FHC #42: Google’s chief doctor previews the health tools of tomorrow

karen desalvo of google AI quote

When it comes to healthcare, the digital hands of Google reach far and wide. Medical school students and residents use Google Search to find obscure case reports and make difficult diagnoses. Before surgery, many physicians now go to YouTube, the Google-owned video platform, to watch world-leading surgeons perform and narrate complex operations. Meanwhile, applications like Google Maps, along with products like HealthAI and Care Studio, are primed to play a meaningful role in the future healthcare.

Here to talk about the tools of tomorrow: Dr. Karen DeSalvo, Google’s Chief Health Officer, a role she has held since 2019. After medical school at Tulane, DeSalvo practiced as an internist (primary care) in New Orleans. Following hurricane Katrina, she served as New Orleans Health Commissioner and then as the city’s Senior Health Policy Advisor. At the federal level, DeSalvo served as National Coordinator for Health Information Technology and as an acting Assistant Health Secretary for U.S. Health and Human Services.

Karen DeSalvo Interview Highlights

On her professional journey to Google  

“When they asked me to serve as the National Coordinator for Health IT, I declined. Because I just didn’t think I had the background and it wasn’t really how I wanted to go deep in the next part of my journey. But (former HHS secretary) Kathleen Sebelius convinced me and helped me see that technology is not the endgame but a tool to health, and also gave me the opportunity to go there at HHS and co-lead the delivery system reform strategy … I love my government service. I carry the stories of my patients, my experiences in local public service. But also, I saw it as an opportunity to apply the tools of technology in other ways to value-based care, and then eventually to public health.”

On her role as Chief Health Officer at Google

“It’s a new job. I was recruited here principally to stand up a clinical team that could work across the Google Enterprise to build up authoritative health information on our ecosystems that are things like Search and Maps and YouTube, where literally billions of people are looking for health information. And we needed to have a way that we could create a framework that would provide clinically great information where we could and then address misinformation.”

On curbing Covid-19 misinformation

“We have leaned on consensus bodies wherever we can. For example, the FDA or the World Health Organization, depending on the geography, and we often start with global consensus if it’s a new issue, and then localized as much as possible, yeah, in the various countries or even all the way down to the county level for recommendations on things like masking, because we think that our role is amplification of information, not creation of the content, especially on surfaces like Search. Now, there are some things though, that are clearly harmful, and is not the information that you would want to put out in the public domain. For the most part, those things have somewhat clearer to be able to define in COVID.”

On whether Google can disrupt healthcare

“I didn’t come to Google to disrupt the healthcare system, or to show the healthcare system how it should be done. I came here because I believe that there’s a couple of key things that are missing in the work we’ve been doing. One, is consumers are not empowered. They don’t have a seat at the table in the way that need to. Two, we’re not taking advantage of tools that can reduce cognitive load and improve the efficiency of care to pull cost out of the system. We’ve instead only, largely, in tech been trying to find ways to add new things to the system.”

On how AI can help doctors, patients

“Computers and AI are really good at reading pixels, better than humans, and they don’t get fatigued. Yes, all of those images and the pathology slides have to be put into context. I do understand that. It’s to me, again, not supplantation, but significant augmentation. Getting to a place where we expect that your prostate tissue slide is going to be read by AI and a human is so necessary. Getting there, though, is the barrier, isn’t only about the AI model. We’ve done a lot of good work in that space and have advanced imaging reads in that area.”

On the most exciting developments in health technology

“Home-based diagnostic testing. I am fascinated by how hungry people are to have convenient, in-home diagnostic tests for COVID and beyond. The part that’s interesting to me about it is laboratory is something that often does require a biologic specimen. It’s not something that can be done completely virtually. There has to be some an interface with the diagnostic tool. The diagnostics in the COVID time have gotten much more sophisticated. The work of the RADx team at the NIH, this billion dollars they received to advance technology for COVID testing, they’re seeing that it’s applicable in other areas of diagnostic testing for convenient at-home tools…”

READ: Full transcript with Karen DeSalvo

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Dr. Robert Pearl is the author of a book about medicine’s invisible yet highly influential physician culture. Check out “Uncaring: How Physician Culture Is Killing Doctors & Patients.” All profits from the book go to Doctors Without Borders.

Fixing Healthcare is a co-production of Dr. Robert Pearl and Jeremy Corr. Subscribe to the show via Apple, Spotify, Stitcher or wherever you find podcasts. Join the conversation or suggest a guest by following the show on Twitter and LinkedIn.