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MTS · 4 min · Nov 8, 2026

Clinical AI needs a deliberate choice about which errors matter

Angela McNeal · CEO, Thread AI

Angela McNeal uses clinical-trial eligibility to show that teams must choose which error matters more: admitting an unsuitable patient or excluding a suitable one.

In this episode

Full analysis
  1. 7:13Model routing depends on explicit business logic3 min
  2. 25:27AI workflows improve through iteration, not instant automation2 min
  3. 4:25Enterprise AI stacks can fail as providers and teams change3 min
  4. 13:22Clinical AI needs a deliberate choice about which errors matter4 min
  5. 10:13Thread's Army DevCom research targets manual deconfliction3 min
“you as a business person with the scientists have to decide what's more important”
Angela McNealat 15:13 · MTS
15:13

Takeaways

  1. Model metrics alone don't decide clinical-trial eligibility.
  2. Teams weigh harm from false inclusion against missed candidates.
  3. Those choices become encoded in the workflow.

About this segment

Angela McNeal uses clinical-trial eligibility to show that teams must choose which error matters more: admitting an unsuitable patient or excluding a suitable one. Those priorities become system logic, so automation requires business judgment.

Angela McNeal

Angela McNeal is CEO and cofounder of Thread AI.

Built Lemma, Thread AI’s orchestration platform for governed AI workflows and agents in mission-critical enterprise operations.

  • Theo Jaffee, Host · Co-founder & host, MTS

    One of the first members of a16z's new media team; earlier hosted the Emergent Ventures-backed Theo Jaffee Podcast.

  • Sophia Dew, Host · Host, MTS

From “Why Full AI Automation Fails in Production | Angela McNea”, Nov 8, 2026. Watch the full episode

Transcript

Transcribed by machine (Whisper) from the episode’s audio, so a word may be off here and there.

  1. 13:26

    So I'm curious, like, what, from, you know, looking at these companies, if you have any takes on sort of the ways that companies are just, like, structurally changing and maybe the role of, like, human agent interplay. Like, what, from your perspective, like, where are we going? Yeah, it's a good question because I couldn't say that there is one singular pattern. And we work across industries, so we work across financial services and manufacturing and hospitality, advertising.

  2. 13:58

    So there's an interesting blend where we're seeing the nature of the developer change. So at these large institutions where, you know, engineering is now moved towards more of a like, I'm managing and reviewing and designing as opposed to implementing. And we're seeing, I think, that kind of rough same pattern happen with like knowledge workers and sort of leaders and experts where the construction of the system, the construction of the process is often the intellectual work.

  3. 14:34

    So like we were talking about designing those gates, you as a business user have to define what is important. Is it, actually a good metaphor is something I used to tell my old team at Palantir. When you're thinking about evaluating a model, and let's say the model is like, hey, this is determining who can join this clinical trial. Okay. And when it's a classic sort of, it's a classification model, you're saying like cool like yes or no in each camp you can join this trial you can't join this trial when you're evaluating it um you have to think about the you are looking at metrics accuracy and precision and recall like you're saying hey like and then you as a business person with the scientists have to decide what's more important is it more important to bring some have the model be wrong and bring someone into this clinical trial and they get these drugs and they're not

  4. 15:31

    a good fit and it can damage their health or is it more important to you know not include someone miss out on someone and so then they you know get this thing and then sort of so like how we wait to those true deaths what's more important um that is often codified into the systems um so it's never like yes or no it's an investment someone makes in the logic as they're building these flows yeah um and so i think that's a sort of we're seeing more intentionality focus there of like what's important to us how do we want to spend our time and how we want our systems okay i see i see i i think that like my um my fear or like what would be an intuitive fear is maybe if you're at a corporation and you're um you know you have a lot of people who are now working on software yeah um and like and i guess that's like now become a flatter skill that

  5. 16:21

    everyone can you know partake in to some extent that there would be uh less intentionality behind And I guess it's different with industries that are very high stakes, but I'm curious, like, you're seeing that it's becoming more intentional with how people are designing sort of like the logic of things. On the, like, big picture process, I think as for an individual's knowledge work, I think that it's like we're still seeing, like, Wild West, right?

  6. 16:45

    Yeah, yeah, yeah. Like, the individual's productivity tools. But when you think of, like, okay, this is like an actual process, um often it's designed that way historically for a reason a combination of people legal regulatory like there are a lot of factors went into designing that thing from the beginning and so if you're looking to disrupt it and if you're looking to automate and inject ai at different components you still all of those factors don't go away you just now have to sort of rethink them in this like ai era so we're seeing again a lot of enterprises spend a good amount of their ip focused on that sort of redesign um which has been pretty cool to see yeah but i do think it is still again like wild west yeah we'll continue monitoring right after this message from our