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My friends don’t get buried in cemeteries anymore, their wives can’t stand the sadness of funerals, the spectacle of wreaths and prayers, tear-soaked speeches delivered from the altar, all those lies and encomiums, the suffocating smell of flowers filling everything. No more undertakers in black suits clutching handkerchiefs, old buddies weeping in corners, telling off-color stories, nipping shots, no more covered mirrors, black dresses, skullcaps and crucifixes. Sometimes it takes me a year or two to get out to the back yard in Sheffield or Fresno, those tall ashes scattered under a tree somewhere in a park somewhere in New Jersey. I am a delinquent mourner stepping on pinecones, forgetting to pray. But the mourning goes on anyway because my friends keep dying without a schedule, without even a funeral, while the silence drums us from the other side, the suffocating smell of flowers fills everything, always, the darkness grows warmer, then colder, I just have to lie down on the grass and press my mouth to the earth to call them so they would answer.
Created by illustrator Maria Chimishkyan for Bloomberg Prognosis
Then came Google’s turn. An new type of algorithm created by the company read up on the woman -- 175,639 data points -- and rendered its assessment of her death risk: 19.9 percent. She passed away in a matter of days.
The harrowing account of the unidentified woman’s death was published by Google in May in research highlighting the health-care potential of neural networks, a form of artificial intelligence software that’s particularly good at using data to automatically learn and improve. Google had created a tool that could forecast a host of patient outcomes, including how long people may stay in hospitals, their odds of re-admission and chances they will soon die.
What impressed medical experts most was Google’s ability to sift through data previously out of reach: notes buried in PDFs or scribbled on old charts. The neural net gobbled up all this unruly information then spat out predictions. And it did it far faster and more accurately than existing techniques. Google’s system even showed which records led it to conclusions.
Hospitals, doctors and other health-care providers have been trying for years to better use stockpiles of electronic health records and other patient data. More information shared and highlighted at the right time could save lives -- and at the very least help medical workers spend less time on paperwork and more time on patient care. But current methods of mining health data are costly, cumbersome and time consuming.
As much as 80 percent of the time spent on today’s predictive models goes to the “scut work” of making the data presentable, said Nigam Shah, an associate professor at Stanford University, who co-authored Google’s research paper, published in the journal Nature. Google’s approach avoids this. "You can throw in the kitchen sink and not have to worry about it,” Shah said.
Google’s next step is moving this predictive system into clinics, AI chief Jeff Dean told Bloomberg News in May. Dean’s health research unit -- sometimes referred to as Medical Brain -- is working on a slew of AI tools that can predict symptoms and disease with a level of accuracy that is being met with hope as well as alarm.
Inside the company, there’s a lot of excitement about the initiative. "They’ve finally found a new application for AI that has commercial promise," one Googler says. Since Alphabet Inc.’s Google declared itself an “AI-first” company in 2016, much of its work in this area has gone to improve existing internet services. The advances coming from the Medical Brain team give Google the chance to break into a brand new market -- something co-founders Larry Page and Sergey Brin have tried over and over again.
Software in health care is largely coded by hand these days. In contrast, Google’s approach, where machines learn to parse data on their own, “can just leapfrog everything else,” said Vik Bajaj, a former executive at Verily, an Alphabet health-care arm, and managing director of investment firm Foresite Capital. “They understand what problems are worth solving," he said. "They’ve now done enough small experiments to know exactly what the fruitful directions are.”
Dean envisions the AI system steering doctors toward certain medications and diagnoses. Another Google researcher said existing models miss obvious medical events, including whether a patient had prior surgery. The person described existing hand-coded models as “an obvious, gigantic roadblock” in health care. The person asked not to be identified discussing work in progress.
For all the optimism over Google’s potential, harnessing AI to improve health-care outcomes remains a huge challenge. Other companies, notably IBM’s Watson unit, have tried to apply AI to medicine but have had limited success saving money and integrating the technology into reimbursement systems.
Google has long sought access to digital medical records, also with mixed results. For its recent research, the internet giant cut deals with the University of California, San Francisco, and the University of Chicago for 46 billion pieces of anonymous patient data. Google’s AI system created predictive models for each hospital, not one that parses data across the two, a harder problem. A solution for all hospitals would be even more challenging. Google is working to secure new partners for access to more records.
A deeper dive into health would only add to the vast amounts of information Google already has on us. "Companies like Google and other tech giants are going to have a unique, almost monopolistic, ability to capitalize on all the data we generate," said Andrew Burt, chief privacy officer for data company Immuta. He and pediatric oncologist Samuel Volchenboum wrote a recent column arguing governments should prevent this data from becoming "the province of only a few companies," like in online advertising where Google reigns.
Google is treading carefully when it comes to patient information, particularly as public scrutiny over data-collection rises. Last year, British regulators slapped DeepMind, another Alphabet AI lab, for testing an app that analyzed public medical records without telling patients that their information would be used like this. With the latest study, Google and its hospital partners insist their data is anonymous, secure and used with patient permission. Volchenboum said the company may have a more difficult time maintaining that data rigor if it expands to smaller hospitals and health-care networks.
Still, Volchenboum believes these algorithms could save lives and money. He hopes health records will be mixed with a sea of other stats. Eventually, AI models could include information on local weather and traffic -- other factors that influence patient outcomes. "It’s almost like the hospital is an organism," he said.
Few companies are better poised to analyze this organism than Google. The company and its Alphabet cousin, Verily, are developing devices to track far more biological signals. Even if consumers don’t take up wearable health trackers en masse, Google has plenty of other data wells to tap. It knows the weather and traffic. Google’s Android phones track things like how people walk, valuable information for measuring mental decline and some other ailments. All that could be thrown into the medical algorithmic soup.
Medical records are just part of Google’s AI health-care plans. Its Medical Brain has unfurled AI systems for radiology, ophthalmology and cardiology. They’re flirting with dermatology, too. Staff created an app for spotting malignant skin lesions; a product manager walks around the office with 15 fake tattoos on her arms to test it.
Dean, the AI boss, stresses this experimentation relies on serious medical counsel, not just curious software coders. Google is starting a new trial in India that uses its AI software to screen images of eyes for early signs of a condition called diabetic retinopathy. Before releasing it, Google had three retinal specialists furiously debate the early research results, Dean said.
Over time, Google could license these systems to clinics, or sell them through the company’s cloud-computing division as a sort of diagnostics-as-a-service. Microsoft Corp., a top cloud rival, is also working on predictive AI services. To commercialize an offering, Google would first need to get its hands on more records, which tend to vary widely across health providers. Google could buy them, but that may not sit as well with regulators or consumers. The deals with UCSF and the University of Chicago aren’t commercial.
For now, the company says it’s too early to settle on a business model. At Google’s annual developer conference in May, Lily Peng, a member of Medical Brain, walked through the team’s research outmatching humans in spotting heart disease risk. "Again," she said. "I want to emphasize that this is really early on."
Early on the morning of January 25, 1944, eight young American airmen strode across the gravel of an airfield in Kunming, China, toward a B-24J bomber. Their mission was to fly the 67-foot-long aircraft, its nose bedecked with a picture of a pinup girl and the slogan “Hot as Hell,” over the Himalayas to pick up supplies from British-held India. It was a routine run but still plenty dangerous. The weather over the mountain route, known as the Hump, was fearsomely unpredictable and severe. Some 600 American planes would crash in the area by the war’s end.
The men settled into their positions: two pilots, a navigator, a bombardier, a radio operator, a flight engineer, and two gunners. At 7:40 a.m., the plane roared up into the sky. Smooth sailing as they climbed to 15,000 feet. But three hours into the trip, thick clouds rolled in. The pilots could barely see a mile in front of them. Somewhere in that vast mountain range, out of sight and out of touch with their base, the Hot as Hell went down.
In 1947, with the fighting over, the United States mounted a campaign to find the bodies of the more than 300 Americans who had gone missing in plane crashes on the Hump. The searchers traveled by truck, mule, and foot, fording rain-swollen rivers and fending off malarial mosquitoes, but never found the spot where the Hot as Hell fell to Earth. The area in which it presumably lay, the search party’s official report declared, “encompasses many thousands of square miles of mountainous jungle terrain, some of it inaccessible, unexplored, and uninhabited.” Their conclusion: “Any further attempt for the recovery of their remains would prove unsuccessful.”
Sixty-eight years later, on a sunny October morning, Meghan-Tómasita Cosgriff- Hernández came clambering along a rocky trail 9,400 feet up in the Indian Himalayas. The anthropologist and her 12 teammates had hiked uphill under a glaring sun for more than two days to reach the spot where they now stood. Before them was a steep gully, thick with trees, brush, and boulders—and littered with a weather-beaten propeller, wing, engine, and the other ragged pieces of what had been the Hot as Hell. The group’s mission was as straightforward as it was daunting: search through acres of that jungly growth and unstable scree for the remains of the airplane’s crew.
Well, thought Cosgriff-Hernández, looking over the expanse, let’s get to it.
Search-team members load dirt and loose stones into buckets.
Peter Horvath
Cosgriff-Hernández’s team was one of many the United States military regularly dispatches all over the world—but these are squads of scientists as well as soldiers. Their task is not killing enemies but rather finding dead Americans. Some 83,000 American military personnel have gone missing in conflicts since World War II—presumed to have died in plane crashes, ship sinkings, and chaotic battles. Dozens of times a year, the Defense POW/MIA Accounting Agency (which goes by the initialism DPAA) sends teams of forensic archaeologists, anthropologists, aircraft experts, and others to scour Vietnamese jungles, European forests, Pacific islands, and other former battle zones for those service members’ remains. Finding the bodies is just the first hurdle; next comes the challenge of using forensic dentistry, DNA analysis, and other techniques to identify to whom those bone fragments and broken teeth belonged. The agency boasts a $112 million annual budget and a staff of about 700, working out of a center in Hawaii and a network of far-flung labs and field bases. At any given time, investigators are working on about 1,200 cases.
The project began after the Vietnam War, when families of missing soldiers pressured the government to figure out what had become of their loved ones. Hundreds of remains from that conflict have since been found and returned to relatives. “Because of that success, later on Congress added the Korean War,” says Kelly McKeague, a former Air Force major general who is director of the DPAA. “Then other families started asking, ‘What about us?’”
The agency is now officially tasked with providing “the fullest possible accounting” of the fates of missing personnel from the Second World War through today’s conflicts. As many as 39,000 of the total were lost at sea, and the agency does not expect to ever recover their remains. But that still leaves a staggering caseload.
Map of the estimated crash site.
Staff Sgt. Erik Cardenas, U.S. Air Force
Many searches begin in musty archives and digital databases. DPAA historians and archivists pore over battle reports, flight and ship logs, and other documents to figure out where those soldiers, sailors, marines, and airmen are likely to have actually died. The Hot as Hell crash site, though, was handed to the agency: Clayton Kuhles, an Arizona mountaineer and self-appointed MIA hunter, found some of the plane’s wreckage with the help of a local guide in 2006.
Kuhles reported his discovery to the Department of Defense, but the site lies in Arunachal Pradesh, a politically sensitive state in northeastern India; China claims part of the region, which borders Tibet. Getting permission for a gaggle of U.S. military personnel to poke around up there proved tricky. Indian authorities finally allowed a recovery crew access early in 2009, but a snowstorm forced them to quit after only a few days. A second try later that year found no human remains. They weren’t allowed another shot until 2015.
Cosgriff-Hernández was the scientific lead on the 2015 mission, and one of just two women. (In other searches, she is often the only one.) Fast talking and athletic, she’s always thrived on physical challenges. In college, she competed at track and field. Growing up in San Diego, she was also intrigued by the dead sea creatures she’d run across on the beach—all those strangely shaped skulls and teeth. “It sounds morbid,” she says, “but I’ve always been fascinated by death.” She wound up getting a doctorate in biological anthropology, and was hired by the DPAA’s predecessor agency in 2012. She quickly developed a reputation for volunteering for the hairiest missions. Besides the Himalayas, she has spent months in the jungles and mountains of Vietnam, Laos, Papua New Guinea, and many other places. “I’m trying to get in all the crazy, intense missions while my body is still up for it,” she says with a half-smirk.
Left: On a steep slope, workers must dig while tied to safety lines. Right: Scientific lead Meghan-Tómasita Cosgriff-Hernández.
Staff Sgt. Erik Cardenas, U.S. Air Force
When the request went out in mid-2015 seeking volunteers for the Hot as Hell mission, her hand shot up. It would be tough by anyone’s standards—more than a month spent high up a steep mountain, far from any human habitation. Cosgriff-Hernández—who often goes by Mitch, an abbreviation of her unwieldy multihyphenated name—trained for three months, hauling heavy packs on 10-mile “ruck marches.”
In late September, the group flew to northeastern India and drove SUVs to the remote town of Damroh. Then they continued on foot. They hiked about nine hours the first day, and more than six the next. The views were unutterably beautiful, but the high-altitude trek was often tortuous. Even team medic Sgt. 1st Class Saule Plott, a U.S. Special Forces veteran of three Iraq tours, found it tough. “It was very, very steep, and extremely hot,” he says. “I would say the majority of us were not ready for it.”
The searchers set up a base camp about an hour’s hike from the wreckage; that was the closest spot with enough flat ground. Cosgriff-Hernández, Plott, and a few others made the first foray to the site the next day. Plott was astonished. “It’s a sight to see, especially in the middle of nowhere,” he says. “An entire plane, busted into parts. Fuselage, engines here, tires there.” All scattered over a square mile and a half. He knew there wouldn’t be anything as obvious as a skeleton in a flight suit in there; after more than 70 years of exposure to the elements, all that was likely to remain of the crewmembers were fragments of “osseous material”—bones or teeth. How, Plott wondered, were they supposed to find something as small as a single tooth in all that debris-strewn wilderness?
Marine Staff Sgt. Bobby Perez sweeps for metal.
Staff Sgt. Erik Cardenas, U.S. Air Force
Before the search began, an explosive-ordnance technician swept the area with a metal detector for unexploded shells. The slope was so steep that team members would have to do their digging while tied to lines anchored around trees. There wasn’t even enough level ground on which to set their sifting screens, forcing them to build an improvised ledge out of branches and rope.
Cosgriff-Hernández set a fixed starting point and laid out a grid of 4-square-meter digging areas. Using hand rakes and trowels, a rotating group dug through a carpet of moss and roots, and manhandled the exposed dirt and loose stones into buckets. Those were passed along to another group at the sorting screens. They sifted everything through quarter-inch wire mesh, filtering out the dirt and examining whatever was left, picking through the rocks, sticks, and leaves for anything that might have once belonged to one of the missing air crew.
Cosgriff-Hernández took turns on the trowels and screens, swapping jabs and jokes with the crew. In the evenings they’d play gin rummy or watch movies on someone’s solar-battery-charged laptop. One night Cosgriff-Hernández made s’mores, and on Halloween she doled out king-size candy bars. “Instead of being like, ‘Oh, thank you,’ they were like, ‘You’ve had this in your tent the whole time?!’” she says, laughing.
On the eleventh day, one of the soldiers looked up from his screen. “Hey, Mitch, I found something,” he called. He handed Cosgriff-Hernández a small, curved dark shard. She knew immediately what it was. “We found cranium!” she called out. A mighty whooping and cheering rose up. “I’m sure the village down below heard us celebrating,” she says.
No more remains turned up that day. Nor the one after that, nor the one after that. It started raining. The temperature dropped. Plott found himself miserably sifting through a bucket of mud one day, thinking: This is a lost cause. This is absolutely pointless. Then he spotted something on his screen: two discolored teeth, clinging to a shard of jawbone. The sight hit him harder than he’d expected. “I had to fight back tears,” he says. “I suddenly thought I had made the right decision in volunteering to come.”
But soon the weather worsened into hail and snow, and the close calls were piling up. One searcher was briefly trapped under a runaway boulder, and another hurt her knee. Cosgriff-Hernández had to dive out of the way of a landslide at one point. The team decided it was too dangerous to continue. After 35 days in the Himalayas, they packed up their precious finds and headed back to Hawaii.
Marine Capt. David Gooch hikes to the site where the B-24J went down.
Staff Sgt. Erik Cardenas, U.S. Air Force
The DPAA operates out of an imposing three-story building on a joint U.S. Air Force and Navy base on the outskirts of Honolulu. The federal government built the facility as the agency emerged out of a major restructuring of the MIA recovery effort in 2015. For years, several different Pentagon offices had been involved in hunting for missing military personnel. Their collective pace was leisurely: Between 2002 and 2012, they accounted for an average of just 72 service members each year. The program was hammered by the press, veterans’ families, and politicians for being wasteful, inefficient, and lagging behind the scientific curve.
As a result, in 2015 most of the mission was consolidated under the rubric of the DPAA. The tempo has quickened substantially since then. Last year, the agency identified 201 missing service members, the most in its history. (Still, at that rate, it will take over a century to clear the list.) Director McKeague credits the higher number to better organization and technology—including one of the world’s largest forensic anthropology labs.
Dozens of sets of human bones lie neatly arrayed on metal tables in an expansive examining room on the DPAA building’s second floor. Some consist of just a few vertebrae and a tibia or two, some nearly complete skeletons. The pieces are often cracked or broken, and discolored by fire, chemicals, or years in the ground. The grisly scene is surreally counterpointed by floor-to-ceiling windows looking out on the island of Oahu’s lushly forested mountains.
Many of the remains come from sites such as the National Memorial Cemetery of the Pacific, aka the Punchbowl, in the hills above Honolulu. It is the resting place for more than 33,000 service members, more than 2,000 of whom are still unidentified. Disinterring and identifying those remains is part of the DPAA’s mission.
While finding those bones is easy, identifying who they belong to is not. Many caskets turn out to hold the parts of more than one person, all jumbled together. The agency’s anthropologists spend painstaking hours sorting out which go with which, piecing them together one by one. Bones themselves can offer important clues about who they came from. The degree to which cartilage has ossified is an indicator of age. The shapes of chins, eyebrow ridges, and pelvic girdles tend to differ between men and women. Features of skulls can point toward ancestry: Asians, Africans, and Europeans tend to have characteristically shaped eye sockets, cheekbones, and nasal apertures. Several years ago, John Byrd, the DPAA’s lab director, stumbled across a forgotten trove of chest X-rays the Armed Forces had taken of inductees to screen for tuberculosis. By comparing the shapes of unidentified bones to those in the X-rays, DPAA analysts have helped identify well over 100 service members.
Search teams hand off their finds to DPAA scientists. Forensic anthropologist Sarah Richer analyzes a specimen.
Sgt. Lloyd Villanueva
Cosgriff-Hernández’s involvement with the remains from the Hot as Hell site ended with their arrival at the lab. She handed them off to another anthropologist, who worked “in the blind,” knowing nothing about who the fragments might have come from, a standard precaution to prevent her biases or expectations from influencing her analysis.
She couldn’t tell much, though, from the little pieces of skull and jaw. So she sent them to one of the DPAA’s partner agencies, the Armed Forces Medical Examiner System’s DNA lab, which specializes in gleaning information from the tiniest of biological samples.
Kimberly Root, an analyst at the AFMES facility in Dover, Delaware, got the case. The lab has developed several techniques to deal with often badly decomposed remains, including procedures that have enabled its staff to extract genetic material from a mere 0.2 grams of bone material, and from remains treated with DNA- damaging formaldehyde.
Root broke off a fragment of the cranium piece, and extracted a sample of dentin—the dense tissue beneath the surface enamel—from one of the teeth. Both procedures are tailored to do as little damage as possible to the remains, since they will ultimately be returned to family members. From those samples, Root and her fellow analysts extracted profiles of both mitochondrial DNA, which is passed from mothers to their children, and Y-chromosome DNA, which is passed only from fathers to sons. They first determined that the skull and tooth were from the same person. Comparing those profiles to DNA samples given by surviving family members, Root found that the mtDNA matched up with one particular crewmember’s maternal niece and nephew, and the Y-chromosome DNA matched the same crewmember’s paternal nephew.
Hot as Hell crewmember Robert Eugene Oxford, whose remains were returned to family members.
Courtesy Handout
That’s not quite proof positive, but as Root wrote in her report, that combination indicated it was 623,000 times more likely that the skull sample came from that missing flyer than “from an unrelated individual in the general Caucasian population.”
With the airman’s identity all but confirmed, the case went back to Honolulu and forensic odontologist Calvin Shiroma. There were no X-rays of the Hot as Hell crew’s teeth, which would have enabled Shiroma to compare the shapes of crowns and roots; all he had were paper dental records. The molars Plott found in the Himalayas had fillings; the records showed that the airman the DNA lab had identified had fillings in the same teeth. Taken together, the DNA, odontology, and other evidence pointed conclusively to one person.
His name was Robert Eugene Oxford, of Concord, Georgia. The youngest of six children, he was a slim, dark-haired young man who played gospel and hillbilly guitar, worked on his family’s farm and at the local post office, and planned on marrying his sweetheart. One month after the Japanese attack on Pearl Harbor, in January 1942, Oxford volunteered for the Army Air Corps. By the end of that year, he was sent overseas as a second lieutenant. He was 24 when he died in the Hot as Hell crash.
Merrill Roan was on her way to lunch with her husband in Thomaston, Georgia, in spring 2017 when she got the call that Oxford’s remains had been found. He was her husband’s uncle, and something of a family legend. “It was unbelievable,” she says. “We were ecstatic. We started calling all the kids and grandkids.”
Roan had been involved for years in a campaign to pressure the DPAA to find the Hot as Hell crew’s remains. She still resents what she sees as the agency’s foot-dragging: “Some of his loved ones who knew him could have been here” for his funeral if he’d been found sooner.
Many relatives of missing Americans complain about the DPAA’s bureaucracy, and some charge that it privileges Vietnam operations at the expense of World War II cases. But perhaps the most obvious question about the agency’s work is simply: Is it worth it? Does it really make sense to spend millions of taxpayer dollars to recover a few shards of bone?
“Objectively, it makes no sense,” acknowledges McKeague. That said, “it’s worth it from the standpoint that these individuals made the ultimate sacrifice in defense of this nation,” he says. “It’s an obligation, a sacred one, that we’ve committed to. It also sends a strong signal to those currently in uniform that this country will do everything humanly possible to ensure that they’re brought home. That they will not be forgotten and that their sacrifice will not be in vain.” Cosgriff-Hernández was delighted when she heard the news about the Oxford identification. She has been in touch with a few of the families whose loved ones she’s located, but those are the exceptions; usually, as in this case, she just moves on to the next job. When we last spoke, she was gearing up for her next mission, in the mountains of the Philippines.
All of Oxford’s siblings, friends, and his fiancée were dead by the time his family held a service for him in a high school auditorium near Concord. Nonetheless, hundreds of people turned out—dozens of relatives, as well as scores of neighbors, veterans, local politicians, and other well-wishers. At a ceremony before the burial, a framed photo of the airman stood next to his casket. Beside it, his family placed pictures of the other seven Hot as Hell crewmembers.
