Sunday, January 16, 2011

IBM's Watson, Jeopardy, and "Revolutionizing Medicine"

In the news recently was a story about a new supercomputer doing amazing things. In a technological tour de force, IBM's Watson supercomputer research project has reached a milestone, beating a group of contestants in the TV gameshow Jeopardy.


The TV game show "Jeopardy"

Will predictions of advancements in medicine follow? Predictably so:

IBM's Watson Supercomputer Beats Humans in Jeopardy Practice Match
eWeek.com
By: Fahmida Y. Rashid
2011-01-13

Watson, IBM's latest DeepQA supercomputer, defeated its two human challengers during a demonstration round of Jeopardy on Jan. 13. The supercomputer will face former Jeopardy champions Ken Jennings and Brad Rutter in a two-game, men-versus-machine tournament to be aired in February.

However, the Jeopardy match-up was not the "culmination" of four years of work by IBM Research scientists that worked on the Watson project, but rather, "just the beginning of a journey," Katharine Frase, vice president of industry solutions and emerging business at IBM Research, told eWEEK.

Supercomputers that can understand natural human language—complete with puns, plays on words and slang—to answer complex questions will have applications in areas such as health care, tech support and business analytics, David Ferrucci, the lead researcher and principal investigator on the Watson project, said at the media event showcasing Watson at IBM's Yorktown Heights Research Lab.

Watson analyzes "real language," or spoken language, as opposed to simple or keyword-based questions, to understand the question, and then looks at the millions of pieces of information it has stored to find a specific answer, said Ferrucci.

This is undoubtedly a remarkable accomplishment.

Indeed, accompanying the announcements we are also seeing predictions that such supercomputers "will have applications in health care."

Indexing of the medical literature, and data mining (for better or worse) from free text come to mind.

However, the current irrational exuberance about healthcare IT in 2011 is based on several misconceptions. This leads to predictions such as this ...

The technology has to process natural language to understand "what did they mean" versus "what did they say," which has a lot of implications in the health care sector, said Frase. Patients are not using the terms doctors learned in medical school to describe their ailments, but more likely the terms they picked up from their parents growing up, she said.


"Patients are not using the terms doctors learned in medical school to describe their ailments"?

What medical school(s), exactly, are being spoken of here?

It seems as if IT folks think medicine was invented just yesterday. In fact, in medical school, internship, residency and practice we learn all about that, and learn how to 'translate' that information or use it to elicit more information as needed in order to provide care. I'm not sure a multimillion dollar supercomputer is needed for that ...

... and related "platform database" predictions such as this:

... A Watson-like system can take that information and co-relate it against all the medical journals and relevant [who decides that? - ed.] information, and say, "Here's what I think [think? -ed] and why," while showing its evidence for how it came up with the conclusion, according to Frase.

(Actually, computers don't think. A more correct statement would be "here are the results of the algorithms that your faithful machine has crunched, using the medical literature as input.")

That's quite naïve and idealistic with regard to actual medical decision making. It is a computer technician's oversimplified, reductionist, amateur view regarding biomedicine, a domain of often wicked complexity.

As I intimated above, one key issue is what is "relevant" with regard to information.

Consider the issue of the medical literature suffering from numerous conflict of interest and dishonesty-related phenomema making it increasingly untrustworthy, as pointed out by Roy Poses in a Dec. 2010 post "The Lancet Emphasizes the Threats to the Academic Medical Mission", at my Aug. 2009 post "Has Ghostwriting Infected The "Experts" With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?" and elsewhere on this blog.

Then too, there are plausibility issues in medical research, as expressed in the paper "Why Most Published Research Findings Are False", John P. A. Ioannidis, PLoS Medicine 2(8): e124, 2005. Dr. Ioannidis observes:

There is increasing concern that most current published research findings are false. The probability that a research claim is true may depend on study power and bias, the number of other studies on the same question, and, importantly, the ratio of true to no relationships among the relationships probed in each scientific field. In this framework, a research finding is less likely to be true when the studies conducted in a field are smaller; when effect sizes are smaller; when there is a greater number and lesser preselection of tested relationships; where there is greater flexibility in designs, definitions, outcomes, and analytical modes; when there is greater financial and other interest and prejudice; and when more teams are involved in a scientific field in chase of statistical significance. Simulations show that for most study designs and settings, it is more likely for a research claim to be false than true. Moreover, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias.

Dealing with these very real-world issues in patient care requires nothing less than human judgment borne of experience, critical thinking skills (emphases on "thinking", which computers cannot do, sorry all you HAL-9000 and M5 fans) and intuition to manage. "Garbage in, garbage out" applies in the extreme.


(The Ultimate Computer, Dr. Richard Daystrom's mid-23rd century Multitronic unit, M5. Fun to watch it beat up on starships Excalibur, Hood, Lexington and Potemkin due to malfunction. Even more fun to watch William Shatner talk it into cybernetic suicide via guilt, and yes, as a teen I knew all the ST trivia cold, but I think sci-fi has gone too far into people's heads.)

There are also other computer-vs-human mind issues at play.

First, let's look at Watson. Just to play the TV quiz show game show Jeopardy, a game largely about the knowledge and recall of trivia, it took the following:

  • Watson is a breakthrough human achievement in the scientific field of Question and Answering, also known as "QA." The Watson software is powered by an IBM POWER7 server optimized to handle the massive number of tasks that Watson must perform at rapid speeds to analyze complex language and deliver correct responses to Jeopardy! clues. The system incorporates a number of proprietary technologies for the specialized demands of processing an enormous number of concurrent tasks and data while analyzing information in real time.


A rack-mountable server ("blade").



Racks of servers, each with multiple advanced CPU's



Racks of servers in IBM's Watson supercomputer, all prettied up, HAL 9000-style


Second, it will be many years indeed before even the current Watson QA capabilities can be tailored to a domain as complex as biomedicine and made widespread for the hundreds of thousands of practicing physicians and the much larger number of allied healthcare professionals in the U.S. or worldwide.

Third, there's this from the same LA Times article linked above:

  • Like its human competitors, Watson won't have Internet access [or access to anything outside its immense local storage - ed.] during the games, so Googling an answer won't be an option, the report said.

I see a significant degree of machine-human unfairness right there. A computer has 100% reliable access to information in its storage media. The human mind does not. That's appropriate for a TV game show that tries to test a persons' knowledge of trivia, but that's not how medicine works.

What if the match were made more fair, giving the humans error-free access to the same information Watson has stored in its own 15 terabytes and
200 million pages?

Fourth, medicine is not about recalling trivial factoids of information based on parsing natural language queries in the "puzzle format" of Jeopardy. As I wrote here and here, medicine is not a platform database information retrieval problem. (I would argue medicine, except in simple cases, is in large part a matter of filtering the irrelevant, unlikely, and unreliable, of which there is an exponentially increasing amount, from information relevant to the subtleties of a complex medical situation.)

Certainly, today's clinical IT will make little dent in healthcare quality and error reduction, as those issues are not in majority due to record keeping problems of paper vs. electronic, as I pointed out in my Dec, 2010 post "Is Healthcare IT a Solution to the Wrong Problem?". The expectations for today's health IT are grossly exaggerated.

How about expert systems technology such as Watson? Regarding NLP and fact retrieval 'tours de force' like IBM Watson, medicine is about cognition, about human judgment born of experience in dealing with ambiguity not just of language but of observations, findings, lab data, image interpretation, etc., about human intuition and assemblage and integration of a huge amount of disparate information in ways not well understood even by its practitioners. The end result is not just recall of a piece of information.

I consider a statement such as:

... a Watson-like system can take that information and co-relate it against all the medical journals and relevant information, and say, "Here's what I think [actually, as mentioned previously, here's the results of the algorithms - ed.] and why"

... to imply just as grandiose a valuation to the technology as the statements I heard a decade ago about the health IT of the day - or even today - "revolutionizing medicine."


I'm not even sure such a capability would be very useful; we already have DXplain developed by domain experts over decades, and that's not had a major impact on healthcare to date.

The real breakthrough will be when a cybernetic expert system can take, say, cases from the Case Records of the Massachusetts General Hospital in the NEJM verbatim, and compete as a peer (e.g., as a peer not recognized to be a machine) with a round-table panel of expert physicians with facile access to the medical literature (e.g., PubMed) on the differential diagnosis, how to establish the diagnosis and to rule out others, the treatment strategies, and the likely outcomes, and then participate in the care.

When this happens (call this the "NEJM Turing Test"), and when such capabilities are affordable and widely available, then medicine will have been revolutionized.

Of course, the enormity of the hardware and the algorithmic advances required to make a truly "revolutionary" tool such as this are obviously staggering. Considering that it takes 10 racks of multiprocessor IBM servers with 15 terabytes of memory and a team of varied domain experts writing algorithms for several years to accomplish the NLP advances and lookups to answer Jeopardy-style trivia questions, one can only imagine what a truly useful cybernetic medical assistance system would look like.

It should also be remembered that Watson does not think. Humans do. Cybernetic Jeopardy and chess playing accomplishments notwithstanding, I believe a machine even close to passing a "NEJM Turing test" will be a long time in coming. Until then, we should be encouraging better support for human physicians struggling to use their medical expertise in a sea of bureaucracy, stress and overwork (part of which will increasingly be a struggle with mission hostile health IT).

Finally, far off as I believe it to be, I do think the hundreds of billions of dollars being devoted to today's health IT would be better devoted to developing a "Dr. Watson" that can pass a medical Turing test as described above, than deploying mission hostile, primitive HIT and developing an unsustainable mega-bureaucracy to support it as in my post here.

This is not to minimize the wonderful accomplishments of the Watson team. I just wish predictions of cybernetic miracles in medicine would be held in abeyance after the lessons of the past fifty years of computers in medicine.

In the meantime, perhaps the current Watson might be useful in remediating our very sclerotic and moribund "mainsteam media," especially in the domain of politics. Its reporters and writers can certainly use cybernetic help in their fact-checking and logic, Jeopardy-style, far more so than physicians.

-- SS

Feb. 23, 2011 addendum:

Gevalt!

From the article "IBM's Watson could usher in new era of medicine", Sharon Gaudin, Computerworld, February 17, 2011:

Jennifer Chu-Carroll, an IBM researcher on the Watson project, said the computer system is a perfect fit for the healthcare field ... Think of some version of Watson being a physician's assistant," Chu-Carroll said. "In its spare time, Watson can read all the latest medical journals and get updated. Then it can go with the doctor into exam rooms and listen in as patients tell doctors about their symptoms. It can start coming up with hypotheses about what ails the patient.

Gevalt indeed ... incredible irrational exuberance. We can easily go from Jeopardy to Medicine ... and then to the Moon, in a hot air balloon! (The moon is up, hot air balloons go up, what's the problem?)

How many patients has Chu-Carroll seen lately?

(Her bio at http://researcher.ibm.com/researcher/view.php?person=us-jencc was initially down at this moment; "The server at researcher.ibm.com is taking too long to respond." Watson must be taking a nap. Archive.org says "The connection has timed out. The server at web.archive.org is taking too long to respond." Just like a doctor!)

Anyway, it now appears:

I am a Research Staff Member at IBM T. J. Watson Research Center. I also manage the Knowledge Structures group which focuses on improving advanced search technology through the use of natural language processing and machine learning techniques. Prior to joining IBM in 2001, I spent 5 years as a Member of Technical Staff at Lucent Technologies Bell Laboratories. My research interests include question answering, semantic search, natural language discourse processing, and spoken dialogue management.

Please, please, please, computer scientists: STOP MAKING THESE PREDICTIONS OF CYBERNETIC MIRACLES JUST AROUND THE CORNER. YOU'VE BEEN DOING IT SINCE THE VACUUM TUBE-BASED MACHINES.

STOP! PLEASE!

(Maybe first they could give us a computer that does a perfect, lucid, coherent, fluent translation of, say, Russian-to-English, another promise made since the 1950's "Robby the Robot" years?)


Robby the Robot in "Forbidden Planet." Lost in Space fans will remember Robby as doing battle with the Class M-3 Model B9, General Utility Non-Theorizing Environmental Control Robot ("Danger, Danger, Will Robinson") as well!

I think the essay in today's WSJ by UC Berkeley philosopher John Searle is also apropos: Watson Doesn't Know It Won on 'Jeopardy!'

-- SS

Addendum: See my Wall Street Journal Letter to the Editor on these matters at this link.

I wrote on a somewhat sarcastic note at this March 2011 post: "Here Comes the Judge! A Quick Thought on Cybernetic Medicine: Why Can't Computers Also Do Law?"

Also see my Sept. 2011 followup post "Once Again, on IBM Watson, Cybernetic Miracles and Reductionist Views of Medicine."

-- SS

16 comments:

Spero melior said...

That so many "leaders" in mainstream IT have such a naive view of healthcare is certainly very disturbing. Besides IBM with Watson, we also have the CEO of Google saying that expert systems are the IT elixir that can cure what ails our health care system.

But I have to alternately shake my head, stare in disbelief, chuckle, and outright guffaw at each of these "thinkers" prescriptions.

Expert systems? Are they really 30-40 years behind the literature of medical informatics research?

There's a reason expert systems are not widely used in health care and it isn't because the AI hasn't been good enough.

Scot M Silverstein MD said...

That so many "leaders" in mainstream IT have such a naive view of healthcare is certainly very disturbing.

I would call it more an arrogant view. They assume medicine is like their own fields and make leaps of logic that appear silly to those who actually know the domain.

-- SS

Anonymous said...

I am guessing Mr. Spero Melior is also an MD doctor like Mr. Silverstein. It's not difficult to guess the reason behind their extreme reactions, but all I want to say as a consumer rather than being the provider of health care service, is that the present system pretty much sucks! Its frustrating for us as ordinary people when the care-givers take us for a ride at our most distressing times! Instead of trying to improve the system with latest technologies, the health care providers have always come up with excuses of shortage of human resource etc. etc., which can be at most times mapped to mere vested interests. Issue IMO is that the providers do not want to come down from their cushy pedestal of an oracular care-giver and invest more in research and technology. Its time now to break the medical monopoly!

PS: I know there will be again extreme reactions to my post, pooh-poohing it as a rambling from a mad, ignorant man, but we have seen too many of such holy institutions biting the dust with the advent of technology that ultimately helps the humanity - point in case finance, telecom....Amen to that!

Scot M Silverstein MD said...

Anonymous January 29, 2011 12:30:00 AM EST writes:

I am guessing Mr. Spero Melior is also an MD doctor like Mr. Silverstein. It's not difficult to guess the reason behind their extreme reactions

I cannot speak for Dr. Melior, but considering the megabytes I've written on this blog and at my academic site about health IT problems and the thousands of hyperlinks I've posted to related material in and outside the academic literature over the years, calling my reaction "extreme" is ill informed at best.

Issue IMO is that the providers do not want to come down from their cushy pedestal of an oracular care-giver and invest more in research and technology. Its time now to break the medical monopoly!

I think you need to read this blog in more depth before rendering judgment against only medical professionals, who at some point may need to "provide" you with life saving treatment, while being harassed by non-medical bean counters and profiteers that come, like Lifesavers (the candy) in multiple varied flavors, and beleaguered and weary from mission hostile IT.

PS: I know there will be again extreme reactions to my post, pooh-poohing it as a rambling from a mad, ignorant man

If you consider the admonition of a graduate level college professor/MD/computer professional to READ before you OPINE "extreme", then so be it.

-- SS

Anonymous said...

I don't mean to bust anyone's bubble but humans lose in the end, regardless of Watson's current defects.

In the past, computers and machines have lagged behind the knowledge work needed for a modern society. So while a word processor eliminated many manual typewriters, the fact remains that PCs need maintenance, upgrades, and of course, Microsoft always adds something to Word to keep everyone on the *paid for* license path.

And looking ahead, even advanced coding machines will require designers and user acceptance testers. And this is despite the fact that mountains of code could be self-generated.

Now, what's different here is that once a set of software widgets can comprehend context, within frameworks of knowledge, the average worker will not be able to catch up. Realize, the number of creative R&D types is a lot less than those who implement the work. This is the case for many corporations, including IBM.

The problem with the Jeopardy Watson 'bot is that it's really the first generation of its kind and at the same time, the processing speeds of today's supercomputers still lack the overall power for the contextual analysis required to make the decisions which appear to be mundane human-like. Once this issue is overcome, the marriage of self-generation/tuning and massive parallel computing could in fact make over half the white collar jobs redundant, within a generation. I don't know when this time will come but it could be before the middle of the century.

And when they talk about medical diagnosis, as a potential app, I'd say that the *only* reason why many general internal medicine doctors will still be around is because of the A.M.A. The field is highly regulated and the final call (or referral to an MD specialist) has to be by a licensed MD professional, not a 'bot. Otherwise, 'bots and nursing assistants can tend to much of the case load before a human specialist is brought in. That's a huge financial savings but it won't be legally palatable.

Scot M Silverstein MD said...

Anonymous at February 16, 2011 8:59:00 PM EST writes:

the processing speeds of today's supercomputers still lack the overall power for the contextual analysis required to make the decisions which appear to be mundane human-like.

Interesting views. I agree that "humans lose in the end" when people start to believe in cybernetic miracles, but not for the reasons you outline.

My criticism is that your clearly linear, reductionist views of human decision making reflect your cybernetic biases. Speed is not the issue. As I wrote:

"...medicine is not about recalling trivial factoids of information based on parsing natural language queries in the "puzzle format" of Jeopardy. As I wrote here and here, medicine is not a platform database information retrieval problem. ... Regarding NLP and fact retrieval 'tours de force' like IBM Watson, medicine is about cognition, about human judgment born of experience in dealing with ambiguity not just of language but of observations, findings, lab data, image interpretation, etc., about human intuition and assemblage and integration of a huge amount of disparate information in ways not well understood even by its practitioners."

Check the above hyperlinks.

And when they talk about medical diagnosis, as a potential app, I'd say that the *only* reason why many general internal medicine doctors will still be around is because of the A.M.A. The field is highly regulated and the final call (or referral to an MD specialist) has to be by a licensed MD professional, not a 'bot. Otherwise, 'bots and nursing assistants can tend to much of the case load before a human specialist is brought in.

You're smart - but not that smart. I have to shield the wall from repeated impacts with my head when I read statements about medicine's simplicity like that ("hey, nuclear fission's easy to do on your kitchen table if you have all the right information").

I could say you're simply wrong on the latter, and that an example of natural selection at work is letting one's family be cared for by 'bots and medical assistants.

Instead I'll say that 'bots and assistants can practice medicine about as well as a certain non-US country can manufacture computer capacitors - that is, shoddily.

One of my 3 year old power supplies recently died and the caps looked like this inside.

I also predict you're relatively young. I pity your generation. You've not only been economically screwed, but you've been robbed of the ability to think critically and understand complexity.

"Humans will lose in the end" - cruelly - due to being taken advantage of by cybernetic alchemists and snake oil salespeople.

-- SS

Anonymous said...

"I also predict you're relatively young. I pity your generation. "

Thank you for the ad hominem maneuver. FYI, I'm not that young, but it was a nice try.

Just so you know, I know 5-6 PhDs in engineering (biomedical, chemical, & electrical), who got over > 35s on the MCATs and went to medical school. None of them speak of medicine as follows:

"about human judgment born of experience in dealing with ambiguity not just of language but of observations, findings, lab data, image interpretation, etc., about human intuition and assemblage and integration of a huge amount of disparate information in ways not well understood even by its practitioners"

They speak of the profession as that, another line of work where a lot of experience counts. And likewise, they used to say the same *glowing remarks* for engineering work but after seeing their labs' work get offshored, opted for medical school. They are from the ages of 40 to 60 today. Thus, they know that it's a guild which protects its workers and are fine with it. Do you have a PhD in engineering?

And physician's assistants do practice a large chunk of general internal medicine. Thus, they're the first line before the final internal med MD makes the call for a referral or a simple prescription (i.e. usually an antibiotic or analgesic). That's at least 50% of the daily case load.


"about as well as a certain non-US country can manufacture computer capacitors - that is, shoddily."

Sure, it's 2011 and you can poke fun at Vietnam & China all you want for QA issues but remember this, in 1980, 70-80% of semiconductors were made in Silicon Valley, today, that 70-80% is made in Taiwan and South Korea & even the R&D is moving there. Thus, using your present day ignorance is no reason to ignore the overall trends in place.

" 'Humans will lose in the end' - cruelly - due to being taken advantage of by cybernetic alchemists and snake oil salespeople"

Ok, let's change that *snake oil* moniker to Corporate America and soon, multinational corporations. Yes, they run this country, not a few salesmen. Bark all you want but the only safety you have is the AMA and your congressional lobbyists.

Scot M Silverstein MD said...

Anonymous at February 18, 2011 5:14:00 PM EST rambles:

Just so you know, I know 5-6 PhDs in engineering (biomedical, chemical, & electrical), who got over > 35s on the MCATs and went to medical school. None of them speak of medicine as follows:

"about human judgment born of experience in dealing with ambiguity not just of language but of observations, findings, lab data, image interpretation, etc., about human intuition and assemblage and integration of a huge amount of disparate information in ways not well understood even by its practitioners"


Wow. Add a few more friends like that (BTW which is it? Five or six?), and you could probably submit NIH grant proposals to build the next cybernetic miracle .. perhaps the Emergency Medical Hologram Mark I.

They speak of the profession as that, another line of work where a lot of experience counts.

As to why your pals take a linear, grade-school approach to wicked domains like medicine, it's probably because they, like you, were in the wrong line when abstract thinking skills were handed out, and know as little about biomedical information science (Medical Informatics) as Mr. Magoo knows about optics.

You want to see medical paraprofesssionals for your care, go right ahead, I wish you luck.

However, we're not interested in your dictatorial impulses that so should everyone else, in your belief in cybernetic miracles, and in your apparent resentment and paranoia about physicians.

I cannot decipher the rest of your comment; it rambles incoherently.

Although my comment that you are likely young was not ad hominem at all, but an expression of pity for the young, I put your age at 30, max.

That seems in my experience to be about the age of maximal arrogance from medical amateurs.

-- SS

Scot M Silverstein MD said...

I note that the WSJ published my comments "about human judgment born of experience in dealing with ambiguity not just of language but of observations, findings, lab data, image interpretation, etc., about human intuition and assemblage and integration of a huge amount of disparate information in ways not well understood even by its practitioners" today.

-- SS

Anonymous said...

Scot M Silverstein MD said...

"...medicine is not about recalling trivial factoids of information based on parsing natural language queries in the "puzzle format" of Jeopardy. As I wrote here and here, medicine is not a platform database information retrieval problem. ... Regarding NLP and fact retrieval 'tours de force' like IBM Watson, medicine is about cognition, about human judgment born of experience in dealing with ambiguity not just of language but of observations, findings, lab data, image interpretation, etc., about human intuition and assemblage and integration of a huge amount of disparate information in ways not well understood even by its practitioners."

Building on these statements, it can be argued that even if a computer algorithm were designed to reference a well designed repository of medical domain knowledge to determine how, in most cases, to resolve medical data ambiguities and reliably infer the same diagnosis as a typical physician would, and --

if a solution including a medical data extraction process, said algorithm, and medical domain knowledge, could be demonstrated to meet the above claim in a variety of controlled studies --

that doesn't mean the solution (as amazing as it seems) can replace all the diagnostic decision-making capabilities of a physician.

The solution is limited to the constraints of its human design: the types of data handled by the algorithm, assumptions inherent in the medical domain knowledge base referenced by the algorithm, assumptions of the algorithm, and specific diagnos(es) the algorithm supports.

However, the above-described solution could have substantial value in fostering adherence to evidence-based clinical guidelines that are not attaining needed levels of adoption in medical practice. If such a solution, configured and validated as safe for assisting in diagnoses of AMI or other heart conditions, also outputted an explanatory component (in human-readable language) that communicated to a doctor the 'rationale' for a computed diagnosis, the solution could further assist these doctors in their own recall and use of the underlying evidence-based guidelines, which may be quite complex - and thus aid in the development of expertise in doctors starting out in clinical practice.

And when data-driven demands for information-intensive cognitive activities outpace the cumulative capabilities of the number of physician staff available, a tool like this could decrease the overall physician cognitive burden immensely - without having to force doctors into accepting the computerized diagnoses. They can and should have the final say in what each diagnosis is, and determine whether additional information/tests are needed to explore other plausible diagnoses.

I believe these kinds of artificial intelligence-based tools can, and should, be developed to benefit our current and future workforces of doctors, not replace them.

However, are the doctors we have humanly able to fully assimilate the imminent tsunami of new types (genomic, proteomic, family history) and high quantities (longitudinal, accessible through HIEs) of clinical data which, when evaluated consistently and in a high throughput fashion against an ever-changing base of clinical guidelines, can result in timely, high quality, and personalized patient outcomes?

As a healthcare consumer/patient, I have great concern for physicians who are unduly challenged by the above question, or cannot answer it satisfactorily. Doctors can say no to unsafe and clunky EHRs, and discount the value of computer-assisted diagnostic tools. But can they make it part of their practice to say no to, or "I'm not accepting any more" patients who want or actually need more personalized diagnoses and treatments that require a tsunami data to determine?

InformaticsMD said...

Anonymous May 17, 2011 12:26:00 AM EDT said..

I believe these kinds of artificial intelligence-based tools can, and should, be developed to benefit our current and future workforces of doctors, not replace them.

Agreed, but the hype that has been proffered at least since the 1950's about cybernetic intelligence is tiring, to say the least.

-- SS

Anonymous said...

Here's a recent update on Watson applications for health care ...

(http://www.networkworld.com/news/2011/021711-ibm-watson-healthcare-job.html?page=1)

(http://www.eweek.com/c/a/Health-Care-IT/IBM-WellPoint-Developing-Health-Care-Applications-for-Watson-417553/)

With a major health insurance provider, as a backer, what was a type of theatrical demonstration, The Jeopardy Show, has already been adopted by an actual provider in the medical industry itself. In other words, at an even quicker pace than typical pharmaceutical work, which would start at a bench and finish in a clinic, in let's say 6 to 12 years, expert systems are entering traditional industries at nearly an unprecedented speed.

Anonymous said...

Dear Dr Silverstein,

As you can tell, a person with a 29-32 MCAT score, a typical internal medicine doctor earning $170K-220K/yr, is not a "genius" by any stretch of the imagination. A lot of people with science and engineering backgrounds can achieve similar marks. Yes, careers in medicine are determined by a linear, numerical analysis. It is not determined by who has the best intuitive problem solving ability.

The arrogance of your profession and this false belief in your superior intellect that computing faculties will not replace diagnostic general internal medicine is wishful thinking. Internal medicine MDs will be made obsolete in another 10-15 years and thus, many MDs will be forced to specialize to keep their jobs.

BTW, I'd taken the MCAT and scored a 36. Perhaps I'll attend medical school if I don't make millions in a hedge fund career.

InformaticsMD said...

Anonymous November 15, 2011 11:20:00 PM EST said...

The arrogance of your profession and this false belief in your superior intellect that computing faculties will not replace diagnostic general internal medicine is wishful thinking ... Perhaps I'll attend medical school if I don't make millions in a hedge fund career.

It is clear from your (anonymous) post that test scores, intelligence, ethics, culture, greed, altruism, self-awareness (and courage) are only loosely related at best.

-- SS

Anonymous said...

SS, then explain to me why a postdoc in Biochemistry (avg +2 years more education in the sciences) earns $35K-$40K per annum versus an MD physician in the $150K-$250K range?

InformaticsMD said...

Anonymous March 28, 2012 2:00:00 AM EDT said...

then explain to me why a postdoc in Biochemistry (avg +2 years more education in the sciences) earns $35K-$40K per annum versus an MD physician in the $150K-$250K range?

Perhaps it has something to do with the fact that physicians have to do a residency and often postdocs themselves after the terminal degree, take Boards, and then handle matters such as these (link), while being held legally accountable for the outcomes.

-- SS