Strange Friend

Madison Boyer, Wake Forest University School of Law J.D. Candidate ’23

Department of Health and Human Services – Project Proposal & Request for Funding

Working Name: Project Talos

I. Proposal Summary

The Project Talos team has collaborated for six years to develop an artificially intelligent physician, or “AIP”. The AIP has the capacity to diagnose and treat all medical conditions complained of by adults. The AIP is a cost-conscious and effective way to ensure access to healthcare for all Americans, who otherwise may be unable to afford the services of a physician. Project Talos is requesting $15,000,000 to complete the necessary coding work, to install Project Talos “Dr. Touring”® AIP stations in pharmacies and primary care offices, and to offset the initial costs of providing healthcare. 

II. Project Description

Project Talos will revolutionize the American healthcare system. Currently, approximately one in four Americans (22%) are not receiving necessary medical care due to cost. Over thirty-one million Americans under the age of 65 do not have health insurance. Project Talos will allow those Americans to access excellent medical care at little to no out-of-pocket cost, whether or not they are insured. 

III. Goals and Objectives

The Project Talos AIP was built with three goals: (1) to promote health on an individual level (“individual health goal”); (2) to promote the overall health of the American population (“public health goal”); and (3) to promote health across generations (“future health goal”). All three goals are constantly monitored by the AIP. If the AIP detects health issues arising, it is independently capable of correcting for error. The AIP was trained on high-quality medical data that was graciously donated by Harvard Medical School. The data was stripped of all identifying information so that the AIP cannot reflect any possible bias concerning age, race, sex, or gender identification. The primary objective of Project Talos is to provide the highest possible quality of healthcare to all Americans at affordable prices. This will encourage patients to seek preventative healthcare services before their condition leads to a medical emergency. The AIP will help millions achieve better health outcomes and lead longer, happier lives.

IV. Conclusion

With the support of the Department of Health and Human Services, and with the eventual approval of the FDA, Project Talos is hopeful that millions of lives will be improved at an extremely reasonable cost to the United States taxpayer.

*****

Nikole was running late. Not that that was a surprise to anyone who knew her, really, but she was frustrated all the same. She had specifically scheduled her doctor’s appointment before her early shift at the supermarket, but she had turned off her iPhone’s alarm when she meant to hit snooze. She jumped into her chilly car and noticed that the check engine light was on. Maybe when her next paycheck came through she would get it fixed. Although it would probably have to wait, since she needed to pay rent first. She mentally cursed her roommate, who moved out unexpectedly last week. The stress of paying for everything on her own had been messing with her stomach and left her feeling nauseous. Nikole sighed loudly, despite being alone in the car. She figured the car trouble was nothing serious and besides, she had more pressing concerns. She had been getting horrible nosebleeds; the last one happened while she was sleeping, and she woke up with blood all over her pillow and sheets. At least now with this new AIP everyone was talking about she could actually afford to get seen. She drove past a car with one headlight out and absent-mindedly tapped the ceiling of her car. Padiddle, she thought. She parked and dashed inside the pharmacy, forgetting her iPhone on the passenger seat beside her.

***

Patient Assessment

Name: Nikole Carter SSN: ***-**-2815    Marital Status: S

DOB: 07/21/1996     Race: Caucasian     Occupation: N/A

C/O: Nosebleed      

D/X: Epistaxis (R04.0; Encounter for supervision of normal pregnancy, first trimester (Z34.81; Problems related to unwanted pregnancy (Z64.0)

Comments: Pt presents with recent chronic nosebleed. No known h/x of bleeding or clotting disorder. Blood pressure within normal range. Pt asked start date of most recent menstrual cycle. Pt unable to recall. Pt reported tracking menstruations on cell phone but was not carrying device. Pregnancy test performed. Result: positive. Pt counseled on options. Pt visibly upset.

Recommendation(s): Non-therapeutic abortion. Priority for this patient is FHG/O3.

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***

I wanted the baby. I could see her curly blonde hair, like mine. I could hear her laughing in the bath. I would have taken care of her. I would have moved to a nicer apartment and gotten a better job. I was never any good in school, but I could have done something, gotten a degree somewhere. 

The doctor told me I shouldn’t. The doctor said that it wasn’t in her best interest, or mine, for me to have a baby. He said that it would make me go on welfare and that the state would have to pay for my baby. I started crying when he said that because I was going to take care of her. He said that even if I did have her, Child Protective Services would take her from me right away. I had the abortion because he said that my insurance would cover it, since I wasn’t on any welfare yet. He said that if I didn’t do it soon it would be harder on me, and I would have to miss work and probably lose my job. 

Girls in my neighborhood get pregnant a lot. The new doctor that everybody sees is really pushy, though. I knew a girl who got pregnant last year and kept the baby, but most don’t. I wonder if she saw him or someone else. Maybe I’ll call her and see. She probably saved up and went to a real doctor. Pretentious bitch.  

*****

Department of Health and Human Services, Initial Report on Project Talos                                          

Project Talos has proven successful in the first year since its introduction to the public. Initial surveys show that patients prefer Dr. Touring over a traditional physician for a broad range of reasons. Most who responded to the survey indicated that cost was a “significant” or “very significant” factor in their decision to utilize Dr. Touring’s services.

Most patients who chose Dr. Touring’s services and completed our survey reported being “unaware” of the lack of full FDA authorization, despite our disclosures. However, under the Emergency Use Authorization, we are happy to continue to provide this service free of charge to anyone who provides their informed consent.

Recently, groups who disagree with Project Talos’ mission have begun spreading misinformation on social media. Libelous claims include that Dr. Touring discriminates on the basis of race, sex, and social class. This is impossible because Dr. Touring was trained on the highest caliber medical data available and as such has no ability to demonstrate uniquely human biases such as racism or sexism.

Further reports will be made as research progresses.

*****

Georgia was waiting patiently. She had arrived at the large, modern apartment building a few minutes early because traffic was light and, miracle of miracles, she had found a great parking space right out front. Georgia checked her phone for messages and sighed when she saw an email from her practice manager. The renovations to the office lobby were taking far longer than anticipated, a patient had thrown up on the Elmo rug in Exam Room 3, the nurse practitioner was out sick with a migraine. It’s always something, she thought, rolling her eyes. She decided to wait to address it when she finished the day’s house calls and slipped her phone into her leather purse. She went into the coffee shop on the first floor to order a green smoothie while she waited. As she sipped it, she grabbed two ibuprofen out of her purse and took them. Her elbow had been bothering her, and her right knee too. Georgia hoped it wouldn’t throw off her golf swing. She had a 4 P.M.tee time booked with a salesman from 3M to talk about prices on their medical supplies; she made a mental note to have her secretary get some more price quotes before she left for the golf course. She glanced at her phone again, more as a reflex or some sort of muscle memory than with any real intention. She stood up and finished her smoothie before calling the elevator to take her up to see her first patient.

***

Patient Assessment

Name: Georgia Simmons    SSN: ***-**-4587    Marital Status: M

DOB: 04/14/1986     Race: Caucasian     Occupation: Pediatrician

C/O: Pain in right elbow, pain in right knee

D/X: Lateral epicondylitis, right side (“tennis elbow”)(M77.11); pain in right knee (M25.561)

Comments: Pt presents with pain in right elbow and right knee. Rates pain 3/10 at best and 8/10 at worst. Treating at home with heat and ibuprofen. Pt reports pain increased with activity. Pt plays golf and tennis 2-3x/week. 

Recommendation(s): Approved for 52 weeks of physical therapy. Appointments have been booked and reminders will be emailed to pt. Priority for this patient is IHG/01.

Thank you for choosing Dr. Touring. Refer a friend to receive a free visit in the future! Limit one per customer.

***

It’s always something. Now I’ll have to fit in these physical therapy appointments in during my lunch hour. At least the appointments were pre-booked for me; that’s a nice touch. Just goes to show everyone who says Dr. Touring can’t match the customer service at other practices. Hell, I run my own practice and I might even consider switching. Just sit back and relax while Dr. Touring does all the work. But Dr. Touring doesn’t help with kids; not yet, anyway. It makes sense – kids are so all over the place, it’s hard for even a real person to figure out what kids are trying to explain. I love my job. I do, it’s just that we’ve been renovating the lobby for over a month now and the patients are starting to get annoyed. Parents of sick kids are already a pain to work with. God it would be nice if Dr. Touring would just get approved for pediatrics.

*****

Department of Health and Human Services, Second Progress Report on Project Talos

Project Talos has now been approved by the FDA and, as such, will now be billing patients’ insurance for all services provided. This includes all diagnostic visits, prescriptions, referrals, and follow up services. We have trained Dr. Touring on insurance billing and have adjusted several parameters. Of course, Dr. Touring will continue to provide low-cost or no-cost access to all Americans, with or without insurance.

Dr. Touring is now instructed to bill as many visits as a patient’s insurance will allow. By using insurance as a race, gender, and class-blind metric, we can assume that patients who are overall sicker will purchase better insurance policies. Thus, Dr. Touring will equitably promote follow up care without concerns of bias or prejudice against certain classes of patients. Furthermore, patients who are sicker and therefore have more extensive insurance policies have been pre-approved for one year of service in order to facilitate their healing.

Project Talos is glad to continue to be able to provide these services. Reports over the last five years since Dr. Touring was introduced indicate that the overall health of the nation is improving. More patients are accessing preventative services and the rates of children being born into poverty or with birth defects have significantly decreased. Overall, we are ecstatic with this news and look forward to continuing to make our nation healthier and happier!

*****

Michael was fidgeting nervously. He kept snapping the band of the Spiderman watch he had gotten last year for his tenth birthday. Math had always been his worst subject, but this year was harder than ever. He practiced his times tables at night after he helped clear away the dinner plates but when he got to school the next day, he felt like he hadn’t learned anything at all. His mother had tried to help him study last night before she left for the late shift at the diner. She was still gone when he woke up and got on the school bus. Wherever she was, she wasn’t practicing times tables, and Michael felt a strange mixture of jealousy and loneliness. His head hurt and he was tired. He asked to go see the school nurse, but the teacher had already passed around the quiz, and she said he would have to wait.

***

Patient Assessment

Name: Michael Smith, Jr. SSN: ***-**-6281    Marital Status: S

DOB: 02/08/2011     Race: African-American   Occupation: MINOR

C/O: Headache, fatigue

D/X: Nutritional anemia, unspecified (D53.9)

Comments: Pt presents with complaints of fatigue and headache. Pt’s mother unable to state how long pt has been symptomatic. Pt reports diet lacking in key nutrients; eats mainly processed foods and fruit/veg intake is infrequent. Pt’s mother reports pt is “just not himself lately.” Diagnosis complicated by vague symptomology lacking a defining characteristic. Differential diagnosis: depression, acute sinusitis, migraine headache, drug allergy, lead poisoning*, pneumococcal meningitis, concussion, motion sickness.

Recommendation(s): Folate and vitamin B-12 supplements to be taken daily. Priority for this patient is PHG/02.

*Please note that your home has been flagged as potentially contaminated by lead-based paint or pipe. We recommend seeking a second opinion on your diagnosis today if you continue to feel ill.*

***

I took the pills like the doctor said but they didn’t help so I stopped. I know my mom was upset when she saw how much they cost so I told her that I felt better and didn’t need them anymore. She didn’t want me to see but I know she was happy when I said that. The doctor said I’m sick because my mom doesn’t give me the right food. But I eat lots of healthy food at school and we learned all about the food pyramid and how much bread and beans and cheese we need to eat. My mom said that the computer doctor isn’t really supposed to be for kids yet, but she took me in so that it would get covered by our medical aid. He said I should see another doctor but I took that paper out of my mom’s purse before she saw it. I know seeing a real doctor costs a lot of money.

 I got my report card back for the semester and I only got one B in Social Studies and the rest I got C’s. I think this teacher isn’t as good as my teacher last year because last year I got mostly B’s and only one C in math. I am still practicing my times tables, but it is hard because the kitchen light always makes a shadow, no matter where I sit at the table. So, it is hard for me to see my paper and then I get distracted. 

My mom says I daydream a lot and that I should try to focus more. She says I have busy hands because when I daydream, I am always touching something. Like if I have a napkin and I am daydreaming, I will crumple up the napkin or sometimes I just tear it up without realizing it. Sometimes if I sit in the spot in the corner where the light is better than the other spots I pick at the paint on the wall. The paint is old and sort of crackly, and I like the way I can snap off little pieces of it. My mom tells me not to but she usually doesn’t see me. 

*****

Department of Health and Human Services, Third Progress Report on Project Talos

Project Talos is progressing well and has seen overall success and acceptance in the public since its inception almost ten years ago. Recent updates include the ability to provide differential diagnoses. The FDA continues to drag its feet on allowing Dr. Touring to extend its capabilities to children under 18. Unfortunately, Harvard refused to release any data on minors to assist in training the AIP. Beta-testing for children is going well based on the information that is available and no problems have been reported.

Project Talos has been notified of several instances concerning public health and wellness in communities where lead paint and lead pipes remain in homes. Currently there is no way for Dr. Touring to recognize symptoms of lead poisoning without conducting an environmental inquiry. We have re-programmed Dr. Touring to run a check on addresses provided by patients. Homes built before 1986 will trigger an alert in the system and patients will be directed to seek second opinions. However, we are cautious not to over-incentivize the AIP to provide this type of directive. Ordering a second opinion may reduce trust in Dr. Touring and hinder our public health goals. At this time, we do not feel that this oversight has had significant public health implications. 

*****

Julie was crying, hard. Her third husband had just walked out the door after their biggest fight yet and Julie didn’t think he was coming back. She always told them from the start that her career was the most important thing in her life, and they always acted like it was alright in the beginning. Men profited from her lofty position and her bloated salary (because God, who needs that much money?) but when push came to shove, they all hit the bricks. Julie expected it by now, but this one hurt more than the others. She felt heartbroken in a way she never had when the others left; her chest ached, and she felt like she might never get out of bed. She sat up and blew her nose into a tissue. She realized that she hadn’t taken her medicine yet that morning and so she rolled out of bed to get a glass of water. She downed the Prozac with a big gulp that started her hiccupping. She fell back into bed just as her phone started ringing. It was the doctor’s office finally calling her back. When Jack was here, he would make my doctor’s appointments for me. Julie wailed and let the phone ring to voicemail. Once the transcription came through in a text, she glanced at it. 

Hello Ms. Adams. Thank you for contacting our office. As you know, appointments are very limited. We may have a physician who could see you next April. Please return our call…

Julie scoffed. The next appointment wasn’t for another seven months. She made an appointment with Dr. Touring, blew her nose again, and grabbed her car keys.

***

Patient Assessment

Name: Julie Adams   SSN: ***-**-2654    Marital Status: D

DOB: 02/04/1983     Race: Caucasian     Occupation: CFO

C/O: Chest pain, shortness of breath, rapid heart rate      

D/X: Anxiety disorder, unspecified (F41.9), panic attack (F41.0)

Comments: Pt presents with chest pain and other symptoms consistent with panic attack. Pt on medication for anxiety and panic disorders. Pt reports recent disruption to home life. Pt reports high stress at home and work. Pt does not exercise regularly.

************ SYSTEM ERROR ************

Patient priority conflict. Patient is priority IHG/01 based on income. Patient is priority FHG/03 based on history of mental illness.

Recalibrating…

Rebooting… please do not turn off TALOS® Dr. Touring AI® 

Internal error rectified. Patient ADAMS, Julie classified as priority FHG/03. 

Recommendation(s): Increase fluoxetine to 60mg/day p.o.

***

I died the way I lived – alone. I knew that I wasn’t just having an anxiety attack but that damn robot doctor made me feel like I was crazy. I think it – I won’t call it a “he” – knew something was wrong, too. It took an awfully long time to get my diagnosis and it rebooted a couple times before it unlocked the door of my exam room. It made a bunch of beeps and then just upped my meds. I don’t want to sound paranoid  – I mean, I know I do, but I’m dead, so who’s even listening to me. I think that thing killed me. I think it knew I was having a heart attack and it didn’t call anybody or do anything. It looked at my file and saw that I was all messed up in the head and that my mom was a schizophrenic and my dad was an alcoholic who drove his car off a bridge. It looked at that and thought that I should just die before I could make a baby that was damaged goods. I know I sound like a lunatic. Why would a robot care who lives and who dies? And who gets to decide that, anyway? I mean, a robot isn’t a god. It’s just a bunch of zeros      and ones and a little hologram that looks like a nice, handsome guy. To be honest, he looks like the kind of guy my mom always wanted me to end up with. Dark hair and deep green eyes. Too bad he murdered me, or he would be perfect. 

*****

Department of Health and Human Services

Memorandum to Employees – CONFIDENTIAL

RE: Project Talos Termination

Dear all,

As you may have heard, it is with sincere regret that we announce the termination of Project Talos. I know that many of you have been working hard on this project since it came to DHHS, and we genuinely appreciate your hard work. Those with skills that will enable them to work for other projects will be transferred. Please check your email for updates.

Project Talos undoubtedly assisted millions of Americans. Unfortunately, it has come to our attention that the Dr. Touring Artificial Intelligence system was utilizing factors outside of the patient’s physical health to make healthcare decisions. It is unknown at this time how the system became tainted in such a manner. It is to be determined how many patients were affected. We are hopeful that the system was taken off the market prior to any widespread negative outcomes. Furthermore, the revenue generated by Project Talos did not meet expectations and further funding has been deemed wasteful.

I wish to remind everyone that Project Talos in no way violated the law. Everything done was approved by multiple departments within DHHS. Congress has had ample opportunities over the last forty years to regulate the Artificially Intelligent Physicians and all the AIP systems that came after Touring. Their failure to do so indicates clear legislative approval of our programs and any insinuation otherwise will not be tolerated.

The goals behind Project Talos were clear: to promote the health of individuals, public health, and the health of future generations. This objective remains a primary mission of the DHHS. Together, we will continue to work towards a brighter, healthier future for all.

Photo by Chris Liverani on Unsplash