GOP Debate, AI in Medicine and the Right Wing's New Favorite Song with Co-Hosts Louie Swisher and Dr. Jeffrey Swisher

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Kara Swisher: Hi, everyone. This is Pivot from New York Magazine and the Vox Media Podcast Network. I'm Kara Swisher. As Scott 3 August continues, and it's going rather well, my co-hosts today are two of my favorite people, my son, Louis Swisher, and my brother, Dr. Jeffrey Swisher. Say hello, boys.

Louis Swisher: Hi, Kara.

Jeffrey Swisher: Hi, Mom.

Kara Swisher: Hey, Louis. Hey, Jeff.

Jeffrey Swisher: Hi, Mom. How's it going?

Kara Swisher: It's going good. I'm glad to be back.

Jeffrey Swisher: I know. I'm glad you're back, too.

Kara Swisher: I'm so thrilled you're here. Explain where we are, Louis.

Louis Swisher: Well, we are currently in a very beautiful old house in Ann Arbor, Michigan, here to drop off my charmingly lovely little brother at Michigan. It's going to be a big year for him. I'm very excited.

Kara Swisher: Yeah. And where are you headed?

Louis Swisher: Oh, me? Me voy al sur. I'm going to Argentina. I'm very excited.

Kara Swisher: Yeah. You're leaving your mother. You're leaving your mother to go to Argentina for the year. Are you excited?

Louis Swisher: Yes. I'm very excited. I think it's going to be a great adventure.

Kara Swisher: Why are you going to Argentina? Explain for the people why.

Louis Swisher: I am going to Argentina because I am studying inter-American politics and all the terrible things our government did in Latin America over the past 100 years. And I'm also a student of fascism, according to my grades last semester, a grade A fascist. So I am very excited to learn more about fascism within the Latin American context and try to apply those lessons here to the United States.

Jeffrey Swisher: Yeah, Kara, don't cry for Louis for Argentina, okay? Because, you know, anyway that's a joke. God, you're not going to be. Don't try to be a bad Scott Galloway.

Kara Swisher: I'm not trying to be Scott. But Louie, I got a question. Is Alex going to be in one of those super high-rise dorms when he goes to Michigan for his housing?

Louis Swisher: No, I don't actually think so. I heard he's... I don't know the exact name of his dorm, but I remember when I came here a month ago for his orientation tour, we went to his dining hall and apparently it's the best one, which is good for him because he's a black hole of consumption.

Jeffrey Swisher: Yeah, there's some advice I want to give him is about high-rise dorms. Do not have sex in elevators because it's wrong on so many levels. Just kidding.

Kara Swisher: Oh, my God.

Louis Swisher: Yeah, that's the theme of today's episode. So it begins.

Kara Swisher: All right, dad jokes.

Jeffrey Swisher: No, no, these two were last night. Last night, they were trading dirty jokes.

Kara Swisher: One of the functions of my brother is to be the obnoxious dad joke guy for my sons. And it's worked out rather well for all of them, except for me. Last night was the bottom of the barrel of all these jokes they were telling.

Jeffrey Swisher: Somebody's got to do it, Kara. It's a hard job, but somebody's got to do it.

Louis Swisher: It is. I am a student of the uncle, and I am ready to carry the torch of the terrible jokes.

Kara Swisher: Okay, please don't. Please don't. This is bad. I should have never introduced you. Let me ask you a question, Louis, before we get to our big stories. College is going well, I think, for you. You're liking college, correct?

Louis Swisher: I am, yeah. My sophomore year was a lot better than my freshman year.

Kara Swisher: That was quite a year. You had the pandemic, yeah.

Louis Swisher: Yeah, yeah. You took a year off. People, I've talked about that. Yeah, gap years are great.

Kara Swisher: But on a scale of one to ten, how influenced have you been by Scott Galloway?

Louis Swisher: By Scott Galloway? Oh, there's not a moment I go without his influence. I think I carry it with me. I carry the algebra of happiness on me every day. I read it. I quote it like the Bible.

Kara Swisher: You do.

Louis Swisher: I think Scott is excellent. I really, I think he's a lovely man who does a lovely podcast with my lovely mother. And it's just a really exciting, bright light to be around. While that light can sometimes burn a bit hot, I think sometimes we need that in our lives.

Kara Swisher: Yeah, we do. You were excited about his book about men, right? You wanted to talk to him. You had some thoughts.

Louis Swisher: It's interesting. I mean, modern, as a son of women, I get asked all the time about modern masculinity and the collapse of masculinity and yada, yada, yada. And I'm just like, buddy, it's just changing. The one constant has changed. So why don't we just all get on board with this train? And also, my life doesn't necessarily need to affect your life.

Kara Swisher: Yep, that's right. Mind your own business so you won't be mind and mind saying Hank Williams. That's a great song.

Louis Swisher: Great song. Hank Williams, go listen to him.

Kara Swisher: Anyway, today we'll talk about the first GOP primary debate of the 2024 election, the pros and cons of artificial intelligence in medicine, and the song that seemingly came out of nowhere to light up the charts. But first, in my latest episode of On With Kara Swisher, I talked to Ronan Farrow about his new piece on Elon Musk. Farrow details Musk's isolation and how his use of ketamine and other drugs may be impacting his decisions. Let's listen to a clip.

Ronan Farrow: [Clip] Ambien, ketamine, weed are all substances that can be taken legally and safely. And you might have varying views on how healthy each of these things are. But there's certainly a valid defense of a healthy use of all of them. Nevertheless, this picture that emerges when you talk about him with people who are close to him and even care about him is of a person who's under tremendous stress. You know, maybe grapples with... I'm not going to diagnose the guy and say depression, but certainly he's talked about sadness, loneliness. And those kinds of substances in excess can be ones where you would be concerned if someone is in bad shape emotionally and using them to excess again in sensitive contexts like launching rockets.

Kara Swisher: What a cocktail. So I know. Right. We'll get to your thoughts on drugs in a second, Louis. But Jeff, talk about this, because let's just say first alleged use of these drugs. He's talked about his use of Ambien. He's talked about his problems with opiates. He's tweeted about it. And many people, the Wall Street Journal had a story about this. He doesn't shy away from talking about this issue.

Jeffrey Swisher: I mean, Elon's always had sly references to drug culture. The whole thing on the price of a Twitter stock, 440 and 420. And 420 in marijuana and smoking on, I guess it was Joe Rogan. Was he smoking a joint on a show? The thing about this, he's always sort of been kind of an edgelord and that's kind of how he sees himself, I think. My concern is that that kind of behavior seems to be getting worse over time. Obviously, I read the article in The New Yorker by Ronan, which was fantastic and extremely comprehensive. And I actually saw today on Twitter, or not on X, Elon basically said Ronan was the enemy of the people. It's a little concerning. The drugs that purportedly he's using, ketamine is a dissociative anesthetic. I use ketamine almost on a daily basis in my patients, and it's a very effective drug. There's a lot of research being done on ketamine, its use in depression in smaller doses. But in higher doses, ketamine is a very powerful dissociative anesthetic, which is what I use it for, for patients. It could be problematic because judgment can be impaired and it can create issues. Ketamine combined with a benzodiazepine like Ambien, or I use midazolam, which is a shorter acting amnestic agent, it takes the edge off ketamine and I'm using it in lower doses and intravenously. I don't know whether Elon is using it intravenously or orally or intramuscularly. But in higher doses, it's got more significant effects.

Kara Swisher: Can there be an abuse of it, just the way there can be abuse of opiates?

Jeffrey Swisher: Yes, of course. There are types of abuse. Opiate abuse is different. Opiate addiction is different than I would think ketamine addiction is. There are opiate receptors in the body that are naturally occurring. Opiates are addictive physiologically as well as psychologically. I think ketamine is probably more addictive from a psychological standpoint than a physical standpoint. I don't know of ketamine withdrawal, for instance, whereas you can have severe opiate withdrawal. There's also a threshold effect of ketamine to a point. At some point you go to sleep. It can be used as an induction agent to make someone fall asleep. So I don't know about long-term effects, but it could certainly impair your judgment.

Kara Swisher: How do you look at this when you hear about these things?

Louis Swisher: I don't know. I've always viewed him with kind of a cautionary glance because I don't trust him. I think that he has an agenda based in his companies that he wants them to do well, as well as his personal agenda as an edgelord trying to instigate conflict among people and stir the pot. To quote the great Timothy Leary, it's all about mindset and setting. If somebody is a corporate figure who has a lot of responsibility on them and continues to add responsibility by purchasing companies that used to be called Twitter or engaging in missions to space, I think there becomes a scale. Do you want to balance your recreation or do you want to have these debts and dues that you owe to the people that you're employing, to the people that are on your board, to the people that are believing in this idea that you're creating? You're not a teenager in the basement. It's fine to experiment and to change consciousness. I'm an advocate for that. I think it can open a lot of thinking channels and ways of getting to understand yourself and the world around you. But still, you have to look at it with a bit of realism and realize that Elon, you're much bigger than you are. I think these drugs might be having an impact on his business and on his empire.

Jeffrey Swisher: The one thing I have to say, the take-home message that I took from reading Ronan Farrow's article is just how powerful Elon Musk is in so many aspects of our life. The part about Ukraine was chilling. At a decision that he makes to flip the switch off of Starlink, it could result in thousands and thousands of deaths almost instantaneously. That was chilling to me. In addition, not just Twitter, Tesla. How many thousands and thousands of vehicles are driving around with software he developed?

Kara Swisher: Which you have.

Jeffrey Swisher: Which I have a Tesla. And I have to say, I do not necessarily trust the self-driving aspect of that car.

Kara Swisher: Louis, does it impact what you would buy?

Louis Swisher: I certainly think it does, to some extent. I'm a big fan of the Mini Cooper I've been driving since 2018. I don't think I'm going to drive any other car. But Tesla has a huge impact. Elon also has a huge impact as an individual. There's the corporate side and there's the personal side. He seems to be trying to separate those and still be the fun uncle on the internet kind of guy. But it's really not fun. And it's not funny.

Kara Swisher: I like to use the word uncle because he thinks he's young. Did you like the cage match? You wanted to go. You and your brother wanted to go, which I was horrified.

Louis Swisher: Hell, I'd love to watch billionaires beat each other up. That sounds like a great afternoon.

Jeffrey Swisher: Your mother wanted to go as well. She wants us to come with me. I think she'd have a great time.

Louis Swisher: But yeah, I think that it is kind of a distraction. I think that it's just trying to put up a big PR event to get us to talk about something else other than the responsibilities that both Elon Musk and Mark Zuckerberg face in the 21st century. And they'd rather have us talk about them fighting.

Kara Swisher: You're wise. Thank you. All right. I'm going to bring up another thing. The right has a new anthem. "Rich Men North of Richmond" by country singer Oliver Anthony has attracted praise from people like Marjorie Taylor Greene, Kari Lake and Matt Walsh. The song is based around complaints about political elites, taxes and obese welfare recipients. The song has so much traction. It debuted at number one on Billboard Hot 100. Anthony is the first artist to ever top the chart with no prior chart history of note. The artist has a playlist of conspiracy theory videos on his YouTube account. Let's listen to a clip.

Oliver Anthony: [Clip] I been selling my soul working all day / Overtime hours for bullshit pay / So I can sit out here and waste my life away / Drag back home and drown my troubles away / It a damn shame

Kara Swisher: First, you, Louis, what do you think of the song?

Louis Swisher: Well, he's no Dixon Dallas, but I think that it's definitely...

Kara Swisher: Explain Dixon Dallas.

Louis Swisher: Dixon Dallas is a hit maker, that's all I'm going to say. But this song is a low and slow... He's hot on Reddit. He's just all over the internet. He loves to make gay country songs, and they're just absolute hits. I don't know how he does it, but catchy songs, bops.

Kara Swisher: Okay. Everybody check Dixon Dallas.

Louis Swisher: Yeah, Dixon Dallas. Good looking. It's filthy. That's a great one. [Singing] Every day we spend together, I fall more into him. That boy, he takes my breath away. I can't find the words to say. So I wrote this little note. Kiss it, seal it so you know I've got some time. If you've got some time too.

Kara Swisher: What do you think of this guy? This song, when I first heard it, I heard it like a working man's anthem at first. And then I listened to it again, and I kind of heard the dog whistle. And then I listened to it again, and I really heard the dog whistle. So I think that within this message of a man who's trying to vocalize his frustrations with the modern complex and modern situation and get back to a day that was simpler that he can better recognize when things were easier. I think within that, he's pushing an agenda, perpetuating stereotypes like the welfare queen and disregarding basic elements of the commonality that we all share. Because I think within that message is a cry of pain that a lot of Americans feel. But then with that pain, he's kind of poking at others and tearing others down rather than just asking the real question of why. Why are we all hurting like this? And what can we all do together? I think you made a good point talking about the rich men north of Richmond.

Kara Swisher: Let me ask you one more question then, Jeff. I'd love, cause you're a musician. You listen to a lot of music, Louie. Do you think this guy has talent?

Louis Swisher: I don't really listen to this kind of music. But yeah, he's got a nice voice, he can play the guitar.

Jeffrey Swisher: So a couple things. I love his dobro. I think that dobro is the type of guitar he's playing. It's a kind of nice sound. I like the melodic transition. I like his switch. His bridges are good. I think he's a good singer. He's fine. It's a little yelly, a little Mumford & Sons yelly for me, and that's not my favorite kind of music. But the thing about the song lyrically, it's all over the map. From the beginning, selling his soul for shitty pay. Check. Number two, the world is changing. Yes, it is. Check. And then he goes into drug overdoses, which is a horrible problem. People burying themselves six feet in the ground. And then, of course, taxes. Nobody likes taxes. So I think the song would have been better if he had just kind of stuck to a few themes. Some people are hate listening to it. There's a bunch of these things like "Sound of Freedom." There's definitely want for this content. People like Ben Shapiro are doing a lot of programming and children's programming. I think this is fine. This is great. And it's always been here. I think many years ago when Louie was a kid, remember VeggieTales, Louie?

Louis Swisher: Oh, yeah.

Jeffrey Swisher: I thought they were fine. There's definitely some subliminal messaging. When you look at them now, you're like, whoa.

Louis Swisher: By the way, there's rich men south of Richmond. The one thing that kind of confuses me though is that whenever people get angry at the government, people get so pissed off at the federal government when it is in fact the state and local government that has the biggest effect on your day-to-day life. I don't know why there's not a song about the Richmond at the Capitol House rather than just in DC. Why the focus is on this lovely place where I've spent seven years where a lot happens and there's a lot of influence. But in reality, it's the politicians that live within your zip code that have a larger effect on your life.

Kara Swisher: All right. Stop talking sense, Louis Swisher. All right. Let's get to our first big story. The first debate in the 2024 Republican primary is happening this week in Milwaukee. We're recording ahead of time. So by the time you listen to this, the dust will have settled or it'll just be dustier. Eight candidates qualified for the debate, including Ron DeSantis, Mike Pence, Chris Christie and Vivek Ramaswamy. Sadly, my guest co-host Will Hurd did not make the cut, and he's pissed about it. He said he did. One candidate not in attendance, the frontrunner, Donald Trump, who announced that he would be skipping the debate, citing recent polls that showed him leading in the field by legendary numbers. That's according to Trump. Trump is staying busy, however, doing an interview with Tucker Carlson that will be posted on Twitter on debate night, of course, surrendering in Georgia with a bond set at $200,000. That's for Thursday. I think I know the answer. Will either of you be watching this debate? Let's start with you, Jeff.

Jeffrey Swisher: No, actually, I'm going out to a birthday dinner. I am going to record it, though, because I do want to watch it.

Kara Swisher: Why do you want to watch it?

Jeffrey Swisher: Well, it's interesting. I think the issue of the elephant in the room is the fact that Donald Trump is not there. I really would like to see these guys develop some spine about Donald Trump. The man is found liable for rape. He should have been disqualified in the last election. He made fun of disabled people. The Access Hollywood tape would have knocked anybody out. We're old enough to remember when Mike Dukakis was pilloried for wearing a helmet that was too big in a tank, when Jimmy Carter was pilloried because a rabbit chased him in a rowboat, and when Howard Dean got knocked out by his famous yell. Any one of the things that Trump has done should have made him literally not qualified to run for president. But it didn't. The voters love him. I understood some voters love him. I would like them to discuss the fact that this man is eminently not qualified by character, by experience, by actions, et cetera. And he had a failed presidency. I think that's something that they should discuss.

Kara Swisher: Well, they're not going to.

Jeffrey Swisher: Well, you don't know that. They might. Obviously, Chris Christie will.

Kara Swisher: Louie, we're going to watch the debate, aren't we?

Louis Swisher: Yeah, I'm pretty eager to watch this debate. I am always a fan of these debates.

Kara Swisher: Why? Tell me why.

Louis Swisher: Well, they're damn entertaining, first and foremost. It's going to be a bit less entertaining now that the big guy's not there. But to some extent, yeah, I agree with Uncle Jeff that I think this is going to be an opportunity for the candidates to finally distance themselves and define themselves other than Donald Trump. Will they do that? I don't know. I think probably they will toe the line and just continue to kiss his ass and beat down Ron DeSantis, demonious as he is their leading contender.

Kara Swisher: Do these debates matter?

Louis Swisher: Yes and no, because what is said on that stage necessarily doesn't matter. They're just talking. They could be lying. They could be making false promises. They could be leading us in other ways. But the impact of these debates surely matters. Go back to the first one, Nixon versus Kennedy. Huge debate swung the election in the way of Kennedy in a huge way, and not necessarily because of what they said, but how they looked on stage. The fact that Donald Trump is not on that stage, it's going to be a very interesting look. I don't think it's going to hurt him that much that he's not there on that stage, but I think it's not going to help the other candidates that much either because honestly, I don't know if they're going to be able to swim without that big guy.

Kara Swisher: What are you looking for? As you voted, you voted in the last presidential election, right? Did you vote?

Louis Swisher: I did not vote in the midterms because I was lazy, but I did vote in the 2020 election. Yes.

Kara Swisher: So this is, as a younger person, I'm sorry to put it all on you as a younger person, you think this is important to listen to what they want to do, correct? To hear them out.

Louis Swisher: Yeah, I think it's definitely important to take any opportunities to hear what these people who want to run our country say. Because not only, even if they don't run the country, what they say and who follows them really can tell us a lot about how the country feels. I think the most interesting thing for this debate, though, for me at least, is going to be how Fox News moderates it. Because I remember earlier this year with the CNN Donald Trump town hall, I was furious at the screen. Can I talk about CNN for a second? Because I thought that they were just trying to cover their ass. That poor woman on stage. She's a very good reporter. Very, very. That night, she might have had the toughest job in America. But I thought that CNN was only really covering Donald or trying to check back on Donald when CNN could be held legally liable, as in whenever he lied about the presidential election. But when he talked about how there was going to be an abortion ban or something like that, or how abortions are allowed up until when the baby was born, there was no check back. There was no rebuttal against Donald for these lies he was spreading on national television. Donald's not going to be at this debate, but I just want to see how Fox News conducts themselves and how they moderate this debate and how they allow people to speak, how they allow people to ask questions, how they allow people to challenge each other. I think that's going to be very revealing of the way this organization is going and of the coverage climate of this election.

Jeffrey Swisher: Louis raises a really good point about the CNN town hall with Trump. It wasn't a debate. It was a town hall. The fact that unchecked lies like Louis raises the abortion issue. I tweeted about this, live tweeted about this when it was going on, about this persistent lie that is not immediately countered when people make this thing about abortion to the time of birth or even after birth. That's just insane. Let me tell you, as a physician, that does not happen. It's not a thing. And yet it's made a thing, and then it becomes a cultural meme as if it is a thing. They really need to fact check more carefully.

Kara Swisher: Yeah, I would agree. Now, Trump made it clear he doesn't care about this debate and is trying to divert eyeballs over to Twitter with his Tucker Carlson interview. Are you watching that? Louis, are you going to watch that over there?

Louis Swisher: Tucker pisses me off. I can't watch him. It's very hard to remain calm for me when I watch him because he reminds me of somebody who was losing an argument and changes the topic because he doesn't have an argument. He does it in such a way that you think you're losing, but that's a form of gaslighting. I don't appreciate that. I've encountered arguers like that out there in the world. I usually just walk away.

Kara Swisher: Walk away. All right, Jeff, what about you?

Jeffrey Swisher: I can't take Tucker Carlson seriously. He's an overprivileged individual who grew up with the Swanson fortune. He's a rich man north of Richmond. He's a very rich man north of Richmond. He's just hard for me to take. He's so smarmy. He's a clown. I can't take him seriously. Won't be watching.

Kara Swisher: Trump's done a lot of interviews. Now, let me shift over. We've been seeing and hearing more about Vivek Ramaswamy in the last few days, thanks to rising poll numbers and some profiles in The Atlantic where he featured some controversial 9/11 and January 6 comments. He posted a video on Twitter of his debate prep, a shirtless workout on a tennis court. He has a very whippy forehand, although not bad. What do you think of this guy? Or do you have any thoughts whatsoever?

Jeffrey Swisher: Yeah, he's slick. He's very slick. He's a good public speaker. He's actually not a bad rapper. I listened to his rap. I'm not a connoisseur of rap, but he's not bad. I certainly couldn't do that. But clearly he lies like he breathes. He's been caught in several lies on the news yesterday. I was listening to Caitlin Collins. She's very good. He's just a slipperier version of Trump.

Kara Swisher: Louis, is there any other Republicans you're looking at? Are there any Republicans you think are interesting?

Louis Swisher: Chris Christie intrigues me a little bit. He's kind of like the guy at the house party who yells, we should calm down when the kitchen's already on fire. You could have said that earlier, buddy. But fine, you're saying it now. I think Chris Christie makes an interesting point about attacking Donald Trump. I think he's very late to doing it. I don't think that necessarily clears his record for holding toe and kissing ass. But I think it's going to be interesting to see how, without Donald on the stage, he directs that passion towards the other players. I think he's going to call out the other candidates on the stage. He's going to be the person who's going to be the anti-Trump. If he can bring those other people with him, Pence has been towing the line with that since he was almost hung at the Capitol.

Kara Swisher: Is it going to work, either of you? Or is it just Trump the candidate?

Jeffrey Swisher: It's not going to work. No, Trump's the candidate. Unfortunately, he's just... yeah.

Louis Swisher: Yeah.

Kara Swisher: Let's go on a quick break. When we come back, by the way, everyone should vote for Louis Swisher in 20 years. Just FYI.

Louis Swisher: Don't do that.

Jeffrey Swisher: He's got my vote.

Kara Swisher: Yes, you would be an amazing candidate. And I would be like your mom in the background. I might be dead by now.

Louis Swisher: Kara putting the nepo in nepotism. Yay.

Kara Swisher: Anyway, let's go on a quick break. When we come back, I'll be asking my brother, the doctor, to weigh in on the benefits and dangers of AI in medicine.

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Kara Swisher: Louis and Jeff, we're back with our second big story. Artificial intelligence seems to have infiltrated all aspects of society these days, and medicine is no exception. Hospitals are now pouring hundreds of millions of dollars into AI software and education, and companies like Amazon, Microsoft, and Google are entering the healthcare space with AI tools to transcribe doctor-patient conversations, quickly provide doctors with medical knowledge and more. But in spite of all the innovations and investments, a Pew Research Center study earlier this year revealed that 60% of Americans would feel uncomfortable if their clinician relied on AI to diagnose or recommend treatments, and 33% think it would lead to worse outcomes for patients. Louis, I will have some questions for you. I'm going to focus on Jeff here. You're on the front lines of all this, and you've told me various things of how you use AI in your work. I'd like your overall thoughts and then some specifics, and I have some questions. So AI, obviously, is going to be a big player in the future in medicine.

Jeffrey Swisher: It is to some extent, but the true power of AI has not been realized in medicine yet. It's going to come in a variety of forms. Let me just briefly go over it. The New England Journal, which is one of the flagship publications for medicine, has a new website: ai.nejm.org. They're going to have submissions about how AI can be used in medicine because frankly, most doctors don't really know how AI is going to be used. It's a very small number of people who are very aware of how AI is going to be used. Let me point out some of the big ways. Number one is data management, integration of clinical data, note writing. When you generate a medical note, you often recreate the wheel every single time. Already with electronic medical records, that's being done to some extent with a lot of copy and paste. But AI is going to do it in a much more organic way, as well as interviewing patients. It will listen to your interview with a patient, and just like a scribe does now in a hospital, the AI will listen to the interview and transcribe what's going on. It will allow you to memorialize a care plan for a patient, their hospital course, any information that happens, their history. It gives you a cohesive patient map about that individual in a way where it can utilize the strengths of AI and hopefully fix things like medical errors in drugs, procedures, and not having an adequate history. That's the biggest strength of it. Secondly, people don't think about it, but insurance integration is going to be helped by AI because right now how we bill for medical insurance in this country is insane. AI will hopefully help streamline that. It will allow doctors to bill more efficiently, and it will also lead to cost savings. The third is actual care management. This is where someone like me, a person on the front lines, comes in. It will allow me to have a vast medical database that allows me to look at everything in medicine, even rare things. Pattern recognition—people like radiologists and pathologists run the risk of being made obsolete, but I think mostly it's going to be like this: think about a hammer. A carpenter uses a hammer, which is a tool. Now imagine the next tool is a nail gun, and then the next one is a laser-guided nail gun. These things allow better use of tools and allow physicians to use their skills with something like AI to provide better care for a patient. For someone like me who's an anesthesiologist, my specialty is liver transplantation, solid organ transplantation. In a liver transplant, you often have a very sick patient with a wide variety of medical problems in a very challenging situation where an entire liver is being removed and their circulation, blood pressure, cardiac output, and vascular resistance changes on a dime due to what the surgeon is doing. I have to deal with blood loss, coagulability, all these kinds of things. In an AI situation, let's take a patient with what's known as vasoplegia, where they're not responding to the typical drugs I use to raise blood pressure. An AI algorithm can help me decide based upon a series of data what the best course of action is in real time, which I can choose to accept or not, but it helps me think on my feet.

Kara Swisher: So it gives you more. It's like a smart person in your ear, right?

Jeffrey Swisher: Exactly. It's exactly like a smart person in your ear. It can't supplant what I do. An AI is not going to intubate my difficult-to-intubate patient, but it can certainly give me ideas in real time on the fly.

Kara Swisher: Which is helpful to you. We talked about the makings of a great business plan for you. A second opinion AI for doctors. Are you off and running with that?

Jeffrey Swisher: I am actually. I did a seed round. I raised about a billion dollars in a seed round and I actually already sold it to Google for $200 billion. So I'm rivaling Elon Musk.

Kara Swisher: Thanksgiving on you, Jeff.

Jeffrey Swisher: Thanksgiving. I am a full-time physician and chairman of a department. In addition to doing all the other things I do, I don't have time.

Kara Swisher: Are doctors getting more innovative? I was talking to one of my doctors who you know, who helped me, and he's got two companies going. Is it time for doctors to be more innovative?

Jeffrey Swisher: Yeah, I wish I had the time to do that. I just don't. I'll be 65 in two years and I'll retire and then I'll do it.

Kara Swisher: Then you'll do it. Doctors have been innovative, but this is opening up a lot of things. Are there things AI shouldn't be used for? I mentioned the stat about people's concern about AI diagnosis, even if they're correct, because I know this is a big shock to people, but doctors don't know everything, as I said to you all the time.

Jeffrey Swisher: They definitely don't. AI, like every tool, has the ability to be used correctly or incorrectly. A doctor, like any tool we use, has to have some background. Look at the case of that lawyer who used an AI argument in court, and it turned out that every single one of the cases he cited was made up by AI. That's concerning. AI has also looked like it's degenerated in its ability to do things for some reason, like mathematical calculations. So you have to constantly trust but verify, I think is the best way to say it.

Kara Swisher: What about the ethical considerations? Senator Mark Warner wrote to Google CEO Sundar Pichai a few weeks ago voicing his concern about possible ethical issues, as well as unproven technology with the company's MedPOM 2 tool.

Jeffrey Swisher: I think people need to know that what they're talking to is a bot and not a human being. I think that's unethical to pass off a person as a human being when in fact they're not. We have to be careful about that. The other thing is they have to make a disclaimer that this thing they're dealing with is not a real person, it's not a physician. Therefore, everything should be verified by a physician beforehand.

Kara Swisher: To that point, just like self-driving, do I trust it? Sort of, but not 100%. Louie, how do you feel comfortable knowing your doctor was using AI for diagnosis?

Louis Swisher: Well, I really enjoyed what Jeff was saying earlier about just having it as another tool on your tool belt. I think that is a very good use of this. You see that across industries. In the legal industry, legal aids are shaking in their boots right now because that is a very AI-able job. I think using this technology in combination with human talent is an excellent usage. When we rely entirely on the robot, that's when things become a bit questionable. I think there is probably an inherent distrust of machines from humans because they're not like us. They are other. We don't see ourselves in them and therefore can't completely trust them.

Kara Swisher: When you're thinking about jobs, you're going to go on the job market, presumably, in the next couple of years. You cook. Someone asked me, what would you like Louis to do? I said he can do whatever he wants, but I would like him to be cooking because you can't AI that. It's not AI-able. Cooking is not, except for looking up recipes. It's a hands-on job.

Louis Swisher: Well, it is, though. It depends. You have people who love to eat Trader Joe's frozen meals, and then you have people who like to cook themselves dinner every night. The former is very AI-able. It's very easy for a machine to crank out frozen meals in a standard package with standard measurements. But there is a human element that people enjoy. I certainly do. As the world becomes increasingly automated and influenced by computers and AI, I think we might lose touch with that human element and desire it a bit more. You see that nowadays. If you have the money in DC, you can sign up for a farm to deliver your milk to your door. That's real old school. There is a desire to go back to simpler human-to-human contact and commerce and connection.

Kara Swisher: Do you think about that when you're thinking about jobs? I don't know if you're thinking about what you're going to do after college, but is that worrisome to a lot of young people? That everything's going to be replaced?

Louis Swisher: Yeah, I think it is.

Kara Swisher: So how do you think about it?

Louis Swisher: I think about it recognizing the fact that I actually can't really think about it. I can't predict the future. I don't know what's going to happen. I would say that most of the jobs that exist today, you could not have predicted 30 years ago. The world is going to change and new jobs are going to go away, certainly. But new jobs are going to emerge and new things are going to emerge to do. I personally, as someone who's culinarily inclined, likes to write, is a student of ideas, I think the realms I occupy are not particularly threatened by automation and AI. But for a lot of people it is. I think there'll be a mixture of combination with AI and machinery as there has been for a while now. There'll also be replacement, but there'll also be an emergence of entirely new sectors and entirely new professions that we simply can't fathom now. So I'm not too worried.

Kara Swisher: Do people your age worry about jobs right now? Is that a big thing they think about?

Louis Swisher: Yeah. A lot of my friends are going into their senior year of college and a lot of them are facing that existential crisis of what do I do now? I think that's a normal thing for people in that transitionary period to experience. But with the way the world is changing politically, economically, culturally, these questions are even more relevant than ever. I don't have the answers. I can't provide any comfort, but it might be all right.

Jeffrey Swisher: So Louis, let me give you some uncle advice and experience here. When I graduated college in 1982, I was an international relations major and medicine was the last thing on my mind. I took exactly three classes as an undergraduate in science: human sexuality, oceans, and G01. That was it. After my year of taking off and living up at Lake Tahoe, I decided I was going to be a doctor for a lot of reasons. You can go to my Substack and read about why if you want to. The thing is, you don't know what the future is going to bring. Carrie will probably say the same thing, when she walked into the Washington Post, into Ben Bradley's office and said...

Kara Swisher: No, I would not. I always knew I was going to be a media mogul, but go ahead.

Jeffrey Swisher: Yeah. I don't think you did. I remember I was there. If you recall, the future is going to happen whether we want it to or not. You're going to change. The tools are going to change. The ability to do things now is so much more. We had to go to the card catalog and look up things. Now everything is at your fingertips.

Kara Swisher: Louie, do you know what a card catalog is? I'm going to stop your uncle-ing here. Louie, do you know what a card catalog is?

Louis Swisher: I plead the fifth.

Kara Swisher: You don't know what a card catalog is?

Louis Swisher: I plead the fifth.

Kara Swisher: See? He doesn't know, Jeff. He doesn't know what a Rolodex is. He doesn't know what a rotary phone is.

Louis Swisher: Oh, I know that one. I know that one because I've seen a toy one.

Kara Swisher: Many years ago, I told the story when I showed them a pay phone, and they were both flummoxed by the entire experience when they were kids in Los Angeles. Anyway, this is fascinating. Thank you, Uncle Jeff. Louis, do whatever you want, but you do need to get a job.

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Kara Swisher: Okay, we're going to do some predictions. I told you guys you had to be prepared, and I'm guessing, Louie, you are not. But you're going to have to come up with some really soon. One I want to note is this story I think everyone should read. The Washington Post has a fascinating story of a Michigan sex educator named Heather Alberta, who lives in a conservative county and came under fire for what she was putting out as a sex educator there. It's an insane story, and it tells me something I've been predicting a lot. All these anti-trans attacks and everything else is all about a larger picture of the strides that gay and lesbian, LGBTQ plus people have made. It's not just about trans, it's about the whole situation. I find it personally threatening. With four kids, although my two older kids are now adults, it still reminds me how terrifying it was, and it will continue to be. I think this is their end game. This is where they're going. Everything they say now, what they are trying to do, is just gaslighting for what they really want, which is to end rights for people that are not straight and probably white, especially in this country. The other prediction I have: I've been predicting the writer's strike will end probably sometime in October. Hollywood Studios have made public their latest offer to writers. They're really interesting offers. Concessions offered include guaranteed minimum length of employment, controls around use of AI, and wage and residual increases. I don't know if it's enough. The union is saying it's not, but it's pretty attractive to a lot of people I've been talking to. It's much further down the pike. When Scott returns in September, we'll be chatting with actor and writer Joseph Gordon-Levitt to get his take on all of it. He recently wrote an interesting op-ed about the use of AI in Hollywood and how he thinks compensation should work. We'll see, but maybe by then or sometime in October, this may be settled. All right, Jeff, you start with your prediction.

Jeffrey Swisher: One of the things I have to say: I do the anesthesia for a lot of trans people having surgery. Number one, minors do not have this kind of surgery, particularly bottom surgery. If they do have top surgery, they have to be emancipated minors. So this whole trope that the right is professing, that these guys are having gender-altering surgery, is just not true. Adults, that's for adults. I work with a lot of these adults, and I have to say they are among the most kind people that I work with. They're very aware of what they're doing. It's a big deal to make this commitment, and you don't do this on a whim. These are people who are uncomfortable in their bodies from a very young age. It has taken a lot of time, effort, psychological preparation, and support from their families. I think we need to be kind to people like that because they're suffering and they have the technology and the wherewithal now to do something about it. It's evil to vilify these people. The doctors who perform this surgery, I think are heroes. Let's do the predictions. Number one: wearable technology has really taken off with the Apple Watch. Every week I have a patient who says they have diagnosed atrial fibrillation with their Apple Watch and they're getting ablations now because of it. I think we're going to see that more and more. In addition to heart rate activity and O2SAT, we'll possibly see glucose monitoring continuously, transcutaneous CO2 monitoring. That will allow people to basically real-time have a record for their physicians. The other thing: I think we're going to see a big increase in genetic and genomic-type testing. The difference is genetic is what you're born with. If you have the BRCA1 gene, if you have cancer, that will allow us to screen people who are at risk and then be able to do early interventions. Genomic testing is for things like colon testing for cancer. There are changes in the DNA of cells that are affected by cancer. We're going to see a lot more of that for a variety of illnesses. I think we're going to be able to design, based on this, what are called bespoke drugs, drugs that will allow individuals to be treated based upon their genomics and their genetics, which is great. I also think that in the next several years, we're going to see a lot more physician's assistants, registered nurse-first assistants providing care in medicine. There is a doctor shortage. There's a severe anesthesiologist shortage. We need to do something about that. All this will allow people to do data group sourcing and to improve medical care and decrease medical errors like drug errors. That's my prediction. I'm really rosy about the future of medicine.

Kara Swisher: Those are good. By the way, just so you know, Dr. Jeffrey Swisher and Kara Swisher are working on a book together, which will include a lot of these things, aren't we, Jeffrey Swisher?

Jeffrey Swisher: We're excited. We like working together.

Kara Swisher: We have a very nice brother and sister. We have another brother, David, who we love too, but he's not going to be working on the book.

Jeffrey Swisher: Well, he might be. You never know. We can recruit him.

Kara Swisher: We can recruit him. He might write the foreword. I don't know. He's busy. He's a smart guy.

Jeffrey Swisher: He is. He's fantastic. If I have to say, he's probably got the highest IQ of us combined.

Kara Swisher: I agree. He might be the smartest of you three.

Louis Swisher: I think he is.

Kara Swisher: He is. Yes. All right. Louis, we're going to end with you with a prediction, please.

Louis Swisher: Yeah. Okay. My prediction is a bit more political. I think that within my lifetime, we will see a huge change in our political dynamic relating to parties in this country. I think our system of two parties worked really well in the 20th century era of bipolarity between the United States and the Soviet Union. After the collapse of the Soviet Union, we entered a period of unipolarity in which the United States was the only world power. We were able to reign free, America's number one top dog. But as we enter the state of multipolarity within the world, as there are multiple major powers emerging with the BRICS nations, the U.S. and Western nations competing, I think that's going to have a domestic effect as well. Our parties are more ideologically splintered than ever, not only in contrast to each other, but within the ranks of themselves. You see the Republicans splitting between Trumpism and conservatism, this huge dynamic between the right and conservative, maintaining the status quo or moving the pendulum to the right. Within the Democrats, there's a lot of disagreement over active progressivism, passive progressivism, and non-action. I think that is going to have a huge effect. To quote Noam Chomsky, there's only one party in this nation, the big business party with two factions. The current system is not good for business. So I think we will either see a challenge to that business and the big business party and see a true emergence of genuine political parties advocating for individuals, or business will be changed. There will be a change to either the Republican, the Democrat, or both or neither, and the big business party is going to establish itself once again. So we'll see.

Kara Swisher: Wow. All right. Wow. Louis Swisher. I'm impressed, Louis. Money well spent on college.

Louis Swisher: Yay. I love it.

Kara Swisher: But you're thinking for yourself. Oh, my God. This is what we learn at our leftist, elitist institutions. You should be proud, Kara. My work is done. This flaming libtard is ready to vote.

Louis Swisher: Actually, I am. I am a flaming libtard.

Kara Swisher: You're a very analytical thinker is one thing I appreciate about you.

Louis Swisher: I think one more thing that we often forget is humanism. We are all individuals of this nation and we all affect each other for better or for worse. At the end of the day, we're all going to die together. So we might as well try to get along together while we're alive.

Kara Swisher: Oh, I love you, Louis Swisher. Can I just say you're the best? Also, we want to give a shout to your amazing brother, Alex Swisher, who's going to be starting here at University of Michigan. At the last minute, he kind of wanted to be on, but he resisted. We would love to have him on at some point. He's also a great thinker and a really great kid. We're excited to focus on him the rest of the day. Correct, Louis Swisher?

Louis Swisher: I am excited to go have lunch with that kid. He's excellent.

Kara Swisher: Wait till you ask him about politics. He's not a kid anymore.

Louis Swisher: He ain't no kid no more.

Kara Swisher: We are all, apparently, going to converge here in California for Christmas, right?

Jeffrey Swisher: Yes, we shall.

Kara Swisher: We'll see you then. So, Louie, I went out to Walmart the other day and I bought one of those artificial Christmas trees. The person asked me if I was going to put it up myself. And I said, "Ew, no, that would hurt. I'm going to put it up in the living room." Ba-dum-bum.

Louis Swisher: Oh my god. I'm never inviting you back.

Jeffrey Swisher: Yeah, you gotta have those.

Kara Swisher: Yeah, yeah. No, sorry. I have to go. I have to go make a friend of mine who's a proctologist feel better because his wife just left him and it absolutely wrecked him. And with that...

[Laughter]

Kara Swisher: Okay, we're ending the show right now because this is very embarrassing for me as a person.

Louis Swisher: Okay, Louis had a high note and then Jeff, you bring it right down.

Jeffrey Swisher: No, no, no, no. Jeff reminded us who we were.

Kara Swisher: In the spirit of Scott, I miss Scott. Hi, Scott. And thank God for George Hahn. I think he was fantastic too. All right, okay. Louis and Jeff, that is the show. Thank you so much. I'm so thrilled and I'm excited to go out to launch Louis in a second. We'll be back on Tuesday with more Pivot. I'm going to read us out. Today's show was produced by Lara Neyman, Zoe Marcus, and Taylor Griffin. Ernie Enderjot engineered this episode. Make sure you subscribe to the show wherever you listen to podcasts. Thanks for listening to Pivot from New York Magazine and Vox Media. We'll be back next week for another breakdown of all things tech and business. Thanks, boys.

Jeffrey Swisher: All right. Thank you.

Louis Swisher: Thank you.