Paging Dr. Gemini, Paging Dr. Gemini

I recently sustained a knee injury doing something I stupidly should not have been attempting. But I was introduced to Dr. Gemini who took excellent care of me. She was able to see me immediately without a wait. She spent as long as I wanted with her, answering any questions I had and even suggested some questions I should ask. She answered all the questions as if she had the knowledge of every textbook and article ever written on the subject. She was compassionate and understanding and I was able to contact her any day and at any hour with immediate responses. I was able to follow up with her on a daily basis, updating my symptoms and discussing my response to her suggested treatment. Best of all, she is free. No need for insurance, copays or referrals. 

My experience using AI to help me with my injury was shockingly revealing. I am not sure that being a doctor myself was specifically helpful to me in using AI but it is clear to me that it will play a major role in the future of health care delivery. It made me think of all the patients I had seen during my career that could have been diagnosed or at least screened by AI. The advantage of AI is its vast knowledge, superior to what any human can store. The disadvantage is the lack of the physical examination which although a dying art is still critically important for diagnostic purposes. Yet in fairness, telemedicine also lacks the advantage of a physical diagnosis.

As an ENT specialist, I was pondering the percentage of patients that could have been effectively screened and potentially treated by AI and which chief complaints could be adequately addressed by AI and potentially replace an office visit. Certainly, someone with ear pain likely needs to be seen as there is no substitute for looking at the ear with an otoscope. Although, at least half of patients who presented with a chief complaint of ear pain had nothing wrong with their ear as it was referred pain from another sourced usually the teeth or jaw. AI may be able to screen this patient so he/she goes to the correct provider.

Take for example the chief complaints of tinnitus, dizziness/vertigo, hearing loss, postnasal drip, nasal congestion/allergies, and globus sensation (look it up, you would be surprised the number of patients presenting with this chief complaint) to name a few. All these chief complaints necessitate a complete history and review of symptoms and the diagnosis and treatment can often be dictated by AI. At least, the patients symptoms can be screened by AI to narrow the possibilities with suggested initial interventions. In any case, I believe, a conservative estimate is that 25% of the patients could be initially treated by AI and not require a doctors visit. Of course, persistent symptoms despite AI need a Dr's visit.

I am having a great experience with Gemini as my "doctor" and I am getting better. It could be that my injury is just taking time to heal and she is just reassuring me which alleviates any anxiety leading to the need to see a health care provider. But even that is valuable as the reassurance to patients allow them to wait for the body to recover, which it often will. AI will get better with time and AI specifically designed for narrower fields such as an ENT specific AI will, no doubt, be developed. 

As in many other fields, the combination of a human with AI will dramatically improve productivity and is here to stay. The quality of the product whether in medicine or in any other field is the question that will be answered over the next several years. But, there is no doubt in my mind that the use of AI in medicine will greatly improve the delivery and financing of healthcare. Most importantly, medical outcomes will benefit as well. 

United States Military Base in Southern Lebanon, a Win Win Situation

The demographic and political makeup of Europe and Asia has changed dramatically in the past decade and the US needs to restructure its commitments based on these changes.  NATO was created in order to defend the West against Russia but it seems that the West's primary threat is from political Islamism. The United States needs to change course with regards to who and where it defends in light of these changes. 

Radical Islamism has also seen a geographic transformation as it is now primarily centralized in Western Europe and not the Middle East. While many Middle Eastern countries have gradually moderated such as Saudi Arabia and the UAE, Iran and Turkey pose major threats as they are both led by radical Islamists with imperialistic motivations yearning to recreate the days of the Persian and Ottoman empires.

In light of these shifts the United States needs to reconsider its commitment to NATO. Western Europe has decisively shown itself to be unwilling to address the threat of radical Islamism either from abroad or from within its own borders. The immigration of Muslims into Western Europe and their resulting political influence has pushed Western European countries beyond the tipping point and the US needs to distance itself from them based on this new reality. The US needs to also prevent the same political shift to occur in its own country. 

The US and Europe have drifted far apart demographically, politically and ideologically and Europe has shown itself many times over to not be willing to engage militarily. The defensive pact is completely lopsided as the US is committed to be the  enforcers while the Europeans sit back and judge. Time to ditch Western Europe.

Similarly, Turkey is part of NATO and it is inconceivable that the US and Turkey belong to the same defensive organization. The two countries are incompatibly connected and either Turkey should be kicked out of NATO or the the US should leave. Turkey is an autocratic regime which is not compatible with NATO. It is a major supporter of the Muslim Brotherhood which is a radical Islamist organization. It has imperialistic desires and it has major ties with Russia, the actual reason NATO was created in the first place. 

The United States needs to restructure its post WWII defensive strategy. It needs to radically change its NATO commitments or just leave the NATO alliance. US bases in Western Europe need to be vacated and and relocated. There is a perfect opportunity now for the US to establish a base in Southern Lebanon. Lebanon is infiltrated with Iranian backed anti-zionists that cannot be allowed to share a border with Israel and a buffer zone is required. Similar to Iran, the majority populations do not want the Islamists to control their lives but they have no way of changing their situations. A US base will help the Lebanese take back control of their country. The presence of a US base, separating Israel from Lebanon helps Israel, Lebanon and keeps the pressure on Iran.

Israel has been shown to be the ally with which the United States should try to strengthen its ties, much to the unhappiness of the antisemites throughout the world. A US base in Southern Lebanon would allow for this deeper alliance and is much more relevant than a base in Germany. Israel is currently depopulating Southern Lebanon setting the stage for a buffer zone between Israel and Hezbollah. The useless and ineffective UNIFIL forces are to be removed to be replaced by a Unites Staes military base. Lebanon should be happy with this arrangement as it can result in the gradual elimination of Hezbollah backed forces, returning Lebanon to its citizens. A US base in Southern Lebanon is also situated to place a major counterweight to Turkey's ambitions. 

The times have changed and the US needs to change its defensive and offensive commitments. Archaic treaties and coalitions need to be modernized and re-established based on the new realities on the ground.  Relocating the US military base from Germany to Southern Lebanon is one such idea which has the potential to expand the Abraham Accords and counter radical Islamism.

The Iranians' Hearts Continue to be Hardened

It is very difficult not to see the parallels between the actions of Pharaoh in the times of the ten plagues during the prelude to the Exodus with the actions of the leaders of Iran in their negotiations with the US. Why did it take ten plagues for Pharaoh to be convinced that he is totally overmatched in his fight against the Children of Israel. The scripture states that God hardened Pharaoh's heart and therefore lacked the free will to surrender. The reason this was done is arguable, but many suggest that it was done to stress God's providence, that it was all being performed under His control and not by his emissaries. 

Similarly, Iran has been completely overmatched yet they negotiate as if they are the ones in a position of strength. One could suggest that they actually see themselves as the victors and their control over the Strait of Hormuz puts them in a strong negotiating position. Alternatively, their hearts are being hardened as was Pharaoh's.

The Iranians believe that with this geographic choke point they can hold the world hostage. Pharoah probably felt that Egypt's geographic position next to an uninhabitable desert and bordered by an impassable body of water put him in a powerful negotiating position to keep the children of Israel as slaves. Both tyrants thinking their geographic position puts them in a strong bargaining position. 

Moses and Aaron tried to negotiate with Pharaoh to allow for better conditions for their people but Pharoah just made the conditions worse. Similarly, the US has tried to negotiate with Iran at each step yet they refuse to be flexible. Perhaps, their hearts are being hardened.

Ultimately, in a miraculous fashion, the Exodus culminated with the parting of the Red Sea allowing the children of Israel to escape the Egyptians. What miraculous events are occurring as we speak? Will the hearts of the Iranians be continued to be hardened in order to demonstrate God's control over current events? Is there a culminating miracle to be performed at the Strait of Hormuz? Will there be overt miracles in our story? We are living in historic times and perhaps we have the playbook that we can refer to. The only thing we can conclude is that this ceasefire is not the end of the war by any means. Stay tuned.