The FDA’s announcement last week that it approved artificial intelligence software that can identify diabetic retinopathy, a common eye disease, without the need for an eye specialist likely shook some doctors already concerned about this new technology. I don’t think they have anything to worry about.
Artificial intelligence, sometimes called AI, is not a dramatic and revolutionary development in the history of medicine. It’s but the latest in a long line of breakthroughs that have made it possible for caregivers to better diagnose and treat illness. We should be wary of the hype surrounding this advance, which is leading to broad misconceptions that AI will replace doctors. What it will actually do is put a premium on physicians’ knowledge and decision-making skills.
The history of medicine during the last two centuries should be seen as the development of ever more precise tools that help doctors narrow the range of possible causes for their patients’ symptoms. One of the great breakthroughs occurred in 1816 when René Laennec used a tightly rolled a sheet of paper to listen to a woman’s heart. This stethoscope helped launch a new era in medicine that placed less emphasis on patients’ descriptions of their symptoms and more on the search for clues within their bodies.
Since then, the development of a dazzling array of increasingly precise diagnostic tools — from blood tests and X-rays to EKGs, CT scans, and gene sequencing — has given doctors a much more accurate sense of the biological and chemical roots of disease.
The development of medical charts in the early 20th century gathered a patient’s information into a single file. These charts allowed doctors to better track the effectiveness of their treatments. They also helped transform medicine from an art based on personal knowledge and intuition into a science based on objective evidence. The development of electronic health records during the last few decades has vastly increased our ability to gather and analyze patient data.
In fact, during the last few decades technology has flipped the information problem upside down. Instead of having too little information, caregivers today have far more than they can process on their own.
This is the great promise of artificial intelligence: to train machines to comb through petabytes of data on their own to find patterns that would elude human caregivers. It is already paying dividends. Stanford researchers used a deep-learning algorithm to identify cancerous spots in medical images. An Israeli-based medical analytics company recently announced it had developed an algorithm capable of detecting intracranial hemorrhages, which are often missed and contribute to nearly 1 million deaths worldwide each year. And researchers at my school, the University of Michigan, have produced an algorithm that analyzes more than 4,000 distinct variables to predict who might be susceptible to contracting a dangerous intestinal infection called Clostridium difficile, or C. diff.
These and other promising breakthroughs have led some to suggest that machines may supplant doctors, just as autonomous vehicles might someday replace drivers. Such thinking puts the cart before the horse. Like the medical technologies that have come before it, artificial intelligence is another tool that will make the knowledge, skill, and judgment of physicians even more central to quality care.
The human body is such a complex and dynamic entity — each one unique in its own way — that medicine will never become a mathematical problem in which data can be crunched to produce the single right answer. It will always involve a process of elimination that allows the caregiver to focus on the most likely cause of illness and determine the most effective treatments from a range of options.
Artificial intelligence will undoubtedly inform and improve this decision making process — guided by physicians. The great challenge going forward is in recognizing and nurturing this irreplaceable human element, to train doctors to work with machines without becoming too reliant on them, and to never forget the centrality of the doctor-patient relationship and the importance of the human touch. Just as the stethoscope was only as useful as Laennec’s ability to assess what he was hearing in his patient’s chest, the success of artificial intelligence will depend largely on the ability of physicians to interpret and apply its findings.
Dr. Abraham Verghese, a graceful writer and professor at the Stanford University School of Medicine, put it best when he observed, “The way here is not to think technology versus human, but to ask how they come together where the sum can be greater than the parts for an equitable, inclusive, human and humane care and practice in medicine.”
Marschall S. Runge, M.D., is the executive vice president for medical affairs at the University of Michigan and dean of the University of Michigan Medical School. He receives funds from Eli Lilly for his work as a member of its board of directors.