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AI in medicine: More science and less art: Arrows



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Will computers alienate us from the healing touch?

When Kim Hilliard shows in the diabetes clinic in New Orleans University Medical Center, it is not just for the eye exam. Human risks, which it receives on the way to help her move her complicated medical condition.

Attached to diabetes, 56-year-old have high blood pressure. She also had back surgery and underwent bariatric surgery to help her control her weight.

Hilliard is also at risk of blindness that can occur as a result of a condition called diabetic retinopathy. Therefore, on this day in February, her vision will be assessed by a new practitioner: a piece of software.

Automation as it starts to penetrate medical help. Depending on how it is deployed, it can help reduce medical errors, and potentially reduce the cost of treatment. It can also create a gulf between the health educators and people of more modest means.

"My fear we will end up with what I call in" medical apartheid ", says Sonoo Thadaney-Israni, School of Medicine, Stanford University," If we create algorithmic care and. "Stall" is in some sense – focusing on efficiency and throughput ability -. the people who will eventually be able to access and use will be those who do not have enough privileges of various kinds "

We are far from this dark world at the moment, but we are moving in this direction? This opportunity with the & # 39 is something that concerns her.

Hilliard experience in the clinic emphasizes the importance of human contact. She's here for the annual eye exam to look for signs of blindness that can occur in people with diabetes.

"I got a full diabetes, when I did 40," she says. It is a challenge for her to stay on top of all your medical conditions. "I go to so many doctor appointments tired!" She says.

Software to detect early signs of diabetic retinopathy, called IDxDR, can do the job without the intervention of an expert, but the qualified medical staff in the clinic, for the moment, at least, still plays a practical role.

After finishing the examination Hilliard, nurse Chevelle Parker shows its image her eyes.

"If we zoom in here, we can see some little fat here, okay?" Parker says. Hilliard leans over and examines the image of the retina. "It could be from the foods that you eat," says Parker. "Think about some of the fatty foods that you eat – sausage, bacon."

Hilliard said she stopped eating those products last fall, after her gastric bypass surgery.

"Well, if you eat that deposits were placed in the eye," Parker explains. "That's why we're talking to you about your diet. And now, when you know that you can not have that this is the reason why, okay? "

Parker continues to increase dietary recommendations for diabetes. Hilliard needs to & # 39; eat breakfast within an hour or so to wake up, and it should be necessary to have a certain amount of protein, carbohydrates and not at the end of the day.

Hilliard gratefully accept tips, as well as referral to an ophthalmologist, who will need to get a closer look at the damage to her eyes.

"I'm doing what I can do to not be blind," said Hilliard, "So they tell me to do what I do. At least I'm trying. "

Experience with Hilliard & # 39 is a stark reminder that health with & # 39 is more than a simple transaction. Six in 10 adults in the United States have a chronic disease, and 4 out of 10 have two or more, according to the Centers for Disease Control and Prevention.

This is the real world in which computer algorithms are starting to take off in medicine.

"I think that for too long we have had the opinion that any new technology is good, more is better," says Heather Abraham, a doctor who works in partnership with Stanford Thadaney in the center, which focuses on the human aspects of care.

"New is not always better," he said, as the three of us sit together in the office.

Medical care, as well as a large part of our society, creates a wealthy and poor, says Thadaney. "We need to ensure that technology does not further exacerbate the problem of equality and inclusion."

"Just to carry this idea forward," says Verghese, "artificial intelligence algorithms, we already know from the & # 39 are the cause of inequality in connection bail real estate inequality", as well as the police. Unconscious racism and other distortions are baked without developers even realizing it. "The same kind of algorithmic approach can easily infect a medicine, and perhaps does," says Verghese.

These technologies are controlled by companies interested in turning a profit, and it does not necessarily lead to better health care. In fact, these technologies promise savings may result from reducing the time an individual spends a face-to-face with a doctor or nurse.

"One thing I think that does not change from ancient times to the & # 39 is that if you suras & # 39; ozna sick you feel bad," says Verghese. "Among all the other things you need, you will also want to have someone take care of you – not just your family member & # 39; and, but someone with scientific knowledge, to also express my concern."

Thadaney says a family member & # 39; and its recently brought this point home. He was injured in a bicycle accident. The treatment involved a difficult trek through two hospitals and a rehabilitation center. Thadaney could speak for him. "I was able to call friends who are doctors," she says. "I was able to, you know, call the leadership of these organizations and ask for something else."

One of the interventions provided, the edge of her family members & # 39; and, but she says that actually helped him was a visit with Verghese. The doctor "did not say anything to him other than he already knew," she says, but it provided comfort and confidence "and I think it hastened his return to life."

Verghese says that he recently read the account of Walt Whitman of his time caring for the wounded in the Civil War medical tent on the Mall in Washington, DC

"He did what these young people are most needed," says Verghese. "They were so far from home. They need someone to read them to keep their hands and write letters for them and take care of each of its task. And it was the most basic type of care. Nothing has changed. You know, we 're still the same human beings. "

Verghese hopes that technologies such as artificial intelligence, can improve medical care, but only if this is not done at the expense of human contact. AI has the potential to make a doctor spends more time with their patients, depending on how it ends unfolds. In principle, the Ministry of Defense may also help the most complex tasks.

"We do not need another pattern recognition [system], "He says." They're all good big and very neat. "

But where this technology can do the best to help sort out the evidence gathered in the course of treatment. "Medicine is dirty," he says. "Help us."

Some improvements nuts-and-bolts of what AI can bring occur, says Thadaney. "Yes, the patient wants you to make sure that you have the efficiency of your system, so they do not get 19 accounts with the same stupid thing."

But patients also want to get better. To achieve this, the doctors and nurses can not just be a complement to the machines. Her mantra young doctors, she recommends it: "In the end, present It is of great importance.".

In March, Stanford opened a new institute to focus on the human aspects of artificial intelligence. "We want to make sure that there is for the creation and dissemination of best practices," says Dr. Russ Altman, professor of bioengineering and genetics at Stanford University and deputy director of the new institute. "It is unfair and unrealistic to expect that the technology to be experts at it."

He shared the concern Verghese and Thadaney, that machines can degrade human relationships based medicine.

"Medicine is a combination of art and science", which will be updated MO, Altman said. "But the act of laying hands on the sick, showing that you really care about is that there is, that's their problem [and] assuring them that you are going with them through an odyssey – it may take some time, "he says." It's very hard to imagine a replacement computer. "

You can contact NPR Science Correspondent Richard Harris rharris@npr.org.

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