The KHIT Blog: The Great A.I. Awakening? Health care implications?

Sunday, December 25, 2016

The Great A.I. Awakening? Health care implications?

From a very interesting long read at the NY Times:

...A machine can already detect tumors in medical scans better than human radiologists, but the machine can’t tell you what’s causing the cancer.

Then again, can the radiologist?

Medical diagnosis is one field most immediately, and perhaps unpredictably, threatened by machine learning. Radiologists are extensively trained and extremely well paid, and we think of their skill as one of professional insight — the highest register of thought. In the past year alone, researchers have shown not only that neural networks can find tumors in medical images much earlier than their human counterparts but also that machines can even make such diagnoses from the texts of pathology reports. What radiologists do turns out to be something much closer to predictive pattern-matching than logical analysis. They’re not telling you what caused the cancer; they’re just telling you it’s there.

Once you’ve built a robust pattern-matching apparatus for one purpose, it can be tweaked in the service of others. One Translate engineer took a network he put together to judge artwork and used it to drive an autonomous radio-controlled car. A network built to recognize a cat can be turned around and trained on CT scans — and on infinitely more examples than even the best doctor could ever review. A neural network built to translate could work through millions of pages of documents of legal discovery in the tiniest fraction of the time it would take the most expensively credentialed lawyer. The kinds of jobs taken by automatons will no longer be just repetitive tasks that were once — unfairly, it ought to be emphasized — associated with the supposed lower intelligence of the uneducated classes. We’re not only talking about three and a half million truck drivers who may soon lack careers. We’re talking about inventory managers, economists, financial advisers, real estate agents. What Brain did over nine months is just one example of how quickly a small group at a large company can automate a task nobody ever would have associated with machines.

The most important thing happening in Silicon Valley right now is not disruption. Rather, it’s institution-building — and the consolidation of power — on a scale and at a pace that are both probably unprecedented in human history...

But even enormous institutions like Google will be subject to this wave of automation; once machines can learn from human speech, even the comfortable job of the programmer is threatened...

I've had a good recurrent run here at "AI" issues. e.g., see "What might Artificial Intelligence bring to humanity?"

See also my 2013 NYeC Conference coverage "Smiling Almighty Jesus" riff going to "interoperability" issues. Gonna have to re-run that experiment now in light of the reported Google Translate improvement. Stay tuned. One has to wonder: might this level of cutting-edge intellectual and technical effort (Google Brain) bear actual transformative fruit in the health IT space (e.g., "interoperability"), relative to all of this incremental API ankle biting of recent years? Seeing the potential health data transparency and fluidity connection requires close study of the Lewis-Kraus article.

ERRATUM

From FoxBusiness "Predictions for 2017,"

Theranos will shut its doors. The lawsuits are piling up and that will drain the coffers of the embattled lab test technology startup. CEO Elizabeth Holmes will finally be forced to seek bankruptcy protection and fade into obscurity, at least until the movie Bad Blood comes out, starring Jennifer Lawrence as the troubled entrepreneur.

How does one go from an estimated personal net worth of $4.5 billion to zero in the space of a year or two? Lordy. See "Theranos had an awful year, and it only has itself to blame."

IMPORTANT UPDATE

From The New Yorker.

REWRITING THE CODE OF LIFE
Through DNA editing, researchers hope to alter the genetic destiny of species and eliminate diseases.
By Michael Specter

A long read (may be paywalled; I'm a subscriber). Well worth your time. apropos of a trio of books I will soon be reviewing.

The arc of existence from the Big Bang to our worrisome Anthropocene. Advances in health IT functionality (including UX) may not mean diddley if we fail to attend to much larger existential issues.

"We have engineered the world around us since the beginning of humanity. The real question is not whether we will continue to alter nature for our purposes but how we will do so. Using a mixture of breeding techniques, we have transformed crops, created countless breeds of animals, and converted millions of wooded acres into farmland. Gene drives are different; one insect could affect the future of our species. But it is a difference of power, not of kind." - Michael Specter

"Engineered traits fail in the wild. But what if we could change that?"

____________

More to come...

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Brave New Health

Commonwell Health Alliance

Another important read (pdf)

I love this kind of stuff. It sustains and humbles me. "As politicians, advertisers, salesmen, and propagandists for various political, economic, moral, religious, psychic, environmental, dietary, and artistic doctrinaire positions know only too well, fallible human minds are easily tricked, by clever verbiage... Common language—or at least, the English language—has an almost universal tendency to disguise epistemological statements by putting them into a grammatical form which suggests to the unwary an ontological statement. A major source of error in current probability theory arises from an unthinking failure to perceive this."

Quotes

"An economist is a person who sees something that works in practice and tries to figure out whether it will work in theory."

- J.D. Kleinke, medical economist
___

"The only person who enjoys change is a baby with a wet diaper."

"Every misspent dollar in our health care system is part of somebody's paycheck.

- Brent James, M.D., M.Stat

“We could do healthcare, at markedly higher quality, for everyone in this country, without rationing or denying anybody the care that they need, without having the government dictate how doctors practice or whether hospitals could expand, at half the cost we do it now.”

- Health Care Futurist Joe Flower

Most of the sciences, unlike parts of medical science, are not concerned with the impossible. There is not complementary and alternative physics, or chemistry, or biochemistry, or engineering. These disciplines compare their ideas against reality, and, if the ideas are found wanting, abandoned."

- Mark A. Crislip, MD

"Q: How much alcohol is too much?
A: More than your doctor drinks."

- a physician I once heard speak during a CME presentation

“Just because science doesn’t know everything, doesn’t mean you get to fill in the gaps with whatever fairy tale most appeals to you.”

- Dara O’Briain

'[I]t is one small step from using the computer for "helping" doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the "good," facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter.'

- Richard Reece, MD

“[T]here ARE statistics which are non-political. Just because The Washington Post/Fox News reports the temperature is 75 degrees doesn’t mean it’s really snowing and sunscreen is a liberal/conservative plot. Even if you earn a living being ideological.”

- Michael L. Millenson

"It is a generally a fairly convincing argument that people shouldn’t have to be subsidized to undertake a change which is in their best interest.

The reconciliation seems to be that EHR is not supposed to make a doctor’s practice more efficient and higher quality. It is supposed to make the system of care more efficient and higher quality, which is not the same thing. Those of you who took calc recall that maximizing the total of variables is not achieved by maximizing any one variable and this is a perfect example of that.

Those of you have served in combat certainly noticed that too — if everyone works as a team the unit takes fewer casualties. If you try to save your own hide, you might, but at the expense of more casualties overall."

- Al Lewis

"There are two ideas to keep in mind about Bayesian reasoning and how we tend to mess it up. The first is that base rates matter, even in the presence of evidence about the case at hand. This is often not intuitively obvious. The second is that intuitive impressions of the diagnosticity of evidence are often exaggerated."

- Daniel Kahneman, "Thinking, Fast and Slow"

"Physicians apply advanced scientific knowledge, but they must do so without the favorable conditions that experimental scientists create for themselves. Multitasking is forced on physicians, often in chaotic environments and under severe time and resource constraints."

- Lawrence and Lincoln Weed, "Medicine in Denial"

"It’s time to stop the whining about Obama care and acknowledge we already have universal health care. We just pay for it in the stupidest way possible that ensures problems are that much more disastrous and complicated when they’re finally treated."

- Mark Hoofnagle, MD, PhD

"Every act of conscious learning requires the willingness to suffer an injury to one's self-esteem. That is why young children, before they are aware of their own self-importance, learn so easily."

- Thomas Szasz, MD
___

"Of course, one reason that process metrics* are so popular is that processes are much easier to define and measure than outcomes."

- The Skeptical Scalpel
___

"There is an “illusion of validity” for any random data point, a seductive sense that is colored by what we hope will be true. Mountains of pharmaceutical claims are often made from mere molehills of data."

- Danielle Ofri, MD
___

"Joy empowers people. It is a source of energy that enables people to hope and plan and change their lives for the better. Spend some time around someone who is relentlessly negative and how do you feel–drained, right? More and more research shows that joy is not something that just happens to you, like a bolt of lightening out of the blue. Joy is, instead, a habit to cultivate. Negative thinking and despair are the crabgrass of our souls–weeds that take root and spread, sometimes to all areas of life. Joy, in contrast, is a soul’s rose–hardy when cared for, able to put down roots over time and withstand disease and extremes. Like a rose, however, your joy can become blighted from neglect or harsh conditions. We all need to tend to our joy–to prune away the badness, and to know that, even though it may look like a prickly bare root, if you invest time in a joyous outlook, gorgeous things will bloom, even in the harshest conditions."

- Dr. Jan Gurley
___

"'Solutions' exist only in mathematics."

- Karen Martin
___

"The issue of how to regulate clinical software is, in the long run, indistinguishable from the issue of how to regulate medicine. The only difference is that medicine is practiced in the open, without secrecy, subject to peer review, and under a merit-based state license."

- Adrian Gropper, MD
___

"Economist, rope, tree: some assembly required."

- Source unknown

DISCLAIMER:

I write this blog wholly on my own time and my own dime. The views proffered are expressly my own as a concerned and active citizen/taxpayer (in addition to being the result of my substantive experience in the various IT fields), and in no way reflect any policy views of my former employer, notwithstanding that some of the thinking has indeed obviously been spurred by the implications of the work with which I have been doing for them.

FAIR USE POLICY
I cite a ton of news and web sources spanning the breadth of relevant technical and policy domains, sometimes at substantial length. I believe I remain well within the bounds of "Fair Use," as [1] I am not doing any of this for profit, [2] I always provide attribution and links -- which, [3] far from negatively impacting any copyright holders' commercial interests, might actually increase traffic to and interest in their offerings.

Nonetheless, should I post anything of yours regarding which you have any objection, just let me know and I will remove it forthwith.

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Sunday, December 25, 2016

The Great A.I. Awakening? Health care implications?

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