{
  "meta": {
    "id": "consumer-health-intelligence",
    "title": "Consumer Health Intelligence",
    "subtitle": "The Living Truth Layer",
    "version": "1.0.0"
  },
  "actors": {},
  "slides": [
    {
      "type": "title",
      "id": "title"
    },
    {
      "type": "hook",
      "id": "hook",
      "line": "Your sources contradict each other.",
      "subline": "And you have no way to weigh them."
    },
    {
      "type": "code",
      "id": "drift-doctor",
      "title": "Source 1: Your doctor",
      "code": "\"Well-tolerated. Nausea is common but transient.\"\n\n// Confidence: high (MD, treating physician)\n// Basis: prescribing guidelines, clinical experience\n// What's missing: doesn't see Reddit, doesn't see FAERS\n"
    },
    {
      "type": "code",
      "id": "drift-fda",
      "title": "Source 2: The FDA label",
      "code": "WARNING: Thyroid C-cell tumors (boxed warning)\n\nAdverse reactions:\n  - Nausea (44%)\n  - Diarrhea (30%)\n  - Vomiting (24%)\n\n// No mention of gastroparesis (yet).\n// Label last updated: 2021.\n"
    },
    {
      "type": "code",
      "id": "drift-reddit",
      "title": "Source 3: Reddit (1.2M members)",
      "code": "r/Ozempic - sorted by top, past month:\n\n\"Ozempic face is real. I look 10 years older.\"    [2.1k upvotes]\n\"Month 3: can't eat, stomach won't empty\"         [1.8k upvotes]\n\"Hair is falling out in clumps\"                    [1.4k upvotes]\n\"Lost 40 lbs, feel amazing, life changed\"          [947 upvotes]\n\n// 4 posts. 4 different realities.\n"
    },
    {
      "type": "code",
      "id": "drift-tiktok",
      "title": "Source 4: TikTok (4M views)",
      "code": "@healthinfluencer:\n\"Ozempic gave me stomach paralysis.\n I was in the ER for 3 days.\"\n\n4.2M views | 340K likes | 12K comments\n\n// One person's experience.\n// Presented as universal truth.\n// Engagement = visibility, not validity.\n"
    },
    {
      "type": "code",
      "id": "drift-nejm",
      "title": "Source 5: NEJM meta-analysis",
      "code": "// Pooled analysis, n = 14,847\n// Design: randomized controlled trials\n\nResult: \"No statistically significant increase\n         in gastroparesis incidence vs placebo\"\n\n// p = 0.23, CI crosses 1.0\n// The gold standard says: no signal.\n"
    },
    {
      "type": "code",
      "id": "drift-faers",
      "title": "Source 6: FDA Adverse Event Reports",
      "code": "FAERS query: semaglutide + gastroparesis\n\nTotal reports:    8,547\nSerious:          3,201\nHospitalizations: 1,894\nTrend:            increasing (2022-2024)\n\n// Self-reported + unverified.\n// But 8,547 reports is a signal.\n"
    },
    {
      "type": "hook",
      "id": "drift-question",
      "line": "Seven sources. Seven answers.",
      "subline": "You make your decision based on whichever one you saw last."
    },
    {
      "type": "code",
      "id": "spiral",
      "title": "The same problem, everywhere",
      "code": "// Gastroparesis:\nDoctor:   \"Rare\"\nFDA:      (not on label)\nReddit:   \"It happened to me\" (x 4,200)\nTikTok:   \"It's an epidemic\"  (12M views)\nNEJM:     \"No significant signal\"\nFAERS:    8,547 reports\n\n// Hair loss:\nClinical trials:   not studied\nReddit:            1,847 posts\nClinical evidence: zero\n\n// Muscle loss:\nPhase III:  \"~40% of weight lost is lean mass\"\nReddit:     \"My legs are wasting away\"\nTrainers:   \"Just lift weights\"\n"
    },
    {
      "type": "hook",
      "id": "spiral-insight",
      "line": "This is the vaccine problem.",
      "subline": "Not misinformation. The absence of a system that can hold all claims and show you the shape of the evidence."
    },
    {
      "type": "code",
      "id": "catastrophe",
      "title": "The Catastrophe",
      "code": "// June 2023: She starts Semaglutide.\n// Her research: doctor + Google + a few Reddit posts.\n// Gastroparesis wasn't on the FDA label.\n//\n// January 2024: FDA updates the label.\n// Intestinal obstruction warning added.\n//\n// Reddit had flagged this a year earlier.\n// FAERS reports were accumulating for two years.\n//\n// Nobody told her. Google doesn't send updates.\n// Her doctor's office doesn't track label changes.\n// The truth changed. Her information didn't.\n"
    },
    {
      "type": "code",
      "id": "catastrophe-pattern",
      "title": "The pattern repeats",
      "code": "// COVID vaccines, 2021:\n// April: \"No myocarditis signal\"\n// June:  VAERS reports accumulating\n// July:  CDC acknowledges elevated risk in young males\n//\n// Millions of decisions made between April and July\n// based on information that was about to change.\n//\n// Not because anyone lied.\n// Because no system could show:\n//   \"Here is what we know, at each level,\n//    and here is what changed since you last looked.\"\n"
    },
    {
      "type": "hook",
      "id": "fix-intro",
      "line": "What if every source had a weight?",
      "subline": "And the disagreement was the answer."
    },
    {
      "type": "code",
      "id": "fix-tiers",
      "title": "Source-class hierarchy",
      "code": "// Not all sources are equal. Make it structural.\n\nTier 0: Regulatory action       weight: 1.0   decay: never\nTier 1: RCTs, meta-analyses     weight: 0.9   decay: 2 years\nTier 2: Observational studies    weight: 0.7   decay: 1 year\nTier 3: Pharmacovigilance        weight: 0.5   decay: 18 months\nTier 4: Clinician case reports   weight: 0.4   decay: 6 months\nTier 5: Patient community        weight: 0.2   decay: 3 months\nTier 6: Media, influencers       weight: 0.1   decay: 30 days\n\n// A million TikTok posts cannot outvote one FDA action.\n// But they can signal that something is happening.\n"
    },
    {
      "type": "code",
      "id": "fix-assert",
      "title": "Store claims with provenance",
      "code": "// Clinical evidence enters with full metadata\nepisteme.assert({\n  subject: \"semaglutide/adverse-effects/gastroparesis\",\n  predicate: \"risk_level\",\n  value: \"No statistically significant increase\",\n  source_class: \"tier-1\",\n  source: {\n    type: \"meta-analysis\",\n    journal: \"NEJM\",\n    sample_size: 14847\n  },\n  confidence: 0.92\n});\n\n// Patient report enters the same graph\nepisteme.assert({\n  subject: \"semaglutide/adverse-effects/gastroparesis\",\n  predicate: \"risk_level\",\n  value: \"Experienced severe gastroparesis after 3 months\",\n  source_class: \"tier-5\",\n  source: { platform: \"reddit\", upvotes: 847 },\n  confidence: 0.3\n});\n\n// Both coexist. Neither overwrites. But they are not equal.\n"
    },
    {
      "type": "code",
      "id": "fix-query",
      "title": "Query returns layers, not a single answer",
      "code": "episteme.query({\n  subject: \"semaglutide/adverse-effects/gastroparesis\",\n  lens: \"layered-consensus\"\n});\n\n// Returns:\n{\n  regulatory:        \"Added to label Jan 2024\",\n  clinical_evidence: \"No signal in Phase III (conflict: 0.34)\",\n  pharmacovigilance: \"8,547 FAERS reports, trend: increasing\",\n  patient_community: \"Widely reported, cluster size: 4,200\",\n\n  overall_conflict: 0.72,\n  summary: \"Trials show low incidence. Post-marketing and\n            patient reports show higher rates. FDA added\n            to label January 2024.\"\n}\n\n// Not \"yes\" or \"no\". The shape of the evidence.\n"
    },
    {
      "type": "code",
      "id": "escalation",
      "title": "Anecdotal signal detection",
      "code": "// The Gardener monitors Tier 5 clusters.\n// When density crosses threshold:\n\nepisteme.assert({\n  subject: \"semaglutide/adverse-effects/hair-loss\",\n  predicate: \"escalation_signal\",\n  value: \"Anecdotal cluster detected\",\n  source_class: \"meta\",\n  meta: {\n    tier_5_count: 1847,\n    growth_rate: \"312/month\",\n    tier_1_count: 0,           // no clinical evidence exists\n    clinical_gap: true\n  },\n  lifecycle: \"under-review\"\n});\n\n// Does NOT claim hair loss is real.\n// Claims: \"people are reporting this, and nobody has studied it.\"\n// The gap is the signal.\n"
    },
    {
      "type": "code",
      "id": "guidance-change",
      "title": "What changed since you last looked",
      "code": "// FDA updates the label. Epoch shifts.\nepisteme.epoch.supersede({\n  old_epoch: \"semaglutide-label-pre-2024\",\n  new_epoch: \"semaglutide-label-2024-01\",\n  reason: \"Intestinal obstruction warning added\"\n});\n\n// Consumer returns 3 months later:\nepisteme.query({\n  subject: \"semaglutide/adverse-effects\",\n  lens: \"layered-consensus\",\n  since: \"2023-10-01\"           // their last visit\n});\n\n// Returns:\n{\n  changes: [{\n    date: \"2024-01-12\",\n    type: \"regulatory\",\n    change: \"Intestinal obstruction added to warnings\"\n  }],\n  prior_assertions_affected: 12\n}\n\n// Not just today's answer. What changed.\n"
    },
    {
      "type": "code",
      "id": "time-travel",
      "title": "What was known when you decided?",
      "code": "// \"I started Semaglutide in June 2023.\n//  What were the known risks at that time?\"\n\nepisteme.query({\n  subject: \"semaglutide/adverse-effects\",\n  lens: \"layered-consensus\",\n  as_of: \"2023-06-15\"\n});\n\n// Returns the June 2023 snapshot:\n{\n  regulatory: \"Boxed warning: thyroid. No GI obstruction.\",\n  clinical:   \"Nausea common, no gastroparesis signal\",\n  patient:    \"Growing reports (cluster size: 340)\",\n  escalation: \"not yet triggered (threshold: 500)\"\n}\n\n// Your decision was reasonable given available evidence.\n// The record proves it.\n"
    },
    {
      "type": "code",
      "id": "disagreement",
      "title": "The disagreement dashboard",
      "code": "episteme.query({\n  subject: \"semaglutide\",\n  lens: \"skeptic\",\n  scope: \"adverse-effects\"\n});\n\n// Returns:\nresolved: [\n  { topic: \"nausea\", conflict: 0.08, \"all tiers agree\" }\n]\n\nactive_disagreement: [\n  { topic: \"gastroparesis\", conflict: 0.72,\n    clinical: \"Low incidence\",\n    faers: \"8,547 reports\",\n    patients: \"Widely reported\" }\n]\n\nemerging_signal: [\n  { topic: \"hair loss\",\n    clinical_evidence: \"none\",\n    patient_reports: 1847,\n    status: \"under-review\" }\n]\n\n// Settled. Contested. Emerging.\n// Honest answers, not false certainty.\n"
    },
    {
      "type": "vision",
      "id": "vision",
      "title": "Episteme",
      "points": [
        "Source-class hierarchy. Not all claims are equal.",
        "Anecdotal signals surfaced without false authority.",
        "Guidance changes propagated, not buried.",
        "Time travel to the evidence at any moment."
      ],
      "tagline": "Git for Truth"
    }
  ]
}