meta: id: consumer-health-intelligence title: "Consumer Health Intelligence" subtitle: "The Living Truth Layer" version: "1.0.0" actors: {} slides: # ============================================ # TITLE # ============================================ - type: title id: title # ============================================ # HOOK # ============================================ - type: hook id: hook line: "Your sources contradict each other." subline: "And you have no way to weigh them." # ============================================ # THE DRIFT - Seven sources, one hour # ============================================ - type: code id: drift-doctor title: "Source 1: Your doctor" code: | "Well-tolerated. Nausea is common but transient." // Confidence: high (MD, treating physician) // Basis: prescribing guidelines, clinical experience // What's missing: doesn't see Reddit, doesn't see FAERS - type: code id: drift-fda title: "Source 2: The FDA label" code: | WARNING: Thyroid C-cell tumors (boxed warning) Adverse reactions: - Nausea (44%) - Diarrhea (30%) - Vomiting (24%) // No mention of gastroparesis (yet). // Label last updated: 2021. - type: code id: drift-reddit title: "Source 3: Reddit (1.2M members)" code: | r/Ozempic - sorted by top, past month: "Ozempic face is real. I look 10 years older." [2.1k upvotes] "Month 3: can't eat, stomach won't empty" [1.8k upvotes] "Hair is falling out in clumps" [1.4k upvotes] "Lost 40 lbs, feel amazing, life changed" [947 upvotes] // 4 posts. 4 different realities. - type: code id: drift-tiktok title: "Source 4: TikTok (4M views)" code: | @healthinfluencer: "Ozempic gave me stomach paralysis. I was in the ER for 3 days." 4.2M views | 340K likes | 12K comments // One person's experience. // Presented as universal truth. // Engagement = visibility, not validity. - type: code id: drift-nejm title: "Source 5: NEJM meta-analysis" code: | // Pooled analysis, n = 14,847 // Design: randomized controlled trials Result: "No statistically significant increase in gastroparesis incidence vs placebo" // p = 0.23, CI crosses 1.0 // The gold standard says: no signal. - type: code id: drift-faers title: "Source 6: FDA Adverse Event Reports" code: | FAERS query: semaglutide + gastroparesis Total reports: 8,547 Serious: 3,201 Hospitalizations: 1,894 Trend: increasing (2022-2024) // Self-reported + unverified. // But 8,547 reports is a signal. - type: hook id: drift-question line: "Seven sources. Seven answers." subline: "You make your decision based on whichever one you saw last." # ============================================ # THE SPIRAL # ============================================ - type: code id: spiral title: "The same problem, everywhere" code: | // Gastroparesis: Doctor: "Rare" FDA: (not on label) Reddit: "It happened to me" (x 4,200) TikTok: "It's an epidemic" (12M views) NEJM: "No significant signal" FAERS: 8,547 reports // Hair loss: Clinical trials: not studied Reddit: 1,847 posts Clinical evidence: zero // Muscle loss: Phase III: "~40% of weight lost is lean mass" Reddit: "My legs are wasting away" Trainers: "Just lift weights" - 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." # ============================================ # THE CATASTROPHE # ============================================ - type: code id: catastrophe title: "The Catastrophe" code: | // June 2023: She starts Semaglutide. // Her research: doctor + Google + a few Reddit posts. // Gastroparesis wasn't on the FDA label. // // January 2024: FDA updates the label. // Intestinal obstruction warning added. // // Reddit had flagged this a year earlier. // FAERS reports were accumulating for two years. // // Nobody told her. Google doesn't send updates. // Her doctor's office doesn't track label changes. // The truth changed. Her information didn't. - type: code id: catastrophe-pattern title: "The pattern repeats" code: | // COVID vaccines, 2021: // April: "No myocarditis signal" // June: VAERS reports accumulating // July: CDC acknowledges elevated risk in young males // // Millions of decisions made between April and July // based on information that was about to change. // // Not because anyone lied. // Because no system could show: // "Here is what we know, at each level, // and here is what changed since you last looked." # ============================================ # THE FIX # ============================================ - 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. Tier 0: Regulatory action weight: 1.0 decay: never Tier 1: RCTs, meta-analyses weight: 0.9 decay: 2 years Tier 2: Observational studies weight: 0.7 decay: 1 year Tier 3: Pharmacovigilance weight: 0.5 decay: 18 months Tier 4: Clinician case reports weight: 0.4 decay: 6 months Tier 5: Patient community weight: 0.2 decay: 3 months Tier 6: Media, influencers weight: 0.1 decay: 30 days // A million TikTok posts cannot outvote one FDA action. // But they can signal that something is happening. - type: code id: fix-assert title: "Store claims with provenance" code: | // Clinical evidence enters with full metadata episteme.assert({ subject: "semaglutide/adverse-effects/gastroparesis", predicate: "risk_level", value: "No statistically significant increase", source_class: "tier-1", source: { type: "meta-analysis", journal: "NEJM", sample_size: 14847 }, confidence: 0.92 }); // Patient report enters the same graph episteme.assert({ subject: "semaglutide/adverse-effects/gastroparesis", predicate: "risk_level", value: "Experienced severe gastroparesis after 3 months", source_class: "tier-5", source: { platform: "reddit", upvotes: 847 }, confidence: 0.3 }); // Both coexist. Neither overwrites. But they are not equal. - type: code id: fix-query title: "Query returns layers, not a single answer" code: | episteme.query({ subject: "semaglutide/adverse-effects/gastroparesis", lens: "layered-consensus" }); // Returns: { regulatory: "Added to label Jan 2024", clinical_evidence: "No signal in Phase III (conflict: 0.34)", pharmacovigilance: "8,547 FAERS reports, trend: increasing", patient_community: "Widely reported, cluster size: 4,200", overall_conflict: 0.72, summary: "Trials show low incidence. Post-marketing and patient reports show higher rates. FDA added to label January 2024." } // Not "yes" or "no". The shape of the evidence. # ============================================ # CLUSTER ESCALATION # ============================================ - type: code id: escalation title: "Anecdotal signal detection" code: | // The Gardener monitors Tier 5 clusters. // When density crosses threshold: episteme.assert({ subject: "semaglutide/adverse-effects/hair-loss", predicate: "escalation_signal", value: "Anecdotal cluster detected", source_class: "meta", meta: { tier_5_count: 1847, growth_rate: "312/month", tier_1_count: 0, // no clinical evidence exists clinical_gap: true }, lifecycle: "under-review" }); // Does NOT claim hair loss is real. // Claims: "people are reporting this, and nobody has studied it." // The gap is the signal. # ============================================ # GUIDANCE CHANGES # ============================================ - type: code id: guidance-change title: "What changed since you last looked" code: | // FDA updates the label. Epoch shifts. episteme.epoch.supersede({ old_epoch: "semaglutide-label-pre-2024", new_epoch: "semaglutide-label-2024-01", reason: "Intestinal obstruction warning added" }); // Consumer returns 3 months later: episteme.query({ subject: "semaglutide/adverse-effects", lens: "layered-consensus", since: "2023-10-01" // their last visit }); // Returns: { changes: [{ date: "2024-01-12", type: "regulatory", change: "Intestinal obstruction added to warnings" }], prior_assertions_affected: 12 } // Not just today's answer. What changed. # ============================================ # TIME TRAVEL # ============================================ - type: code id: time-travel title: "What was known when you decided?" code: | // "I started Semaglutide in June 2023. // What were the known risks at that time?" episteme.query({ subject: "semaglutide/adverse-effects", lens: "layered-consensus", as_of: "2023-06-15" }); // Returns the June 2023 snapshot: { regulatory: "Boxed warning: thyroid. No GI obstruction.", clinical: "Nausea common, no gastroparesis signal", patient: "Growing reports (cluster size: 340)", escalation: "not yet triggered (threshold: 500)" } // Your decision was reasonable given available evidence. // The record proves it. # ============================================ # DISAGREEMENT DASHBOARD # ============================================ - type: code id: disagreement title: "The disagreement dashboard" code: | episteme.query({ subject: "semaglutide", lens: "skeptic", scope: "adverse-effects" }); // Returns: resolved: [ { topic: "nausea", conflict: 0.08, "all tiers agree" } ] active_disagreement: [ { topic: "gastroparesis", conflict: 0.72, clinical: "Low incidence", faers: "8,547 reports", patients: "Widely reported" } ] emerging_signal: [ { topic: "hair loss", clinical_evidence: "none", patient_reports: 1847, status: "under-review" } ] // Settled. Contested. Emerging. // Honest answers, not false certainty. # ============================================ # VISION # ============================================ - 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"