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Wait until you have a rare disease before you say something like you want AI help diagnose you (or make decisions about your healthcare for that matter—the US i

Wait until you have a rare disease before you say something like you want AI help diagnose you (or make decisions about your healthcare for that matter—the US is going to be a mess if they go this route). 7% of the general population collectively has a rare disease, so it’s not uncommon to have a rare disease. Most of them are classified as very rare. I personally have 2 rare diseases affecting my peripheral nervous system, and one of them is very rare. The very rare disease is believed to have also caused my type 1 diabetes. The wild part? The very rare disease, which I had prior to my type 1 diabetes diagnosis, which was also undiagnosed at the time, was blamed as “type 1 diabetes related complications” specifically autonomic neuropathy by human doctors. Do you think AI would get this right? The answer is an obvious no. Also, I am in my early 30s. My endocrinologist was surprised that I was 30 and was making a big deal about it (as in “you survived and you shouldn’t be alive” sense). It was never statistically likely that I would be alive, which is why AI should never be used. So do you think AI should be making health decisions in a healthcare system that already has a ton of human error, and is trained on those errors? I mean, the third leading cause of death in the US is believed to be preventable medical errors: https://www.bmj.com/content/353/bmj.i2139 https://www.bmj.com/content/353/bmj.i2139

ska 5y ago
> Do you think AI would get this right? The answer is an obvious no. Today? Sure. But really one of the most plausible ways in which AI could be more effective than human clinicians is in rare diseases. It assumes a massive input of data of course, but clinicians are biased against this in ways that are hard to do anything effective against. This is why so many people with rare conditions spend years before getting a proper diagnosis.
- nradov 5y ago
  Getting that data is an extremely hard problem. In general the data is low quality, incomplete, poorly coded, and full of errors. Cleansing the data to the point where it could be used to train a useful decision support algorithm would require a tremendous amount of human labor by expert clinicians. This isn't something that can be automated.
  - ska 5y ago
    > [...] to the point where it could be used to train [...] require a tremendous amount of human labor by expert clinician. This is how it has been done for decades at this point (at least in some systems), and yes it is expensive. To really tackle things like above rare disease interactions, it would require at least an order of magnitude change, this is at least plausible; but would require some systemic changes.
  - Verdex 5y ago
    Okay ... how do doctors (individually or as a whole) get better at doctoring? Either we're saying they look over the data OR we're saying that they somehow just mystically know better as time goes on. Who cares if it turns out that we can't automate the formation of the AI. But we're doing the same work to continually educate and improve doctors already. At least with the AI it won't die of old age once it starts to get really good at what it's doing. And maybe it turns out that the best that AI can do is duplicate a middle level doctor who isn't really interested in self improvement. If that's the case then at least everyone can get cheap and fast health care that's the same frustrating quality that we're stuck with now. Only with the AI you can say that it's dumb and everyone will believe you. With a doctor you have to fight past "impugning the reputation of the profession" in order to get a real diagnosis.
    - nradov 5y ago
      Doctors are getting better at doctoring mostly through simple things like checklists and evidence-based medicine treatment guidelines. Those reduce variance and the risk of error. Improved interoperability between clinical systems also has potential to reduce errors by making sure all members of a patient's care team have complete access to the patient's entire record. Diagnosis isn't particularly difficult or time consuming in most routine cases after gathering the necessary data. If you see a jagged line on the x-ray then the patient has a fractured bone. If the A1c level is 7.5% then the patient has diabetes. Etc. Improving diagnostic accuracy will help in rare cases and is worth doing, but that won't have much impact on the health care system as a whole.
      - 5y ago
- deleted 5y ago
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Verdex 5y ago
I don't understand your argument. You're saying that humans are unacceptably bad. Then why is it a problem to replace them with also unacceptably bad AI. Like, either way you're not getting the treatment you need. At least if the AI fails you, then nobody is going to get their ego stepped on if you go to get a second opinion. Whereas with a doctor you have to go through a few uncomfortable conversations and then hope that the next guy isn't going to ignore you because they don't want to sour their relationship with your first doctor.

ska 5y ago

> Do you think AI would get this right? The answer is an obvious no. Today? Sure. But really one of the most plausible ways in which AI could be more effective than human clinicians is in rare diseases. It assumes a massive input of data of course, but clinicians are biased against this in ways that are hard to do anything effective against. This is why so many people with rare conditions spend years before getting a proper diagnosis.

nradov 5y ago
Getting that data is an extremely hard problem. In general the data is low quality, incomplete, poorly coded, and full of errors. Cleansing the data to the point where it could be used to train a useful decision support algorithm would require a tremendous amount of human labor by expert clinicians. This isn't something that can be automated.
- ska 5y ago
  > [...] to the point where it could be used to train [...] require a tremendous amount of human labor by expert clinician. This is how it has been done for decades at this point (at least in some systems), and yes it is expensive. To really tackle things like above rare disease interactions, it would require at least an order of magnitude change, this is at least plausible; but would require some systemic changes.
- Verdex 5y ago
  Okay ... how do doctors (individually or as a whole) get better at doctoring? Either we're saying they look over the data OR we're saying that they somehow just mystically know better as time goes on. Who cares if it turns out that we can't automate the formation of the AI. But we're doing the same work to continually educate and improve doctors already. At least with the AI it won't die of old age once it starts to get really good at what it's doing. And maybe it turns out that the best that AI can do is duplicate a middle level doctor who isn't really interested in self improvement. If that's the case then at least everyone can get cheap and fast health care that's the same frustrating quality that we're stuck with now. Only with the AI you can say that it's dumb and everyone will believe you. With a doctor you have to fight past "impugning the reputation of the profession" in order to get a real diagnosis.
  - nradov 5y ago
    Doctors are getting better at doctoring mostly through simple things like checklists and evidence-based medicine treatment guidelines. Those reduce variance and the risk of error. Improved interoperability between clinical systems also has potential to reduce errors by making sure all members of a patient's care team have complete access to the patient's entire record. Diagnosis isn't particularly difficult or time consuming in most routine cases after gathering the necessary data. If you see a jagged line on the x-ray then the patient has a fractured bone. If the A1c level is 7.5% then the patient has diabetes. Etc. Improving diagnostic accuracy will help in rare cases and is worth doing, but that won't have much impact on the health care system as a whole.
    - 5y ago
deleted 5y ago
[deleted]

Verdex 5y ago

I don't understand your argument. You're saying that humans are unacceptably bad. Then why is it a problem to replace them with also unacceptably bad AI. Like, either way you're not getting the treatment you need. At least if the AI fails you, then nobody is going to get their ego stepped on if you go to get a second opinion. Whereas with a doctor you have to go through a few uncomfortable conversations and then hope that the next guy isn't going to ignore you because they don't want to sour their relationship with your first doctor.