AI is making people in medicine nervous. Doctors worry it's going to replace them. But Dr. Ami Bhatt, Chief Innovation Officer at the American College of Cardiology and Chair of the FDA Digital Health Advisory Committee, has a different take.

She explains what collaborative intelligence actually means and why clinicians shouldn't be scared. We talk about how wearables are giving women the data they need to advocate for themselves when doctors dismiss them. We also get into the bias that's built into AI algorithms and what it means when the technology learns your preferences.

Women are adopting AI faster than men. Data is validating symptoms doctors ignore. And understanding how AI works is becoming essential to being a good clinician. This episode is about how technology and medicine can actually work together.

Dr. Bhatt and I discuss what the reality of what clinicians face: in 20 minutes with a patient, you're trying to absorb electronic health records, current guidelines, recent research, their life circumstances, and now wearable data. It's impossible for one brain to hold all of that. That's where collaborative intelligence comes in. AI organizes the information so you can use your judgment. It's not thinking for you, it's giving you back time.

On the patient side, wearables aren't just gadgets. They're validation. When you feel something is wrong and your data backs it up, that's power. Especially important for women who get dismissed or told it's anxiety when it's actually a real health issue.

But there's a catch: algorithms have bias built into them. They learn from your search history, your preferences, what you've looked at before. Understanding those limits is what makes the difference between using AI well and being led in the wrong direction.

Highlights

• The freezer analogy: AI is like understanding why your freezer gets ice on food. You have to know how to adjust it or it doesn't work for you.
• Dr. Rahman's son used ChatGPT to prepare for a doctor appointment and had a whole conversation without her input because he felt validated and knew what to say.
• Women should be believed, but data gives you evidence when doctors dismiss you.
• Sleep is the next frontier in wearable tracking, especially during perimenopause and menopause.
• Good AI governance is infrastructure with guardrails, not over-regulation or no regulation.
• Health literacy is everything. Patients and clinicians need to understand what technologies actually do and don't do.

I hope this episode helps you understand that AI isn't coming to replace your doctor or your nursing team. It's a tool to help them help you better. If you're a clinician listening, don't be afraid to understand how technology works. If you're a patient, trust your body and use the data you have to advocate for yourself.

If you've found this episode helpful, please subscribe so you don't miss future conversations about technology, health, and what it means to take care of yourself.

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Hey y'all, it's me, Dr. Smeener Mon Dyno Girl. Welcome back to another episode of Gyno Girl Presents Sex Drugs and Home Hormones. I'm Dr. Smeener Mon. I'm a board certified OBGYN sexual medicine and specialist and menopause specialist as well. today I'm stepping outside of the pelvis into the heart, but always they're always intertwined and interrelated. So but we know that heart disease is still the number one killer in women, and yet you know women die earlier from their first heart attack. we underdiagnose it.

That exists continues to cause women to not seek get the appropriate cure that they need. We normalize their symptoms because we say that they should have our elephant crushing heart pain, chest pain, where sometimes they have other symptoms. And in communities like like our like mine, like Dr. Botts, who we're gonna talk about, is South Asian communities, especially. We have earlier disease at lower BMIs, and we have significant dyslipidemia and diabetes that are.

really predispose us as a population. And so today I'm thrilled to invite Dr. Ami P Ami Butt, who's a cardiologist at Harvard Medical School. She's a chief innovation officer at the American College of Cardiology and the chair of the FDA Digital Health Advisory Committee. Sorry. I hope it'll have you read. Okay.

You got it all.

I'm gonna have her also reintroduce herself, but we're gonna today I want to talk about AI as collaborative intelligence, the bias in cardiovascular algorithms, South Asians and heart disease, midlife women, wearables, all the things, all the new innovation for prevention that we are coming about in this age of you know rapidly changing technology. So thank you, Dr. Bot, for being here. Ami, I appreciate you being here. This is exciting. I love learning about other things happening in other sectors.

Thank you for having me. This is great. I feel like the key thing is none of these things happen by themselves. We don't one day have something with our heart and the next day a question about a variable and the next day a gynecologic issue. All of them are happening all the time. so I just love being here and I love talking about it in the perspective of we are a whole person and there is a holistic approach to what's going on. So this is great.

Absolutely. And I think for you know, there's so much like new social science data around how patients really in when they get dismissed, they really feel like things are so siloed that they're only looked at upon like their organ of treatment, right? And so I I do think there's this huge aspect of that that happens in medicine, and we really need to think of the whole person in front of us. And I think that's where like my understanding of menopause and perimenopause has really helped me to be a better doctor because I don't always just think of guy's.

Yes.

stuff now because now the hormones are affecting every cell in your body. So it makes sense that X, Y, and Z are happening. but before we get started on this great discussion, tell me I'm Diano Girls, I like a good backstory. So tell me your backstory, what brought you into this field, why cardiology, why all the things that you're doing now.

Right, right.

my goodness. Well, I guess the short version is the following. Came to Boston wanting to do medicine and pediatrics. I was going to be able to see anyone who walked through the door. I want to be the typical Norman Rockwell doctor. And fell in love with cardiology specifically. But interestingly, I fell in love with cardiology because of this population of patients called adult congenital heart disease patients. Kids who had heart disease right at the time that I was there and like,

I didn't know I was a builder. Now we refer to these people like me as like, she's a builder. She sees a need and then she goes to build something. I didn't know that. I just knew like, hey, there's nobody to take care of them on the adult side. I'm trained in pediatrics and adult. There are a couple of people doing this. Seems like there's room in the field. It's a need and I'm gonna do this. And that really kickstarted kind of my career in digital health, which maybe makes no sense until I tell you they wanted to FaceTime with me, because they were in their 20s and FaceTime was a thing.

Yeah.

And I was like, no, no, I will be arrested. Like, this is bad. And so I started doing telemedicine back in the 2010s when not a lot of us were doing it. It wasn't actually compensated at all sometimes, if not well. And then once you start seeing a patient across the screen, you think, huh, I need to figure out how to work with a digital stethoscope or an ultrasound. And then not only the data and technology, like how do I get my hands on the patient, but

Yeah.

Yeah.

How do I teach the person in the community what they need to know about taking care of someone, not so that they can do like exquisite something level, whatever, but just good enough to triage. This I can take care of. This is gonna, I'm gonna send a doctor about it Mass General Hospital. And so I started thinking about education in a distance. And then I realized, well, I gotta educate my patients too, because who's a better advocate than like you for yourself. And so.

Right? New, right?

Fast forward many years into COVID. I was the director of the Mass General Hospital outpatient clinics. By the way, you learn so much by sometimes taking a role that is outside of your normal scope. So this was like a management role, nobody reported to me. And then I had all these really good friends of mine who had their own really nice practices, small practice, own secretary, know. Like we're gonna go to 43 rooms with 10.

Higher.

Yeah. Yeah. Yeah.

Yeah.

admins out front and people were like, what, this is the end of medicine. And I wasn't great at it. Let's be honest, like my first management job. But boy, do you learn a lot from not being strong at something and teaching yourself and figuring out, oh, I need to learn this better about personalities or people or how to present or communication. And I think all that added up together to when we got to COVID, we had to turn on telemedicine. So you do that.

Yeah.

You already done.

You know, we were there and then we repurposed clinical research assistants who were young people, pretty facile with tech, not to be ageist, but we repurposed them as at the Elbow Telemedicine Help, right? And they felt useful. And so it was just, it was an interesting experience. So when I came out of COVID at Mass General and the opportunity to be this chief innovation officer role at American College of Cardiology, I was like, yeah, I'll take it. And it grew so quickly to something so different than what it was when I took it because

AI was like, you're going to take a new job that might be related to AI. Here you go. Bam. And like here it was. so again, learning is growing. And so my big initiative now is called the AI enabled clinician. And it is a campaign to have anybody considers themselves a clinician, doctor, nurse, caregiver, family member, community health worker, understand AI. And then the partner to that is the patients understand.

it as well. And so that's where I am today in a way. And the FDA really just fits well with that because some of these technologies, we got to figure out how they fit into the patient's life, into the clinician's life, and make things better and make that road easier for people. And so all of that kind of comes together nicely in my new career, if you will.

That's amazing.

yeah, I you know, I've been I've done a lot of like back research on AI too, just because you know, you hear about all the things that are gonna get replaced with AI. You know, I think there was some guy that was on the Chase Health Medical Conference and he's like, We tell doctors that AI is not gonna replace them so they can work with us, but AI is gonna replace them. You know, so like it was one of these funny things and you're just like, how could it do this? And so I started looking at AI myself a lot, just like in in its application to medicine. I find it interesting

Interesting because I think it can be a very great adjunct so many people. And I've talked about this on my podcast before. I've seen like patients who are more neurodivergent who don't know how the words to communicate, right? There's this low cultural capital, help cultural health capital that exists within medicine and whether or not you can communicate well with those people who's in front of you, right? Like if I communicate better with someone, then I'm gonna get better here. And so I have patients who have used

Mm-hmm.

That's right.

like AI to to tell me that they might have vulvadinia or vestibuline because they've been able to to now know what's down there, right? It's not just down there anymore. Help and so and so it's true you do you do better communicate with people when they have a better understanding of their own anatomy. So so tell me how you're looking at it in terms of like from a cardiology perspective or how you see it. I mean because I know that I love how you say that it's more of a collaborative intelligence instead of artificial intelligence. But

Mm-hmm. Mm-hmm.

I'm sure.

Yeah.

Also speak to the clinicians out there who are like really scared that their job is not gonna be worth anything in ten years.

Yeah. I think there's a few ways to think about it. And the first thing to me is when you're sitting with your patients, you have maybe 20 minutes. Let's be realistic. How much time do we get nowadays? The amount of knowledge that there is out there between their electronic health record, the guidelines, the research since the guidelines about their multiple things that you're probably trying to address, their feelings about it, their social determinants, their drivers of health, and then their wearable. Ain't no way my brain is going to be able to

Sure.

Yeah.

20 minutes, like it's just not gonna happen. And so now what we want AI for is, can you pull all that together for me? Can you give me a summary? And if there's anything in there that doesn't seem right to me, I'm gonna go to the source, I'm gonna confirm, I'm gonna make sure, but can you just like pull and trigger me to think about certain things on a negative way, but in a positive to like, like remind me about certain things that would be really helpful. And so that's the collaborative intelligence, right? Because we don't want the computer to think for us.

asking for that. Right now, we're just asking for the computer to use its compute power to get all the things that we don't have time to get. Give it to us. Let us use our clinical acumen. So that's how I want doctors, nurses, others to think about it. Now, the key is companies are going to come at you and say, I can provide you with this. I can save these many hours. I can save these many dollars. And our answer is clinicians back. Like an AI enabled clinicians answer is, how are you going to help me make patient care better?

And the company's got to be able to answer that question. Like that's must, right? And so that's what I'm trying to achieve with the AI enabled clinician. Understand what the technologies are. What is a large language model? How does it work in imaging, right? Understand the basics. You don't have to be able to create it. Maybe understand how to generate good prompts and do some vibe coding with the things you have, But mostly understand how to talk with the companies and say, this is my unmet need. How are you going to answer that?

rather than how can I fit your square peg in this round hole? And I think that's really, that's really, when I say AI enabled clinician, I want us to feel empowered to help the tech industry, to help the VC firms put the money, put the effort into the things that are actually going to make patient care better. And that's where the patients and clinicians can partner too. Because we all as patients and as clinicians, we all have the same goal, which is we want to actually make patient care better. And in the beginning, all of the AI that was implemented so far,

largely back office, largely administrative. Look, I love making the paper oriented workload less for clinicians. Like I am all over that. However, I don't want people to push on efficiency, burn out people further, not need clinicians there because they think they can do it with AI, right? Are there things that can be done with AI? Sure. Look at Doctronic, right? You could do med refills with AI probably better than you can with a human.

Now that's not necessarily replacing a job. Pharmacists still have jobs, doctors, nurses still have jobs. But how many times if I try and go get a medication refilled, like do I fail at that? Right? Or is it hard? Or do I give up? Or do I not trust the health system? All those downstream things that are actually really unsafe for me, like could happen. And instead, if you have AI as a backup. So there are places, yes.

Yeah.

Yeah. Yeah.

where AI may take things over, but it's not directly from a human in the provision of medicine. It is in places where we already are kind of not doing great and failing. And now AI is our safety backstop. That's where I want to see it. And that's where I need clinicians. And I'm so glad you do this podcast because we're reaching more people to say, it's not replacing you. You have to tell it where it belongs. And that physician voice, that nurse voice,

Yeah.

It's a little bit lost right now. We've got to find that.

And I think it's because you're right, there's either fear around it or this like, I don't get that text stuff. You know, like you just hear people say like I'm not gonna I'm not gonna I don't know computer science, I'm not gonna learn that stuff. And so I think those AI physicians or clinicians that don't use it are really gonna be behind the eight ball when it comes to so much of this stuff.

And there's not a world in which that tech stuff exists, right? So digital health is not over there. The field of digital health is gone. The field of digital health is health. Health has all the digital abilities. We need to use them because we can't do it without it. The AI is here. We need to figure out how to harness it.

and other people outside of us are coming into our lane. And so we've got to understand and not make them outsiders, but say, okay. But we're the coordinators of this. So let's help coordinate it. Right. and so think those partnerships are also so important. So I just, I want clinicians to hear that, that there is not a, don't get the tech stuff. Like if you're going to be a doctor or a nurse or a community health worker, the tech stuff is actually what's going to enable you to do a really good job.

Absolutely. And what do you think about, you know, when it comes to you know, there's that element there's that element, but you know, we we talk about a lot of the social determinants of health and really nuanced healthcare.

and

And you know, there's some data suggesting when people when you know people one person uses chat GBT and is a woman of color, she'll get a different answer than someone who's white or a male. And so, you know, there's this whole idea of algorithmic bias and who's making the algorithms and who's putting the information into the LLMs. Like, is there a world where that black box that exists can be modified to really create more nuance? I mean, you know, is there a world where someone that has complex sexual health

needs or vulnervaginal disorders is not gonna get like you know a one spit it out algorithmic automated answer, right?

Yeah. Yeah. So here's the thing, right? The large language models are giving us answers based on the relationship of words existing in the world today. So if there's not a lot of information about that readily available to it, first of all, then it may not, the average chat GPT may not be able to give you an answer because that data is not out there. Now let's say you and your colleagues,

Right.

created something where you force the data that you know that's important, your own knowledge into it and build something off a large language model that said, hey, if you have questions about this type of global vaginal issues, health, et cetera, and then that information is in there, okay, now we're getting somewhere, right? Now they're getting kind of some version of your brains and papers you know and research that you put in.

And so I think part of the magic of large language models is not people going out there and being able to like find everything, but us actually being able to build for our patients, knowledgeable, you know, areas that they can go to chatbots agents, other things to be able to ask those questions and then step it up to us when it's something that's like, Oh, that's a little more complicated. So, so that's the excitement. other thing I'd say though is

There's something that can be positive or negative about your large language model. There is a Wall Street Journal reporter, Nicole, who's a good friend of mine, she reports on personal tech and health. And she asked like three different large language models questions, and then, you know, she wanted to grade them and stuff. And I said, I looked at her outputs and I realized her outputs are different than mine with the same question, because my chat GPT, Claude, Gemini has learned me based on my question history.

So it is learning who I am and now it is putting that bias of who it thinks I am into the answers it gives me. So I get really great digital health answers that she could never get, but she can get great answers about personal tech that I'm not gonna get, right? And so you have to think about the lens of whose LLM did you look in also, right? And if you tend to do Ayurvedic medicine,

Yeah.

Yeah.

Yeah. Yeah.

It may give you that before it gives you a statin for a South Asian woman who's trying to protect herself from the number one killer of women, right? And so I think those are some of the things that we have to, again, teach people. That's what it means to be AI enabled. It doesn't mean I can cope. It means I get how this thing works and why it works this way. It's like your freezer. If you turn the temperature up too much, everything has ice on it.

Yeah.

Yeah, yeah.

Right.

Works.

Someone's gotta teach you, turn the temperature down a little bit, it doesn't need to be that cold and you won't get ice on all your food. But until somebody tells you that, God, mean, I'm just thinking about when I was first leaving college and this happened to me. I was like, I know. I wouldn't really know that. Those are the kind of things that we need to start sharing, yeah.

Yeah. I'm thinking about my freezer actually. Yeah. Yeah.

when talk about some of I was gonna ask you. What with terms to with the work that you're doing with the FDA, like a lot of d do you remember I don't know, a couple months ago they had announced the doomsday count countdown was like, you know, th was closer because of and one of the reasons they listed that were closer to the apocalypse, I forget the body of science that did this, now I'm blanking, but it was because of the unregulation around AI, like that that

Yeah.

especially countries like, you know, us and other arenas are not regulating what's happening with AI. And so, you know, my husband's a big, you know, tech geek science geek person who who is just thinking about like, you know, when when AI's gonna come and attack us, like the Terminator. He's like, I'm gonna have to come back in another form and come and save the the humanity. Like

Yeah. Nope. So here, look, there's, so many ways to think about this. So the first is, on the people who really do AI are probably the most scared right now because an unregulated model can do a lot of things. mean, there, this morning I was at a conference, we have Boston tech week this week. So it has been amazing in Boston. when you

Wow.

You really realize that we are the new hub of where tech and AI engineering is coming from. Like no doubt, sorry, Silicon Valley, but like Austin is where all the brains are right now. Right. And it's just, it's amazing. And so this week has been incredible, but there were some people who said, no, like there have been times where you're like, Nope. then the AI wiped out like I am wiped out all of my data. Model wasn't regulated. People weren't like literally just wiped out data. And so there were stories this morning of people who are deep into this, say regulated.

Now there's a difference in what you're talking about with regulation. There is an AI model that is safe. There are things we're putting in place that have protections. There's privacy security for data. There's cyber security, huge risks that people are addressing. And so that's all like at that science and model level. Then there's a regulation you're talking about with me, which yes, includes all of that. But at the FDA, and I'm not speaking for the government, but that's a different type of regulation, which is

How are things getting through? What needs permission and what doesn't? What is wellness? What is a wellness claim? What is a medical claim? When do you need it? And so those are the kind of things. And I will say, one of the fears I have, one of the other meetings I was at this morning, we talked about this, one of the things I want to solve for is I don't want us to deregulate so far that there's not control people to understand.

But I also don't want us to backswing, let's say things change, right? Governments change every four years, things are happening every two years into like an over-regulated where all the companies that we're designing now run out of money, can't do things and really good science doesn't get to people and help them. And so neither side is really good. And what we need to build is really, we need to build an infrastructure. Good AI governance is an infrastructure with guardrails. It's not just the guardrails. It's not the lack of guardrails. It is

building the infrastructure with the guardrails to say, here's how we're going to use AI to make blank better. In my case, it's healthcare. And I think that's what I want our model to be when we're advocating on the Hill, when we're talking as companies and clinicians and patients is, hey, what's the infrastructure? Everybody's got to be all in on there's an infrastructure to use AI and that has guardrails. But if we say, I'm going to regulate everything, nothing's going to get done. If I deregulate everything, nothing's going to get done.

Yeah.

with the infrastructure and then you need the guardrails. And so I really want us to have a national approach where like that's the way we're thinking. And when I say national, I don't just mean government. mean, like all of us who are doing this need to aim for good AI governance is infrastructure with guardrails. makes everything safer. And I think that's really important.

Yeah, no, that's really great to hear. And it I agree with you. I think that 'cause there there's a if we do over regulate then we're not gonna make the advances that we need. But if we under regulate then people can get hurt and other things can happen. because I think there was was there like a s news article about somebody who was talking to their AI and something was suicidal and I think they ended up taking their own life, unfortunately.

Right.

There's been quite a few of those stories over the past few years. And, you know, we talk about this a lot in mental health, is that is dangerous. And at the same time, the reason people are going to mental health chatbots is because they can't get access. And so you also have to think about all the people that are committing suicide because they have no access to mental health care. And so I think for a lot of these things that are population level health, what we don't know is what's the denominator of people who are just not getting any care.

And can the models we create adequately do two things? One is, sorry, I'm going to geek out for second, but one is like things with high specificity. Meaning if I tell you, have a disease, you have it. If I say there's a trend towards this, you show up at the doctor and they're like, yeah, good catch, right? You want that from your first models. That's going to build trust. That's not going to overburden the system, right? And then the second thing you want to do is you want to just understand like,

No, I love it. I love I'm so intrigued.

Yeah. Yeah.

well, they missed some people. You use this and you missed, well, I mean, we're missing people left and right in the United States for every disease. You are out there preaching to women to listen to their symptoms and to be willing to talk about below the belt. And the majority of us are still not willing to learn, not willing to understand until we meet you. And then we're like, wait, this is a thing. And so thank you, by the way, for what you do. But I think...

Disease.

I think it's important to recognize that this is an opportunity for us to use AI to find things to help people. And we don't want to over subscribe on like find everybody, because honestly, we don't have a system that could take the patients if you found everybody who might possibly someday have blank. So I like the idea of finding people like when I can do something about it.

Support.

Yeah, yeah.

Yeah, yeah, yeah.

Like that's a great place to start. And it's hard to say. Some people say, no, doctor, I wouldn't you want to know about everything? And I say, no, I didn't do 23 and me. I don't want to know everything right now, because if you can't do something, I know myself, I'll have health related anxiety about it till the cows come home because I'm a type A doctor. Right. So I think we have to think about those balances when we're thinking about using AI and the benefit. When we think about that way, it's less scary, but also you feel like you have more power as a patient.

Yeah. It's not true.

Yeah. And

and as a doctor or nurse or clinician, you feel like you have more power, because you're like, wait, wait. Yeah, let's harness the technology for the things that we want. But right now, tech's being thrown at us, and we're either just buying it the way it is, because wow, it's cool, or we're throwing out the window, because we're like, I don't do tech. And neither one of those is going to work.

Yeah, no, that's very true. And I think like when we talk about the evolution of like say treating women in the menopause space, right? We know that we cannot treat every w woman in menopause in an office. Right. So all of these, you know, new acts.

That's right. It's half the world, right? It's literally half the world, maybe more. Yeah.

And so you know, some people are like, I don't like the fact that you use this telehealth platform. And I'm like, you like what it gave her access to then come see me, but it was a start, it was a foot in the door. And I think most telehealth platforms will tell you they're not trying to replace the boots on the ground doctors and clinicians.

No, no, no. And in fact, a lot of people now are like, hey, someone gave me something that feels like an answer when I was super stressed out, especially now that we have wearables, we have numbers, we have data, we have chat GPT, you have a symptom, what are you gonna do? You call your doctor or you mess with them through the portal and.

Yeah.

I mean, God bless the doctors that get back to you within a day, but they're just shy of being burned out. If your doctor is getting back to you that quickly, either they have a great system set up, make sure that's the case, they're, right, or they're contagious, or they're just shy of like being burned out. And so I like the idea that sometimes there are ways to just get some answer, some help on your way to the system. Like we need a system before the system where

Or they're concierge.

Yeah.

Hey, I have some symptoms. I'm curious about this. I don't have a definitive diagnosis that needs blank, but like I might be on my way. I might have risk factors. I want to talk about it. And I think the people fulfilling that through whatever it might be education content, good social media, podcasts, telemedicine. I think humans are changing. I think we used to be like, I want to see my doctor in person. Now people are like, you know what? Just want somebody to give me an answer.

Yeah, that's

gotten so hard nowadays. And so I do think that the current is changing and the average consumer today as a patient is like, give me trusted information however you can get it to me.

Yeah, and and speaking of the wearables, like I had a patient just yesterday inbox me because her pulse has been consistently high for like a month. And there were times where it went above a hundred at night sitting, you know, and so it was like she's like, I'm worried, you know, I'm I I'm

primary ovarian insufficiency kind of thing. And so, you know, I'm getting her to a cardiologist to do, you know, to maybe get her scans in her ultramolder or whatever because I think she's having palpitations as well. But she wouldn't have really known it. Cause it wasn't like she well I said, well, you know, when you were up at the higher levels, did you feel like your heart was pound 'cause like some people don't know what a real palpitation feels like, right?

Yeah.

So she's like, Yeah, I guess maybe. But like it wasn't it was triggered by the fact that she was like, Why is my pulse so high, even though I had no caffeine or I had no X, Y, or Z? And so, you know, we'll see what comes out of it. But I think that, you know, it could just be a basil motor symptom, but we don't know because, you know.

And that's the thing, I think one of the conversations people are scared to have, because they're not really sure how to have it, is what should I be measuring? Measure 100 things a day. And when I say scared, I don't mean patients don't know what they should be measuring. I think clinicians don't know what to tell people to measure sometimes. And so we spend, I spend a lot of time trying to educate people on like...

Thanks. Yeah. Yeah.

Here are the things you might want to measure. Here are the things you don't, right? In whom is an oxygen level actually relevant? It turns out a relatively small percent of the population, unless you're in the middle of COVID. Different story. Right? like, so, so there are times also when measuring certain things are important compared to others. and so I really like giving people a better sense of like, here's what it means. Like, here are your numbers. And I think that responsibility lies with the tech companies. If the tech companies say the hover beats a minute, they should have something.

Yeah.

that says, hey, this is your manager, this is out of range, or here's some information about a heart, has heartbeat, or do you want to see a telemedicine specialist to talk over what these things could be? And maybe then they'll give you something to go to your doctor with. But I think we should ask tech companies to take that responsibility of not just giving data. Now they're doing a good job of giving insights, but then actually potentially giving care or the beginnings of an answer. And again, not.

Right.

over from doctors at all, but helping like bridge that gap from I have data, I have insights, now I'm not sure what's going on, give me some answers and help me figure out where to go. Right. And so I think again, this goes back to that AI enabled or just like tech enabled clinician and patient who say, tech company, don't just say it's a thing. Help me.

So yeah. And I think that's where I see like I'm on a lot of Facebook groups with different OBGYNs and they get very frustrated because then I I'm not in a traditional practice anymore, but when I was, you're seeing thirty patients a day, right? And you get a patient and they're like, I'm so tired of getting this data from wearables, like, you know, don't wear it if you don't want to you know, so they get very frustrated and you can hear and I and I could I can see a part of me

Yeah.

used to be that way, right? Because I used to see the 30 day now I accept it because I have a practice of my own and I can do what I want to to, you know, see provide the best care for my patient. But I I know what that feeling was like where a patient would come up to you with this data and you're like, okay. So I mean how would you speak to like the gynecologist who was like, why why do why do they keep coming to me with all this data that I don't know what to do with?

Yeah, so you know what, I think two things need to happen. So one is we started this actually at the American College of Cardiology with the Apple Watch for the AFib breeding, because that was coming up all the time, right, in cardiologist offices. And so we heard that from our members and we were, you you have 60,000 members, 3,000 hospitals, yelling at you about that. And we were like, we will work. And Apple was great. They worked with us and we created like a guide. Now the guide is like 40 pages long, right? But of like,

Yeah.

Yeah.

What is the research behind it? Why should you trust it? And most importantly, I think the most valuable thing is the page that says like, what should you do and bring to your doctor? Right? Like, we need that for wearable companies should be creating that. Like, here's what you can go to your doctor with if this is happening, right? And I think that's really important to be able to help. And then...

Yeah, that's great.

I think it would really help if all the clinicians were also testing out wearables and understanding what they do. Because if we don't, yeah, like if you don't understand what they do, then how do you talk to your patients who have it? Now, part of that might just fall on the companies and say, yeah, like, why don't you educate the doctors more about it? Why you put some on their wrists and like have these conversations? Because there's a lot of good information. And the part I love is the predictive ability.

Yeah, I got an R in for that reason.

Sabing.

of continuously modern day. let's just, mean, we'll go to our subject matter together. If you think about menopause, paramenopause, affects the heart, affects the sleep, affects the mood, affects gynecologic issues. I think there is aura, whoop, I'm sure, Fitbit, Garmin, maybe Apple, down the road. But I think all of them are thinking about this population. I was on a panel for menopause at whoop.

I think Aura is doing a peri menopause mode now.

Just recently we showed the movie by the way at the menopause movie is so good but But I think the important part is having a continuous measurement of what's going on in your life Such that you know your own baseline Right, and then when you feel off and your numbers are off What you want to feel is not scared that my god Why is it a hundred but I didn't notice instead you want to say hey?

the other one. Yeah.

That's true.

When I feel off, my numbers are in fact off and I'm right. Whatever it is, whether it's exhaustion, whether it's disease coming, like something's going on. Now you have agency. Now you and your wearable are a partner together in your health saying, yeah, not only do I feel off, especially for women. Remember, so, you know, I think we talk about this all the time, but women tend to be kind of under diagnosed, underappreciated, underscreened, especially in cardiovascular disease, right? They don't necessarily have the same symptoms.

Yeah.

They're not taking it seriously. A lot of people are turning away saying, you you have anxiety. They end up coming back in with a real cardiovascular event. And then they don't even get offered. Oftentimes the same numbers of procedures that men do. And so in a way it all starts with agency way upstream, which is when I feel often these numbers are off, that is legitimacy to me and empowers me to say there is something right. What comes next? What do I need to do to activate for myself? And

And so I think a lot of that patient agency comes really upstream before you even have a diagnosis of, trust my body.

Yes, I think.

I guess this is right. Yeah.

clinician and the and the patient, right? We do not trust when a woman tells us they're in pain. We do not believe her symptoms. And so the fact that we have to have aware you know to me, like I like listening to you I get, I know what you're saying, and it just infuriates me too to some degree to the fact that like we have to show you our wearable for you to believe that my pulse is you know what I'm saying? Like and I know that you and I probably don't practice that way, but I feel like

is in today. Yeah.

Yep.

You know, we are built in a system of systemic sexism and racism that have existed before we have even entered into the scene, right? But I just think if you look at why women's health is so booming as a market, it's because the erosion of trust.

Yeah. Yeah. Yeah. Yeah.

Yeah, I mean, you're exactly. So first of all, this is like, you know, it just gender disparity worldwide for a variety of reasons, implicit bias that has existed for centuries and we are still fighting it. So I think all of that is. Yeah, right. I mean, it's still called a hysterectomy. Nobody has changed that in the OBGYN world. Like we haven't called it a different word yet. I feel like somebody should. This is maybe my call to you and your colleagues.

Yeah. Still fighting hysteria, the notion of hysteria. Yeah. Yeah. I'm writing. I'm

Yeah. Yeah, exactly. Hello everyone, we need to change that work. We change P of us. We we just changed PP on us. We could change this.

I something else now. But, yeah, that's right. But having said that, I think the other thing is, and just to be clear on, I don't want women to take their wearable and be like, trust me to a doctor. What I want them is to trust themselves and walk in knowing and be like, I'm not leaving. Something is wrong. I am certain something is off. I am telling you these symptoms. I need you to take me seriously. If you won't take me seriously, I will find another deduct.

Yeah.

Right, right.

take doctor to take me seriously. And I think that's what I really want. I want that empowered feeling of sometimes you're like, am I just tired? Am I sick? What is happening? And I think that's where that help comes in of like, yeah, I know my baseline. I feel off baseline and I see I'm off baseline. It is all tracking and therefore I will go be my own agent. And I think that's more it than like, hey, look, my wearable says this. I worry less about that and I kind of.

That's not necessarily what I'm looking for people to do, but I want them to be able to understand and know their own bodies. And sometimes you see those things and you're like, yeah, okay, like this tracks, this makes sense. Something is going on. And sometimes it's not even an issue that needs a doctor. Sometimes it's, you know, like every time I have that drink after 9 p.m., this is what happens, right? And, you know, I'm using that example from a friend, but you know.

Yeah, exactly. Yeah. One side of life.

Yeah. That's what they tell me. Yeah, exactly. No, that's great. I think that's a great way to look at it. And I think it it does matter how we frame these things because, you know, it's all in and that's why they say words matter. It's all how you would introduce something to someone to under to help them understand it. And I said I think if we start framing it in that capacity, we use AI and these wearables as an adjunct to helping us understand ourselves and understand, you know, and clinician can then understand.

That's right.

You know, it's interesting that you mentioned the kind of the aspect of like how people see things and how we message, right? And so breast cancer does a great job of messaging, right? The kind of the pink ribbon and they do great. It turns out that heart disease kills more women than all cancers combined. Right. And so I have a little marketing chip on my shoulder. Like we have the Heart Association, we have Go Red for Women. was just at a, so a women in construction meeting. Okay. So these are women.

Dr. Sameena Rahman (38:00.355)

Yeah.

leading construction firms throughout the country. And I'm there on stage talking to them and I asked how many of them have heard about or seen the red dress or go red for women and maybe a third of them raised their hand. I said, how many have seen the pink ribbon for breast cancer? The whole room raised their hand. And I was like, this is, and so I think it's really, it is, but it's important because like these are the things that need to be marketed and talked about. And so I think the other thing that I want from us

Marketing.

is to recognize that our patients are consumers and that's okay. They are being flooded, especially nowadays with information from every direction. And so the marketing budget, if you will, of the medical community to teach people about their health is straight up marketing budget, right? And we don't have that to teach. We consider education of patients to happen one-on-one with your clinician, which by the way, how stressed out are you when you're-

Yeah.

Yes.

patient in a room in a blue gown? Like, are you learning any? You're not hearing a thing. Right. And so how do we find people in that receptive state where they're hearing about it? And I'm not saying they should hear about it through a company that's going to make money off of selling them a drug. Like, we, the establishment of clinicians, should do health education as a massive marketing campaign. And I think we need to figure out how to put the dollars there. And I'm not sure.

Yeah. No. Wear clothes when you're talking to a

to talk to to get that done. it's one of the, like after we figure out regulation, not deregulation, pro-regulation, but rather infrastructure, like my next goal in life is going to be how do we actually have a massive marketing campaign about preventative health throughout our country?

Yeah. Yeah. Marking.

Mm. Yeah, no for sure. And I think I mean I think that's the only reason why half of us are on social media because we know there's all this other noise going on, right? That we have to like try to deflect like with like teaching.

Yeah, yeah, yeah. And we want to spend our time not deflecting, but just teaching and like, how do you get there? And how do you find a budget that big? Because if we really value people's health, then we need to educate them. Health literacy is everything.

Everything. Totally. I agree with you. let's talk a little bit about, you know, like actual heart disease. I want to talk to you microvascular disease. I wanna just talk to you because

Yes. Yes.

Well, it was interesting when I was at when I was listening to the menopause societies, I didn't get to attend the meeting this year, but there were a lot of great cardiologists there who spoke about a couple of things that I find that I love to talk to other cardiologists about. One is the fact that what you said that we have such terrible marketing that no that that most populations don't even believe or don't even realize that heart disease is still the number one killer in women.

Yes.

Yep.

The second was on the microvascular disease phenomenon, which I think we don't talk enough about or have known much about, or you know, th this was new to me as a gynecologist, but just understanding that, you know, the that women will just talk to us about microvascular disease, because I know it's affects more women than than not, and how how can we go about getting those women diagnosed and treated.

Yeah, so we had a American College of Cardiology and Hello Heart Women's Health Summit just two weeks ago. And it was great. Jane Morgan, who's a clinician. Yeah, so Jane was there. Mia Chorney, who does cardiology and menopause. Myself, Wood, who does Women's One. And so we were all talking about this. And I think there's a few things. So the first is what you're describing just for the audience is you have the big coronary arteries that kind of feed your heart, that kind of

Any two. Yeah.

Yeah.

We typically talk about plaque building up, giving you a heart attack. Note to self, women have those. Like we get plaque in those big arteries, and we get heart attacks that plaque develops at a young age. And it starts developing when you have hypertension that you're not controlling because you're not measuring your blood pressure. It is when you have cholesterol that is elevated relative to where you should be.

but you're not necessarily checking it every year, keeping an eye. It's because you have things like lipoprotein little A, LPA, or APO-B, which are different types of cholesterol, not included in the regular lipid panel, but give you a significantly higher risk, and sometimes a family risk, of having blockages, right? And then you might be pre-diabetic and you don't know it. So all of those things at a younger age are what are taking years off our life. Like we can take up to eight years off our life if by age 50 we have multiple of those factors. And most of us don't know we have those factors.

because we're not measuring it regularly. So let's just start there. On a positive note, you can add eight years of life if you follow these things and keep them in check, which is the best longevity drug we have out there is good cardiovascular health. No drug out there is going to give you no peptide, no whatever is going to give you eight years of life right now, only taking care of your heart risk factors. So that's first. Now, in addition to that, oftentimes,

Yeah.

Yeah. Well.

in the smaller arteries, not only in the heart, but in the brain, in the kidneys, right? In other places, the small arteries can also get blockages, they can get spasms, right? They can get disease and you may not see that as easily because we can't image them as easily. It requires a little bit, it requires thinking of it first and then looking for it, right? Or treating for it. So it's really important to recognize that even if people say, hey, I don't see the classic thing in you, your answer is

Okay, look a little further and look woman specific, please. And that's when we find that microvascular disease. Exactly, exactly. But I want to remind people that even though microvascular disease in women is so important, it's under diagnosed, the majority of women have straight up disease that comes from being pre-diabetic, hypertensive, overweight, stressing too much, taking on everybody else's problem as your own, not getting in at least 7,000 steps a day.

Yeah. Classic classic for a man is not classic for a woman.

Like those things that you can actually work on checking your blood pressure. Like if you're watching this podcast and you haven't checked your blood pressure in the past week, go check it. Right? Like, so those are the kinds of things that we want to also focus on because I don't want people to walk away thinking it's the rare things that the women have, which we have the common things. And we also have the microvascular disease, which is not rare by any means, but also exists.

And everything exactly.

Yeah. And that's kind of like when you have the chest pain without coronary disease.

Correct, you have chest pain, but your obvious big coronary arteries in the pictures don't come up as having plaque, and yet you have typical symptoms, and that's because it is the microvasculature. And so microvascular disease is what we call it, specific to women. And then the other thing I think to think about just while we're on the women topic is if you've had preeclampsia, if you had diabetes in pregnancy, if you had hypertension in pregnancy, if you delivered a child early,

preterm labor, or if your child came out small, intrauterine growth retardation. Those are risk factors for you developing heart disease. So add it onto the list, just like blood pressure or diabetes, like add that on, like woman-specific factor. Make sure your doctors know about it, because again, those things become additive over time.

Absolutely. and and if someone you when you talk about diagnosing for microvascular disease, I just asking because there's so many centers that don't do the diagnosis and treatment court. And so I think you have to look for but I think there is a website that you can find centers that do sort of microvascular disease assessments.

absolutely. would look for, I would look for people who, know about that. I think the important thing, and this goes for men of Oz too. I think it's important to recognize that if it's a relatively rare thing, we often have a tough time finding people who can take care of it. And then we feel frustrated and I hate to say it, but like, there are a lot of rare things.

it often occurs with women or areas like menopause that aren't, they're not rare by any means, just not studied enough. Like keep going till you find like a Dr. Samina Rama. Like don't stop till you find her, right? Just because somebody out there knows and you just have to keep at it until you find them.

Right. Master.

Right, exactly. and and again you have to be your best advocate, right? You're honest to you.

Mm-hmm.

Okay, so tell me because I know we're getting close to time, but tell me what's coming up in the market in terms of what you're excited about when it comes to like either wearables, do you believe in these the watches that check your blood pressure? Like tell me what you think is gonna be really exciting in the field, not only for women but for like heart disease, and then and and we'll start with that first.

Yeah, I'm really excited about the wearable market because so few things. One is I've spent most of my life being inside kind of the big academic house. And what I realize is we can't prescribe one-to-one to you to get you remote continuous monitoring to follow all of your diseases. Like that takes a lot of time, effort, and we just don't have the numbers to do it. There are fewer of us than there are patients.

And so I love the idea of patients actually being able to follow their own numbers. I do think we need education of clinicians and patients to make sure we're following the right things for each person. Okay, so that's that. But what's exciting? So I think things like, I'm obsessed with sleep right now. In fact, I'm at a new sleep company today. And what I'm excited about with sleep is what if there are ways for our wearables to start to help predict

Yeah. Yes.

Hey, your sleep is changing at the same time that you're in perimenopause. When you started your estrogen patch, that sleep got better, right? Things that aren't particularly like healthcare, but that are actually making my health better. I don't call them wellness either, right? They're just my health. And I think the monitoring off of these wearables, especially if you include some advanced diagnostics and other things that they're starting to offer, can really give me a better sense of

Yeah, yeah.

how I'm doing, right? So am I pre-diabetic? Is this going to be a thing? How can I make my sleep better? Did the addition of that new drug make a difference? I think those kind of things and getting a sense of them is probably the next really exciting area where women are adopting AI far faster than men are. Like at the current moment, since 2020, women adopt AI faster. So just think about what that means for our ability to measure ourselves.

Yeah.

and to take note of what's happening, then advocate for ourselves. Like we will catch up if we all keep doing this. And so that I'm really excited for that aspect of predictive modeling that is health, not wellness, not healthcare, that some of the really good wearables can kind of offer us. And I wear my wearable and there are days where I don't check the app. Maybe that's sacrilege to say, but there are times where I know I need a screen break from everything.

Yeah.

Yeah.

That might even include my wearable. But what I do is I don't take it off because I know it's learning me in the background. And that's really important to me long term because what I now want to see is if you start wearing something in your 30s and then you get to your 40s and you get to perimenopause, can I predict things earlier? If you start to change, right, what about through pregnancy? So I'm really excited about the real longitudinal use of some of these. And I think that's really promising.

Yeah.

Right.

Yeah, that's really that is actually very exciting. 'cause again, we you know, we used to just broadly say perimenopause your cycles will start being irregular and now we know a lot more people start having the mental health challenges, start having the sleep challenges, which nobody again, nobody considered those in the past, but we always we saw it, you know, we saw women who are like, I don't I can't fly anymore because I'm so anxious. Like I don't feel like myself and and that's what's being studied and I think that's that I g would be exactly what

Yeah.

we'd see with some of these wearables what's happening with your with your pulse what's happening with you know over time longitudinally like what's what's going so that's very free and so i do this thing vagilante hot take which is like really your hot take my husband jokes that like my listeners are vagilante so what's your vagilante verdict like what's your hot take for the listeners to take home with them in terms of like one thing you want everyone to know no matter who they are

That's right.

That's right. That's right.

Yeah.

I want you to trust your voice. No one's ever going to know your body better than yourself. They just aren't. They can be a Harvard Yale educated doctor. Like, it doesn't matter. Nobody knows your body better than you. And if there was ever a time for women to stand in that truth, it is now. And if we don't, each individual woman stand in that truth.

Then I think a lot of the things that come down the road that feel like implicit bias, et cetera, like we could have probably curbed a lot of that by just standing in that truth. So I think you know your body best and you need to be vocal.

So

Hundred percent. And I think in social science they call it testimonial injustice where your story is not believed by the person that might have more sort of knowledge on the subject in general. So you should you should absolutely believe in yourself and advocate for yourself and and

That's the only way that we can actually improve as a society too. So I agree with you. That's great. I'm so excited listening to you out, honestly. Cause I you know, I the reason I started really reading more and studying more about AI is 'cause of my own trepidations around it. But then I I think I I've said this before on this podcast, but it was telling to me that I took my son to his

Thank

appointment a couple months ago and he had the flu. And he's, you know, he's somebody that I used to like really have to talk to the doctor myself. You know, he's he was a teenager, you know, go and talk. So I went in with him and he basically verbalized, like spit out the whole thing on his own. And I had no I didn't have to communicate with the doctor at all. And I thought, wow, that was so interesting. Like you've become a great communicator. And he's like, Yeah, I just talked to Chat GPT beforehand. And told him that's he told me he told me my symptoms were valid. And so he th

Yeah, that's awesome.

But you know, I mean, I love that. That's such a great example, right? Of like being empowered by getting a little bit of knowledge. And what I love is, and people ask me this all the time, right? I tell doctors and patients this. Use chat, be a patient advocate, be a partner in your health. But maybe also if you know you have a certain type of doctor, your doctor's not one that's doing that, give them a heads up.

No

Yeah. Yeah.

Two weeks before, send a little message being like, hey, I looked a couple of things up on chat. I totally respect your opinions, but here's what I want to talk about. And then to the doctors and nurses, OK, like message back. Or when you get there and you see that message that day, say, yeah, let's talk about that. But I also have two things we need to get done at your annual visit. And then look, now we have a partnership.

Yeah.

Yeah.

Yes. Absolutely. A hundred percent. look, he knows you're almost done.

I know, he was so quiet. I will slightly blame the teenage daughter who walked in with him while I'm on a podcast relaxing.

Provavelmente.

I know. I've got some of those too. Anyway, Ami, thank you so much. This has been wonderful. You're such a wealth of knowledge. I hope to meet you in real life one day and work with you in the future in any capacity. I would love that. But thank you for being on this episode. I'm Dr. Meanerman, Guy Nor Girl. Remember, I'm here to educate so you can advocate for yourself. Please join me next week.