#also there's a HUGE lag whenever i use the search bar to search for a playlist i made

[wickedhawtwexler]

spotify please hire back all the tech workers you fired, your app is literally becoming unusable

[zagubionywilk]

USE THIS WEBSITE TO GENERATE YOUR MUSE’S POKEMON TEAM.

usually this is a meme but fuck that,  i’m stealing this from one of my other blogs so i guess i’m re   -   tagging myself.    anyway,    i’ve been lagging on writing up geralt’s pokemon au  /  team for awhile so    . .    lo and behold here we go we did it boys.  the   au itself   is effectively a side step version of his    modern au    but,    you know,    pokemon.    tl;dr:    geralt’s been alive since 1925 and wandering around doing witchery stuff as usual for people with his pokemon in tow helping him out and assisting him whenever he needs assistance getting rid of  monsters.    there comes a time where the wolf becomes worn out and  semi  -  retires   on his corvo bianco ranch as he occasionally goes out to help folks,    again with his pokemon in tow,    when necessary.    pokemon ages  ??   who knows and cares,  leave me and his pals alone   --------    now,  time to meet the team:

geralt’s pokemon partner    and    first pokemon is his mudsdale,    roach    with the moveset:  double kick,    heavy slam,    high horsepower and stomp.    he’s had her since she was itty bitty and a mudbray when he survived his trials at kaer morhen.    initially he had taken a shine to her prior to the trials and she to him    ;    always excited and trotting around the boy when he came to look over her.    geralt humored her always,  after surviving he and roach never really were apart when it came to going out of the stone walls of kaer morhen,    the little pokemon protective of its partner that she had come to trust.    once the wolf had left the school’s walls years later,  his little horse had become large and intimidating    ;    still gentle to him even though her temper had surged with her evolution.    as they went on in the world,    as the years went by,   they still stuck together through everything    ---    ever closer.    roach is hugely protective of her witcher and will    stomp you to death with her hooves    if you so much as threaten him.

tsareena,    nickname    petal    with the moveset:    stomp,    high jump kick,    power whip and solar beam.     all in all,    petal wouldn’t leave geralt alone.    one of the very last pokemon he gained on his team recently,    petal ran into geralt when she was her previous evolution,  steenee    -----    all due to the fact her little home had come under the attention of some humans.    a litwick had been causing a bit of a stir for them,    having sucked a few people’s life forms to dust which led humans to go searching for the pokemon to try and get rid of it.    geralt had been passing through and,    well,    ended up saving petal indirectly.    she was enamored and thankful for this friendly    (    yet kinda scary    !!    )    man who helped her and just   . .   followed him.    geralt’s heart couldn’t keep ignoring her for long and thus let her stick around,   the little pokemon doing her best to impress him and doing so    ;  leveling herself as she did and eventually,    when she gained stomp,  she evolved into tsarenna.    she’s a tomboyish little thing with an attitude now but never ungrateful for the help given to her.    she’ll also stomp you to death with her leetle feet.    during hunts she’s usually quick to assist.

absol,    nickname    sol    with the moveset:    dark pulse,    bite,    night slash and taunt.  geralt’s second pokemon was sol,    an absol he had found during one of the heavier winters in the kaedwin mountains.    she was wounded after a human had harmed it in one of its descents down the mountain to warn of impending disaster.    geralt had come across her in the snow,   bleeding out from the injury and managed to calm her down enough to get her out of the cold.    the disaster had been an avalanche,    no one getting hurt barring the man that had left the pokemon to die in the snow.    alas,    she survived.    in the small cave out of the heavy storm,  roach,    sol and geralt rode it out.    the wolf making sure the absol would survive her wounds with the resources he did have on hand and once it was over the dark pokemon stuck by his side.    with the myth that the pokemon brings disaster    ---    there’s a minor irony of it sticking around the witcher,    becoming his partner    ;    as both are detested and both are feared because of what and who they are.    sol detests fighting lest she can help it,    as it does hurt her to strain herself.  geralt doesn’t use her much on hunts but does bring her along    (    or she just trails behind anyway    ). 

sylveon,    nickname    bow    with the moveset:    disarming voice,    moonblast,    quick attack and psych up.    another one of the recent ones,    however a relatively long lasting one as well.    bow was given to geralt as a   thank you   from dandelion,  initially as an eevee.    the small thing took a shine to geralt and geralt took a shine to the little pokemon who enjoyed his space as well as sol’s.    he wasn’t a fan of staying in his pokeball whenever geralt was    uncomfortable    with a situation or when the wolf was highly upset over something.    effectively the eevee became a sort of    .  .    comfort pokemon for geralt.  when it came down to evolving,    geralt wanted to try for an  umbreon    but got bamboozled when bow evolved into a    sylveon    due to amount of friendship and love bow had for his trainer.    she likes to sit on geralt’s shoulder,    gently holding on with her ribbons that do well to settle him down if he’s ever overwhelmed or upset,    thus being the resident comfort pokemon if anything goes awry.    he’s equally protective of geralt and the friends he has,    rather bouncy and excitable as well.    his presence itself stumps humans and their assumption that witcher’s don’t feel    .  .    considering the required affection and loving on needed for sylveon to    .  .    be.

zebstrika,    nickname    z    (    yes how original     )    with the moveset:    wild charge,    discharge,    thrash and shockwave.    mad.    just    .  .    mad.    z doesn’t like humans very much,    only putting up with those that geralt is close to but irritable enough to stomp and make it known that it doesn’t want many near him.    z found geralt first,    or rather     roach    found the pokemon first,    leading geralt to the zebstrika when upon roaming had found him caught in a man    -    made trap.    after nearly an hour and a half of calming z down and with some assistance from roach just    snorting    and stomping in frustration   . .    geralt was able to get close enough to remove the trap.    z,    at first,    ran off,    only to follow them from a safe distance through the forest before coming to steal a few of the apples geralt had in saddlebags overnight.   begrudging thanks became true once geralt had gained the zebstrika’s trust.    not entirely    “    tame    “    z will still lash out sometimes if unsure of a situation but    will    come to geralt’s aid when its required    .  .   and for pets.

mightyena,    nickname    wulf    with the moveset:    suckerpunch,    crunch,    scary face and bite.    wulf was geralt’s third pokemon he gained,    having gained its trust over a period of a year after its habitat had been uprooted.     initially wary of geralt she came to trust him mostly by how geralt would bring it food when it couldn’t find any due to the uprooted home it came from.    she grew attached and after a time began to follow him out whenever he left.    with geralt’s experience wulf became loyal and ready to defend and fight when needed.  she’s cozy to be within and outside her pokeball but,    unsurprisingly,  has a grand ol time outside of it    ;    being chaotic and tomboyish. 

+   a cubone.    they’re new.    geralt found it while it was crying and it just pretty much  also  won’t leave him alone now.    it doesn’t fight.  just hangs out and is a cute nuisance.  its name is    buttercup.

[ionecoffman]

Millennials Are Sick of Drinking

On January 20, 2017, Cassie Schoon rolled into work with a hangover. It was the morning of Donald Trump’s presidential inauguration, and Schoon, who doesn’t count herself among the president’s fans, had gone out for drinks with friends the night before to take her mind off it. The evening’s distraction left her in pretty rough shape the next day. “I was in this meeting feeling absolutely miserable and I was like, you know, this is not what grownups do,” she says.

Since then, Schoon, who is 37 and lives in Denver, has cut way back on alcohol. “[Drinking] has to be more of an occasion for me now, like someone’s birthday or a girl’s night,” she says. “So it’s once every couple of weeks, instead of a weekly occurrence.” Drinking less wasn’t always simple for her: Denver is a young town with a vibrant brewery and bar scene, and Schoon’s social circle had long centered itself around meeting up for drinks. But avoiding booze has been worth it. “I started to realize there’s no reason I can’t see these people and go to museums or go out for waffles or something,” Schoon says.

In the past few weeks, I’ve heard from more than 100 Americans in their 20s and 30s who have begun to make similar changes in their drinking habits or who are contemplating ways to drink less. They have good company: Public-health efforts have helped drive down adolescent drinking rates, and American beverage manufacturers are beginning to hedge their bets on alcohol’s future. Media, too, has noticed that change is afoot. Recent months have seen a flurry of trend stories about millennials—currently about 22 to 38 years old—getting sober.

But sobriety, a term that generally refers to the total abstention practiced by people in recovery from substance-abuse problems, doesn’t quite tell the story. What some have been quick to characterize as an interest in being sober might actually be more like a search for moderation in a culture that has long treated alcohol as a dichotomy: You either drink whenever the opportunity presents itself, or you don’t drink at all. Many millennials—and especially the urban, college-educated consumers prized by marketers—might just be tired of drinking so much.

There isn’t any great statistical evidence yet that young adults have altered their drinking habits on a grand scale. Changes in habit often lag behind changes in attitude, and national survey data on drinking habits reflect only small declines in heavy alcohol use. (For men, that’s drinking five alcoholic beverages in a short period of time five or more times in a month; for women, it’s four drinks under the same conditions.) From 2015 through 2017, the most recent year for which data is available, the rate of millennials who report that they have consumed any amount of alcohol in the past month has remained pretty steady, at more than 60 percent.

But there are limitations to this data that would make it difficult to capture the types of changes that people described to me. Someone who has cut back from regularly having two or three glasses of wine with dinner to only having a glass once a week, for example, would still fall into the same statistical category, eliding shifts that might make a huge difference on a personal level. And a desire to drink less doesn’t mean that people no longer enjoy drinking. Instead, it might be that alcohol-centric socializing has crept into more parts of people’s lives and stuck around for longer than previous generations had to contend with it.

For young Americans, drinking is very social. “I drank pretty regularly in my 20s, especially in social situations,” says Leanne Vanderbyl, who lives in San Francisco. “It wasn’t until I hit my 30s that I realized that alcohol was no longer my friend.” A few decades ago, marriage and children might have moved urban, college-educated young adults away from social drinking naturally, but fewer millennials are taking part in traditional family-building, and the ones doing it are waiting longer than their parents did. Now, the structure of social life isn’t that different for many people in their mid-30s than it was in their early 20s, which provides plenty of time spent drinking on dates and with friends for them to start to get a little tired of it.

For a generation that’s also behind its forebears when it comes to wealth accumulation, whether or not it’s a good idea to buy a bunch of beer or several $13 cocktails three nights a week can come down to practical concerns. Alex Belfiori, a 30-year-old IT professional in Pittsburgh, decided recently to stop keeping beer in the house. “I’ve already calculated how much I’m saving by not drinking, and I’m thinking about where I can put that money now,” he says. Nina Serven, a 24-year-old brand manager living in Brooklyn, is similarly over it. “Drinking just feels boring and needlessly expensive,” she says, even though she feels social pressure to drink. “I just started a medication that shouldn't be mixed with alcohol, and I'm relieved that I have an easy out.”

Britta Starke, an addictions therapist and the program director of the Alcohol and Substance Abuse Center at the University of North Carolina, sees a similar malaise in those seeking guidance from in her practice. “There does come a time when there has to be some introspection,” she says. “Folks in the millennial generation have maybe a better sense of balance. Some do yoga or meditation or are physically active, so they don’t need to find stimulation and stress-reduction in substances.” That mirrors the generation’s general interest in maintaining its health, and for those questioning their habits, realizing that a healthier relationship with alcohol doesn’t require most people to give up drinking might ease people’s social concerns.

Still, Starke has noticed some worrying attitudinal trends toward alcohol among her younger patients. Millennials who haven’t developed their generation’s signature coping skills often use alcohol heavily. Starke sees an alarming number of people under 35 with advanced liver disease or alcohol hepatitis. As attitudes may be moderating for many young adults, plenty of others are struggling: Nearly 90,000 people still die from alcohol-related causes in America every year, and that number hasn’t started to meaningfully improve.

Moreover, drinking doesn’t exist in a substance-use vacuum. All the other things millennials are well-known for ingesting play a role in its shifting popularity. “It still seems like this is a generation of self-medicating, but they’re using things differently,” says Starke, and the normalization and ever-more-common legalization of cannabis plays a big role in that.

Among the people I spoke with in detail, several mentioned replacing their evening wine with an evening bowl. “I smoke weed to unwind—thank you, California,” says Vanderbyl. For her, cannabis lacks the lingering effects that drove her away from alcohol: “I can wake up in the morning feeling ready for the day.” She’s not alone in making that switch. A 2017 study found that in counties with legalized medicinal cannabis, alcohol sales dropped more than 12 percent when compared to similar counties without weed. Recreational legalization has the potential to bolster that effect by making cannabis products even more broadly accessible.

Millennials have also shown what Starke says is worrisome interest in other drugs, the abuse of which may be diverting some of their attention from alcohol. She sees many patients looking for help with opioids, as well as benzodiazepines like Xanax. Just because young people want to drink less often doesn’t necessarily mean they’re better off: Suicide rates are up among young adults, and prescription abuse is a problem the country is only beginning to address.

The beverage industry does seem to see the writing on the wall. Over the past decade, a tide of artisanal alcohol businesses met the swelling millennial market for booze-based socializing, including innumerable microbreweries and distilleries, as well as high-end cocktail bars and wine shops targeting younger clientele. Now, 2018 Nielsen data shows that sales growth across alcohol categories is slowing. Bon Appetit estimates that the market for low- or no-alcohol beverages could grow by almost a third in just the next three years.

If he spaces in which alcohol is consumed will also have to change to meet shifting consumer demands. It’s become notably easier in recent years to find alcohol-free cocktails in urban bars across America. In New York City, a few young entrepreneurs are opening up new kinds of spaces to serve the tastes of their peers. Listen Bar, a clubby pop-up that gives patrons a chance to party without alcohol, is crowdfunding to lease its first permanent location. In Brooklyn’s Greenpoint neighborhood, Getaway, a bar so dedicated to being booze-free that it won’t even use bitters that contain alcohol, is opening in a few weeks.

Getaway’s owners, Sam Thonis and Regina Dellea, left careers in media to open the bar, which was an idea inspired by Thonis’s brother’s recovery from alcoholism. So far, the reception the pair has received bears out the broader generational shift they’re anticipating. “It feels to me like the older people are, the more they see [our bar] as a thing for sober people. They see it as black or white—you drink or you don’t drink,” says Thonis. “With younger people, there’s a lot more receptiveness to just not drinking sometimes.”

Instead of being the tipping point of any grand trend in alcohol consumption themselves, millennials might simply be the canaries in the coal mine. Statistically, it’s Gen Z, the age group currently in high school and college, that may force a sea change in America’s relationship with alcohol. They’re drinking at lower rates than adolescents have in generations, and so much about a person’s lifetime relationship to substance abuse and consumption is set by usage in early life.

For now, many young adults seem relieved that pressure they’ve internalized to drink is easing and more options are opening up. Drinking’s spot in people’s lives doesn’t have to be as all-or-nothing as American culture has long regarded it. “For many people, when they’re honest with their friends [about wanting to skip out on drinks], their friends are like, ‘Oh my god, I was thinking about that too,’” says UNC’s Starke. “I don’t know too many people who have gotten a negative response.”

Dellea has also noticed a mix of excitement and relief among her bar’s prospective patrons. “An Instagram account put up a picture of the bar,” she says. “A lot of the comments were just people tagging their friends.”

Article source here:The Atlantic

[nancygduarteus]

Millennials Are Sick of Drinking

On January 20, 2017, Cassie Schoon rolled into work with a hangover. It was the morning of Donald Trump’s presidential inauguration, and Schoon, who doesn’t count herself among the president’s fans, had gone out for drinks with friends the night before to take her mind off it. The evening’s distraction left her in pretty rough shape the next day. “I was in this meeting feeling absolutely miserable and I was like, you know, this is not what grownups do,” she says.

Since then, Schoon, who is 37 and lives in Denver, has cut way back on alcohol. “[Drinking] has to be more of an occasion for me now, like someone’s birthday or a girl’s night,” she says. “So it’s once every couple of weeks, instead of a weekly occurrence.” Drinking less wasn’t always simple for her: Denver is a young town with a vibrant brewery and bar scene, and Schoon’s social circle had long centered itself around meeting up for drinks. But avoiding booze has been worth it. “I started to realize there’s no reason I can’t see these people and go to museums or go out for waffles or something,” Schoon says.

In the past few weeks, I’ve heard from more than 100 Americans in their 20s and 30s who have begun to make similar changes in their drinking habits or who are contemplating ways to drink less. They have good company: Public-health efforts have helped drive down adolescent drinking rates, and American beverage manufacturers are beginning to hedge their bets on alcohol’s future. Media, too, has noticed that change is afoot. Recent months have seen a flurry of trend stories about millennials—currently about 22 to 38 years old—getting sober.

But sobriety, a term that generally refers to the total abstention practiced by people in recovery from substance-abuse problems, doesn’t quite tell the story. What some have been quick to characterize as an interest in being sober might actually be more like a search for moderation in a culture that has long treated alcohol as a dichotomy: You either drink whenever the opportunity presents itself, or you don’t drink at all. Many millennials—and especially the urban, college-educated consumers prized by marketers—might just be tired of drinking so much.

There isn’t any great statistical evidence yet that young adults have altered their drinking habits on a grand scale. Changes in habit often lag behind changes in attitude, and national survey data on drinking habits reflect only small declines in heavy alcohol use. (For men, that’s drinking five alcoholic beverages in a short period of time five or more times in a month; for women, it’s four drinks under the same conditions.) From 2015 through 2017, the most recent year for which data is available, the rate of millennials who report that they have consumed any amount of alcohol in the past month has remained pretty steady, at more than 60 percent.

But there are limitations to this data that would make it difficult to capture the types of changes that people described to me. Someone who has cut back from regularly having two or three glasses of wine with dinner to only having a glass once a week, for example, would still fall into the same statistical category, eliding shifts that might make a huge difference on a personal level. And a desire to drink less doesn’t mean that people no longer enjoy drinking. Instead, it might be that alcohol-centric socializing has crept into more parts of people’s lives and stuck around for longer than previous generations had to contend with it.

For young Americans, drinking is very social. “I drank pretty regularly in my 20s, especially in social situations,” says Leanne Vanderbyl, who lives in San Francisco. “It wasn’t until I hit my 30s that I realized that alcohol was no longer my friend.” A few decades ago, marriage and children might have moved urban, college-educated young adults away from social drinking naturally, but fewer millennials are taking part in traditional family-building, and the ones doing it are waiting longer than their parents did. Now, the structure of social life isn’t that different for many people in their mid-30s than it was in their early 20s, which provides plenty of time spent drinking on dates and with friends for them to start to get a little tired of it.

For a generation that’s also behind its forebears when it comes to wealth accumulation, whether or not it’s a good idea to buy a bunch of beer or several $13 cocktails three nights a week can come down to practical concerns. Alex Belfiori, a 30-year-old IT professional in Pittsburgh, decided recently to stop keeping beer in the house. “I’ve already calculated how much I’m saving by not drinking, and I’m thinking about where I can put that money now,” he says. Nina Serven, a 24-year-old brand manager living in Brooklyn, is similarly over it. “Drinking just feels boring and needlessly expensive,” she says, even though she feels social pressure to drink. “I just started a medication that shouldn't be mixed with alcohol, and I'm relieved that I have an easy out.”

Britta Starke, an addictions therapist and the program director of the Alcohol and Substance Abuse Center at the University of North Carolina, sees a similar malaise in those seeking guidance from in her practice. “There does come a time when there has to be some introspection,” she says. “Folks in the millennial generation have maybe a better sense of balance. Some do yoga or meditation or are physically active, so they don’t need to find stimulation and stress-reduction in substances.” That mirrors the generation’s general interest in maintaining its health, and for those questioning their habits, realizing that a healthier relationship with alcohol doesn’t require most people to give up drinking might ease people’s social concerns.

Still, Starke has noticed some worrying attitudinal trends toward alcohol among her younger patients. Millennials who haven’t developed their generation’s signature coping skills often use alcohol heavily. Starke sees an alarming number of people under 35 with advanced liver disease or alcohol hepatitis. As attitudes may be moderating for many young adults, plenty of others are struggling: Nearly 90,000 people still die from alcohol-related causes in America every year, and that number hasn’t started to meaningfully improve.

Moreover, drinking doesn’t exist in a substance-use vacuum. All the other things millennials are well-known for ingesting play a role in its shifting popularity. “It still seems like this is a generation of self-medicating, but they’re using things differently,” says Starke, and the normalization and ever-more-common legalization of cannabis plays a big role in that.

Among the people I spoke with in detail, several mentioned replacing their evening wine with an evening bowl. “I smoke weed to unwind—thank you, California,” says Vanderbyl. For her, cannabis lacks the lingering effects that drove her away from alcohol: “I can wake up in the morning feeling ready for the day.” She’s not alone in making that switch. A 2017 study found that in counties with legalized medicinal cannabis, alcohol sales dropped more than 12 percent when compared to similar counties without weed. Recreational legalization has the potential to bolster that effect by making cannabis products even more broadly accessible.

Millennials have also shown what Starke says is worrisome interest in other drugs, the abuse of which may be diverting some of their attention from alcohol. She sees many patients looking for help with opioids, as well as benzodiazepines like Xanax. Just because young people want to drink less often doesn’t necessarily mean they’re better off: Suicide rates are up among young adults, and prescription abuse is a problem the country is only beginning to address.

The beverage industry does seem to see the writing on the wall. Over the past decade, a tide of artisanal alcohol businesses met the swelling millennial market for booze-based socializing, including innumerable microbreweries and distilleries, as well as high-end cocktail bars and wine shops targeting younger clientele. Now, 2018 Nielsen data shows that sales growth across alcohol categories is slowing. Bon Appetit estimates that the market for low- or no-alcohol beverages could grow by almost a third in just the next three years.

If he spaces in which alcohol is consumed will also have to change to meet shifting consumer demands. It’s become notably easier in recent years to find alcohol-free cocktails in urban bars across America. In New York City, a few young entrepreneurs are opening up new kinds of spaces to serve the tastes of their peers. Listen Bar, a clubby pop-up that gives patrons a chance to party without alcohol, is crowdfunding to lease its first permanent location. In Brooklyn’s Greenpoint neighborhood, Getaway, a bar so dedicated to being booze-free that it won’t even use bitters that contain alcohol, is opening in a few weeks.

Getaway’s owners, Sam Thonis and Regina Dellea, left careers in media to open the bar, which was an idea inspired by Thonis’s brother’s recovery from alcoholism. So far, the reception the pair has received bears out the broader generational shift they’re anticipating. “It feels to me like the older people are, the more they see [our bar] as a thing for sober people. They see it as black or white—you drink or you don’t drink,” says Thonis. “With younger people, there’s a lot more receptiveness to just not drinking sometimes.”

Instead of being the tipping point of any grand trend in alcohol consumption themselves, millennials might simply be the canaries in the coal mine. Statistically, it’s Gen Z, the age group currently in high school and college, that may force a sea change in America’s relationship with alcohol. They’re drinking at lower rates than adolescents have in generations, and so much about a person’s lifetime relationship to substance abuse and consumption is set by usage in early life.

For now, many young adults seem relieved that pressure they’ve internalized to drink is easing and more options are opening up. Drinking’s spot in people’s lives doesn’t have to be as all-or-nothing as American culture has long regarded it. “For many people, when they’re honest with their friends [about wanting to skip out on drinks], their friends are like, ‘Oh my god, I was thinking about that too,’” says UNC’s Starke. “I don’t know too many people who have gotten a negative response.”

Dellea has also noticed a mix of excitement and relief among her bar’s prospective patrons. “An Instagram account put up a picture of the bar,” she says. “A lot of the comments were just people tagging their friends.”

from Health News And Updates https://www.theatlantic.com/health/archive/2019/04/millennials-sober-sick-of-drinking/586186/?utm_source=feed

[med20]

No matter where you are in the world, there is never enough healthcare to meet demand. There are too many human bodies out there to be maintained, tended to and healed. But we’re living in an age of automation and AI. Couldn’t there be an answer in technology?

Havas LYNX’s Interactive Director Adam Emmott thinks so. “With healthcare systems being pushed to their limits, there is a need to understand and implement how intelligent, AI-driven chatbots could help ease some of the burden and perhaps improve data infrastructures,” he says. “As we move in to new ways of delivering better ‘beyond-the-pill services’ in healthcare, the chatbot is emerging as an interesting opportunity to support.”

With healthcare professionals stretched thin, live face-to-face time with a healthcare professional can be variable. “These live conversations can be poor quality, average quality, or amazing, and the reality is that not enough are amazing,” says Dr John Reeves, Chief Medical Officer at conversationHEALTH, a Toronto-based startup that builds chatbots for healthcare and adjacent sectors. “These one-to-one conversations cannot scale to meet real time customer demand,” he adds.  He believes branded conversational AI can step in to plug this gap. “Chatbots allow brands to capture the very best conversations (and those that are on-brand message) and scale to millions of end customers. And they do so in an on-demand, personalised way.”

You may have already encountered services like Babylon, Sensely and your.md that demonstrate the power of tracking user healthcare data in meaningful ways, but also using that data to make meaningful diagnoses. “It is still early days,” admits Adam, “but with the use of machine learning and huge data lakes of usable medical information being collected, it should be inevitable that we could see much needed support from chatbots in healthcare provision.”

The end game of that thinking is hard for us to countenance in 2018: a world where you can chat to an AI about your symptoms and receive a diagnosis that you can trust.  Adam imagines the power of good conversational AI in the mental health space. “Supported, meaningful, conversation obviously lends itself to provide support in talking therapies. When we are able to create truly sensitive, personal conversations available whenever a user needs it, we could be onto something incredibly powerful. Connect that with deep learning, we begin start something groundbreaking in the understanding of mental health, from provision to diagnosis.”

That’s getting ahead of ourselves though. Chatbots aren’t likely to replace your doctor anytime soon. “There isn’t really a strategy around AI and bots that I’ve seen any health system or pharma company put together,” says Ritesh Patel, Chief Digital Officer for Health and Wellness at Ogilvy. “You’ll see point solutions coming through, not necessarily a strategic view of using this technology to really change the delivery of care model. Entrepreneurs will go after the market faster than health systems will. They’ll see a need, see how much the area is worth and go for it.”

Pharmaceutical brands are taking the chatbot arms race seriously, as Dr John is witnessing. “Compared to the three previous big digital opportunities (web, apps, social), conversational solutions (messaging, chatbots, voice) are gaining traction at a faster rate,” he says. “Pharma sees massive potential in the use of AI across the enterprise, including marketing communications to reimagine the way they engage their customers in a more ‘modern’ way. I mean, texting and talking is how life is lived now. No one wants to be searching or navigating through web sites, articles, brochures, videos to resolve a specific need.” Ritesh observes that there are two arms races among the pharma clients in this space. One of them is the race to be first to market. In this case, being first is valuable, he believes: “You’ll be the first chatbot people use and they’ll remember you’re the one. And when someone else comes along, unless they have something amazingly different or unique to offer you, it’s much less likely you’re going to use it.”

The second arms race is the technology and the ability for image recognition, AI and natural language processing. “I think it’ll drive a lot of these bots to become voice-activated bots,” says Ritesh. “Right now while it’s chat and you’re typing. I think you’re going to see an explosion of voice. Where now you see people saying ‘OK Google’ and ‘Hey Siri’, you may get a doctor saying ‘Hey Pfizer’ or ‘Hey Merck’.”

Chatbots from pharma brands will appear in doctors’ offices before they appear on patients’ phones more generally, Ritesh predicts, and he can imagine how they might make physicians’ lives significantly smoother. “The doctor doesn’t wait until the pharma rep arrives at 2pm on a Thursday to hold all their questions. The brand’s website is highly complex and tough to navigate to get the content you need. So if I’m doing my rounds and I need a bit more information about the drug I’m going to prescribe to you, I’ve got two ways I could do that - look it up on the website of the pharma company and try and find the dosing information or I could just whip out my phone and say ‘Hey Merck M.D., what’s the dosing information for this medication? I’ve got a 55-year-old female who’s taking this medication and this medication. Can I also give them this? And how many milligrams?’ So that instant access to bits of data that I need during my day is the value proposition for a chatbot for healthcare professionals.”

Naturally, this is great marketing for the pharma brand with the best bot. Whatever makes doctors’ lives easiest will benefit from doctors considering that brand’s products more often.

There’s also a compelling argument for chatbots’ use around clinical trials. Chat apps on a patient’s phone could make the collection of data more natural as well as reminding patients to take their drugs when they need to and report any side effects. Many jobs that once took up a nurse’s time can be automated. “It used to be that I gave you a book and you wrote down everything that occurred on a daily basis,” says Ritesh. “Now the bot does that. Anyone who has a mobile phone can install it and you can log your day with this medicine you’re taking during the trial. It also checks in with you - a virtual nurse: ‘How are you feeling today? Did you have any adverse effects?’ Sometimes people don’t report them because they don’t think it’s a side effect.”

Alongside the pharma brands, we are likely to start seeing chatbots emerging from advocacy groups for specific conditions to raise awareness around these diseases. In the UK the Asthma Foundation recently launched a chatbot for living with asthma that was sponsored by Boehringer Ingelheim called Tabatha. It’s a Facebook Messenger bot created to educate and help people. It ran as a pilot earlier this year and Ritesh found it interesting how well it was received. “It’s a generational thing. The millennials are adopting these things in droves because it’s part of their whole workflow. They’re good with things like chat because of text and Snapchat and all these apps.”

The concept of a chatbot has been proliferating for years now and we see them all over the web in customer service roles and it is now easier than ever for health and pharma brands and their agencies to build them. Adam notes that services such as Dialogflow and Bluemix do “most of the heavy lifting” for developers these days. “The challenge, as always with digital, is making them good! We are in that awkward toddling phase like we have seen with all new tech. We may have small pockets of awesome in our agencies, however, making those function across all disciplines is the challenge. As the development tools get better, functionality will undoubtedly improve. Hopefully, within the next 18 months, we’ll start to see chatbot personalities coming from outside of the big players and offering real value in healthcare research.”

The decisions the industry makes now will be vital, setting the bar by which conversational health solutions are measured for years to come, until we reach that point when we have trustworthy AI doctors. “Ultimately, we will begin to see patients ‘converse’ with their digital twins, a bot that will understand who we are, what we like and what healthcare issues we have faced in the past,” says Adam. “When considering the build of these kinds of interactions, I often think of the base interactions as ‘starter yeast’! Whatever core interactions we create and define now will form the ‘personalities’ of our chatbots of the future. Now more than ever, we have to get these foundations correct.”

Ritesh realises the challenge here comes from brands’ motivations. “Most marketers want to tell you stuff. They don’t want to help you. So how do you fix it so that you’re having a conversation and that leads to you giving me something of value so that I keep coming back to your brand? That builds a brand.”

Bot agencies tend to compete on the tech side and it’s easy to get lost in functionality, but as Dr John recognises, “all tech does is allow anyone to create a so-so bot. The magic lies in the conversation strategy and execution within this highly regulated industry (and how technology can enable this).”

One of the main reasons healthcare has always lagged behind in the innovation space is that it’s important. It’s literally a matter of life or death. So naturally, innovation by health and pharma brands faces a lot of scrutiny.  

“As soon as we open up this area of conversation though, we inevitably end up in rabbit hole of ‘how much can and should we know?’, ‘who owns my data?’, and ‘how the hell will we approve this?!’” laughs Adam. “The major challenge for pharma clients is the age-old issue of compliance. How do we create meaningful, compliant experiences for our customers that go beyond the linear multiple-choice pathways provided by most pharma chatbots?” Giving medical advice via an AI? That’s scary for corporate lawyers. “If you give bad advice and somebody dies, then what? You have to be overly cautious. Anything that slaps of providing medical advice is going to be difficult,” says Ritesh.

But difficult doesn’t mean impossible. Dr John denounces the perception that pharma can’t play in the messaging space. The fear is that AI might generate conversations that might include incorrect or off-message information and put the client at legal risk. “The reality is that pharma solutions can leverage AI in a different way,” he says, “meaning that all conversations are pre-structured and pre-approved and AI is used only to understand the user questions and then serve up the right conversation (from an extensive library which is pre-approved).”

Another huge paranoia is the great bogeyman of 2018 - use of personal data. Health issues revolve around the most personal kind of data - age, location, lifestyle choices - and chatbots often end up on Facebook Messenger as a natural environment for them to operate in. “For healthcare, the question is in the access to usable data sets,” posits Adam. “How do we let private companies have access to personal information? Even with the current level of chatbot capability, they could help provide the much-needed improvements in infrastructure. Enter blockchain. Once we have patient data available on a robust, secure and universal platform then maybe we can start to think of a future with android doctors.”

The final challenge for health chatbots is a more subtle, human one. Do you trust a robot doctor? “On the patient side I think trust is going to be enormous,” says Ritesh. “I think that’s why some of these bots in healthcare will come from patient advocacy groups, which is a trusted resource in patients’ lives if they’re living with a disease. They’re more likely to trust it than something coming from a pharma brand.”

None of these challenges are insurmountable though. Pharma brands are undeterred. Ritesh has been watching this space and predicts that we’re on the brink of something. “In 2019 you’re going to see an explosion of healthcare professional bots from pharma companies. The advocacy groups will be a bit slower. It will reach healthcare professionals before consumers.”

Dr John and conversationHEALTH are actively working with eight global pharma companies. “All are aggressively moving into the conversation world, he says, “with two quickly moving to voice solutions for healthcare professionals. Our belief is that all brands will have conversational solution (just as all have websites). Why would a user want to search for answers when they can simply ask and get one immediately?”