Science
California plans to enlist AI to translate healthcare information
Tener gripe, tener gripa, engriparse, agriparse, estar agripado, estar griposo, agarrar la gripe, coger la influenza. In Spanish, there are at least a dozen ways to say someone has the flu — depending on the country.
Translating “cardiac arrest” into Spanish is also tricky because “arresto” means getting detained by the police. Likewise, “intoxicado” means you have food poisoning, not that you’re drunk.
The examples of how translation could go awry in any language are endless: Words take on new meanings, idioms come and go, and communities adopt slang and dialects for everyday life.
Human translators work hard to keep up with the changes, but California plans to soon entrust that responsibility to technology.
State health policy officials want to harness emerging artificial intelligence technology to translate a broad swath of documents and websites related to “health and social services information, programs, benefits and services,” according to state records. Sami Gallegos, a spokesperson for California’s Health and Human Services Agency, declined to elaborate on which documents and languages would be involved, saying that information is confidential.
The agency is seeking bids for the ambitious initiative, though its timing and cost is not yet clear. Human editors supervising the project will oversee and edit the translations, Gallegos said.
Agency officials said they hope to save money and make critical healthcare forms, applications, websites, and other information available to more people in what they call the nation’s most linguistically diverse state.
The project will start by translating written material. Agency Secretary Mark Ghaly said the technology, if successful, may be applied more broadly.
“How can we potentially not just transform all of our documents, but our websites, our ability to interact, even some of our call center inputs, around AI?” Ghaly asked during an April briefing on AI in healthcare in Sacramento.
But some translators and scholars fear the technology lacks the nuance of human interaction and isn’t ready for the challenge. Turning this sensitive work over to machines could create errors in wording and understanding, they say — ultimately making information less accurate and less accessible to patients.
“AI cannot replace human compassion, empathy, and transparency, meaningful gestures and tones,” said Rithy Lim, a Fresno-based medical and legal interpreter for 30 years who specializes in Cambodian and Khmer languages.
Artificial intelligence is the science of designing computers that emulate human thinking. A type of artificial intelligence known as generative AI, or GenAI, in which computers are trained using massive amounts of data to “learn” the meaning of things and respond to prompts, is driving a wave of investment, led by such companies as Open AI and Google.
AI is quickly being integrated into healthcare, including programs that diagnose diabetic retinopathy, analyze mammograms and connect patients with nurses remotely. Promotors of the technology often make the grandiose claim that soon everyone will have their own “AI doctor.”
AI also has been a game changer in translation. ChatGPT, Google’s Neural Machine Translation and Open Source are not only faster than older technologies such as Google Translate, but they can process huge volumes of content and draw upon a vast database of words to nearly mimic human translation.
Whereas a professional human translator might need three hours to translate a 1,600-word document, AI can do it in a minute.
Arjun “Raj” Manrai, an assistant professor of biomedical informatics at Harvard Medical School and the deputy editor of New England Journal of Medicine AI, said the use of AI technology represents a natural progression in medical translation, given that patients already use Google Translate and AI platforms to translate for themselves and their loved ones.
“Patients are not waiting,” he said.
He said generative AI could be particularly useful in this context.
These translations “can deliver real value to patients by simplifying complex medical information and making it more accessible,” he said.
In its bidding documents, the state says the goal of the project is to increase “speed, efficiency, and consistency of translations, and generate improvements in language access” in a state where 1 in 3 people speak a language other than English, and more than 200 languages are spoken.
In May 2023, the state Health and Human Services Agency adopted a “language access policy” that requires its departments to translate all “vital” documents into at least the top five languages spoken by Californians with limited English proficiency. At the time, those languages were Spanish, Chinese, Tagalog, Vietnamese, and Korean.
Examples of vital documents include application forms for state programs, notices about eligibility for benefits, and public website content.
Currently, human translators produce these translations. With AI, more documents could be translated into more languages.
A survey conducted by the California Health Care Foundation late last year found that 30% of Spanish speakers have difficulty explaining their health issues and concerns to a doctor, compared with 16% of English speakers.
Health equity advocates say AI will help close that gap.
“This technology is a very powerful tool in the area of language access,” said Sandra R. Hernández, president and CEO of the foundation. “In good hands, it has many opportunities to expand the translation capability to address inequities.”
But Hernández cautioned that AI translations must have human oversight to truly capture meaning.
“The human interface is very important to make sure you get the accuracy and the cultural nuances reflected,” she said.
Lim recalled an instance in which a patient’s daughter read preoperative instructions to her mother the night before surgery. Instead of translating the instructions as “you cannot eat” after a certain hour, she told her mom, “You should not eat.”
The mother ate breakfast, and the surgery had to be rescheduled.
“Even a few words that change meaning could have a drastic impact on the way people consume the information,” said Sejin Paik, a doctoral candidate in digital journalism, human-computer interaction and emerging media at Boston University.
Paik, who grew up speaking Korean, also pointed out that AI models are often trained from a Western point of view. The data that drive the translations filters languages through an English perspective, “which could result in misinterpretations of the other language,” she said. Amid this fast-changing landscape, “we need more diverse voices involved, more people thinking about the ethical concepts, how we best forecast the impact of this technology.”
Manrai pointed to other flaws in this nascent technology that must be addressed. For instance, AI sometimes invents sentences or phrases that are not in the original text, potentially creating false information — a phenomenon AI scientists call “hallucination” or “confabulation.”
Ching Wong, executive director of the Vietnamese Community Health Promotion Project at UC San Francisco, has been translating health content from English into Vietnamese and Chinese for 30 years.
He provided examples of nuances in language that might confuse AI translation programs. Breast cancer, for instance, is called “chest cancer” in Chinese, he said.
And “you” has different meanings in Vietnamese, depending on a person’s ranking in the family and community. If a doctor uses “you” incorrectly with a patient, it could be offensive, Wong said.
But Ghaly emphasized that the opportunities outweigh the drawbacks. He said the state should “cultivate innovation” to help vulnerable populations gain greater access to care and resources.
And he was clear: “We will not replace humans.”
Science
More middle-class Californians cancel health coverage after losing federal aid
Facing higher premiums and the loss of federal subsidies, 374,000 people with health insurance from the state marketplace known as Covered California canceled their coverage in the first three months of the year, according to government statistics.
The cancellations amount to 19% of those who had renewed their policies on the state marketplace during open enrollment, state officials said. Those cancellations are higher than in the past three years when they ranged from 13% to 15% of those who renewed.
Jessica Altman, executive director of Covered California, attributed the jump in cancellations to the expiration of enhanced federal subsidies that caused the cost of a plan to leap for most middle-class Californians.
“We expect coverage losses to increase through the year,” she said.
Overall, Covered California had 1.8 million enrollees in February, down from 1.94 million the year before — a decline of 7%.
Altman said monthly enrollment numbers are delayed because consumers have a three-month grace period to resume their premium payments before the insurance carriers end their coverage for nonpayment.
This year, many middle-class Californians who depend on the state-run insurance marketplace created under the Affordable Care Act faced annual costs that were hundreds of dollars higher than last year because of the end of enhanced federal subsidies that began during the COVID-19 pandemic.
In 2021, Congress voted to temporarily boost the amount of subsidies Americans could receive for an ACA plan.
The law also expanded the program to families who had more money. Before that 2021 vote, only Americans with incomes below 400% of the federal poverty level — currently $62,600 a year for a single person or $128,600 for a family of four — were eligible for ACA subsidies. The 2021 vote eliminated the income cap and limited the cost of premiums for those higher-earning families to no more than 8.5% of their income.
On top of the loss of the enhanced federal subsidies, the average premium charged by insurers this year for a Covered California plan rose by more than 10% because of fast-rising medical costs.
The decline in ACA plan enrollees, however, has been greater in some other states. California has tried to keep people insured by using state tax money to fill in the gap for lower-income families.
This year, the state budgeted $190 million for premium subsidies for people with incomes of up to 165% of the federal poverty level.
In his budget plan, Gov. Gavin Newsom proposed spending $300 million on those state subsidies in 2027. That would expand the subsidies to enrollees with incomes up to 200% of the federal poverty level, or $31,920 for an individual or $66,000 for a family of four.
“We may actually see a number of Covered California enrollees paying less in 2027” because of the additional state subsidies, Altman said.
In May, Newsom also proposed in his budget that an additional $27 million in state money be used to help enrollees pay for the cost of gender-affirming care. That amount is an increase to the $30 million that he earlier proposed be spent this year and next to defray those costs for Covered California enrollees, according to state officials.
Last year, federal health officials enacted a rule that said the federally subsidized ACA plans could no longer cover gender-affirming care because it was no longer considered an “essential health benefit.”
Newsom’s proposed budget still faces debate in Sacramento and approval by the state Legislature.
The state marketplaces, created by the Affordable Care Act, also known as Obamacare, were meant to help those who don’t have access to an employer’s health insurance plan and have incomes too high to qualify for Medi-Cal, the government-paid insurance for the poor and disabled.
Because of the higher cost this year, more people are choosing the lower-priced Bronze plans. Those plans have higher co-pays and deductibles than the more expensive plans.
“We’re very concerned with the large shift to Bronze,” Altman said. “When you have higher cost-sharing, you’re more likely to defer care.”
Science
Political play or budget fix? Competition for JPL’s management comes at a fraught moment
Weeks after Trump administration officials announced that management of NASA’s Jet Propulsion Laboratory would open to competitive bidding for the first time, questions remain as to why Caltech could lose control of the lab its researchers founded in 1936.
On one hand, observers note, high-profile delays and cost overruns on significant recent JPL projects earned sharp criticism from NASA even before the 2024 presidential election.
On the other, the second Trump administration’s record of squeezing scientific funding and attacking institutions in Democrat-led states make it difficult to consider any action separate from the charged political atmosphere, analysts say.
“My first instinct is that this [competition] isn’t necessarily a bad thing. It’s not written in stone that Caltech must run JPL, and it wouldn’t be the worst thing to have some competition for running the place,” said Casey Dreier, chief of space policy at the non-profit Planetary Society.
“That said, that requires this contract evaluation to be fair and unbiased, and this administration has no credibility in such things,” he added. “The responsibility is on NASA to earn the trust and ensure such an evaluation is open and free from political meddling. That’s almost impossible.”
JPL became part of NASA when the space agency was formed in 1958, and Caltech has been awarded the contract to run the institution outright ever since.
Its current 10-year contract with NASA, which is valued at up to $30 billion, runs through Sept. 30, 2028.
NASA Administrator Jared Isaacman announced the competition on May 22 as part of a slate of sweeping organizational changes at the space agency.
“When you step back, it is worth considering how many additional missions we could have undertaken with the resources lost to program cancellations and cost overruns over the years,” Isaacman wrote in a memo to staff. “That is the problem we must fix, so the American taxpayer and space-loving community can receive the highest scientific return on every dollar we spend at NASA.”
Competing the contract for JPL, the lone Federally Funded Research and Development Center (FFRDC) in NASA’s portfolio, was an effort to address cost-efficiency concerns, Isaacman wrote.
“This process will take several years, and I do not anticipate it having any impact on the projects underway or the location of the facilities,” he wrote. “It does, however, provide an opportunity to evaluate management costs, overhead burdens, and ideally find ways to get after the science faster and more affordably.”
In a joint statement, Caltech President Thomas F. Rosenbaum and JPL Director Dave Gallagher said the competition was “no surprise” and that a team was already in place “to ensure we are positioned for success.”
In July, NASA’s Office of Procurement held an informational event for companies and institutions interested in the upcoming FFRDC contract.
The dozens of registered attendees included universities like USC, Texas A&M University and Georgia Tech, aerospace companies such as Boeing and Lockheed Martin and nonprofit corporations like MITRE, which manages several FFRDCs, and Universities Space Research Association, a university consortium founded by the National Academy of Sciences in 1969. (SpaceX, which has been awarded more than $13 billion in NASA contracts in the last decade, was not on the list.)
“Lockheed Martin has more than 50 years of deep space exploration success with JPL, supporting landmark missions to Jupiter, Venus, Saturn, Pluto, including nearly a dozen missions to Mars,” said Bob Behnken, VP of Exploration and Technology Strategy. “We look forward to building on that unmatched partnership in the years ahead. We are closely following NASA’s review and will continue to assess how we can best contribute to the agency’s mission.”
Other attendees contacted by The Times declined to discuss their involvement.
Isaacman indicated that JPL could come under scrutiny even before he took over NASA. The billionaire entrepreneur referenced high costs at the La Cañada Flintridge institution in a memo prepared in advance of his confirmation hearings on his priorities for the space agency.
“Contract structure: Very expensive,” Isaacman wrote of JPL in a table outlining organizational issues at each of NASA’s centers. “Must increase the output and ‘time-to-science’ KPI.”
The institution has recently suffered a number of high-profile management stumbles.
After the JPL-managed Psyche mission to a metal-rich asteroid failed to meet its 2022 launch date, NASA commissioned an independent review that said internal reorganizations and personnel changes created distracted and uninformed managers and burned-out, stretched-thin staffers.
After a 2023 independent review found there was “near zero probability” of the JPL-managed Mars Sample Return mission making its proposed 2028 launch date, and “no credible” way to bring rocks back from the Red Planet within the stated budget, Isaacman’s predecessor Bill Nelson put out a call for proposals to industry and all other NASA centers, forcing JPL to compete for its own project.
After Trump’s election, Nelson announced that the final decision would be in the next administration’s hands.
The White House pushed for massive cuts to NASA’s 2026 budget that Congress overturned, and has lobbied for similarly steep cuts again this year. JPL has instituted painful cost-cutting measures of its own, reducing staffing from roughly 6,500 employees in 2023 to 4,500 last year through layoffs and attrition.
Its struggles come at a point when NASA is enthusiastically embracing private industry. Last month the agency awarded several key contracts for its upcoming lunar missions to Jeff Bezos’s Blue Origin and other private companies.
Trump has also made no secret of his willingness to punish states that haven’t voted for him through job losses. In announcing his decision to move U.S. Space Command from Colorado to Alabama, Trump acknowledged that his loss in Colorado in three presidential elections played a part in the move.
It’s impossible to consider any decision on JPL’s future separate from the administration’s track record of politically-motivated decisions, Dreier said.
“At the heart of this is why? Why now? If this is not just some rank political attack on California, what do they hope to gain from this?” Dreier said. “That deserves explanation, because the administration otherwise has no credibility here.”
Science
Dive Into a Very Noisy Sea With Some Very Rare Whales
The Gulf of Mexico, which the Trump administration calls the Gulf of America, is one of the noisiest bodies of water in the United States. Air gun blasts are the loudest element there, according to research by scientists who monitor underwater acoustics. Shipping traffic is another major contributor.
The noise could affect the ability of Rice’s whales to find food and mates, scientists say. The chronic stress of living in a loud environment could be detrimental to their health.
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