Category Archives: Humanities

Artificial Intelligence and Healthcare

I’m taking a philosophy class that touches a lot upon what cognition really means. Which led me to thinking – if we’re becoming closer and closer to developing artificial intelligence that rivals human intelligence, could we develop artificial intelligence to solve problems within healthcare?

Solutions are already in the works. A 2013 study from Indiana University showed that artificial intelligence machines were able to diagnose and reduce the cost of healthcare better than physicians by 50%! Using 500 randomly selected patients from that group for simulations, the two compared actual doctor performance and patient outcomes against sequential decision-making models, all using real patient data. They found great disparity in the cost per unit of outcome change when the artificial intelligence model’s cost of $189 was compared to the treatment-as-usual cost of $497.

However, one problem with replacing physicians with artificial intelligence may be the possibility of removing the doctor-patient relationship from the equation and undermines the importance of human relationship in the treatment process.

We are reaching a time in our society that we are slowly developing the tools needed to create intelligent beings that could solve problems. But a key distinction so far is that our goals in artificial intelligence have always been to create something as good or better than an average human.

But what if we switched that around? What if our goal was actually to create an artificial intelligence that had a problem itself? For example, could we develop an artificial intelligence that thinks like a patient in order to understand patient behavior?

There are plenty of virtual reality programs that exist for doctors to test their skills on surgery on specific parts of the human body, and now we know artificial intelligence could even replace doctors in diagnosis, but could there be one day be an artificial intelligence modeled after a sick person – an intelligent agent that may not be biologically (mainly because if it’s a robot it may not be made of biological parts) sick but we install a state of mind into it that would make it behave as it was sick? I’m talking about creating a robot patient who we would somehow program into thinking it has cancer, and doctors could be able to talk to the robot and it would respond and behave the same way as a cancer patient. It would be a great tool for doctors to understand patient behavior and how to meet their needs relationally, and I can see the uses it may have in studying psychology and philosophy as well.

As a Cognitive Science major, I can’t help but wonder since scientists, philosophers, and engineers have not been able to agree on an exact theory and replica of an artificial intelligence that represents a normal, healthy human, then how much harder would it be to create an accurate artificial intelligence that is a replica of someone who is sick.  After all, to model something that we might called defective, do you need to have a complete understanding of the original, non-defective object first?

Another complication would be distinguishing whether we could create a patient based on what is called “weak artificial intelligence” vs. “strong artificial intelligence”. Weak artificial intelligence is being able to create a machine that behaves intelligently, but strong artificial intelligence is creating a machine that can actually think. The current goal of researchers is to create strong artificial intelligence, which is why you have supercomputers like Watson who apparently can solve problems and answer questions by finding the information on its own. So if we even were able to create a machine that can behave like a patient, would it be because it has weak or strong artificial intelligence?

I believe there are many factors to consider both in philosophy and in technology before this possibility could ever be achieved. But for now, perhaps the best way to understand patient behavior is to communicate with the patient.


Guided Medicine or Big Brother: A Thought Experiment

Self-tracking devices have been lauded as the potential solution to filling in the gaps in traditional clinical data collection.  Oftentimes, measurements in the doctor’s office are not truly indicative of the patient’s everyday behavior and lifestyle; patients may experience white coat syndrome, or increased anxiety in the presence of the doctor.  Automatic self-tracking in everyday living may provide more accurate data because the data is collected in more natural settings.

One of the goals of self-tracking is to model and predict human behavior.  This sounds quite promising; however, how does this automated self-tracking actually come about?  Would we want our personal handheld devices to predict our next moves?  And what a fascinating thought experiment it would be to have our phones, these inanimate devices, give us life suggestions.  But oh wait, they do.

Google Now carefully watches its users’ every interaction to improve its efficacy.  It can predict where you will go judging by your past behavior.  It can detect that on Wednesdays, you like to get a Grande green tea frappe at Starbucks before your Russian literature class, and sometimes, when you’re having a particularly packed week, you treat yourself and venture into the bold Venti end of the spectrum.  While Google Now has the potential to notify you if there is a promotion on green tea frappes, it may suggest another drink perhaps, and as a subtle suggestion, a drink with fewer calories and a lower fat content.

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Popular Science awarded Google Now as the 2012 “Innovation of the Year” for its potential to serve as an “intelligent personal assistant.”  It can infer your age bracket from your recent searches and tailor advertisements to your curated predilections.  For your mother, it can suggest her favorite hair dyes or jewelry boutiques, but what if one day following her sixtieth birthday, it begins suggesting cholesterol medicine and life insurance?  While this teeters on the edge of being mildly insensitive, it may regrettably be a sensible recommendation.

But it doesn’t stop there.  Google Now has a minute-by-minute map of your life.  Not only can it suggest nearby attractions and events, but it can also summarize your daily physical activity.  Given your latest late-night food adventures, it could now suggest restaurants with healthier vegetarian options.  It could also suggest a route that requires more physical exertion (to make up for that discreet donut run that you thought went undetected), and in your hurry, you wouldn’t notice that it was slightly more strenuous, with a steeper incline of about two degrees.

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Physicians have the potential to produce mobile health applications that use the same tracking devices as Google Now.  While they have the promise of displaying customized content and advertisements, they can also subtly suggest healthier eats and longer walking routes.  With smartphones constantly linking accounts and contacts, mobile health applications will soon be connected to the information collected by Google Now.  And suddenly, without your conscious awareness, you will be forced to be utterly and irrevocably healthy.

Instant Access to Yourself

With our constant obsession with technological advancements and the fashionable desire to be the first owner of the newest products, we must remember what we already have.  And this isn’t just a banal platitude about being grateful for what we have.  Even though the answers to the world’s problems seem to lie in the continued miniaturization of sensors and further embedded systems, have we forgotten what is already available to us?  Perhaps we should shift the focus from finding the most sophisticated devices to becoming more proficient with what already exists.

In the summer of 2013, I took a psychiatry course at the Geffen School of Medicine at UCLA.  The course had the rather grandiose title: “Personal Brain Management,” yet that was exactly what the physician taught.  It turns out that by having a greater control of what we think and how we think can protect us from a wealth of illnesses.  The only technological advancement I needed to supplement my project was a thermometer, yet that was enough.

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My independent project focused on utilizing biofeedback for Mindfulness-Based Stress Reduction (MBSR).  MBSR advocates that practicing mindfulness meditation can help reduce stress and promote greater mental and physical health.  By using a simple stress thermometer, I was able to increase my awareness of my body temperature.  While such a physiological marker may seem to be beyond our control, managing our internal thermostat is surprisingly possible. Roughly speaking, more relaxed states are correlated with increased body temperature, and the thermometer served as a means to quantify these changes.

With just a crude thermometer in hand, I was able to cultivate my relaxation response (in contrast to the familiar stress response).  At the end of a six-week trial, I found that I was better able to control my body temperature, and I scored significantly lower on a battery of stress measures.  For my project, I did not need a smartphone or the newest Nike product or the most sensitive sensors.  I needed myself and 30 minutes of my day.  And am I really so important that I cannot sacrifice the entirety of 30 minutes to myself?

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In our constant and desperate search for what is new, let’s not forget that we have instant access to ourselves.  While innovative electronic devices can help us organize data and take measurements, let’s not get carried away with their seemingly whimsical promises.  It is as much our duty to discover and invent as it is to make more effective use of what already exists.  By remembering that the first generation of iPhones was released in 2007, we become aware of the humbling reality that perhaps society can function without a supercomputer in hand.

While simple and sophisticated mobile health applications can encourage patients to become more empowered, decreased reliance on digital technology is in its own right just as empowering.  My project at UCLA showed me that I could become more self-sufficient and cultivate my body’s natural capacity to heal with a minimalist approach to technology use.

A Technocultural Medical Revolution

ePatients are often lauded for their effective use of technology.  They use technology as a means to take measurements, research information, and create communities.  While their use of technology is often the focus of attention, their culture is often neglected.  Ferguson and Frydman (2004) address both of these points in their seminal article about ePatients and argue, “We are witnessing the most important technocultural medical revolution of the past century.”

The culture of the ePatient movement definitely needs attention.  By changing the dynamics of the physician-patient relationship, ePatients are effectively changing the culture of how laypersons interact with physicians.  Carman (2013) proposes that there is a continuum of engagement for patients in direct care.  Currently, most patients fall under the category of consultation; that is, they receive information about a diagnosis.  ePatients argue that they should have greater engagement.

Patients may get more involved by sharing their preferences in a treatment plan, thereby taking into account their individual culture, background, and spirituality.  On the most engaged end of the spectrum, patients have partnership and shared leadership with the physician.  Carman (2013) imagines that with this level of engagement, “treatment decisions are made based on patients’ preferences, medical evidence, and clinical judgment.”

Clearly, this is a step away from current physician-patient interactions.  With higher levels of engagement, patients are expected to be health literate.  They are considered equals with the physicians and can elect their own treatment plans.

But is this change in culture possible?  People around the globe unanimously regard physicians to be the most respected professions, and there are multiple reasons for this.  Medical professionals have a direct impact on the lives of everyday people.  They are present when people feel the most vulnerable, and they serve as their confidants.  Physicians tend to have higher levels of education and higher income, and they have great responsibilities and expectations.

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In cultures that have a predominant social hierarchy, the idea of being an ePatient seems almost frightening.  For many East Asian countries, some patients would not dare correct their physicians.  It would be disrespectful, impolite, and indicative of lesser social status.  It would disregard power dynamics, and the patients would be overstepping long entrenched boundaries.  It is, therefore, unsurprising that the ePatient movement has its roots in the Western world.

Additionally, in the ePatient-physician relationship, it is critical to distinguish the difference between health literacy and medical education.  While patients may understand the biological processes behind their illness, physicians have had at least seven more years of education in medicine whether in medical school or in residency.

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In this technocultural medical revolution, there must be balance.  Mutual respect is key.  There must be an acknowledgement that the physician has greater expertise, but physicians cannot regard themselves as superior.  It is true that the physician cannot fully understand what the patient is experiencing, but the physician can at least practice empathy.

In any case, we must be aware of these cultural phenomena if the ePatient movement is to be globally ubiquitous.

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The Art of Medicine

Is medicine a science or an art?

Physicians and artists alike have tried to answer this question for over two thousand years. The former tend to claim that medicine is predominantly a science, and that it is an art only because it involves skills acquired by experience or observation. The latter commonly say that medicine is predominantly an art, for it evolves on the basis of human values and seeks to heal above all else.

So which is it?

It’s not a science. It’s not an art. It’s both.

Effective medicine employs science to accurately diagnose and treat, but it also utilizes art to arrange our awareness of health and healing into a storied structure. This “narrative medicine,” as it’s often called, takes a medical story and unfolds it in a way that gives meaning and purpose to both illness and the experience of recovery.

Narrative medicine, however, is not the only art form to have influenced medical storytelling. Throughout history, each introduction of digitalized technology into medicine—take the X-ray, the CT scan, and the ultrasound, for example—has utilized illustrative visualization to enhance medical accuracy.

Analogous to illustrative visualization, recent development in graphics hardware has enabled the rendering of innovative medical imaging methods that are completely changing the way that we see and study the human body. These new techniques enable both photo-realism and a technical form of hyperrealism in art in which it’s possible to enhance medical visualizations to better convey information.

But medical illustration and anatomical imaging are beginning to break out of the confines of the hospital. They are beginning to crawl into the dirty gutters and cracked sidewalks of the real world in the form of something known as street anatomy.

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Street anatomists are experimenting with new mediums, such as papier mâché, graffiti, and sculpture, to portray the human body in creative new ways. Thanks to this new form of biomedical visualization, human anatomy is no longer contained within the human body. Science no longer lives in a hospital. Take a look around and you’re bound to notice your skeletal system plastered to a telephone pole or your back muscles adhered to the side of a Metro bus. You may even discover that your heart has been spray-painted on the side of your apartment complex.

I went ahead and gave street anatomy a whirl, too. Here’s what I ended up painting:

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While painting these on the concrete floor of my dorm room, I was silenced by the realization of how truly incredible the human body is.

It is a wonder of science.  It is a work of art.


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