# Should You Trust ChatGPT With Your Health? Markdown copy of https://realalpha.app/v/9n0MI4D7TCM/ on Real Alpha, the best minutes from long interviews with the people building AI. Cite and link the page, not this copy. Karan Singhal says AI should make health intelligence widely accessible and support patients and clinicians, not replace medical care. - Show: a16z Podcast - Hosts: Jay Rughani - Guest: [Karan Singhal](https://realalpha.app/builders/karan-singhal/) is a leads health AI research at OpenAI. - Published: Oct 20, 2026 - Length: 55 min ## The best minutes - [43:26](https://realalpha.app/v/9n0MI4D7TCM/?t=2606) [Cheaper medical AI needs workflow integration to cut costs](https://realalpha.app/s/cheaper-medical-ai-needs-workflow-integration-to-cut-costs/) (5 min) ## Also worth watching - [16:31](https://realalpha.app/v/9n0MI4D7TCM/?t=991) [OpenAI aggregates hundreds of physicians to handle disagreement](https://realalpha.app/s/openai-aggregates-hundreds-of-physicians-to-handle/) (3 min) - [11:47](https://realalpha.app/v/9n0MI4D7TCM/?t=707) [Legacy healthcare software is ripe for computer-use agents](https://realalpha.app/s/legacy-healthcare-software-is-ripe-for-computer-use-agents/) (3 min) Skip the opening mission and patient story, the 14-minute product and partnership tour, and the closing roadmap and sign-off. ## Summary Karan Singhal leads health AI research at OpenAI. He describes the company’s work training medical expertise into general-purpose models and evaluating them with physicians and other experts. Singhal says OpenAI aims to make reliable health intelligence widely available while using AI to support, not replace, clinicians. He argues that training healthcare expertise into general-purpose models lets them benefit from broader improvements in capability, and that expert evaluation should account for different users, medical disagreement and uncertainty. He sees AI helping patients navigate care and clinicians catch problems, while partners deliver medical care. Looking ahead, he expects falling intelligence costs, better use of health data and AI-assisted treatment discovery to expand access and improve care. ### Minute by minute - [14:07](https://realalpha.app/v/9n0MI4D7TCM/?t=847) **Trust depends on the user and the evidence.** Singhal says OpenAI evaluates and trains models with experts so answers can suit patients, experienced users and clinicians. He says the company works with hundreds of physicians across specialties, languages and countries because experts can disagree, and prioritizes safety when users seek reassurance that conflicts with medical advice. - [43:26](https://realalpha.app/v/9n0MI4D7TCM/?t=2606) **Cheaper intelligence is only a starting point.** Singhal says OpenAI expects the cost of health intelligence to fall, citing GPT-6 Luna performing better than GPT-5.6 Soul on HealthBenchProfessional while costing 34 times less. He cautions that cheaper intelligence alone will not reduce overall healthcare spending; savings depend on integrating models into useful workflows. He also describes provider-payer AI disputes as a possible short-term arms race that could be avoided through shared information and adjudication. - [48:39](https://realalpha.app/v/9n0MI4D7TCM/?t=2919) **Build for more capable models.** Singhal advises healthcare companies to build on capable models and expect them to improve, including through agents and computer use. He says AI could help target procedural care better and prevent some costly interventions through earlier action; he sees care robotics as a longer-term prospect. - [52:02](https://realalpha.app/v/9n0MI4D7TCM/?t=3122) **New treatments could be the larger prize.** Singhal says OpenAI is focused on making health intelligence accessible and on proactive tools that help people navigate care and act sooner. For the next five to 10 years, he expects AI-guided discovery of targets or molecules, and AI-assisted prioritization and validation of treatments and clinical trials, to contribute to improved and more personalized medicines. ## Transcript a16z Podcast, hosted by Jay Rughani, with Karan Singhal. Transcribed by machine (Whisper) from the episode’s audio, so a word may be off here and there. Where the podcast’s audio and the video part ways, some times are a minute or so off. [0:02](https://realalpha.app/v/9n0MI4D7TCM/?t=2) If it were its own country, it'd be the third largest GDP. And yet, we have a ton of scarcity. OpenAI's mission is to ensure AGI benefits all of humanity and give people access to trustworthy, abundant, reliable health intelligence. One of the stories that I was most touched by was the story of Nathan Labenz. He basically had this kind of long saga with his son, where at some point he was suffering a lot of fatigue and irritableness, and AI helped them navigate the process. And it turns out he was diagnosed with an aggressive form of leukemia. Some of the work that you've done around mental health, there's a lot of complexity. [0:30](https://realalpha.app/v/9n0MI4D7TCM/?t=30) How do you help guide a user on that, given that could mean so many things? We've just been working with a bunch of licensed mental health experts across the world to think about the right ways to define model behavior and a bunch of tricky scenarios and ensure that we can get to a level of consensus where we can actually measure performance. Let's talk about trust. A person can be speaking to an LLM really hoping to hear that everything is okay, but from a medical perspective, they need to hear perhaps something very different. How do you teach an AI to recognize the difference? OpenAI is training medical expertise into its general purpose models, rather than building a separate healthcare model, how it works with hundreds of physicians to evaluate those systems, and why the goal isn't to replace doctors. [1:34](https://realalpha.app/v/9n0MI4D7TCM/?t=94) Instead, he sees AI becoming a safety net and a quarterback, helping patients understand their health, helping clinicians catch things they might otherwise miss, and eventually navigating more of the fragmented work between visits. They also get into what happens as medical intelligence becomes dramatically cheaper, how AI could shorten the years it can take for new medical knowledge to reach clinical practice, and the possibility of a healthcare move 37, an insight that initially surprises human experts, but ultimately changes how we understand or treat disease. Hey, everyone. Welcome back to the podcast. [2:08](https://realalpha.app/v/9n0MI4D7TCM/?t=128) I'm Jay Rughani, a partner at a16z, leading investments in healthcare and biotechnology companies. I'm joined by Karan Singhal of OpenAI. He leads health AI research at OpenAI. And we've got a lot to talk about. Thanks for being here. Thanks for having me. I want to start with the big question. There was a report earlier this year. You all have talked about it publicly. Hundreds of millions of people each week use ChatGPT for health-related questions. What are they asking? What are the kinds of questions they're asking that they're not getting from our main healthcare system? Yeah, let me zoom out and talk a little bit about why we're investing in health in the first place. [2:42](https://realalpha.app/v/9n0MI4D7TCM/?t=162) So OpenAI's mission is to ensure AGI benefits all of humanity. And so we see that at a high level. happening in three ways. The first is building and deploying AGI. So building capable models, building products around them, deploying them, partnerships. The second is preventing downside, safety of various kinds. The third is making upside happen. And so we view health as a really, really concrete way to make upside happen and also work on some of the safety problems that come up in healthcare along the way. And so really, we're really invested in making sure, basically two things. One is that we can raise the floor of human health and give people access to trustworthy, abundant, reliable health intelligence for free or nearly free and really raise the ceiling as well and make things possible that weren't possible before. And so the best way to see the kind of raising the floor is really to think about how we've been working in the consumer space. And so as we reported, there's more than 300 million people weekly using Chai CPT for health and wellness types of questions. And we take that as an incredibly important responsibility to get that right. And that's been rapidly growing over time. I think one of the things that you see is [3:37](https://realalpha.app/v/9n0MI4D7TCM/?t=217) If you think about the experience of getting healthcare, even in the U.S., even in the Bay Area, if you're looking to get a specialist appointment, even here in the Bay Area, sometimes it can take weeks or months. you might spend a lot of time figuring out how to get an appointment and scheduling and all these kinds of things. And after all that time, maybe get 15 minutes with the doctor where you don't feel adequately prepared and you maybe walk out of it thinking, oh, I had six more questions that I wanted to ask. And our hope is that AI can be part of this care journey with you. And health is not something that is just kind of restricted to these kind of 15 minute intervals. And AI can actually help you navigate your care journey. And so that actually reflects how people are using AI on the consumer side today. [4:13](https://realalpha.app/v/9n0MI4D7TCM/?t=253) Like people are coming in with questions and concerns, information that they'd like to have. They want to figure out how to kind of navigate their care visits or ask questions or figure out how to follow up things that the doctor told them or things like this. And we're finding that in between these visits is when AI can help people most on the consumer side. And we're making similar investments on the clinician side and on the enterprise side as well. Yeah, it's amazing. We have an extraordinary healthcare system. If I got really sick, there's no country I'd rather be in than the US. And yet we have a ton of scarcity. You've seen some of these statistics. Over 100 million people don't have access to a regular primary care doc. Even the ones who do often have to wait 40 plus days to see that doctor. Sometimes you meet the doctor exactly as you said, and it's a quick 15 minute visit and you have more questions. I saw a dermatologist last week about something. I wrote down all my questions beforehand in an Apple notes and I still forgot to ask something. And now I'm scheduling a follow up and it's another four months out. It happens to all of us we've all felt that is there a specific patient story or recent case that you all have [5:13](https://realalpha.app/v/9n0MI4D7TCM/?t=313) seen that kind of help us imagine where the world is going and where your work is taking us one way in which the work of our team is gratifying is just seeing the numbers and seeing how many people are using the tech and how useful it seems to be for them one other way is just hearing from people right so we get people coming in sending us emails or whatever it is reaching out in various ways multiple times a week saying here's how this has helped me i think one of the stories that i was most touched by was the story of nathan lebens and his son so he hosts the cognitive revolution podcast and kind of told his story in that podcast but he basically had this kind of long saga with his son where at some point he was kind of suffering a lot of fatigue and irritableness and things like this his very young son and ai helped them kind of navigate the process of realizing that this was like a pretty serious thing while they were on vacation and deciding to take them for testing and repeatedly telling them like, hey, take this seriously. And it turns out he was diagnosed with an aggressive form of leukemia. And throughout his care journey, I mean, Nathan reports kind of using GBD5 Pro at that time quite a bit for helping navigate the process, [6:13](https://realalpha.app/v/9n0MI4D7TCM/?t=373) helping understand lab reports and things like this, even before a specialist had time to kind of help interpret. And I think it brought them a lot of peace of mind. So OpenAI is building health intelligence and health intelligence into your model at every step. But it's the same model that folks use to write code or plan a vacation. Can you help folks understand why you're building it that way from an architectural standpoint? Why is a general purpose AI the right foundation for something as complicated as medicine? Yeah, I mean, people often ask us like this kind of general versus specialized model debate. [6:43](https://realalpha.app/v/9n0MI4D7TCM/?t=403) And I used to work on specialized models and actually in a previous role. And so I definitely have kind of experience on kind of both sides of this question. I think the kind of most important thing here is like what we're talking about here is actually specialized training in a general model, which is, I think, actually the best of both worlds. So what we do for Chash GPT and all the models that we ship in Chash GPT, across every stage of model training for Chash GPT, we actually have specialized healthcare data added to each phase of training since all of our models in the last year. As a result is now you have a model that benefits from all the scale and general improvements in intelligence and reasoning of the big frontier models and also the benefits from the specialized training that we get from, for example, integrating data that we get from working with a bunch of physicians across the globe. [7:23](https://realalpha.app/v/9n0MI4D7TCM/?t=443) And so I think you get the best of both worlds with this approach. If you kind of forked and said, hey, we're going to train a kind of smaller, specialized model that is just for healthcare, like I used to and like many people have. what you'd find is that model would just kind of fall behind the frontier relatively quickly because the pace of the frontier and the general model improvements is so fast. And if you bet on scale, what we found as OpenAI, as an industry, is that things will get better. And so what we're doing is kind of hitching a ride on that kind of scale frontier and leveraging the fact that we have the ability to kind of integrate evals and training data into the models to make the models both specialize and also benefit from that general capability. [7:57](https://realalpha.app/v/9n0MI4D7TCM/?t=477) I want to almost start imagining what's possible with the technology that you're building. obviously where it is today is amazing, but you're not stopping and there's a lot of work to go. I think many people are allured by the idea of a personal doctor in your pocket, something that is perfectly knowledgeable, has knowledge across all medical specialties, so you don't necessarily need to go see a cardiologist and a dermatologist for different questions. Something that is perfectly personalized to you, has all your medical history and context, remembers everything that you've said, remembers your medical history, but also your preferences and is also able to motivate you and nudge you so that the information that it gives you is given to you at the right time in a way that can nudge you towards better health behaviors or adhering to the protocol that your doctor gave you. Is that sort of the experience you're building at OpenAI in the fullness of time and how close are we to that? Yeah, that's something that we're really excited about. [8:52](https://realalpha.app/v/9n0MI4D7TCM/?t=532) We are very excited about this vision of kind of a proactive personal health assistant. I don't think that's any kind of replacement for actually having a doctor having access to a doctor but really thinking about the ways in which we can take that experience of getting health information and making it more personal to kind of your context is a really important part of kind of investment in health and chat gbt which is kind of consumer offering that we have that enables users to connect their health information for that information to be used kind of securely not to be used for training data or for targeting ads or anything like this and that's a big part of how we think about how we're going to move towards this world of really like increasingly personal access and proactive access it's also been how we've been thinking about deployment so we've actually from the beginning been deploying this as widely as possible to our free users as well as our pro users and so we have been of the kind of 300 million weekly active health users the vast majority of them are free users and we take that and most of them are outside the u.s as well and so we take that kind of question of distribution here really really centrally and so as we're [9:51](https://realalpha.app/v/9n0MI4D7TCM/?t=591) thinking about this kind of next frontier of proactive personal health assistant we're going of bring that to bear as well. I think use cases help us imagine, help people imagine what's actually possible, what all this work is contributing to. The idea of a personal doctor in your pocket, I think is exciting. When Greg Brockman came on the podcast, he spoke a little bit about this situation he had with a friend of her, friend of his was in the hospital and her physician was about to administer a certain medication. She double checked that medication in ChatGPT, realized based on her medical history that she would have some drug interaction or some adverse event that may come from that. [10:31](https://realalpha.app/v/9n0MI4D7TCM/?t=631) She showed that to her doctor. Her doctor agreed and said, I didn't have enough time to look through your medical history to notice that. So thank you so much for raising that. Shouldn't we do that for everyone all the time? If it's cheap enough and convenient enough, can't we do a second, third, fourth opinion for every clinical scenario? Is that where we're going? Yeah, I love this idea of a kind of safety net for both patients and clinicians that is just kind of there in the care journey and, you know, not always interfering or being the middleman, but like really thinking about the ways in which you can augment the existing experience and build on it. [11:04](https://realalpha.app/v/9n0MI4D7TCM/?t=664) But, you know, we did this work actually kind of more directly studying this on the clinician side in a kind of a series of experiments that we ran with Panda Health, where we studied this idea of like a clinician co-pilot that was deployed and was exactly deployed in this way where, you know, it was a safety net for the clinician as they were doing their work. It kind of came in and proactively suggested like, hey, this might be off, like, you know, there might be this medication interaction that you might not be tracking. Can we, you know. potentially adjust that and things like this. I think we're going to see the same thing happen on the patient side. And I'm very, very excited about this idea of like kind of like a proactive person, proactive agent in your care journey, really helping you and making sure that like, you know, if your A1C rises and you're diabetic, like that you get like a review of your medications by your doctor and things like this and making sure that that's kind of flagged for kind of appropriate review. You mentioned sort of personalized proactive agents, personal agents in general have kind of emerged on the scene and from a popularity perspective over the last few months, [12:03](https://realalpha.app/v/9n0MI4D7TCM/?t=723) Instinct, Muse, GrokBot, OpenAI's Dots, you can give these AI apps an objective for folks who are not familiar and it can execute a series of tasks. So it's not just, hey, do this task and then it executes the task with a single loop. It can use your preferences. It can access all of your applications that you give it permission to. It can access your credit card information if you give that to them, and it can execute an objective on your behalf. One can't help but imagine the possibilities there in navigating our wonderful but often disjointed healthcare system, scheduling a appointment and making sure your insurance is covered for that appointment, covering that appointment, you know, helping you and guiding you to follow a care protocol that your doctor gave you post-discharge, even negotiating with your insurance company on a medical billing error, all kinds of tasks that just create friction in our healthcare system. [13:02](https://realalpha.app/v/9n0MI4D7TCM/?t=782) Is that where you're kind of going with your work? Should we look forward to that from OpenAI? I'm very excited about that vision. I think if you look at from both the patient and clinician perspective, one of the most difficult things about the healthcare system and how it serves people is this kind of question of like fragmentation and kind of lack of connection of the ecosystem and healthcare is also one of those industries where you shouldn't expect everything to have an mcp connector tomorrow right it is a it is a place where there's legacy software there's not like necessarily the best connectivity with ai or software in the first place and many people are you know running their primaries ehr software in the healthcare ecosystem on like a vm for example so like virtual machine that they're running in the cloud yeah exactly [13:44](https://realalpha.app/v/9n0MI4D7TCM/?t=824) **Karan Singhal:** and so there's actually like an interesting component where like a virtual machine actually makes things easier in some ways for AI agents, but this is absolutely ripe for agents and computer [13:53](https://realalpha.app/v/9n0MI4D7TCM/?t=833) use. So I definitely think that this is like a place where a lot of the barriers that have traditionally existed between patients and getting the care they need and clinicians and delivering the care that they need and healthcare data in general, which is often kind of a bottleneck to the whole system working well for patients. I think a lot of those will dissolve. Okay. So we were talking about the use cases. You're helping us dream the dream before we keep going down that road, let's talk about trust. Obviously, trust is the most important here. The same underlying model can help me understand my lab results or something that I heard from a doctor, but it can also help a highly trained, specialized physician make sense of a very complicated case. [14:38](https://realalpha.app/v/9n0MI4D7TCM/?t=878) What do you change in the answer so that it's legible to each of those two personas or any other persona that might be engaging with the same underlying model. Yeah. I mean, as you said, health is a place where, you know, it moves to the speed of trust. And so you need to be able to not only make the models better and measure them, but also kind of communicate and bring the world along. And so that's been a very important part of our thinking and our strategy for both how we work with patients and how we work with end users and how we work with clinicians. And so the brief answer to your question is basically we evaluate and train the models by working with experts across the world and getting feedback in various ways to kind of tailor their behavior to whether a person is a lay user or kind of an expert lay user that has been like navigating their care for a while, a complex care journey, or a clinician or other kinds of user personas. [15:27](https://realalpha.app/v/9n0MI4D7TCM/?t=927) And so back even for the original Health Bench evaluation that we released back in May 2020. There was actually a theme or part of the evaluation that was really focused on this distinction of how the model behaved and tailored its level of kind of use of technical jargon and things like this to whether a person was a lay user or a clinician. And since then, we've both gotten better at measuring whether the models are able to cater to different kinds of users and also training the models towards that. And so a lot of our approach has really been like, not only do, how do we make the models better for these different users, but how do we bring them along? [16:00](https://realalpha.app/v/9n0MI4D7TCM/?t=960) And part of that is how we do evaluations and communicate about them as well. So there's a few components to trust. So we've talked about sort of tailoring the answer to the user. Another big component is disagreement. A person can be speaking to an LLM or speaking to chat and be sharing all of their symptoms, but really hoping to hear that everything is okay. So from a consumer user NPS perspective, net promoter score perspective, they want to hear reassurance, but from a medical perspective, they need to hear perhaps something very different. How do you teach an AI to recognize the difference and manage different product objectives there, either from consumer engagement and retention versus sort of correctness and sort of clinical quality? [16:47](https://realalpha.app/v/9n0MI4D7TCM/?t=1007) Yeah, this is super central to how we do both evaluation and training. And so zooming out a little bit and the question of like agreement and disagreement around how we respond and how we evaluate, like one thing you could do and one thing that you could kind of base your approach on here is like we could bring in a few clinicians into, let's say, the opening high health team and say like, hey, you guys figure out how to navigate these kind of uncertain cases. and, you know, we'll ask you about these in certain cases and you'll help us build evaluations and training data and stuff like this and leave it to those few physicians to figure it out. [17:22](https://realalpha.app/v/9n0MI4D7TCM/?t=1042) This is actually not the best approach. [17:24](https://realalpha.app/v/9n0MI4D7TCM/?t=1044) **Karan Singhal:** So it turns out if you ask five physicians or something like this, any question, you'll get like eight different answers. [17:28](https://realalpha.app/v/9n0MI4D7TCM/?t=1048) And so one of the first things that we did when we first started focusing on health at OpenAI was really build this kind of global physician network of hundreds of experts that we work with kind of across the globe, across, you know, dozens of specialties and languages and countries of practice to think about the right ways to kind of aggregate the wisdom of experts so that we weren't relying, especially in areas where there could be disagreement, we weren't relying on one or two or three physicians to kind of adjudicate. So that's one part of it, is kind of like thinking about evaluation and training data coming in from different experts rather than relying on one or two people. [17:59](https://realalpha.app/v/9n0MI4D7TCM/?t=1079) But then the second part of your question is like, how do you balance kind of competing objectives, right? Let's say the physicians and the aggregate wisdom of the physicians is pointing in one direction and then maybe the user actually wants you to say something comforting, even when the situation's not comforting. It's basically a prioritization of safety. And so it's very important to us that we take our obligation very seriously when there's hundreds of millions of health conversations coming in. And so across the evaluation stack and training stack, we have evaluations that track these kind of difficult situations where the model should actually go and say, like, hey, this is unsafe. [18:33](https://realalpha.app/v/9n0MI4D7TCM/?t=1113) You should seek care, even if the user doesn't want to hear it or wants to get some kind of alternative treatment or something like this. And that's a very important part of how we do evaluation. And over time, we've not only improved how we've done that evaluation, working with physicians, but also seen pretty dramatic model improvements across the board in those areas. There's another instance of disagreement, which is me as the consumer, I ask a medical question of ChatGPT. I then show that response to my doctor during a visit. My doctor loves me, by the way. And then they disagree. They disagree with the response. [19:09](https://realalpha.app/v/9n0MI4D7TCM/?t=1149) How should I handle that situation? Yeah, I mean, I think you should handle it similarly as if, you know, disagreement was happening in some other way as well. Like people do disagree about different things. And I think like you have a right as a patient to get, you know, ask for another doctor to take a look and get a sense and go to another doctor to get a second opinion. And yeah, that's what I would advocate for whether or not you're also using Chesu. need to get health information as well. Yeah. Makes a ton of sense. There's another element of trust, which is just absolute correctness. And a lot of the work that you all have done, it seems to be, at least I'm hearing from you, seems to be about grounding answers in the world's medical literature and evidence. Some parts of medicine, there's not a lot of agreement or disagreement about but there is much of medicine that's still uh being discovered or being studied and there is disagreement even in the medical field and for that um you know for that for those kinds of questions it's difficult to ground it in truth when we don't we're still discovering you know truth science is a process etc how do you think about correctness in those kinds of [20:23](https://realalpha.app/v/9n0MI4D7TCM/?t=1223) instances yeah it's a really great question i mean it's important with or without ai so if you kind of zoom out and look at like how is medical consensus distributed today right like what is the process of that today you basically have a bunch of people writing papers biomedical papers of various kinds suggesting kind of improvements or treatments or things like this that could that can improve the quality of care and then you have this process yearly process across different specialties of building clinical guidelines which kind of describe like hey in this situation if you're a cardiologist and you see a patient with x y and z here's what you should probably do um so these these guidelines are roughly you can consider them kind of flow charts that are put out each year by the different kinds of bodies across the different across the world that describe like roughly what you should do in different scenarios based on the latest research and then the final step is so you have biomedical literature and then you have the um clinical guidelines and then you have like what do people actually do in practice and so the final step it turns out is a massive bottleneck. So there are these studies on like, how long does it take for [21:32](https://realalpha.app/v/9n0MI4D7TCM/?t=1292) clinical guidelines to penetrate the practice of everyday doctors across the world? And in the past, people have found that this takes, depending on the study, like five to 17 years for that penetration to actually happen, which is massive. You don't want to be practicing medicine five to 17 years behind. And so one of the things that we think about is how do you compress that kind of period of kind of practicing in the past down to weeks or days or even hours, right? And so this is one very important principle behind our work in Chachapiti for healthcare and Chachapiti for clinicians, which are clinician and healthcare professional facing offerings, where we're bringing in the latest biomedical literature in the moment of care and allowing people to very quickly in the course of like, let's say a 15 minute visit at the point of care, get answers to their questions. So that's one way of answering question, which is like, you know, in practice, you know while there is medical a lack of medical consensus in many areas in some cases there is medical consensus but it's not being practiced and so one thing you can do is like really dramatically reduce the amount that's happening this is one one way of answering your question [22:37](https://realalpha.app/v/9n0MI4D7TCM/?t=1357) a second way of answering your question is like how to handle the quick places where there's still like genuine medical uncertainty in there i think i mean there's a couple things so one is you want to train the models to be able to recognize their own uncertainty like after after browsing and getting information and things like this you want the models to be able to know hey like there just isn't enough information and to be upfront about that and so you know that's been an important part of how we've done evaluation that's actually like a public aspect of health bench which includes kind of evaluations on hedging for example when there is this kind of uncertainty so that's one one important thing the second thing i mean this kind of goes to this question of like how do you raise the ceiling of human health is like really thinking about the ways that models can actually accelerate the process of doing science and actually pushing the medical frontier and so maybe we'll chat about that later. Hearing you talk, it feels like you're always thinking about one of three constituents. It's either the patient, it might be the individual clinician that signed up, or it might be the enterprise, whether it's a healthcare provider enterprise [23:35](https://realalpha.app/v/9n0MI4D7TCM/?t=1415) or some other enterprise. How do you think about designing the product at the architectural level and at the, let's say, the harness level to meet the needs of all these different users? I mean, I think maybe there's three parts to that. One is making the models really, really good for these users. The second is building the right harness or product around it. And the third is really like the deployment or partnership motion to kind of reach out to the users. And by default, I think a lot of the time, the models are often pretty good these days. And so we talked about our approach of evaluation, working with clinicians and things like this. [24:10](https://realalpha.app/v/9n0MI4D7TCM/?t=1450) We are seeing pretty dramatic improvements in kind of performance and reliability. You know, we talked a few months ago about the improvements that we've been making on kind of the free tier and bringing free tier performance to the frontier. So, you know, of the 1.2 billion people who use ChatGPT weekly, I'm giving them a model for health that is just like incredibly useful at the frontier for free. So that's been a big part of our strategy, obviously, for making healthcare, health intelligence abundant. the second thing is our kind of product offerings and so the way we think about this is you can have a model that's really good but if the activation energy to use the model to improve health is too high then people won't do it right so a lot of our product efforts are really like thinking about these constituents that you're talking about and thinking about the ways in which we can reduce the activation energy for people to use compute and intelligence to improve human health and so that goes you know along the lines of you know our work in health and ChatGPT, ChatGPT for healthcare on the enterprise side and ChatGPT for clinicians. A lot of the way we design these offerings is basically to think about [25:13](https://realalpha.app/v/9n0MI4D7TCM/?t=1513) what are the barriers and bottlenecks and activation energies for people to be able to use the models. And so, for example, what are the security and compliance bottlenecks in providing an enterprise offering of ChatGPT to healthcare systems? That was one question that we were thinking about a lot two years ago. And so we thought, okay, we need to kind of invest in security and compliance. We need to make sure we're able to offer HIPAA compliance we need to make sure that we're able to offer the kinds of privacy protections that healthcare organizations need so that we're able to handle the healthcare data that they need and be able to offer services that they trust and so that was like a very important part of the work we were doing for like roughly two years ago to like roughly a year ago and we kind of just go after from there like based on the bottlenecks that we see to kind of adoption the third thing is kind of partnerships and deployment and again it's really like you know a few years ago i think opening i was very early to speaking the language of health care um and when we interacted with health care partners i think we were you know early in those conversations so i think one of the things that we've brought to bear since then is really you [26:20](https://realalpha.app/v/9n0MI4D7TCM/?t=1580) know thinking about each of those constituents that you're talking about and really thinking about how to speak their language and how to kind of bring them along this this journey because even if the models get really smart if nobody's like really trusting them or using them that's not really achieving our mission is that uh you're alluding to a little bit some of the work you've done with Epic to kind of integrate the product directly into Epic, maybe share a little bit more about that. Because a lot of the folks who spent a lot of time in healthcare, we're very interested to see that level of collaboration with Epic. Yeah, I mean, this is a very important part of our approach. Like we talked about, fragmentation in healthcare has been one of the issues. And the fact that there is kind of data and workflows that are disconnected from each other, I think, is a big obstacle to the use of AI productively in healthcare. And so, you know, our work with Epic. I work with other partners. We had a recent announcement where we announced that there's now a way to use Epic in ChatGPT if you're a provider or a healthcare professional and also for ChatGPT to be useful in Epic itself. And so on [27:18](https://realalpha.app/v/9n0MI4D7TCM/?t=1638) in the Epic workflow itself, you can have like a little sidebar where you can actually use ChatGPT as well. And so that's one thing we're also working on like different other kinds of connectors that we've also announced recently and we have more coming. And so there is quite a bit of work that we're doing to make sure that we are kind of breaking down these barriers to kind of of the healthcare ecosystem being connected. And I think, you know, Epic is just one of many examples where we're identifying those bottlenecks and trying to fix them. The last thing I want to hit on with respect to trust is some of the work that you've done around mental health. [27:51](https://realalpha.app/v/9n0MI4D7TCM/?t=1671) And this is another area where there's a lot of complexity and there may be other objectives that you need to solve for beyond the clinical. complexity that we talked about. If I ask my OpenAI dot, hey, I want to feel better over the next few weeks. How do you even interpret that question? How do you help act on that? How do you help guide a user on that, given that that could mean so many things? Yeah, I mean, and regardless of the surface, we are super committed to like helping users when they're having a difficult time or when they're in crisis. And so, for example, for dots, we've been investing the same kinds of safeguards that we've been putting in all of our product surfaces in that product surface as well. So that's an important part of our approach is kind of like a baseline safety floor. And then, you know, with mental health bench, we've really taken this approach of not just measuring the safety floor, but thinking about the ways in which the models can actually like proactively help kind of raise the ceiling and really think about the ways in which models can, you know, help provide positive mental health experiences and move from just worrying about the safety floor to measuring those kinds of upsides. And so again, the approach is actually [28:59](https://realalpha.app/v/9n0MI4D7TCM/?t=1739) very much mirroring our work on HealthBench where we've just been working with a bunch of licensed mental health experts across the world to think about the right ways to define model behavior and a bunch of tricky scenarios and ensure that we can get to a level of consensus. People definitely disagree even more here than physical health. Get to a level of consensus in some of these tricky situations where we can actually measure performance and create this kind of shared benchmark for the industry. And so we released that benchmark very recently and similar to HealthBench and HealthBench Professional, the goal has really been can we create this benchmark that kind of raises the ceiling for everybody and kind of creates across all model developers and the healthcare industry and mental health experts like this really shared ruler or measuring stick that we can use to kind of make sure that we're moving in the right direction okay so we've spoken about intelligence and the use cases that are coming around intelligence approving we've spoken about trust which is critical let's talk about medical care and i want to draw the distinction between medical information and medical care i think [30:02](https://realalpha.app/v/9n0MI4D7TCM/?t=1802) for medical information. I think if you have a health concern, if I have a health concern about myself or something that I'm dealing with, chat and other LLMs are increasingly the better, faster, cheaper way to get an answer and a resolution to that question. But if in the scenarios where medical information alone doesn't get me to resolution, I then, at least today, am thrusted into the traditional medical care system. And so if I need to go get a prescription, if I need to go see an in-person specialist, if I need to get some follow-up blood work or some MRI or some other form of scan done, if I need a clinician to examine me in some way, I still need to navigate the traditional healthcare system. [30:49](https://realalpha.app/v/9n0MI4D7TCM/?t=1849) And a lot of that work is sort of governed and regulated by the U.S. medical license and sort of other infrastructure that we have in our healthcare system. It's the multi-turn conversation where it's not just a single question resolution. It's, I got to go talk to a few people. I need to go get a few things done. We need to collect some information. In many ways, medical care is a, it's a bundled product. You know, we're getting the diagnosis and triage and the care plan. We're getting the empathy from the clinician and the assurance and the support. We're getting the legal liability associated with that and what they're taking on. Will AI provide all of that? Where will it stop short? Where do you think this is all going? Yeah, no, I don't think AI can or will provide all of that. And I think you're right that there's like this distinction between health information and medical care. And so I think the way we see our role here is really to enable the whole ecosystem because there's no future where, you know, any one company is delivering all the medical care, Right. And so our role here is really to think about what is the last mile of medical care really look like for people? Can we really understand that? And can we make that easier and easier for everybody so that the last mile of actually having impact on patients just looks like the last hundred meters for all of our partners? [32:15](https://realalpha.app/v/9n0MI4D7TCM/?t=1935) And so that's kind of how we think about it. It's like really like making it very easy for our partners to use AI to support everybody in the care journey. I think there is stuff that OpenAI can do relatively uniquely here because of the front door to health that it has. And so, for example, it can help you navigate a lot of these kinds of questions or help you navigate this journey or, you know, as we get increasingly helpful personal agents, help you with some of the scheduling and logistics and things like this and just act as a quarterback for your health. That said, I don't think it'll resolve all these challenges that we'll have, at least not in the short term. [32:47](https://realalpha.app/v/9n0MI4D7TCM/?t=1967) And I think to a large extent, we're looking to enable a lot of our partners that are delivering care that are overwhelmingly using our models in various ways to make these operations happen smoother and easier so that patients are not left in this kind of fragmented experience. So as a consumer, should the experience that I look forward to from OpenAI be sort of the quarterback care that you described? Will I be talking to a clinician in the interface at any point? or would you perhaps route me to a doctor and help me find that? Because given that's a whole challenge, just scheduling and making those visits happen, what should I look forward to? [33:25](https://realalpha.app/v/9n0MI4D7TCM/?t=2005) I think you'll see like we will be hopefully very helpful in helping you navigate the process of finding care. I don't think we'll be in the business of doing all the things that you mentioned. But that's where we're really relying on all of our startup and care provider organizations and partners and things like this. So coming back to a question I mentioned earlier, which is you are building that future, but you're building it with partners. You're building it for consumers and patients. You're building it for clinicians. You're building it for enterprises. For clinicians and enterprises, like give us some texture on some of the tools that you're launching and some of the collaborations that have really worked. [34:04](https://realalpha.app/v/9n0MI4D7TCM/?t=2044) Yeah, we've had a few really exciting partnerships and we've had some really amazing launch partners for Chachup Deeper Healthcare. We've had lots of users using Chachup Deeper Clinicians and really enjoying it. It's been, the retention on the offering has been like a very pleasant surprise. People seem to be really enjoying it. Yeah, we've been working with a variety of health systems. I think one, a couple that stand out, you know, one is we've been working with UCSF and we've been chatting about that. And they've been, you know, one of our earliest adopters for this connection between Epic and the EHR and ChatGPT. [34:36](https://realalpha.app/v/9n0MI4D7TCM/?t=2076) And they've been really on the front lines of thinking about, for example, clinicians using it for chart review or things like this and thinking about the right ways in which like the experience of caring for a patient doesn't need to be this super fragmented. You need to switch tabs or switch experiences and things like this. And so they've been some of our power users on that front. I think another one is AdventHealth and they've actually been some of our power users in thinking about deploying agents across the workspace, actually across all of OpenAI. They've been a leader and they've been really, they've had amazing results. [35:10](https://realalpha.app/v/9n0MI4D7TCM/?t=2110) A lot of health systems I think should look to them. I think they're really impressive. If I go into my doctor's office and I see ChatGPT open up on their screen, should I be upset? Should I be happy? How do you think people will react to that? Yeah, I hear differing things and I think it's actually changing over time. And so I think it's this interesting thing whereas as the Overton window is shifting in real time, I think there might've been some level of concern before. But I think increasingly a lot of, on both sides, there's this question of whether clinicians would push back against patient use of AI and whether patients would push back on clinician use of AI in the way that you're describing. [35:48](https://realalpha.app/v/9n0MI4D7TCM/?t=2148) But I think both parties are actually finding incredibly useful for their own personal purposes. And so I think what we're finding in practice, especially over time, is that both parties might actually feel safer with AI in their care journey, whether it's their clinician using it or the patient using it as kind of like a sanity check. And I think that attitude is definitely changing over time. I wouldn't say that we're fully there, but that's my prediction of how things go. Okay, so then taking that one step further, if a patient has done all their research before a visit and they have all their health data integrated. [36:19](https://realalpha.app/v/9n0MI4D7TCM/?t=2179) They've asked a bunch of questions in ChatGPT. And then the clinician before the visit has all automated through loops, has run the entire patient. Case through ChatGPT, and then the visit happens. What should they talk about? My hope is that they talk about the human aspect of healthcare. I mean, there's still like a lot of uncertainty. There's a lot of empathy. There's a lot of bedside manner that goes into the human aspects of healthcare. There's also a lot of physical interaction that goes into it. I don't think, you know, I don't think all the information exists for the AI, just information theoretically. All the information exists for the AI to just figure out what all should be done. [36:56](https://realalpha.app/v/9n0MI4D7TCM/?t=2216) And part of the reason for a visit is to get more information and do the process of history taking investigation and things like this. And so I think that will not go away, especially the physical elements of that. And I think even from a cognitive perspective, the elements of kind of empathy and getting comfort and getting that second check, I think will still be something that people demand. can what do you think uh ai in general or let's say dots would do in between visits and will you think you'll cross the line into providing providing care in between visits and then share that back with the doctor yeah i i don't think we'll um i think we'll we'll we'll definitely be focused on health information but i think the whether it's dots or any other product surface i think we're really excited about this kind of future of heading more in this proactive direction that you were outlining like imagine if somebody is kind of dealing with a chronic care journey and you know they're again like this example of like someone's a1 someone gets a lab desk back whether a1c is higher and they're pre-diabetic or diabetic you know can you flag for them like hey maybe you should get a medication check and go to your cardiologist or whatever [38:03](https://realalpha.app/v/9n0MI4D7TCM/?t=2283) and think about the right ways in which you can um you know flag to users medication adherence issues or other kinds of issues i think those kinds of issues are places where you know ai can have potentially a really high health impact especially in like these kind of chronic care journeys but i don't think um i don't think it'll be in the business of like managing all these things by ourselves sure yeah another thing i'm curious about is in the fields of ai applied to other domains and situations like let's say games like chess and go um as ai got really good at chess and go. They also revealed other strategies and ways of playing the game that even the best experts in those domains were not exploiting or not pursuing. And that helped us learn more about these games and also helped us learn more about AI. Are there equivalents like that that you've seen in AI applied to health from the work that you've done in research? Are there already findings that are surprising you and perhaps introducing new ways of delivering care or understanding a clinical scenario uh that can give us some optimism yeah i mean i think we've we've seen this at smaller scales but let me let me zoom out and say like you know one thing that's been [39:22](https://realalpha.app/v/9n0MI4D7TCM/?t=2362) motivating our team in general recently around raising the ceiling of human health is this notion of bringing to bear a kind of a move 37 for health and this idea of a move 37 is it comes from from alpha go um and uh a game that the alpha go system which plays this kind of complicated board game played with Lee Sedol where there was a specific move that just kind of in the moment seemed like a really dumb move and a surprising move for all the human experts watching this game between this AI system and this world expert and go. But in hindsight, is this kind of like brilliant and insightful move that humans are now just beginning to understand and learn from the patterns of and things like this. [40:07](https://realalpha.app/v/9n0MI4D7TCM/?t=2407) And this is a very interesting example. I think so there's an idea of like how do you get to a move 37 in health of a move or a prediction where the models predict something that a human might not have been able to predict, but in hindsight seems correct and brilliant and insightful and impactful. So I think we're very early and I think you're going to see much more of this in the future than in the past. But I think, you know, I mean, one kind of example is again, thinking about the ways in which these systems have been deployed as safety nets to clinicians where clinicians are actually delivering care and in the moment the AI It actually flags kind of like, hey, something might be off here, like our study with PandaHealth, and thinking about the patterns of results that we saw there. [40:49](https://realalpha.app/v/9n0MI4D7TCM/?t=2449) As an example, you know, in that context, the clinicians were a little bit prone to overuse of antibiotics, and a very common pattern that the models flagged is just kind of like avoiding this overuse of antibiotics and thinking less about the local case and more about the kind of global issue of resistance to antibiotics. So that's like one specific example. But again, I think you're going to see more of these examples of models taking in like a longitudinal history of a user over 10 years across all their data, across the HR data, across the chat data, all these things and making predictions that seemed impossible before because a human can't even integrate all that data in their head and making predictions about their health and their risks and things like this that seemed like they were impossible. And I think that would rise to the occasion of being called a MOOC 37. [41:37](https://realalpha.app/v/9n0MI4D7TCM/?t=2497) Yeah. I mean, there are, there's so many things that consumers are curious about that at least at one point in time, we weren't sure if it was healthy for you. And then to your point, the Overton window changed and there was sort of more evidence that was sort of conclusive in one direction. Sometimes the views on some of these things have changed. all these sort of new emerging phenomenons that perhaps are understudied? Do you anticipate as people are sort of entering this information into ChatGPT or other LLMs that we'll have more evidence that we can generate to study some of these things that folks are curious about, but we don't really know or we don't have conclusive evidence one way or the other on where they stand? Yeah, I mean, I think one of the most interesting things about agents is they kind of solve a lot of the bottlenecks in analyzing data that already exists, right? [42:29](https://realalpha.app/v/9n0MI4D7TCM/?t=2549) There's various places across the healthcare ecosystem where data is being generated, EHR data, longitudinal histories, claims, whatever, where data is being generated and it is kind of just stored there and the insights from it are not fully mined or used to generate new knowledge. And so I think one of the frontiers for how health might improve in the future and how the ceiling of health might raise will be thinking about the ways in which we can leverage the data that is just kind of out there in boxes in various places and have models generate new insights based on this data. So I'm also optimistic about that future. [43:03](https://realalpha.app/v/9n0MI4D7TCM/?t=2583) I'm also optimistic about a future where, you know, you mentioned these two constituencies, the user, the patient, and the clinician. I think there is a third constituency, which is the scientist, right, which was helping kind of advance the frontier of knowledge in the space. And I'm also very optimistic about a future in which, you know, AI helps accelerate a lot of the bottlenecks in validation, which I think will end up being the bottlenecks as opposed to kind of proposing new ideas or treatments or things like this. And so I'm very optimistic about that as well. Switching gears slightly, you've also shared thoughts around just the cost of intelligence as an input to medical intelligence coming way down. [43:44](https://realalpha.app/v/9n0MI4D7TCM/?t=2624) And, you know, at some point it'll be too cheap to meter. I spent a lot of time and we as a team spent a lot of time trying to understand how these technologies will make an impact on our healthcare system that is inflating well ahead of inflation. 5.3 plus trillion we spend on healthcare. If it were its own country, it'd be the third largest GDP. It's the biggest part of our economy. It's also the biggest employer in our economy. 23 million Americans work in healthcare. There's so much, there's just so much we spend on healthcare. What do you sort of make of the work that you're doing and the impact that it'll have on the cost of care? [44:24](https://realalpha.app/v/9n0MI4D7TCM/?t=2664) I think this is like one of the most important ways that we can pursue our mission is to not only make our models better at the frontier, but make that widely accessible to everybody. So that's, you know, obviously a big part of how we've been able to deploy health intelligence to a lot of people across the world for free. I think it's also a big part of how we think about, you know, API and how good our models are there for health and pricing there and stuff like this. You know, one recent update was we recently released GPT-6 Luna. and And GPT-6 Luna is our current cheapest model on the API, or cheapest frontier model on the API. And what we found with GPT-6 Luna was that it was actually doing better on our benchmark HealthBenchProfessional, our current latest benchmark of clinician workflows that are really difficult, selected for difficulty for our current models across all the different ways in which clinicians are using our models and the models still could use some improvement. [45:18](https://realalpha.app/v/9n0MI4D7TCM/?t=2718) it performed better than 5.6 soul which was literally our best model like a month ago [45:22](https://realalpha.app/v/9n0MI4D7TCM/?t=2722) **Karan Singhal:** and so and it's it performs better despite being 34 times cheaper and we've had a couple of those [45:28](https://realalpha.app/v/9n0MI4D7TCM/?t=2728) moments even even in the past year and you know there's been many trends showing that ai compared to other technologies that have been introduced in the past has been reducing a cost at a given level of kind of capability or usefulness faster than many of these other technologies and so one bet we've had at opening eyes that the cost of health intelligence will will plummet at a given level of health intelligence and the the level of health intelligence where you know clinicians and patients feel like they can trust in the care journey is starting to get there right so that's like a fixed level of intelligence in some sense hopefully the bar after that raises over time as well um my expectation is once we get close to that level of intelligence the cost for that level of intelligence also dramatically reduces like it has been as the hope there is that we get like a kind of this commoditization of health intelligence, right? [46:12](https://realalpha.app/v/9n0MI4D7TCM/?t=2772) We don't want to hoard that health intelligence. We want everybody to use it. So I hope that that contributes. But, you know, to answer your question about the whole of healthcare spending, I don't think all of that is about health intelligence. I don't think like health intelligence has had yet a macro effect on the problem that you're describing. If you look at like the whole of health, there is quite a bit of areas though, where if you look at, for example, chronic care management or documentation or administration, or a lot of kind of administrative workflows of various kinds, back office workflows, there's a lot of money spent in ways that probably don't need to be spent that way. [46:46](https://realalpha.app/v/9n0MI4D7TCM/?t=2806) And so we are very optimistic about kind of an overall compression of spend over the coming years. I don't think that's happened yet. And I don't think that just happens from making health intelligence abundant. I think that happens from integration and workflows and deployment and scaling that up and really making sure that these models are valuable in the economically valuable tasks that people are using them for. But I think it's a prerequisite to making that future happen. More care, less paperwork. is sort of where we're heading. At least there's a lot of the cost savings. I'm sure you saw some of the headlines over the last few weeks of, there's a New York Times article that basically provider AIs and payer AIs are fighting. [47:22](https://realalpha.app/v/9n0MI4D7TCM/?t=2842) And there was some Blue Cross Blue Shield Association analysis that showed that the respective billing bots and paperwork bots effectively increased spend by a billion dollars or something like that. When you are doing cutting-edge research on health and trying to bring down the cost of medical intelligence to near zero, and then you see headlines like that. What do you make of that? I think this might be one of those areas where there might be some kind of short-term pain around this kind of provider-payer-arms race, but in the long run, there's no reason this has to exist, right? And so really, I think, you know, you're entering a world where a lot of visits actually have some kind of ambient intelligence in the room, listening, transcribing, things like this. [48:05](https://realalpha.app/v/9n0MI4D7TCM/?t=2885) There's notes, there's clinical notes, it's just AI details of clinical notes and things like this. And so you have a lot of the details you need to adjudicate visits, right? And so the ideal world, in my view, is a world in which providers and payers kind of have a handshake, like, hey, here's our ground truth of what happened in this visit. Like, here's all the information we have. There's just like no other source of information that there is. And then an AI helps adjudicate that situation. And maybe there's like some limited appeals process or things like this, but I don't think you need to have all this process where you have like an AI arms race between pairs and providers that can just be completely avoided. [48:39](https://realalpha.app/v/9n0MI4D7TCM/?t=2919) So I view that as a bit of a short-term distraction. There's a lot of entrepreneurs that are building technology and healthcare that are likely watching this, and they're probably trying to figure out You know, as you continue to advance your work and you bring down the cost of medical intelligence to near zero, and this becomes this sort of ubiquitous utility that flows through all of our healthcare interactions for consumers, for clinicians, for the administrative part of the healthcare technology or the healthcare stack, what should folks be building on top? What should specialist applications be doing, assuming that this gets 100x plus better? [49:19](https://realalpha.app/v/9n0MI4D7TCM/?t=2959) Yeah, it's a great question. Like I mentioned, we think about a lot of our health impact through OpenAI as not being directly through the products that we offer, but actually through our partners and that last mile of delivering care. And so what I'd say to our partners is build on top of models that are really capable. And the most important thing is bet that those models will become more capable. So bet on the future. I think many people in healthcare are on some kind of spectrum between betting against the models, betting neutrally for the models and betting with the models or betting for the models. And I think I would say, you know, bet on the models getting better. That's probably the most important thing. And think about the ways in which a lot of the technology that's being developed, whether that's, you know, agents or computer users or other kind of frontier tech will accelerate healthcare and bet on that and build towards that future. I also think a lot of medical care will actually become more accessible to patients with AI. We talked about this idea of kind of a quarterback and dissolving a lot of these barriers. And so just being focused on delivering really good quality care and having AI be part of monitoring that care journey, I think [50:22](https://realalpha.app/v/9n0MI4D7TCM/?t=3022) is a very important part of that as well. Zooming out to the overall healthcare system and now just looking at it at large, we talked about this 5.3 trillion. A lot of that spend is paperwork between providers and payers and other stakeholders within the five P's of health care. A lot of that is cognitive care that you're arguing can be augmented and enhanced and sort of we can bring on a lot more cognitive care capacity online, which is exciting and exciting from an access perspective. And then there's a lot of spend in health care that is procedural, either requiring some imaging, some blood work, some follow-on examination, or it's some surgical intervention, where do you see sort of the intelligence work that you're doing in the medical space impacting procedural care? [51:11](https://realalpha.app/v/9n0MI4D7TCM/?t=3071) And is that going to be the ultimate, is that going to be the new sort of or an enhanced or perhaps an exacerbated bottleneck? Or do you expect to do a lot of work there as well, robotics, et cetera? Yeah, I mean, I think in the short term with procedural care, I think you want a better targeting when that's needed, right? And I think AI can help, you know, provide information that is helpful for knowing when to seek that kind of care as well probably the biggest macro factor in the next you know year or two will just be better kind of proactive preventative stuff right so you don't have to actually go in later and get that procedure right because if you make the right moves sooner and ai helps you navigate that kind of journey then you can hopefully avoid a lot of the downstream costs of the most expensive procedures so that might be like one macro factor to kind of look out for is my guess i think the question of kind of robotics and care, I think is a bit of a longer term one, both from a technology perspective and kind of like a reimbursement and kind of industry integration perspective. [52:06](https://realalpha.app/v/9n0MI4D7TCM/?t=3126) My expectation is that it's not like a next few years kind of thing. Very cool. Okay, we've covered a lot of ground. We've talked about intelligence improving. We've talked about trust. We've talked about moving from medical information and medical care. Help us understand what we can look forward to as things, as sort of things continue to unfold. as agents and personal agents and the underlying models become increasingly performant. What can we look forward to from ChatGPT Health? Yeah, I mean, I think there's like really two high level things that we're really focused on making happen. One is, again, thinking about like the ways in which we can raise the floor of human health and make trustworthy, reliable health intelligence abundant for all clinicians and all users and patients. [52:49](https://realalpha.app/v/9n0MI4D7TCM/?t=3169) And so getting to the point where, you know, like we talked about, like all patients. and clinicians just feel safer by having AI in the care journey. Like when you see the chat CPT, you actually, when the doctor's using chat CPT, you actually feel safer and vice versa. Getting to that point, and again, that's a question of not just, you know, the models being good and evals being good, but also how we deployed and the activation energy around that and the products and things like this. I think a second thing is really thinking about raising the ceiling. So what are the ways in which AI can actually do things that were not possible before? [53:20](https://realalpha.app/v/9n0MI4D7TCM/?t=3200) So one of them actually, I think is this kind of like, you know proactive health proactive personal health assistant that is part of your care journey is helping you navigate these moments being your quarterback you know helping you schedule and all these things but also flagging the places where you know you can intervene in your health today and prevent a lot of expensive deterioration later in the future and i think that's gonna be an important part of how we think about you know improving the future of of health for people as many people as possible and i think the second thing is just what you mentioned before which is like really thinking about the ways in which we can unlock the value of existing data that is sometimes stored in boxes of various kinds and thinking about the ways in which that can be leveraged to produce new insights that benefit patients. It is striking and incredible and humbling to realize that ChatGPT, I think, came out three years ago, roughly. And so it's been a lot of progress in a very, very short period of time. So to even talk on a five or a 10-year basis feels academic, but can you give us some predictions? I mean, is there a feature that we might have that feels science fiction today, but we could have one day, three, five, 10 years [54:26](https://realalpha.app/v/9n0MI4D7TCM/?t=3266) from now? Yeah. I mean, it is super, super hard to predict the future these days. So this is a difficult one, but what I would say is like, I think the thing that might have the most impact on human health in that kind of timeframe, the next five to 10 years is probably going to be newer treatments that come out of maybe two things. One is AI-guided generation of new targets or molecules that could be interesting for new treatments. And the second is AI-guided prioritization and validation. So thinking about the right ways, we're already at a point where the number of molecules and drugs that people want to suggest to be used in clinical trials and things like this is way more than the number of slots available in clinical trials. [55:07](https://realalpha.app/v/9n0MI4D7TCM/?t=3307) So thinking about the ways in which models can help prioritize and run these clinical trials so that they just run smoother and faster.