Like me, most of you have probably been following the ups and downs of OpenAI in the press this last week since Sam Altman, its CEO, was fired and now reinstated with essentially a new board. It turns out it was down to a boardroom battle between the AI boomers and AI doomers, and it seems the boomers have won the day.
‘On one side are the “doomers”, who believe that, left unchecked, AI poses an existential risk to humanity and hence advocate stricter regulations. Opposing them are “boomers”, who play down fears of an AI apocalypse and stress its potential to turbocharge progress.’ The Economist, 19-11-2023.
This is not a trivial issue. When I previously floated the idea of using AI to improve the management of MS, I got a lot of pushback (please read ‘Has AI come of age?’, 13-April-2023). Despite the pushback, I remain an AI boomer and want to take AI to the next level. In short, I want to create an equivalent of Chat-GPT for MS.
Imagine an MS Generative Pre-trained Transformer (MS-GPT), analogous to Chat-GPT, that you interact with on WhatsApp, a bespoke App, a website or your favourite social media platform. For it to be transformative, it has to fit in with how you acquire and use information. Imagine MS-GPT as a personalised MS guide with which you chat and interact regularly.
I envisage you sending MS-GPT text, voice messages, or even photographs, and it responds to you in the format you select. Similarly, if you allow it, MS-GPT can send you spontaneous messages, and you can respond to them. The value is in the two-way dialogue and how it will lead to better management of your MS and better long-term outcomes.
Please note we envisage training MS-GPT using well-defined MS-related material from peer-reviewed journals and pre-vetted websites with a reliable reputation. We don’t want to use the whole of the internet as a training resource as this will include debunked theories, quack remedies, etc. Yes, we want MS-GPT to be better trained than the best MS Neurologist on the planet, and we want to build real-life feedback into the platform so that it can learn and improve with time.
Some of you who have gotten this far will think this is science fiction and be asking how this will work. Let me explain.
If you have just been diagnosed with MS and you register with MS-GPT and select WhatsApp as your preferred platform for communication. WhatsApp's use of encryption may make you feel better about data privacy. However, MS-GPT will ask whether or not you want your chat(s) recorded and analysed for your regular assessment with your neurologist and MS team. If you permit it, it will analyse your data over time and assess whether you are stable, improving or worsening. It can also summarise the issues that need addressing at your next appointment. So, there will be an incentive to record and analyse your interactions with MS-GPT.
As a newly diagnosed patient, you may ask the following questions:
What is MS?
What to expect from having MS?
Do I tell my partner I have MS?
When you set up your account, you will be asked what level of detail you want to interact with MS-GPT. This will tell MS-GPT to provide short, concise answers or longer, more detailed answers. You can even ask MS-GPT to recommend online resources to read, listen to or watch. Please think of the interaction as being quite personal. In the end, you want a long-term relationship with MS-GPT.
Later, you will ask MS-GPT detailed questions about specific disease-modifying therapies, including their relative efficacy, side effects and monitoring requirements. I envisage MS-GPT being intelligent enough to ask you about family planning issues, and it will prompt you to consider this information in your decision-making process.
Over time, MS-GPT will learn about how you function. It will ask permission to access your step-counting function from the relevant health applications on your phone. This data will be needed to monitor your mobility. If you give MS-GPT access to your GPS function and microphone, it will start to monitor your toilet habits and detect urinary frequency, nocturia and bowel habits. If you use a sleep monitor, it will be able to track your sleep pattern via the third-party application’s API (application programming interface). This will all be kept in MS-GPT documentation or memory about you, which it will use to produce periodic summaries.
When it detects urinary frequency or nocturia, it could ask you whether you think your bladder function has changed. It could recommend some simple self-help solutions or advise you on this problem, and it will include it in your summary to bring this up with your HCP.
You will prompted if you want MS-GPT to remind you about lifestyle changes. For example, if your exercise drops off, as documented in your Strava application or other health app, it can ask you why. You could ignore its advice or apologise to it and get down to the gym. MS-GPT will gently nudge you to improve your lifestyle.
In the future, I envisage building an HCP vetting function into MS-GPT. If, for example, MS-GPT recommends a specific class of medication for managing leg spasms at night, you could flag the response as being in need of vetting, and it will then be sent to an HCP for confirmation. A message will then come back from an HCP saying whether or not the advice is correct. In this way, MS-GPT will learn. This latter functionality will have to be costed and paid for in some way; for example, the NHS or your medical insurance may cover the subscription cost.
Please note that all MS-GPT represents is AI-driven knowledge curation and communication. It will replace what I am trying to achieve with MS-Selfie Newsletters and Podcasts and with MS-Selfie Microsite. I envisage MS-GPT taking over my job and doing it much better. I will be obsolete. This is what some of the AI-doomers are worried about the hollowing out of the knowledge economy. I suspect the latter is being overstated because doing a physical examination and ordering diagnostic tests will still require an HCP to be in the loop, at least for the foreseeable future.
MS-GPT could go beyond the obvious and detect how you function using outputs from other smartphone applications. I envisage it being able to detect you having a tremor or making typing mistakes due to incoordination. If it does detect these problems, it could ask you to do a formal assessment for these problems, document them, and then advise you on how to manage them.
MS-GPT could help you manage your bowel, bladder and sexual problems. It could help with CBT and mindfulness. In short, it will be an indispensable guide on self-managing and self-monitoring your MS. It may sound like science fiction, but if I had access to funding and a group of bright techies, we could build a prototype within two years.
My vision would be not to make MS-GPT MS specific but to allow it to acquire general medical knowledge to answer questions beyond the management of MS; it will be much more knowledgeable than your neurologist. It could provide answers to specific questions about HRT (hormone replacement therapy), the management of hypertension, warts, etc. In other words, MS-GPT will be a general medical and lifestyle guide.
The naysayers will say I don’t want this; I really want quality time with my neurologist. I suspect it will achieve this because anyone using MS-GPT will realise they have a neurologist of sorts on their smartphone and that when they do see their actual neurologist, they will have a summary of how they are doing and what problems to focus on. The neurologist will find the summary helpful. I predict MS-GPT will be a win-win-win: a win for the person with MS, the neurologist looking after the pwMS and the healthcare system paying for the MS care.
Steve Jobs, who created Apple and turned it into the most valuable company in the world, is famous for saying, “Some people say, ‘Give the customers what they want,’” he said in one of his most-quoted statements. “But that’s not my approach. Our job is to figure out what they’re going to want before they do.” I predict pwMS are going to want and need MS-GPT much sooner than they realise.
Innovation
Innovation is creating and implementing novel ideas, methods, or products that bring about positive change and improvement. It is the ability to think creatively and find new solutions to existing problems or to address emerging needs and opportunities.
Innovation is essential for several reasons. Firstly, it drives progress and advancement in various fields, such as technology, healthcare, and business. Without innovation, we would be stuck in a state of stagnation, unable to evolve and adapt to ever-changing circumstances. Innovation fuels economic growth by fostering the development of new industries, creating job opportunities, and increasing productivity.
Furthermore, innovation plays a crucial role in improving the quality of life for individuals and society. By introducing innovative ideas and products, we can find more efficient ways to perform tasks, enhance communication, and solve complex challenges. For example, the invention of the internet revolutionized how we access information, connect with others, and conduct business globally. AI will take this to the next level.
Innovation also encourages competitiveness and fosters a culture of continuous improvement—healthcare systems and individuals who fail to innovate risk being left behind in a rapidly evolving world. By embracing innovation, institutions, businesses and individuals can stay ahead of the curve, differentiate themselves from competitors, and meet the ever-changing demands of their members, customers, patients and colleagues.
Moreover, innovation can have a positive impact on sustainability and the environment. By developing innovative technologies and practices, we can reduce our carbon footprint, conserve resources, and find alternative energy solutions. This is crucial in addressing the pressing global challenges of climate change and environmental degradation.
Innovation is the driving force behind progress, growth, and improvement. It empowers us to think outside the box, challenge existing norms, and solve complex problems creatively. By fostering a culture of innovation, we can create a better future for ourselves and future generations.
Please let me know what you think of MS-GPT as a concept and how you would use it if it became available.
Innovation Challenge
Roche and Genentech asked me to join an innovation challenge steering committee to drive early detection of MS disease worsening, thus enabling early and effective treatment and improving the monitoring and prediction of the impact of disease on people’s lives, including disability trajectories. If you know anyone with an innovative idea that needs funding, please forward them this email and encourage them to apply.
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General Disclaimer
Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Queen Mary University of London or Barts Health NHS Trust. The advice is intended as general and should not be interpreted as personal clinical advice. If you have problems, please tell your healthcare professional, who will be able to help you.
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