Signals, notes, and essays about AI, health technology inside and outside healthcare, and how consumer health tech is changing the healthcare system.
Current AI health tools share the same flaw as traditional healthcare: they're episodic, not continuous. OpenClaw — a nerdy new tool that’s shot to 2 million users in nothing flat — shows us what comes next: AI assistants that monitor your health 24/7, cross-reference data sources, and act on your behalf without being asked.
For the last 50 years, the engine of technology innovation has been a consumer engine. Consumers have steadily accumulated new health capabilities — including diagnosis, treatment, and monitoring — much faster than healthcare organizations. This has caused a decades-old, large-scale migration of health-related activity from the healthcare system to the consumer tech system. But in my experience speaking with hundreds of healthcare CEOs and board members, these migrations remain largely invisible to healthcare leadership.
The FDA just updated its General Wellness guidance, allowing consumer devices to measure clinical parameters for coaching — no clearance required. The same week, Utah let AI renew prescriptions with no doctor. Both are doing the same thing: moving healthcare tasks out of traditional systems and into consumer channels.
Blue Cross Blue Shield of Massachusetts just posted a $400 million loss — the worst in their history. The culprit? GLP-1 medications that could eventually save insurers billions. The costs hit today, the savings arrive years later, and health systems are caught in the middle.
GLP-1 medications may do far more than treat diabetes or reduce weight. If they substantially cut obesity and metabolic disease, they could trigger the first large-scale decline in healthcare demand seen in the modern era. This piece explores how earlier demand shocks reshaped medicine, why GLP-1s pose a similar challenge for chronic-disease–based service lines, and what hospitals must do now to prepare for a world with fewer cardiometabolic patients.
The New York Times built one of the best digital products in media — yet its real revenue and profit have fallen by more than half. That’s what disruption actually looks like: the work moves elsewhere while the industry shrinks. Healthcare is now entering the same pattern, driven by consumer tech, GLP-1s, and safer mobility. We’re heading toward better health — and a smaller healthcare system.
Digital coaches are taking prevention where healthcare and public health can’t reach — into daily life. Activity trackers like Apple Watch, Fitbit, and Garmin now deliver personalized, continuous feedback at global scale, turning prevention into a business that keeps people healthier — and needing healthcare less.
AI health coaches aren’t just for athletes anymore. They’re starting to handle the day-to-day interpretation, advice, and treatment adjustments that once required doctors. From glucose monitoring to hypertension management, technologies like Dexcom, Teladoc, and Omada are quietly taking over the work of routine clinical decision-making. This new generation of digital health coaches marks the next step in a long trend — technology shrinking healthcare by making us need it less.
Lawmakers are moving to ban AI-only insurance denials, requiring human sign-off for every case. It sounds compassionate, but it locks us into the same slow, opaque, costly system. The smarter move is AI with guardrails — transparency, audits, and contestable rationales — for faster, clearer, more accountable decisions.
The naturalist John Muir saw how everything in nature is connected — and today AI is showing us the same truth inside the body. From Apple Watch studies on atrial fibrillation to new hypertension alerts, hidden links in long-collected data are transforming how we understand health.
From telemedicine to wearables, fewer clinic visits mean fewer emissions. And as new products like low-carbon inhalers and self-administered HIV therapies move toward over-the-counter access, the environmental benefits of consumerization become even clearer.
The overwhelming majority of health-relevant data — movement, behavior, speech, sleep — is now generated outside the clinical setting. As a result, health innovation is increasingly shifting toward consumer devices and tech platforms that actually hold the data — not the EHR or the healthcare system.