March 4, 2026 Forum

Jeremy

I agree. I mean, I think that’s very well said. The lifestyle medicine folks, such as Mitch, can attest to the power of groups, Other domains of healthcare delivery are moving in that direction as well. Because why have complex lifestyle conversations over and over again with individuals? Why not have some of the principles discussed in a group setting? And I think group visits, again, are valuable. I think it was Kaiser in Hawaii that really sort of innovated in the 1980s, early 90s, group visits. And some of the other Kaisers manifested that group approach.

It is very challenging, actually, to get group visits. I helped launch that at Contra Costa County. Karen Burton actually did most of the heavy lifting and pretty much all the heavy lifting.

But introducing that idea met with enormous resistance. A fear of fraud. Fear of how you can bill. There were just enormous fears. And I think that’s kind of the dilemma. We’re in an industry where the first 10 answers are NO. It’s only through persistence and perseverance that you can innovate in the process sphere. You can innovate in the procedure sphere by just changing a couple of things in the procedure. You give it your new label and bring a robot in, and there you go. Let’s charge 10 times more. The care offered in the process field, which includes cognitive care, primary care, and behavioral health (we are predominantly cognitive in nature), is not rewarded with innovation in anywhere near the same fashion or same magnitude. I can think of motivational interviewing. I don’t think anybody’s gotten rich off of doing motivational interviewing, and yet that was a profoundly impactful process that burst out of the substance use environment and has been demonstrated to be helpful for diabetics and lots of people.

Mitch

AI is not going away. It’s going to get more. And so we got to dig into it and deal with it and face it and learn from it and see how we can use it. And we have to have these caveats in place. And Harari also says in his talks that AI represents a bureaucracy. Once we had clay tablets, we went to the Gutenberg Bible, and soon after Gutenberg we had all sorts of manuscripts and bureaucratic things being printed in books and papers and being passed around.

And Harari talked about the witch hunts. The witch hunts were fabulously put down on paper and passed around and then used as proof that there had to be witches. Look at all this corpus of material that verifies witches. And look at all these witches that have been killed. We’ve got witches in our whatever, and we’ve got to get rid of them. That’s a cautionary tale of bureaucratic use of information without some kind of massive oversight. The witchcrafts and the witch hunts occurred because of those bureaucratic operations. These operations created a powerful intersubjective reality (which is a word he uses). This intersubjective reality becomes God. God is an intersubjective reality.

The AI that’s agentic is capable of doing on its own as it gathers information, no longer needs to connect with its human code writers, and can now start having interconnection with other agentic agents, other AI agents. These AI agents can create their own intersubjective reality. That has not yet happened; however, that is something that’s going to happen, he predicts. And how do we prevent that? How do we get oversight? And they’ll be talking about things like you’re talking about. You know, atomic scale understanding of things that we can’t even come close to comprehending. They’re doing this. And Harari cites that as probably one of the biggest risks. So we don’t want to have witch hunts that we’re not even aware of that have been generated by the AI interaction with each other and create their own reality.

I thought that was astounding.