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I used to be a doctor in the NHS, and have worked on a medical startup also, so I’d like to think I have some relevant perspective and experience with respect t
by ghufran_syed 9y ago
I used to be a doctor in the NHS, and have worked on a medical startup also, so I’d like to think I have some relevant perspective and experience with respect to patient safety and confidentiality.
There is a lot of hand-wringing in this article, with no reasonable attempt to discuss the balance between possible benefit and possible harm to the patient.
A lot of the paper argues that there was no direct care relationship between deep mind and each patient, and that the data transfer was therefore inappropriate. I disagree, and think in the future we will see many algorithmic systems involved in direct patient care. After all, you could pay an army of clerks to review the notes and results (I.e. patient data) of every patient at the royal free hospital, run it through an algorithm (paper flowsheet), then notify the doctor that there might be impending acute kidney injury, leaving it to the doctor to make the clinical decision about whether there was in fact AKI (true positive) or not (false negative), like we do with EVERY piece of information we get when assessing a patient. That could have been done any time in the last 100 years, without anyone being concerned about the appropriateness of it.
Deep mind was essentially doing the same thing on behalf of the doctors at the hospital.
The risk of harm and the regulatory framework should certainly be considered and developed, but it has to be weighed against the potential benefits, same as every other medical advance (and setback) in human history. Listing a whole bunch of potential dangers is an easy way to write an article that gets attention, but I’m more worried about articles like this unreasonably impeding progress in the field of “algorithmic medicine” than I am about Deep Mind and the Royal Free’s approach to this, at this exploratory stage.
I would feel differently if there was an identifiable business model that conflicted with the interests of the patient, but I think at this super early stage we should err on the side of exploration, not restriction.
- QAPereo 9y agoThere is a principle in medicine that you need to demonstrate efficacy first, before taking further risks at the potential expense of the public. Advancing the tech sounds good on paper, but the cost is unknown and the benefits unclear at best. “Someday it’ll be great” isn’t an argument for your government giving Google private information.
- joe_the_user 9y agoThere is a principle in medicine that you need to demonstrate efficacy first, before taking further risks at the potential expense of the public. This is a key point. It should be noted that health care systems and credit bureaus have in common the ability to accumulate information people without those people effectively having choice. Thus it's especially important to have controls and "hand wringing" that a company is just taking data without the destination or use being evident is entirely appropriate.
- ghufran_syed 9y agoWould the same be true for the manual version of the same procedure I outlined? If so, what are the risks you are concerned about? If not, why would the computerized version be different?
- joe_the_user 9y agoOf course it's true that a manual version of google/deep-mind should involve informed consent for data being given to a third party - and should also be tested for its effectiveness. The large group of clerks you describe seems like it could leak a lot of data, just for example. The thing is neither the Google algorithm nor your idea have proven effectiveness. The "obviously it would improve things so worries over implementation and data control are hand wringing" attitude seems to neglect the fact that all sorts of apparently logical steps actually have turned out to not do the good people expected (Cholesterol drugs being a good example, yes they lower cholesterol, no they don't improve life expectancy, etc)- and also that a good program should be implementable with good data controls, there no reason to frame this as a trade-off.
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- QAPereo 9y agoEven worse, if the public comes to associate ML in medicine with shady dealings and lost privacy, then adoption of proven tech will be delayed or stopped. The ethical constraints around medicine exist for good reasons, and shortcuts can cost lives in innumerable ways.
- quickben 9y agoI like your optimism. Personally, having sat on 'watson for healthcare' presentations by top architects, and having had conversations with them, I'm far less optimistic about the whole AI in healthcare approach.
- killjoywashere 9y agoAs someone working in this space, there is a massive disconnect between the engineers and the medical providers. One has never been in clinic. The other never took linear algebra. To stand with a foot in both worlds is utterly fascinating.
- quickben 9y agoYeah. It's still an interesting project, I just don't think there will be a product anytime soon.
- ghufran_syed 9y agoFunny you say that, I just started studying for an MS in math and stats, while working as an ER doc :) Thonking about maybe going on to do a PhD - I was interested in learning how machine learning might safely improve medical care, and began to suspect that to do so without understanding the math would be like diagnosing disease without knowing anatomy, phyiology, biochemistry, pathology, pharmacology,... It turns out that math is at least as fun as emergency medicine.. :)
- killjoywashere 9y agoWe are small minority. I want to get the AAMC to add stronger math requirements to the medical school pre-reqs.
- b4lancesh33t 9y agoIsn't Watson known to be somewhat snake-oily? I don't think it's reasonable to transfer assessments based on Watson to Deepmind or any other organization.