Artificial Intelligence hype and reality are everywhere. However, the last month or two has seen some thoughtful reflection. HHS / ONC announced “Hype to Reality: How Artificial Intelligence (AI) Can Transform Health and Healthcare” referencing a major JASON report “Artificial Intelligence for Health and Health Care [PDF -817 KB],”. From a legal and ethical perspective, we have a new multinational program: “PMAIL will provide a comparative analysis of the law and ethics of black-box personalized medicine,…”. Another Harvard affiliate writes “Optimization over Explanation” subtitled “Maximizing the benefits of machine learning without sacrificing its intelligence”. Meanwhile, an investigative journalism report from the UK “Google DeepMind and healthcare in an age of algorithms”, “…draws a number of lessons on the transfer of population-derived datasets to large private prospectors, identifying critical questions for policy-makers, industry and individuals as healthcare moves into an algorithmic age.”
What sets these major papers apart from the constant AI and Big Data science or hype is that they are not particularly technical. Although long, they are accessible to pretty much anyone including physicians and patients. What shocks me, as a career medical technology engineer also trained as a physician, is how passive physicians and patients seem as medicine shifts from open public science to secret corporate black boxes.
Medicine is a profession that is rapidly losing control of its tools to corporate and political interests. First, they came for the information itself and introduced electronic health records that doctors do not purchase or control. Some doctors, frustrated by the loss of control, retired but most just complained and learned to type faster. Now they’re coming for the very core of the profession as a “learned intermediary” trusted by the patient. Black box AI may pay lip service to the physician as an intermediary but everyone understands that it’s the secret and proprietary machine that’s doing the heavy lifting. In machine we trust.
From a patient and physician perspective, two things define our loss of control and shifting trust: health records and secret methods. Patients have lost control over health records. Since 2002, corporations are able to use our health records without our consent. The trend to involuntary and hidden surveillance of everyone continues and grows to nationwide scale with the new HHS administration. This, we’re told, is the price we must pay to keep us safe and make research, including machine intelligence, effective.
Secret methods, we’re told, is the price we must pay to bypass the limitations of human understanding. Asking the AI to explain itself or making the AI an open public good like medicine used to be would simply slows progress and costs lives. Patients lose control of the records that train the AI. Physicians lose control of the open science that used to be the foundation of trust in the profession.
I firmly believe in the power and promise of technology, including AI, but we must not cede control out of greed and frustration. As the JASON report clearly states, EHRs don’t have access to the full range of trusted information the AI needs. We can build a national health surveillance bureaucracy like European countries have but it’s unlikely to have access to our cell phones and the social determinants of health. We can also regulate black box AI at a corporate level but that takes the power of innovation and experimentation away from the licensed clinician.
AI is becoming an essential part of medicine. Patients need to trust their most sensitive data to the machines the way we used to trust our physicians before institutional EHRs and national-scale data breaches. Doctors need to remain the learned intermediary by keeping full transparency and interactivity with the machine. Secret software and black-boxes do not respect the role of physician as the root of trust and decentralized regulation. The current approach to AI is not in the public interest and the medical profession needs to snap out of its daze.