The Dissection Room Justin Cottle

Why is the process of creating a new and highly beneficial pharmaceutical drug so difficult? What are the hurdles researchers face when trying to identify a new drug? Why are side effects so challenging to predict? Why are pharmaceutical drugs so expensive?
In today's episode, we dive deep into drug discovery, and see how AI is already changing the process from the ground up, leading to what can only be described as a revolutionary acceleration in pharmaceutical precision and personalization.
Timestamps
0:00 Intro
0:48 The Dream of Medicines
1:53 The Incredible Challenges of Finding New Medicines
8:36 Deepmind and AlphaFold2
14:33 How AI Is Impacting Drug Discovery
22:58 Outro


This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit justincottle.substack.com/subscribe

Something borderline magical happens around the age of 5 years old…
Squiggly black lines on a piece of paper or screen suddenly transform from being meaningless shapes into something incredibly powerful.
I’m experiencing the magic as a parent right now. My 5 year old’s learning to read, and it’s one of the most beautiful things I’ve ever seen in my life.
His mind is making connections he never knew possible, and the sense of empowerment that he feels is contagious, leaving me ready to jump for joy every time he reads something on his own.
Equally impressive is how quickly it’s all come together. In the span of just a few weeks, I’ve watched him occasionally recognize letters in his name, to reading full on sentences with confidence.
Here’s the thing — it really hasn’t been that quick. This is just the latest stage in a process that’s been happening deep inside his head since 6 months of age.
I want you to picture a 6 month old baby, blowing raspberries, babbling, and experimenting with different sounds.
Besides being frustratingly cute, these simple actions are laying the foundation for what’s to come - learning to read.
You see, the brain is undergoing a rapid transformation. Neurons are firing and connecting at a blistering pace, forming pathways that will one day allow the child to make sense of the squiggles and lines we call letters.
But it’s not just neuronal connections being made — the orofacial muscles are getting stronger, and the facial skeleton itself is making adjustments as teeth begin to come in, allowing for more sophisticated babbling. The child isn’t just making sounds anymore — they’re beginning to understand that these sounds have some meaning.
They’re entering the world of the alphabetic principle.
At its core, the alphabetic principle is the understanding that letters of the alphabet represent specific sounds in spoken language (unless the language is Chinese or Japanese, which use different but equally fascinating systems). It's the realization that these sounds, or phonemes, can be blended together to form words.
A “phoneme” is a sound, or a group of different sounds.
For example, the letter "B" makes the "buh" sound, while the letter "A" can make the "ah" sound. By saying “buh”, “ah”, “t”… you’re pronouncing the phonemes of the word “bat”.
When you hear a child saying “mama”, “dada”, “bruhbruh”, you’re hearing them associate phonemes with meaning, specifically their parents and siblings, and other familiar people and things around them.
But this is just the beginning of the alphabetic principle, and it only gets cooler from here.
The Pre-alphabetic Stage
The pre-alphabetic stage runs from birth to about 3 years old, although children are all different and there is some wiggle room in these age ranges.
I want you to picture a toddler, around 3 years old, flipping through the pages of a colorful book. At this pre-alphabetic stage, they’re not making the connection between letters and sounds. Instead, they’re developing what’s known as phonological awareness - the ability to recognize and manipulate the sounds in spoken language.
Specifically, they’re learning to identify syllables, clusters of syllables, and phonemes.
One of the funnest methods to help a child identify syllables is to have them place their hand under their chin, and then say a word. Every time the mandible drops, that’s a syllable.
Go ahead and do it yourself right now. It really is kind of fun.
“Mama” has to two syllables, “papa” has two syllables, but “mom” and “dad” only have one syllable.
As this is happening, the auditory cortex is processing the sounds the child hears from both their own mouths and the parent or teacher with them. This is crucial for distinguishing between different phonemes, and helps create powerful connections throughout the brain.
At the same time, Broca's area in the frontal cortex is developing, which will

I want you to imagine that the year is 2030, and you are a nurse entering a patients room that’s recovering from abdominal surgery…
As you step through the door, the lighting is soft and adjustable, automatically adapting to the time of day and the patient's sleep cycle.
You approach the bedside and glance at the large, wall-mounted display. The intelligent monitoring system greets you with a summary of the patient's condition. It highlights that the patient's vital signs have been stable throughout the night, with no significant abnormalities detected.
The AI-powered system has been continuously analyzing the patient's heart rhythm, respiration, blood pressure, and oxygen saturation, providing real-time insights and alerts if any concerning patterns emerge.
You remember when you had to manually check and record each vital sign, every few hours. Now, the intelligent monitoring system does this seamlessly, allowing you to focus more on patient care and less on documentation.
Next to the bed, you spot the patient's IV line, connected to an advanced infusion pump. The pump is controlled by an intelligent agent that precisely regulates the flow rate and dosage of medications, ensuring optimal pain management and preventing any potential medication errors. In the past, you had to double-check each medication and rate, but now you can trust the system to administer the correct dosage at the right time.
As you check the patient's surgical incision, you notice a small, non-invasive device attached to the skin nearby. The device uses advanced sensors to detect any signs of infection, such as changes in temperature or skin color, and alerts the medical team if there's a potential complication. This early warning system has dramatically reduced the incidence of post-operative infections in your hospital.
You gently reposition the patient to prevent pressure ulcers, and as you do so, the smart bed automatically adjusts to distribute the pressure evenly. The bed also monitors the patient's movement and can alert you if the patient is at risk of falling.
Before leaving the room, you take a moment to review the patient's electronic health record on the bedside tablet. The intelligent system has already updated the record with the latest vital signs, medications administered, and your observations. It also suggests potential interventions based on the patient's condition and evidence-based guidelines.
With a satisfied smile, you quietly exit the room, knowing that your patient is in good hands, monitored and cared for by a seamless collaboration of human expertise and artificial intelligence.
Healthcare, along with society at large, is changing. At the center of this change are advancements being made in artificial intelligence and specific applications of AI known as intelligent agents.
These days we’re all familiar with artificial intelligence, but few seem to properly understand the potential that comes with its advancement. Even if research were to stop today, the progress that’s already been made is enough to revolutionize everything around you, and that includes everything inside of healthcare.
Our goal today is to understand what an intelligent agent is, the different types of intelligent agents, the varying degrees of autonomy, and the incredible potential they have to reshape healthcare from the ground up.
If you stick with me until the end, we’ll do some responsible speculation as I like to call it , and discuss what I personally believe to be the inevitable outcome of intelligent agent development — hive intelligence. We’ll view it from the lens of healthcare, but the implications of its existence will reach far beyond the realm of medicine.
With that said, let’s start by asking ourselves a simple question: what is an intelligent agent?
What Is Agency?
Agency refers to the capacity of an entity to act in the world.
It’s the ability to make choices, take actions, and shape one's own life and environment.
An a

It’s different this time, it really is.
Most healthcare workers are either too busy to pay attention to what’s happening in AI today, or are stuck in the past and have only experienced low quality AI.
In today’s episode, we’re going to discuss why this is a mistake.
Healthcare workers aren’t immune to the impact of AI, and they need to start preparing for significant changes to their job description in the next 5 years.
____
Timestamps
0:00 Why You Should Care
8:17 FDA Hurdles
9:39 History of Neural Networks: 1940’s - Present
19:12 AI & Medicine: 1940’s - Present
28:32 How LLM’s Can Impact Frontline Medical Works
35:42 The Incredible Potential of Autonomous AI Agents In Medicine
____
References

Dermatology
https://www.nature.com/articles/s41598-021-96707-8
https://news.mit.edu/2021/artificial-intelligence-tool-can-help-detect-melanoma-0402
https://www.jidonline.org/article/S0022-202X(20)31201-X/fulltext
https://www.frontiersin.org/articles/10.3389/fmed.2020.00100/full
https://www.mdpi.com/1660-4601/18/24/13409
https://journals.lww.com/idoj/fulltext/2023/14060/artificial_intelligence_in_diagnostic_dermatology_.4.aspx
https://arxiv.org/abs/2311.01009
https://www.mdpi.com/2079-9292/12/6/1342

Ophthalmology
https://onlinelibrary.wiley.com/doi/10.1111/ceo.13381
https://journals.lww.com/ijo/Fulltext/2020/68070/Insights_into_the_growing_popularity_of_artificial.22.aspx
https://bjo.bmj.com/content/105/2/158
https://www.dovepress.com/artificial-intelligence-in-ophthalmic-surgery-current-applications-and-peer-reviewed-fulltext-article-OPTH
https://www.frontiersin.org/journals/digital-health/articles/10.3389/fdgth.2022.889445/full
https://ieeexplore.ieee.org/document/9716741
https://ieeexplore.ieee.org/document/10340746
https://www.cureus.com/articles/164004-artificial-intelligence-in-ophthalmology-a-comparative-analysis-of-gpt-35-gpt-4-and-human-expertise-in-answering-statpearls-questions#!/
https://ieeexplore.ieee.org/document/9674065

Pathology
https://www.frontiersin.org/articles/10.3389/fmed.2019.00185/full
https://gut.bmj.com/content/70/6/1183
https://www.mdpi.com/2075-4418/13/19/3115
https://www.mdpi.com/2072-6694/11/11/1673
https://www.nature.com/articles/s41571-019-0252-y
https://www.frontiersin.org/articles/10.3389/fmed.2019.00185/full
https://pathsocjournals.onlinelibrary.wiley.com/doi/10.1002/path.6168
https://jcp.bmj.com/content/74/2/73
https://ieeexplore.ieee.org/document/9745795

Cardiology
https://www.sciencedirect.com/science/article/pii/S0735109719302360?via%3Dihub
https://www.ahajournals.org/doi/10.1161/JAHA.119.012788
https://www.emjreviews.com/interventional-cardiology/congress-review/26886-2-j090122/
https://pubs.rsna.org/doi/10.1148/ryct.2021200512
https://www.nature.com/articles/s41569-018-0104-y
https://www.sciencedirect.com/science/article/pii/S0735109719302360?via%3Dihub
https://arxiv.org/abs/2310.12630

Neurology
https://link.springer.com/article/10.1007/s00415-019-09518-3
https://linkinghub.elsevier.com/retrieve/pii/S0377123721001490
https://www.degruyter.com/document/doi/10.1515/revneuro-2021-0101/html
https://pubs.rsna.org/doi/10.1148/radiol.2018181928
https://jkns.or.kr/journal/view.php?doi=10.3340/jkns.2022.0130
https://journals.salviapub.com/index.php/gmj/article/view/3158
https://www.eurekaselect.com/article/136533


This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit justincottle.substack.com/subscribe

Radiologists are in short supply. Backlogs are only continuing to build. With an aging population and burnout from COVID only making things worse, something needs to change or outcomes for patients will only get worse.
In today’s episode, we discuss how Artificial Intelligence is assisting Radiologists and their midlevels in workflow, and soon with diagnostics as well.
With hundreds of startups around the world using synthetic data generation to train AI models with a level of precision never before seen, the natural question to ask is, how will this impact radiologists within the next decade?
____
Timestamps
0:00 Intro
1:30 The Problems Facing Radiologists
14:37 The Hurdle of the FDA
18:05 Improving Radiology Workflow
21:15 The Data Availability Struggle
22:44 De-identifying Data
23:26 Synthetic Data
29:48 MONAI
30:37 The Beginning of the Future
38:24 Opthamology, Cardiology, Neurology
41:45 Last Thoughts
____
References
World Population
* https://www.worldometers.info/world-population/us-population/
Healthcare Provider Statistics
* https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage
* https://www.statista.com/statistics/186269/total-active-physicians-in-the-us/
* https://www.bls.gov/oes/current/oes291071.htm
* https://www.aanp.org/about/all-about-nps/np-fact-sheet#:~:text=There%20are%20more%20than%20385%2C000,NPs)%20licensed%20in%20the%20U.S.&text=More%20than%2039%2C000%20new%20NPs,academic%20programs%20in%202021%2D2022.
* https://www.bls.gov/oes/current/oes291229.htm
* https://www.statista.com/statistics/209424/us-number-of-active-physicians-by-specialty-area/
* https://www.zippia.com/radiology-assistant-jobs/demographics/
* https://www.google.com/search?q=can+an+rpa+interpret+radiology+exams&oq=can+an+rpa+interpret+radiology+exams&gs_lcrp=EgZjaHJvbWUyBggAEEUYOTIHCAEQIRigATIHCAIQIRigAdIBCDk0NzVqMGo0qAIAsAIA&sourceid=chrome&ie=UTF-8
* https://radiologybusiness.com/sponsored/1073/mmp/topics/healthcare-management/business-intelligence/radiology-assistants-users
Radiology Backlog
* https://radiologybusiness.com/topics/healthcare-management/healthcare-economics/large-volume-radiologist-reporting-backlogs-urgent-global-issue#:~:text=The%20problem%20persisted%20at%20the,99%25)%20for%20chest%20radiographs.
* https://www.rsna.org/news/2022/may/global-radiologist-shortage
* https://www.aidence.com/articles/workload-in-radiology/


This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit justincottle.substack.com/subscribe

The next 5 years are going to be incredible. Still, it’s important to stay grounded and not feed into the hype.
Chances are good that you’ve heard people question whether or not ChatGPT will replace doctors. The easy answer here is — no.
But other models from Google can and will.
In this episode, Justin discusses:
* The shortage of Health Care Providers in the United States
* Health Care Provider dependency on the medical version of Wikipedia — Up to Date
* Google’s AI models: MedPaLM2, MedLM, and AMIE
* The use of of AI as a collaborator
* The most likely jobs within healthcare to be impacted negatively in the next 5 years
* How patients will interact with AI models, leading to better healthcare outcomes
____
Episode Timeline
0:00 Intro
1:14 The Topics Discussed Today
4:15 Use This Episode Timeline to Scan Ahead to What Applies to You
4:42 The Shortage of Doctors In the US
8:22 The Purpose of Physician Associates and Nurse Practitioners
12:39 The Stresses of Being a Healthcare Provider
14:04 Wikipedia for Doctors
18:17 Brief Intro to LLM's
22:29 Meet the Mind Blowing MedPaLM2
27:46 Meet the New UptoDate — MedLM
30:17 Meet Your New Doctor — AMIE
33:39 The Problem for PA's and NP's
39:47 The Future of Medicine In Your Pocket
____
References
Provider Statistics
* https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage
* https://www.statista.com/statistics/186269/total-active-physicians-in-the-us/
* https://www.bls.gov/oes/current/oes291071.htm
* https://www.aanp.org/about/all-about-nps/np-fact-sheet#:~:text=There%20are%20more%20than%20385%2C000,NPs)%20licensed%20in%20the%20U.S.&text=More%20than%2039%2C000%20new%20NPs,academic%20programs%20in%202021%2D2022.
* https://www.bls.gov/oes/current/oes291229.htm
World Population
* https://www.worldometers.info/world-population/us-population/
Schooling References
* https://extension.harvard.edu/blog/how-to-become-a-physician-assistant/#:~:text=To%20become%20a%20PA%2C%20you,for%20two%20to%20three%20years.
* https://uthscsa.edu/medicine/education/ume/outreach/become-doctor
* https://www.usmle.org/
* https://en.wikipedia.org/wiki/Physician_assistant
* https://en.wikipedia.org/wiki/Nurse_practitioner
* https://www.aanp.org/news-feed/explore-the-variety-of-career-paths-for-nurse-practitioners
* https://www.usmle.org/scores-transcripts/examination-results-and-scoring#:~:text=*%20USMLE%20Step%201%20score%20reporting,of%20a%20three%2Ddigit%20score.
Artificial Intelligence Models
* https://sites.research.google/med-palm/
* https://blog.research.google/2024/01/amie-research-ai-system-for-diagnostic_12.html
* https://cloud.google.com/vertex-ai/generative-ai/docs/medlm/overview#medlm-versus-palm
* https://www.nature.com/articles/s41586-023-06291-2


This is a public episode. If you’d like to discuss this with other subscribers or get access to bonus episodes, visit justincottle.substack.com/subscribe