; students lost more than half a year of learning. Students have now made up about a third of what they lost. b) For the same period, reading scores also plummeted; students have only made up a quarter of what they lost during the pandemic.
c) The achievement gap between students from privileged and under- served communities—already huge before the pandemic—has widened. Some children may never catch up and could enter adulthood without the full set of skills they need to succeed in the workforce and life.
Jersey, dedicated to maintaining the care of his life-endangered patients, continued his practice but slept in his car each night so as to avoid infecting his family. When COVID’s airborne transmission was confirmed (i.e., not by touch) he began relaxing
his at-home regimen and safely rejoined his wife and family each evening. Alas, state education decision makers, as well as countless politicians and “experts,” never pivoted. Instead, they doubled down on their school-closure stances and students were distanced from their teachers and peers for more than a year. Yet, in the midst of the national social-justice referendum, and focusing renewed attention and care on our under-served communities, we ignored the obvious and inevitable. We failed to recognize that school closures would impinge a generation of potential advancement among this very population. If you believe, as I do, that education is the longest-lasting and most beneficial way for one to advance in our society, months of school closures set us back in unfathomable ways. The first, obvious clue appeared in the spring of 2020. The Los Angeles Unified School District, the second largest district in America, released its report on at-home, virtual learning among its students. As I reported in these pages that year, more than 14,000 high school students had not logged onto one single Zoom class that year! They either had no access to computers, a too-crowded home in which to function as students, no place at all to call home, or were surrounded by guardians lacking the capacity to help. Believe me, these were not factors for Angelinos living in Westlake, Beverly Hills or the toniest parts of Malibu. These were the disadvantaged children who were scraping by before the pandemic. Now, in a flash, their educational futures were compromised. The chickens have now come home to roost. A stunning analysis published Jan. 31 by the New York Times has revealed what we all saw coming. The policies we tolerated during the
d) The result: Students in under-resourced communities are at a greater disadvantage today than they were five years ago. In certain pockets of society, student success is showing recovery signals. But, Lordy, there’s still miles of ground to cover to merely get us back to where we stood pre-pandemic. Which brings me to Read On, Sonoma, functioning brilliantly for 1,300 second through sixth graders in six Sonoma County elementary schools. Former Superintendent Ron Calloway “corralled” a few of his peers in 2021 to see if the task of reading could be turned into a game—complete with prizes, measured accomplishments and a ton of recognition. Guy Fieri lent his name and reputation to inspire others to join in. We had the incredible good fortune of bringing on Michelle Leisen as our director this school year. Michelle has dynamic educational experience including both as a teacher and a principal in the Roseland Elementary School District. Beyond Michelle’s credentials, her passion and energy for young readers is boundless! And with Michelle at the helm, we now have hard data that shows without a doubt, Read On Sonoma is increasing the Instructional Reading Level (IRL) in our six elementary schools. Instead of struggling to regain lost ground, these students now exceed state standards. The average IRL increase for third and fourth graders was 1.23 school years! Please visit readonsonoma. org to see how you can get involved and support literacy in our community. Please stay in touch.
Always good to hear from you…even when you point out my misunderstandings…. So send me a note at Lawrence@Northbaybiz.com.
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Work/Life/ Meds
The reason behind crazy prescription names
By Jason Walsh
T ime to renew your vagifem? Forgot that daily dose of carfilzomib? Asked your pharmacist for digoxin when you meant digitoxin? The medicine word salads in Prescription Drug Land have baffled malady sufferers since long before Romanian chemist Laza Edeleanu first synthesized his tongue- twisting phenylisopropylamine (aka amphetamine) in 1887. But, believe it or not, there is a method to the methylprednisolone madness. Health regulators like the U.S. Food & Drug Administration have strict rules about branding a medication—notably, it can’t sound too much like a different medication (to avoid prescription mistakes), it can’t make medical claims and it can’t be overly promotional. Nor can a name imply unfounded superiority to other similar drugs, which is why the FDA rejected the insulin name NovoRapid due to the suggestion it was faster-acting than other insulins (it eventually became NovoLog). Pharmaceutical companies put a lot of thought into naming their drugs, according to the National Library of Medicine. They want them to be easy to pronounce in other languages (hence the scarcity of letters H, J and W) and not unintentionally translate to something offensive. The letters X, Y and Z are popular because they sound science-y, according to the National Center for Biotechnology Information. Products aimed toward women may have the letters S, M and L, as they’re soft-sounding, according to the NCBI, which cites birth control pills Alesse, Yasmin, Seasonale as examples. While a name can’t be overly promotional, it can imply the intended outcome of the drug—for instance, Lunestra includes “lune” (French for moon) in naming its insomnia medication and anti-depressant Prozac starts with “pro,” Latin for “on behalf of” and generally associated with helpfulness or positivity. Generic names for medications, meanwhile, often indicate to doctors a medical function of the drug, according to Pfizer.com . For instance, sildenafil—which Pfizer markets as Viagra—is among several erectile-dysfunction generics whose name contains “afil,” which in medical terms means it helps control blood flow. Still for every lyrical-sounding Lyrica, there’s a headache- inducing Ipratropium bromide. And for that headache, take two Tylenol, named from the compound acetyl-para-aminophenol.
Why regulations matter
P rior to the institution of FDA regulations, the wild- west days of branding medicine was, quite literally, the Wild West. That’s back when alcohol and morphine could be packaged together as a concoction dubbed Mrs. Winslow’s Soothing Syrup, a supposed cure-all for fussy babies. One teaspoonful contained enough morphine to kill the average child, according to Pharmacy Times . In 1868 alone, Mrs. Winslow’s reported selling more than 1.5 million bottles. Tragically, it was highly effective in putting babies to sleep permanently. It’s estimated thousands of infants died from the “remedy” before anyone realized the syrup was deadly toxic. Despite tightening regulations and the American Medical Association denouncing it as a “baby killer” in 1911, Mrs. Winslow’s was still sold into the 1930s.
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E xchange Bank is excited to sponsor “Read On, Sonoma.” We know that reading and literacy skills are essential to educational success. In honor of the “Read On, Sonoma” challenge, we’ve asked three Exchange Bank employees to share their spring favorites. Happy Reading!
The Very Hungry Caterpillar by Eric Carle “The Very Hungry Caterpillar is one of my favorite kids’ books because of the story of the adventure of the caterpillar. It helps young children learn
Itsy Bitsy Spider by Kate Toms “I love reading the Itsy Bitsy Spider to my kids. They love the cute story about how Itsy keeps trying to climb that waterspout but gets washed out every time. In the end, Itsy learns another way to take on the spout and achieves success. The story shows my kids the importance of trying your hardest even when you fail. If you keep trying, then you will find another way to achieve the same goal.” Heather Walker, Retail Service Manager
the life cycle of a caterpillar, the days of the week and to count. Over the years I’ve read this book to my nephews, who will soon graduate high school, and my grandkids.” Stacy McKee, AVP, Assistant Controller
exchangebank.com
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February 2024
Work/Life/ Retail Retail crime has been trending down for years
By Rosie Padilla
H ave the countless headlines in recent months fomenting alarm about a retail crime wave sweeping the U.S. been, er… lifted from bad data? That’s the case regarding at least one influential report from the National Retail Foundation (NRF), which claimed in its April 2023 survey that around $45 billion in merchandise had been lost to U.S. retailers the prior year due to organized retail crime
What merchandise is most-frequently targeted by retail thieves? According to data from NSW Bureau of Crime Statistics and Research, these are shoplifting’s Fab Four: Alcohol 37% Retail theft greatest hits
Clothing/footwear 22% Food and beverages 15% Perfume/cosmetics 12%
(ORC). But in November, trade publication Retail Drive called out the data as faulty—and on Dec. 1 the NRF revised its report, conceding the data was inaccurate. The problem? It’s more likely that $45 billion amount reflected the overall inventory loss, or “shrink”—not necessarily all of it from theft. Shrink is often used interchangeably with the term theft, but the NRF says shrink more directly refers to all lost inventory for retailers— including administrative errors such as inaccurate inventory costs, accounting errors, incorrect pricing, paperwork mismanagement, E-commerce fraud and inventory damage. The NRF’s mistake could be chalked up to something along the lines of the old game of Telephone—their report possibly stemmed from 2021 testimony before U.S. Congress, when retail analyst Ben Dugan mischaracterized the $45 billion as retail loss from theft; and he may have gotten his info from a 2016 retail trade group survey which reported that amount more accurately as overall shrink. The good news: While there remain pressing issues about organized retail crime—a kind of professional shoplifting run by crime rings, including smash-and-grab, truckjacking and cargo theft—overall shoplifting incidents in major cities have fallen 7% since 2019, according to the Council on Criminal Justice, with notable exceptions in New York City and Los Angeles. Closer to home, the San Francisco Police Department was recently awarded a $15.3 million grant to crack down on organized retail theft and the SF District Attorney’s Office received a $2 million grant to help prosecute ORT.
Note: While swiping any and all booze is popular among thieves, particular favorites are bourbon, whiskey and vodka, according to the NSW
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Local North Bay businesses that participated in the January nonprofit issue and support local nonprofits in a multitude of ways.
North Bay Credit Union
American AgCredit
Oliver’s Market
Biagi Bros., Inc.
Carlile s Macy, Inc.
Omega Mortgage Group
Park Plaza Shopping
Central Valley Environmental
P&L Specialties
Clear Blue Commercial
RHA Builders, Inc.
Costeaux French Bakery & Cafe
Ritch Insurance
Culligan Water
Sawyer Construction
Earthtone
Soiland Company
Elow & Associates
Sonoma Federal Credit Union
Exchange Bank
Smothers European Mercedes-Benz and Volvo
George Petersen Insurance Agency
Summit State Bank
Ghilotti Construction
Team Ghilotti Inc.
Hennessy Advisors, Inc.
Valley Memorial Park
Image Tree Service
Veale Outdoor Advertising
J. Pedroncelli Winery
Wasson Investment Services
Julie Atwood Events
Western Farm Center
Landesign Construction & Maintenance, Inc.
Whitestar Group Inc.
Law Office of Linda L. Daube
Windsor Golf Club and Charlie’s Restaurant
Linkenheimer, LLP
McDevitt Construction Partners, Inc.
GROWING YOUR BUSINESS BY PARTNERING WITH NONPROFITS
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February 2024
Work/Life / Fair Housing
By Jason Walsh Housing discrimination in the North Bay
L andlords in Sonoma and Marin counties regularly California (FHANC), a nonprofit based in San Rafael, was released Dec. 18 and showed that 58% percent of the North Bay landlords investigated practiced some sort of housing discrimination against renters with families, and over 30% discriminated against Latino renters. About 15% of landlords investigated discriminated against both, according to the report. discriminate against Latinos and renters with families, according to a recent investigation by local fair-housing watchdogs. The report by Fair Housing Advocates of Northern
The Solano County tests showed the lowest levels of discrimination, with evidence of familial status and national origin discrimination at 25% and 23.5% respectively. According to FHANC, tests at “large” properties of more than 50 units showed “significantly less evidence of discrimination” at 21% than those conducted at “small” and “medium” properties, which were 72% and 67%, respectively. In announcing the results of the investigation, FHANC Executive Director Caroline Peattie said that while housing discrimination has been outlawed for decades, studies like this show that Latino families continue to experience discrimination as a barrier to housing choice—a barrier that’s further compounded when they have children. “It’s clear that more enforcement actions are needed, as well as increased education and outreach to property owners and
The investigation in the two counties focused on 40 landlords—20 in Sonoma County and 20 in Marin—and was carried out from January through April 2023. Another 20 landlords were investigated in Solano County during that time span. As part of the investigation, trained pairs of testers—one Latino and one white non- Latino—posed as potential renters with children and called to inquire about the availability of listed rental properties. FHANC then
managers,” said Peattie. “When housing providers are willing to openly state their discriminatory housing policies, even in writing, that suggests the likelihood that at least some are unaware of their legal obligations. This really points to the need for increased education and
compared the experiences of the testers to determine whether disparities existed in the way each tester was treated and whether they were offered or informed about different housing opportunities, policies, terms and amenities. According to federal fair housing law, discriminating against households with children or expressing a preference for households without children is considered familial status discrimination. Similarly prohibited, discrimination against Latino renters is considered national origin discrimination. Tests conducted in Marin County revealed the highest incidence of discrimination, with 67% of tests revealing at least some evidence of discrimination, FHANC reported. Fifty-three percent of the tests conducted in Marin County revealed evidence of familial status discrimination. While Marin tests revealed the most discrimination overall, tests in Sonoma County revealed the greatest evidence of national origin discrimination at 35%, with familial discrimination at 40%.
outreach.” The report makes a number of recommendations,
including disseminating the report to North Bay officials and the general public; monitoring the sites where there was an indication of differential treatment and taking possible enforcement action; training private and public housing providers and working with them to ensure they understand the law; and spreading the word to potential targets of discrimination. “It’s really difficult to find any kind of affordable housing in the Bay Area now,” said Peattie. “This report points out how much more difficult it is for single Latinx mothers. We need to redouble our efforts to make sure housing providers not only understand the law but comply with it and start removing barriers for families with children and particularly Latinx families.” For more information or to report potential housing discrimination, contact FHANC at fhanc@fairhousingnorcal.org or 415-457-5025, ext. 101.
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Putting the GP in Chat GPT
How artificial intelligence is transforming the doctor’s office near you
By: Judith M. Wilson
A rtificial intelligence is all around. Ask Siri a question on an iPhone or give Google’s Alexa an instruction, and AI comes into play as an electronic personal assistant to meet one’s needs. ChatGPT makes jobs like writing reports easier, and AI can analyze large amounts of data quickly and efficiently to recognize patterns and reach conclusions. In health care, it’s able to evaluate images and identify areas of concern, often at the crucial early stages of disease, giving physicians new tools to help save lives and prevent the life-altering consequences of undetected conditions. In addition, AI is making tedious tasks—such as transcribing medical records—a thing of the past by converting audio to text rapidly, freeing employees to spend their time on more meaningful work.
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Evolution Although AI has only become mainstream in the public consciousness in recent years, as an area of computer science, it’s far from new. The term artificial intelligence was coined in 1956 and the Department of Defense began exploring possible uses in the 1960s. The Defense Advanced Research Project Agency took advantage of AI to do street-mapping projects in the 1970s, and the first application in health care came in the same decade with the development of an AI program that identified blood infections. In 1979, the American Association for the Advancement of Artificial Intelligence ( aaai.org ) came into being, and AI continued to advance in the 1980s and ‘90s with research on methods to collect and process data faster and assist in making some medical procedures more precise. For instance, robotic surgery such as the DaVinci system, which augments a
AI is specialized software that allows computers to replicate human intelligence by using algorithms—the commands a computer follows—to complete tasks. It has access to large volumes of data sets and, when programmed with the correct questions, it can use the data to focus on solving a specific problem. As it processes masses of information, it also learns from it to do its assigned tasks better, so its ability improves over time. It’s able to analyze large quantities of data much faster than people and is typically more accurate, partly because machines don’t get tired or have interruptions to the workflow the way multi-tasking humans do. The goal, though, isn’t to replace people. Rather, in health care, AI is a tool that assists medical professionals by providing valuable information quickly so they can use it to enhance their decision-making—resulting in better outcomes and benefiting patients.
surgical team’s capabilities, was in use in operating rooms in Europe in 1999 and received approval from the U.S. Food and Drug Administration in 2000. Progress was slow but steady until 2011, and then AI began to get the public’s attention when breakthroughs in deep learning— also known as strong AI—modeled on the human brain made it possible for computers to perform tasks using images, text and sound. Its use accelerated, and several areas of health care, including primary care, radiology, screening, the diagnosis of disease and telemedicine, now use it as an integral part of their practices. When time counts Patients having strokes lose more than a million brain cells a minute, so the faster they get treatment the better. AI is a gamechanger in such cases, because in providing images quickly, it allows a physician to put a treatment plan into action sooner than is possible with traditional methods. Stroke specialists in Sutter Health’s network are using an AI-based platform that automatically processes CT scans to identify large blood-vessel clots and deliver clear images that are easy to interpret. “Hospital stroke teams and emergency department personnel receive these results in three minutes or less,” says Laura Wilt, a senior vice president and Sutter’s chief digital officer. “This rapid response enables doctors to diagnose the stroke type and plan treatment faster and more accurately,” she explains, giving victims a better chance of recovery. In imaging, AI can find subtle abnormalities that are difficult for the human eye to see. The National Institutes of Health, a federal agency noted for its medical research, reports that physicians are using retinal scans to identify diabetic retinopathy, a complication of a type
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February 2024
A physician’s pen indicates brain pneumonia and cancer cells on X-rays displayed on an AI biomedical algorithm screen.
of diabetes that causes lesions on the retina and can lead to blindness if not caught early. Ophthalmologists can diagnose the condition manually, but it’s a lengthy, costly process with the risk of misdiagnosis, and AI’s deep learning has produced more accurate results. In addition, the NIH reports that AI can analyze routine eye scans to spot changes in the retina’s tiny blood vessels that are a sign of vascular disease and identify patients at risk for heart attacks. AI also shows promise in helping
MarinHealth is also using new technologies in cardiac care, which include AI image-guided technology for detecting Abdominal Aortic Aneurysms (AAA) and a cardiac MRI program that increases scanning throughput (the amount of data that goes through a computer) for myocardial function with quick ejection fraction, stroke volume and mass calculations. “This means physicians will have access to enhanced images and more accurate data regarding a patient’s
heart and its function to make better, more informed decisions regarding patient care,” says a statement from MarinHealth. Also in cardiology, the Mayo Clinic reports using AI techniques in a screening tool that identifies left ventricular dysfunction and in an Apple Watch to detect a weak heart pump. In addition, its studies show that AI-guided electrocardiograms can detect faulty heart rhythms before a patient becomes symptomatic. Lightening the workload AI’s streamlining of administrative tasks provides benefits for both medical personnel and patients. It can estimate the amount of time a particular surgery will take, for instance, allowing improved operating-room schedules and shorter wait times. When
diagnose cancer early, and the NIH reports that studies using AI and Machine Learning—a subset of AI—have been highly accurate in finding several types of the disease, including breast, brain, lung, liver and prostate cancer. The NIH encourages developing the technology further, and in 2020 Sutter Health partnered with Ferrum Health in San Francisco to study ways to find tumors at earlier stages. MarinHealth Medical Center is using AI solutions in key areas that include diagnosis assistance, imaging enhancement and patient monitoring, such as rapid response of warning systems in the ICU. Provider documentation and
Artificial intelligence is being used to identify diabetic retinopathy and other subtle abnormalities difficult for the human eye to see.
virtual scribes, predictive analytics for population health and length- of-stay monitoring and alerting, as well as clinical-decision support, are additional areas where AI is delivering benefits.
physicians record their observations and appointment notes, AI can use natural language processing to transcribe them
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February 2024
and post the records on online portals, giving both doctors and patients access to medical records. And because machines can work 24 hours a day, the information is available quickly. “Administrative tasks consume a significant portion of clinicians’ workdays,” says
AI FYI: 5 types of artificial intelligence
Artificial intelligence is replacing many tasks that required human intelligence in the past. Five types of AI perform different functions to assist healthcare professionals. Machine learning: robot-assisted surgery, customized patent treatments, prescription error detection. Deep learning: clinical trial cohort selection, synthetic MRI image generation, drug property predictions, health insurance fraud detection Natural language processing: chatbots or virtual assistants speech-to-text clinical transcription, protected health identification and de-identification, treatment coding assignments Computer vision: patient identification via facial recognition, surgical procedure recordings to catch errors, lung cancer detection via X-ray images, polyps detection via colonoscopy videos Explainable AI: patient screening and diagnosis, disease prediction, model bias detection Source: Redox: Healthcare professional’s guide to AI redoxengine.com/blog/the-healthcare- executives-guide-to-ai/ Redox: Healthcare professional s
Laura Wilt, Sutter Health’s chief digital officer, says the rapid response available through AI enables doctors to identify strokes faster and more accurately.
Wilt, and she explains that Sutter is using AI to improve
in-basket workflows and complete the documentation requirements that regulations and insurers require. Sutter is also working on a pilot project with Epic, a Wisconsin- based company that specializes in electronic health records and produces software for hospitals. “More than 60 Sutter- affiliated physicians are testing generative AI methods to respond to patient messages,” she reports, explaining that the Epic software uses AI to analyze the content of messages from patients and draft responses based on their charts and history. Doctors then review and send the final response. She adds that Sutter is experimenting with generative AI technology, such as ChatGPT, to automate clinical documentation as well. “This exciting initiative is a practical step toward transforming how physicians work and interact with patients, focusing on automating administrative tasks during patient visits,” she says. With technology a part of everyday life, Wilt finds that patients expect it to have a role in health care and the way they access it as well. “Sutter is proactively responding to these expectations with our digital strategy and evolving technologies, including AI, with the goal to provide a seamless, high-quality patient experience,” she reports. “Our approach revolves around elevating the entire health care experience for patients and our care teams. We see endless opportunities to deliver an even more personal, connected and convenient experience.” UCSF MarinHealth announced in August 2022 that it would begin using APeX, a version of Epic EHR created specifically for its system. It gives patients access to their medical records through MyChart, an online portal that keeps all their medical information in one place. They can see tests results, schedule appointments, send messages and request prescription renewals simply by logging onto the portal on their personal devices at their own convenience. Clinicians also have access and can see detailed information, such as patient records, notes from other doctors, current prescriptions and upcoming appointments with specialists. AI thus provides a big picture that helps them to make better diagnoses and decisions about treatment. Looking ahead Among its applications, Kaiser Permanente is using AI natural language processing to analyze email messages from patients to identify their areas of concern so that the best person responds.
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The World Economic Forum held in Switzerland in 2020 took a deep dive into the future of artificial intelligence in health care.
It is also using predictive analysis to develop algorithms that can evaluate COVID-19 patients and identify those at risk of developing more severe symptoms. Creating and evaluating algorithms using AI and ML are a focus of Kaiser’s Division of Research, and the stated goals of its Augmented Intelligence in Medicine Initiative, which is located in Northern California, are “to advance research methods, identify best practices and build capacity for effectively implementing and rigorously evaluating the use of AI/ML algorithms for diagnostic decision- making in real-world settings.”
annual meeting in Switzerland in 2020 predicted three major ways that AI will change health care by 2030. First, AI predictive care will identify factors such as inherited medical conditions, diet, the environment, income and stable housing, which can impact health, allowing physicians to recommend measures that patients can take to help prevent a disease from developing. Second, digital networks will connect health care centers, including hospitals, same-day surgery centers, clinics and even patients’ homes, so
“We see endless opportunities to deliver an even more personal, connected and convenient experience.” — Laura Wilt, Sutter Health chief digital officer
patients can get care at the most appropriate location, and health care personnel can go to the spot where they are needed the most. Third, good experiences aid recovery and create a better workplace, and
In December 2023, AIM- HI announced that it had awarded grants of up to $750,000 to allow five health care organizations across the country to carry out research projects using AI and ML. One project, at Parkland Health in Dallas, involves an AI/ML model for pediatric asthma care
AI will provide better experiences for both patients and staff, as it reduces wait times, improves workflows and takes on more
in safety net health settings, and the use of AI in diabetic retinopathy screening is the focus of another at San Ysidro Health in San Diego. The funding is for three years, and AIM- HI’s advisory committee will provide support by sharing best practices and lessons learned and advancing the use of AI and ML in healthcare. Looking farther into the future, the World Economic Forum’s
administrative tasks to relieve the burden on employees. “By learning from every patient, every diagnosis and every procedure, AI creates experiences that adapt to the professional and the patient. This not only improves health outcomes, but also reduces clinician shortages and burnout, while enabling the system to be financially sustainable,” the report concludes. Innovation and initiatives that explore new uses make the
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February 2024
Among the ways AI is expected to change health care in the next decade are in predictive care, improved networking between health centers and better experiences for patients and medical staff.
future of AI in healthcare look bright—yet it still has challenges. A human programmer must set up the system and ask the right questions without bias to create a well-constructed algorithm that will produce the desired results—so even highly sophisticated software has the risk of error. In addition, audio recordings need to be high-quality and clear, with a speaker who articulates well, for computer transcription to be accurate, although doctors usually have an opportunity to review reports and make corrections. And in identifying problem areas on scans, the minute detail AI analysis provides can produce more information than a physician needs. Worries about privacy and security are also an issue. MarinHealth reports that it takes a rigorous and principled approach to evaluating the security, effectiveness, ethics and potential outcomes of any new AI adoption and development. To do so, it has gathered a cross-functional team of experts to ensure that any initiative is safe and feasible within its technology framework and that the expected workflow will benefit clinicians in helping them make better decisions in caring for their patients. Oversight The FDA is responsible for the oversight of software in health care and has approved many of the AI products currently in use, although not all. The 21st Century Cares Act, which Congress enacted in 2016 to provide substantial funding for research to the NIH, exempts many AI tools from FDA regulation if health care providers don’t rely on them to make diagnoses or decisions on treatment. In 2022, however, the FDA announced
that it would categorize some types of tools—such as smartwatch software that uses data from electrocardiograms to detect arrhythmias—as medical devices, so greater scrutiny is likely as the use of AI grows. In October 2023, the FDA announced that it had reviewed and approved 171 AI and ML-enabled medical devices, including the irregular rhythm notification feature on Apple’s watch. The FDA released the list as a service to the public and reports that its review focused on the devices’ overall safety and effectiveness. “Digital health technologies are playing an increasingly significant role in many facets of our health and daily lives, and AI/ML is powering important advancements in this field. Ensuring that these innovative devices are safe and effective and that they can reach their full potential to help people is central to the FDA’s public health mission,” the announcement says. Despite the growing pains, AI has the potential to provide groundbreaking innovations that do a great deal of good and ensure better outcomes—much as X-rays, mammograms and vaccines did when they were first introduced. It holds the promise of more to come, but AI is already making a difference, and as time goes on, functions that once seemed to be in the realm of science fiction could very well become reality. J
Please email comments to jwalsh@NorthBaybiz.com
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NorthBaybiz 25
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March Wine, Wine, Wine!
Insights into the latest developments in Wine Country—from industry innovations and consumer trends to the local vintners who pour their heart and soul into every bottle. Bonus Issue: NorthBay biz Top 500 A one-of-a-kind resource, featuring information on the top revenue- generating companies in the North Bay—a who’s-who of businesses that make the Sonoma, Marin and Napa economies tick. April Construction and Real Estate Development, the housing market and other property sales are hot-button issues in the North Bay—NBb casts a spotlight on the state of markets, projects and other local industry trends.
26 NorthBaybiz
February 2024
Tech Talk
As I like to say, I’m not overweight, I’m undertall.
Better Living Through Chemistry: How pharmaceuticals are changing the game for weight loss
By Michael E. Duffy
L ike many Americans each January, my spouse and I decided to lose some excess pounds this year. As everyone knows, we (as a country) are not in great shape. According to the National Institutes of Health, “nearly 1 in 3 adults are overweight. More than 1 in 3 men and more than 1 in 4 women are overweight. More than 2 in 5 adults have obesity (including severe obesity). About 1 in 11 adults (9.2%) have severe obesity.” That’s based on measures of the Body Mass Index (BMI), defined as one’s weight in kilograms, divided by one’s height in meters squared. For me, that works out to a number above 30, which labels me as obese (a normal BMI is below 25, overweight from 25 to 30, and severely obese above 40). As I like to say, I’m not overweight, I’m undertall. The BMI is somewhat controversial because, for dertall. e, for
from Novo Nordisk) and tirzepatide (Mounjaro, from Eli Lilly) are now approved for weight loss, as Victoza and Zepbound, respectively. All these “weight-loss versions” of diabetic drugs are alike in that they provide a higher dose of their respective ingredient than the version for diabetics. And they all share the same downside: You have to keep taking them to keep weight off. Which is good news for the drug companies, and bad news for people wanting to lose weight. But who picks these brand names? Wegovy? Ugh. Victoza? Really? Zepbound is the only one that sounds remotely cool. (As it turns out, there are rules: tinyurl.com/mkyk5s2v ) Which is most effective as a weight-loss drug? Tirzepatide appears to be the most effective. Liraglutide, approved for weight loss since 2014 and never caused much
appears to be for weigh of a s we e
one thing, it doesn’t directly assess body fat (even though BMI and accurate measures of
of a stir, has shown the lowest impact on weight loss. All three drugs produce side effects, the most common being nausea, vomiting and constipation. Some, like thyroid tumors and bowel obstructions, are life-threatening. Although the incidence of the worst effects is low, broader use leads directly to more actual events. There’s also the cost of these brand-name drugs. A package of four weekly doses of Wegovy b ev Th
body fat are highly correlated). And the historical population statistics used to assess that correlation are based largely on white men—so for women and people of color, it’s probably less accurate. Its big advantage is that it’s cheap and easy to measure—all you need is your height and weight. Google “BMI calculator” if you want to check your own, just be aware that it’s just one way of assessing a healthy weight. Enter Ozempic. In 2011, I spoke to a computer science class o e way l
drugs. A costs $1,350. Th
costs $1,350. That’s $337.50 a pen, or $17,550 a year. Zepbound, at $1,060 for four pens, is less expensive (as Lilly Z b d $ f
at Sonoma State and predicted that the next Bill Gates would be the person who solved the obesity problem. It appears, however, that it won’t be a single person, but pharmaceutical companies. Ozempic, a medicine developed by Novo Nordisk used to treat diabetes and approved for use by the FDA in 2018, was discovered to also cause significant weight loss. Some doctors began prescribing the drug “off-label” (i.e. not for its intended use) to their patients, and it snowballed from there, aided by rumors that many celebrities were using it. Jimmy Kimmel opened the 2023 Academy Awards last March with: “When I look around at this room I can’t help but wonder, ‘Is Ozempic right for me?’” Ozempic’s real name is semaglutide. Novo Nordisk won FDA-approval for the use of semaglutide for weight loss in June of 2021 (eliminating the need for off-label prescriptions), under the brand name Wegovy. Both drugs are typically given as a once-a-week injection. Semaglutide is what is called a “glucogen-like- peptide agonist” (GLP agonist), because it mimics glucogen, which stimulates insulin production and lowers blood sugar. Lower blood sugar levels are clearly good for diabetics (who have high levels). But lowering blood sugar also appears to increase feeling “satisfied” and reduce craving, leading to weight loss. Diabetic drugs which are similar to semaglutide, liraglutide (Saxenda, also
Michael E. Duffy is a senior software engineer for Atlanta-based mobile gaming company Global Worldwide ( globalworldwide.com ), who lives in Sonoma County. He has been writing about technology and business for NorthBay biz since 2001. In the long term, these drugs will improve and become generic, hopefully solving our national problem with obesity. But for now, my spouse and I are counting our calories with myFitnessPal, logging our weight on our Withings internet-connected scale, and trying to be more active. tries to break into the market dominated by Novo), but still $13,780 on an annual basis. And these drugs won’t likely be available as generics for 20 years. Whether health plans will cover the cost of these drugs, and on what basis, remains to be seen. But there are probably plenty of people who are overweight, have money to spend, and are willing to risk the side effects. Elon Musk, Chelsea Handler and Oprah Winfrey have all gone on the record as Ozempic users (google “what celebrities have used ozempic” for a longer list). And that encourages others to do the same.
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