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No, they really don't. I'm married to a physician and I can tell you that Medicine is an incredibly nuanced profession, and though doctors and nurses can benef

by na85 13y ago

No, they really don't. I'm married to a physician and I can tell you that Medicine is an incredibly nuanced profession, and though doctors and nurses can benefit greatly from computer assistance, they cannot be reliably and safely replaced by computer algorithms. The single data point of Watson diagnosing lung cancer is not enough to generalize over the entire profession and range of ailments. Medicine is a great deal more than differential diagnoses, doctors are a great deal more than "professional diagnosers", and nurses are a great deal more than morphine dispensing diaper-changing automatons. Most medical schools (in my country, at least) have moved to an entirely evidence-based and patient-centred-care model years ago. The problem of course is that evidence is not always easily gathered because of ethical issues (e.g. most hypothermia knowledge comes from Nazi human experimentation on POWs and Jews. Also it's hard to conduct a study on OB/GYN topics because you could potentially be putting infants, fetuses, and their mothers at undue risk). Being treated by a computer is not going to change this problem of poor evidence. That forum post was written by someone who has only a shallow appreciation for/understanding of the field of medicine.

Brakenshire 13y ago
You may well be right, but nevertheless, where medical care can be automated, it should be. Because otherwise medical care never gets more affordable. The economy doubles in size, wages double in the general economy, and ... doctors wages double. As long as we consider medicine an elite profession (so that we don't train an overabundance of doctors and drive the wages down, which most of us wouldn't want to do) employing medical staff will always cost some approximately fixed multiple of the median hourly wage. And medical care is and has always been too expensive to provide proper care for the entire population. If, for instance, we can automate doctors taking blood pressure readings, by giving patients their own sensor, or automate the drawn out process of step-by-step diagnosis by driving down blood cost prices so that 50%, 5% and 1% diagnoses can be explored simultaneously, or have automated machines which allow frail, elderly patients to bathe without needing a nurse, then we can really start to improve care, and decrease cost (which, in any case, will simply be reallocated to dealing with other ailments). Doctors lose nothing, but, step-by-step, the general population gains immeasurably.
- eru 13y ago
  > And medical care is and has always been too expensive to provide proper care for the entire population. Which countries are you talking about here? (I agree with your general sentiment, though.)
  - Brakenshire 13y ago
    I know there are issues which are specific to the States, but I would say this applies almost everywhere. Almost everywhere doctors are paid 5-10 times the median wage, because they are chosen from the top few percent of students, and that difference in wages introduces an inherent asymmetry in how many hours of work are necessary to buy an hour of a doctor's time. The majority of the population, certainly as people age, have low level health issues which they manage imperfectly. You don't exercise enough because your knee is a bit gammy (perhaps requiring physiotherapy or knee surgery), your cholesterol is high, cancer is spotted six months later than necessary because you thought your dodgy stomach or sore throat was just something minor, etc, etc. And, you know, even in countries with good health provision for the poor, the middle-class still get much better care, because they talk to their doctor friends, know how the system works, research their options thoroughly, and so on. Perfectly reasonable behaviour, but the fact that it is necessary shows up the gap and the inherent limits in provision. The cheaper healthcare is, the higher the baseline and the average can rise.
    - eru 13y ago
      Oh, sure, there's an infinite amount of (generalized) health care people might want to consume if the prices are low enough. You can get there either by lowering the pay of health care people, or by making them more productive per humman-hour, eg via automation or just better business practices.
      - dagw 13y ago
        There are two prices of health care I have to pay. One is the up front cash (or monthly insurance) cost I have to pay, the other is the massive time sink and general pain and inconvenience it is to get it. I live in country where the cash cost is basically zero, yet I consume as little health care as possible due to the high second cost. In fact the times I do need health care I often opt to pay more up front to avoid as much of the second cost as possible. As long as you keep the second high enough the demand for health care won't go to infinity even as the first cost goes to zero.
scarmig 13y ago
Whether evidence is easy or hard to gather is a red herring. Patients present a body of evidence. Small or large, that evidence is what doctors and machines both use to generate diagnoses. The places where machines have the potential to excel is situating the evidence within a broader universe of evidence. The human body is amazingly complex, and it's unfair to hold it against human doctors that they don't have the capabilities to use the enormous amount of information we've collected on it so far. Machines do, though, and they're already on the brink of matching or exceeding human capabilities. It's true that medicine is more than generating diagnoses. But the years of training and huge personnel costs are caused by the advanced levels of knowledge required to perform with competence. The deprofessionalization of medicine means you can substitute expensive labor with much cheaper labor. There's also the value that comes from standardization. The best human doctors are probably going to surpass machine doctors in their chosen field of expertise for awhile yet. But very few people have access to the best human doctors, and the best human doctor in one area of specializaton is unlikely to be exceptional in areas outside his or her specialization. The proper comparison isn't against the best doctors, or even the average doctors: it's against the worst doctors who make terrible errors in judgment and doctors working outside their area of expertise, whose work will be most easily replaceable by Watson-like software.
- na85 13y ago
  >Whether evidence is easy or hard to gather is a red herring. No it's not, it's incredibly relevant. How can you take an evidence-based approach to newborn and infant care when no studies have been done? How do you run studies ethically on infants who can't give consent? Are you willing to subject a baby to an untested delivery procedure, that could potentially go very very wrong, or would you rather stick with the devil you know? >Patients present a body of evidence. Small or large, that evidence is what doctors and machines both use to generate diagnoses. The places where machines have the potential to excel is situating the evidence within a broader universe of evidence. Such was my point; that a human doctor or nurse, supplemented with computer analysis, will inevitably be a better care provider than either human or computer alone.
  - derefr 13y ago
baddox 13y ago
The fact that the discipline is incredibly nuanced is precisely why I want computers doing the heavy lifting, at least when it comes to diagnosis. I find it extremely hard to believe that even the best doctors could come close to touching the accuracy of an expert system. Now, obviously there is still the necessity of a trained and skilled doctor. A doctor should always have the last decision (before the patient, that is), but the doctor should be trained to understand how expert systems work. And of course, doctors and nurses will be needed to gather information from the patient, both through medical tests and verbal questioning. The fact is, every time I have gone to the doctor for anything other than an obvious diagnosis (e.g. I need stitches in the hand because it is cut and bleeding), I have been appalled at the experience. I experienced fairly serious chest pain at the age of 26, with no history of health problems. I quickly read online about all the things it could be, ranging in seriousness from reflux to a heart attack, and I expected a doctor to have some sort of academic methodology, or do something vaguely resembling science, but instead, they x-rayed me, said everything looks fine, and prescribed me extra strength Tylenol. I wish doctors would at least pretend that they're doing something that a walk-in x-Ray booth attached to a computer system couldn't do.
- yeukhon 13y ago
  I won't argue that machines can't do amazing things. Technology definitely has helped us to live longer and diagnose more accurately. I don't have any source to backup my arguments and claims, but for many older medical practitioners, including my family (we have been a medical practitioner for several generations), we feel that the younger doctors lack of confident and knee knowledge because they rely on machines. I have a hard time to put my family's words into English because they are Chinese (they are Western medicine practitioner btw), but the basic idea is that they learn to use their fingers and their sensory inputs to gather empirical information about the patients. I won't say they can diagnose a tumor at a precise location or detect the type of cancer precisely, but experts can diagnose to a very good estimate. Back then they didn't have x-ray in every hospital. Only the major one has x-ray in China and my grandma and my father had to use their fingers to determine the location of the tumor, or the type of tumor. When my dad first saw the x-ray machine back in the 70s when he was still in China, it was amazing to him what he could do with him, but he said practical experiences and hands-on experience matter. Ask how many new practitioners can do that with confident? I supposed few. Because most of them rely on machines. What if machine is down? What if the machine is not capable of telling the truth? It has limitation. I am arguing that machines can't help, but doctors should never rely on machine. They need to rely on their experience and knowledge and this is what distinguish an expert from an average practitioner. To be honest, getting people x-ray all the time is largely because of suing medical mistreatment and then good part of just being efficient (or lazy if you want to be harsh). Hospitals are scared of getting sued so they'd put everyone through an x-ray machine.
zone411 13y ago
You are overestimating the skills of an average doctor. I'm sure your spouse is very skilled, but there have been other success stories facts besides lung cancer when it comes to the diagnosis and treatment http://arxiv.org/ftp/arxiv/papers/1301/1301.2158.pdf http://arxiv.org/ftp/arxiv/papers/1301/1301.2158.pdf: "The results shown here demonstrate the feasibility of such an approach relative to human decision-making performance. Even in its early stages of development, such an AI framework easily outperforms the current treatment-as-usual case-rate/fee-for-service models of healthcare." I'm not sure what the difficulties in gathering additional evidence do to support your argument? The doctors have huge difficulties even with following explicit guidelines and existing studies.
discreteevent 13y ago
I agree. I think this is the same kind of narrow minded mistake that AI made by focusing on getting computers to play chess instead of realising that the hard problem was really building something that could even recognise a single chess piece in different lighting conditions. A lot of medicine is about perception. Obviously there is a huge amount of physical perception and pattern recognition but also, for example, a brilliant doctor who is not from the same culture as the patient will often miss something vital when taking a history from that patient that a local doctor will pick up straight away. These things are complex and subtle. We need to recognise just how limited technology is if we ever want to really improve it instead of getting too exited about the things it can do.

by na85 13y ago

Brakenshire 13y ago

You may well be right, but nevertheless, where medical care can be automated, it should be. Because otherwise medical care never gets more affordable. The economy doubles in size, wages double in the general economy, and ... doctors wages double. As long as we consider medicine an elite profession (so that we don't train an overabundance of doctors and drive the wages down, which most of us wouldn't want to do) employing medical staff will always cost some approximately fixed multiple of the median hourly wage. And medical care is and has always been too expensive to provide proper care for the entire population. If, for instance, we can automate doctors taking blood pressure readings, by giving patients their own sensor, or automate the drawn out process of step-by-step diagnosis by driving down blood cost prices so that 50%, 5% and 1% diagnoses can be explored simultaneously, or have automated machines which allow frail, elderly patients to bathe without needing a nurse, then we can really start to improve care, and decrease cost (which, in any case, will simply be reallocated to dealing with other ailments). Doctors lose nothing, but, step-by-step, the general population gains immeasurably.

eru 13y ago
> And medical care is and has always been too expensive to provide proper care for the entire population. Which countries are you talking about here? (I agree with your general sentiment, though.)
- Brakenshire 13y ago
  I know there are issues which are specific to the States, but I would say this applies almost everywhere. Almost everywhere doctors are paid 5-10 times the median wage, because they are chosen from the top few percent of students, and that difference in wages introduces an inherent asymmetry in how many hours of work are necessary to buy an hour of a doctor's time. The majority of the population, certainly as people age, have low level health issues which they manage imperfectly. You don't exercise enough because your knee is a bit gammy (perhaps requiring physiotherapy or knee surgery), your cholesterol is high, cancer is spotted six months later than necessary because you thought your dodgy stomach or sore throat was just something minor, etc, etc. And, you know, even in countries with good health provision for the poor, the middle-class still get much better care, because they talk to their doctor friends, know how the system works, research their options thoroughly, and so on. Perfectly reasonable behaviour, but the fact that it is necessary shows up the gap and the inherent limits in provision. The cheaper healthcare is, the higher the baseline and the average can rise.
  - eru 13y ago
    Oh, sure, there's an infinite amount of (generalized) health care people might want to consume if the prices are low enough. You can get there either by lowering the pay of health care people, or by making them more productive per humman-hour, eg via automation or just better business practices.
    - dagw 13y ago
      There are two prices of health care I have to pay. One is the up front cash (or monthly insurance) cost I have to pay, the other is the massive time sink and general pain and inconvenience it is to get it. I live in country where the cash cost is basically zero, yet I consume as little health care as possible due to the high second cost. In fact the times I do need health care I often opt to pay more up front to avoid as much of the second cost as possible. As long as you keep the second high enough the demand for health care won't go to infinity even as the first cost goes to zero.

scarmig 13y ago

Whether evidence is easy or hard to gather is a red herring. Patients present a body of evidence. Small or large, that evidence is what doctors and machines both use to generate diagnoses. The places where machines have the potential to excel is situating the evidence within a broader universe of evidence. The human body is amazingly complex, and it's unfair to hold it against human doctors that they don't have the capabilities to use the enormous amount of information we've collected on it so far. Machines do, though, and they're already on the brink of matching or exceeding human capabilities. It's true that medicine is more than generating diagnoses. But the years of training and huge personnel costs are caused by the advanced levels of knowledge required to perform with competence. The deprofessionalization of medicine means you can substitute expensive labor with much cheaper labor. There's also the value that comes from standardization. The best human doctors are probably going to surpass machine doctors in their chosen field of expertise for awhile yet. But very few people have access to the best human doctors, and the best human doctor in one area of specializaton is unlikely to be exceptional in areas outside his or her specialization. The proper comparison isn't against the best doctors, or even the average doctors: it's against the worst doctors who make terrible errors in judgment and doctors working outside their area of expertise, whose work will be most easily replaceable by Watson-like software.

na85 13y ago
>Whether evidence is easy or hard to gather is a red herring. No it's not, it's incredibly relevant. How can you take an evidence-based approach to newborn and infant care when no studies have been done? How do you run studies ethically on infants who can't give consent? Are you willing to subject a baby to an untested delivery procedure, that could potentially go very very wrong, or would you rather stick with the devil you know? >Patients present a body of evidence. Small or large, that evidence is what doctors and machines both use to generate diagnoses. The places where machines have the potential to excel is situating the evidence within a broader universe of evidence. Such was my point; that a human doctor or nurse, supplemented with computer analysis, will inevitably be a better care provider than either human or computer alone.
- derefr 13y ago

baddox 13y ago

The fact that the discipline is incredibly nuanced is precisely why I want computers doing the heavy lifting, at least when it comes to diagnosis. I find it extremely hard to believe that even the best doctors could come close to touching the accuracy of an expert system. Now, obviously there is still the necessity of a trained and skilled doctor. A doctor should always have the last decision (before the patient, that is), but the doctor should be trained to understand how expert systems work. And of course, doctors and nurses will be needed to gather information from the patient, both through medical tests and verbal questioning. The fact is, every time I have gone to the doctor for anything other than an obvious diagnosis (e.g. I need stitches in the hand because it is cut and bleeding), I have been appalled at the experience. I experienced fairly serious chest pain at the age of 26, with no history of health problems. I quickly read online about all the things it could be, ranging in seriousness from reflux to a heart attack, and I expected a doctor to have some sort of academic methodology, or do something vaguely resembling science, but instead, they x-rayed me, said everything looks fine, and prescribed me extra strength Tylenol. I wish doctors would at least pretend that they're doing something that a walk-in x-Ray booth attached to a computer system couldn't do.

yeukhon 13y ago
I won't argue that machines can't do amazing things. Technology definitely has helped us to live longer and diagnose more accurately. I don't have any source to backup my arguments and claims, but for many older medical practitioners, including my family (we have been a medical practitioner for several generations), we feel that the younger doctors lack of confident and knee knowledge because they rely on machines. I have a hard time to put my family's words into English because they are Chinese (they are Western medicine practitioner btw), but the basic idea is that they learn to use their fingers and their sensory inputs to gather empirical information about the patients. I won't say they can diagnose a tumor at a precise location or detect the type of cancer precisely, but experts can diagnose to a very good estimate. Back then they didn't have x-ray in every hospital. Only the major one has x-ray in China and my grandma and my father had to use their fingers to determine the location of the tumor, or the type of tumor. When my dad first saw the x-ray machine back in the 70s when he was still in China, it was amazing to him what he could do with him, but he said practical experiences and hands-on experience matter. Ask how many new practitioners can do that with confident? I supposed few. Because most of them rely on machines. What if machine is down? What if the machine is not capable of telling the truth? It has limitation. I am arguing that machines can't help, but doctors should never rely on machine. They need to rely on their experience and knowledge and this is what distinguish an expert from an average practitioner. To be honest, getting people x-ray all the time is largely because of suing medical mistreatment and then good part of just being efficient (or lazy if you want to be harsh). Hospitals are scared of getting sued so they'd put everyone through an x-ray machine.

zone411 13y ago

You are overestimating the skills of an average doctor. I'm sure your spouse is very skilled, but there have been other success stories facts besides lung cancer when it comes to the diagnosis and treatment http://arxiv.org/ftp/arxiv/papers/1301/1301.2158.pdf http://arxiv.org/ftp/arxiv/papers/1301/1301.2158.pdf: "The results shown here demonstrate the feasibility of such an approach relative to human decision-making performance. Even in its early stages of development, such an AI framework easily outperforms the current treatment-as-usual case-rate/fee-for-service models of healthcare." I'm not sure what the difficulties in gathering additional evidence do to support your argument? The doctors have huge difficulties even with following explicit guidelines and existing studies.

discreteevent 13y ago

I agree. I think this is the same kind of narrow minded mistake that AI made by focusing on getting computers to play chess instead of realising that the hard problem was really building something that could even recognise a single chess piece in different lighting conditions. A lot of medicine is about perception. Obviously there is a huge amount of physical perception and pattern recognition but also, for example, a brilliant doctor who is not from the same culture as the patient will often miss something vital when taking a history from that patient that a local doctor will pick up straight away. These things are complex and subtle. We need to recognise just how limited technology is if we ever want to really improve it instead of getting too exited about the things it can do.