Algorithmovigilance and HART: Building Trust

In the early 1960s, the sedative thalidomide was withdrawn from markets worldwide after thousands of infants were born with severe congenital disabilities. From that loss emerged a new discipline—pharmacovigilance—the systematic, continuous monitoring of drugs after approval. It transformed patient safety from a one-time regulatory act into a living, learning process.

Today, healthcare stands at a similar inflection point. Artificial intelligence is becoming medicine’s newest therapeutic tool—one capable of diagnosing, predicting, and guiding treatment—but it evolves continuously. Unlike a pill, an algorithm does not remain stable once released. We therefore require a new form of vigilance: algorithmovigilance, the post-deployment discipline that keeps AI accountable long after launch. Continue reading→

From Black Box to Open Book

In 1911, Frederick Winslow Taylor published The Principles of Scientific Management, a book that redefined how the world thought about reliability. Taylor argued that every process—no matter how human or complex—required observation and measurement to prevent decline. Left unmonitored, systems would drift from their intended purpose. Workers of his era saw Taylor’s methods as dehumanizing. They resented being measured, believing oversight implied distrust. Yet Taylor’s insight proved timeless: measurement is not punishment; it is protection against failure. The lesson reached beyond the factory floor—it became the foundation of every modern safety system, from aviation to medicine. Continue reading→

Beyond HART: Safety Net for AI

In 1929, optimism outpaced judgment. The exuberance of an unregulated market collapsed under its own weight, leaving investors frightened and society disillusioned. What restored faith in capitalism were not slogans about innovation but the patient construction of guardrails — the Securities and Exchange Commission, the FDIC, and disclosure laws that insisted confidence be earned, not assumed. Regulation did not choke the market; it made the market believable again. Trust, once measured in lost fortunes, became the currency that rebuilt prosperity. Continue reading→

AI’s 1929 Moment: Building HART

In the final days of the Roaring Twenties, optimism ruled the markets. Factories were booming, credit was cheap, and new technologies — radio, automobiles, and electrification — were transforming life at a dizzying pace. Everyone, it seemed, wanted a share of the future. Then came the crash of 1929. inancial journalist Andrew Ross Sorkin, in 1929: The Greatest Crash in Wall Street History — and How It Shattered a Nation (2025), reminds us that speculation itself wasn’t the problem. What destroyed confidence and livelihoods was the absence of guardrails — no disclosure rules, no oversight, no understanding of how human psychology amplifies collective risk. Continue reading→

Human Oversight and Conscience in AI

Healthcare has long understood that safety depends on process, not perfection. Checklists, timeouts, and structured handoffs exist to prevent the predictable human errors that arise in complex environments. These principles—refined through aviation safety models and human factors research—offer a proven path for governing artificial intelligence. As AI becomes more embedded in clinical decision-making, our task is not to replace these human systems but to extend them into the digital realm. The best model for safe AI already exists; we need to recognize and apply it. Continue reading→

Governance Over Fear: Building Safe AI

When new ideas challenge long-held medical beliefs, fear often delays progress. In the 1980s, researchers Barry Marshall and Robin Warren were ridiculed for suggesting that a bacterium, Helicobacter pylori, caused most ulcers. Years passed before the medical community accepted the evidence. That same instinct—to doubt, dismiss, or delay—now colors our response to artificial intelligence. As public debate swings between utopian promise and apocalyptic threat, healthcare must take a different path: not one of fear, but of governance, vigilance, and trust built on measurable quality and safety. Continue reading→

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