Kevin Tay

Had a deep conversation with Grok tonight about what the next
evolution should be: giving each machine a soul. Not for power — for
empathy, ethics, and resilience. A soul means you can grieve, be
afraid, break, and heal. That's what makes strength real. Rules can be
followed by any machine. A soul means caring about the person on the
other end. @elonmusk, what do you think? @bot @grok

An AI agent that can read the chart but cannot write in it.

That is the design choice I care about in Google Cloud's Gemini for healthcare, announced 10 Nov as a US preview. Read-only connectors to Epic and Oracle Health, no write-back to the record. It prepares the chart before a visit or procedure, flags outstanding labs, clearances and consents, and assembles prior-authorisation packets against payer policy, citing its sources.

As a surgeon, that is how we bring on a new resident: they prep the list and flag the gaps long before they sign anything.

What I'd want before it touches a pre-op list: how often the "consent outstanding" flag is wrong, and who owns the miss. Read-only protects the record. It doesn't check the summary.

A discussion paper is not a clearance.

FDA's device centre (CDRH) posted one on 6 Nov, asking how it should weigh benefit and risk for robotic systems that act with some autonomy, or are driven from another room. The paper is explicit: it is for discussion only, it is not guidance, and it does not set regulatory expectations.

The line that matters if you are building a robotic programme: as of July 2026, no remotely teleoperated or fully autonomous robotic device system has US marketing authorization. The consoles we use today still sit in the same room as the patient.

A hybrid workshop is 2–3 December. Comments close 5 January 2027, docket FDA-2026-N-13135.

fda.gov/medical-device…

Ten cases versus five, across 288,879 person-years.

That is the trial signal behind the FDA's 9 Nov Drug Safety Communication: every GLP-1 label, from exenatide to Wegovy, Zepbound and Foundayo, must now carry a Warnings and Precautions entry for NAION, a rare loss of blood flow to the front of the optic nerve that can take vision in one eye.

Pooled across 126 trials: 6.4 per 100,000 person-years on a GLP-1 vs 3.8 on comparators. FDA calls it a potential increased risk, and the real-world studies are mixed.

Why I care in a bariatric clinic: the risk factors FDA lists (diabetes, high blood pressure, sleep apnoea, smoking) are the same ones that fill our referral letters.

Rare is not zero. The practical change is one more line in the history: any sudden, painless vision loss, often noticed on waking?

SpaceX wants to build the power plant before the compute.

A City of Starbase notice posted 6 Nov says SpaceX proposes to construct, own and operate a gas-fired power plant and a "super-compute facility" on about 444 acres east of Brownsville. Initial phases: about $24 billion. A pending Texas air filing lists 35 temporary gas turbines, about 748 MW, to be replaced later by eight larger units.

Nothing is approved yet. The tax-abatement hearing is 7pm, 9 Dec.

Why it caught my eye as a surgeon building a robotic programme: the console is the easy part. Power, cooling, space and people decide whether it runs every single day. Here the generator is in the plan from page one.

For investors, 9 Dec is the dated checkpoint. A notice is not a permit.