Can a Computer Replace Your Doctor?
Can a Computer Replace Your Doctor?
By ELISABETH ROSENTHAL SEPT. 20, 2014
AS a former physician, I shivered a bit when I heard Dr.
Vivek Wadhwa say he would rather have an artificial-intelligence doctor than a
human one. “I would trust an A.I. over a doctor any day,” he proclaimed at a
recent health innovation conference in San Francisco, noting that artificial
intelligence provided “perfect knowledge.” When asked to vote, probably a third
of those in attendance agreed.
But it made sense: Dr. Wadhwa is a professor,
entrepreneur and technology visionary. What’s more, the conference took place
in San Francisco, where faith in the power of technology and data to solve
problems holds unshakable sway.
There was certainly plenty of innovation on display at
the conference’s rooftop reception, called “Health by the Numbers”: One device
attaches to your iPhone and turns it into an otoscope so you can see if your
child has an ear infection; another allows it to check your blood alcohol
level. Attendees could check out home cholesterol test kits, and a wearable
device to track the “quality” of their breathing.
Silicon Valley is bringing a host of new data-driven
technologies to health care, many of them with enormous potential. But before
we rush to measure every human attribute in real time, it would be a good idea
to ask: When is more data actually useful to promote and ensure better health?
And when does technology add true value to health care? The results have been
mixed.
“It holds great promise and excitement, but so far
everyone is often disappointed with the outcomes,” said Steven J. Van Kuiken, a
director at McKinsey and Company who studies technology and health care. “There
are lots of interesting ideas, but how do you get data that’s useful to
patients, physicians or regulators? And then how do you get them to act on it?”
While the proliferation of fitness trackers suggests
there is commercial potential in consumer health data technology, utility may
be limited. “I don’t doubt the wearable piece is going to be a productive
business model for people,” Ian T. Clark, chief executive of Genentech, said at
the conference. “I just don’t know whether it’s going to bend the curve in
health outcomes.”
Last month Aetna announced it was discontinuing CarePass,
its personalized health data platform for patients, because it hadn’t delivered
on anticipated results. And some studies show that half the people who buy
portable fitness trackers stop using them in a matter of months. That is
probably because most people who wear them are already health-conscious and
there may be little long-term value once they take note of their activity
patterns, Mr. Van Kuiken suggested.
So how can we create innovative new technologies that
will revolutionize health rather than end up as discarded Christmas presents?
One big challenge is that the elusive state we call
“health” is not always easily measurable. Normal blood pressure jumps up and
down in response to thoughts, hydration and stress. Some healthy people have
low platelets or slight elevations of liver enzymes.
In some cases, the ability to collect data has outpaced
medical understanding. There is no “normal” testosterone level for an aging
male, yet millions of men have been told they suffer from a condition called
Low T and are using testosterone gels, even though medical studies have shown
the products are dangerous.
In other cases, the data can show up fine, even when the
patient is not. You don’t always measure the right thing. When I was in medical
school, there was a gallows joke that some patients die with “Harvard numbers.”
In other words, the lab tests that were ordered were all perfect, but the
patient died anyway.
On the other hand, the test results can look bad even
when the patient is fine. Scans of the spine, for example, show that many
people have big bulging discs but no back pain. So which do you treat, the M.R.I.
or the patient?
One central rule of doctoring is that you only gather
data that will affect your treatment. There are now devices that track the
activity of your sympathetic nervous system as a measure of stress. But what do
you do with that information? Other devices continuously monitor breathing for
wheezing that isn’t noticed or audible. Does that matter? Some studies have
shown that continuous monitoring isn’t useful for children hospitalized with
bronchial infections.
If you were dieting, would stepping on the scale 1,000
times a day help you lose weight? Or consider the treatment of an abnormal
heart rhythm. It’s true that constant monitoring for a few days can be highly
useful to identify the pattern and what provokes the attacks. After that,
though, for many patients a wearable cardiac tracker might simply record normal
beats that normal people experience all the time, increasing anxiety for many
patients.
Everyone agrees, of course, that useful technology can be
lifesaving.
At the Mayo Clinic’s Transform symposium this month in
Rochester, Minn., I heard Eric Dishman, a general manager at Intel, explain how
he had used data to individualize his own cancer care. More than a decade ago,
when he was only partly responding to chemotherapy for a rare kidney cancer, he
used a step monitor to help figure out what provoked his pain and then worked
with a physical therapist to treat it. More recently, scientists were able to
analyze the genetic sequence of his tumor, identifying a medicine for treatment.
He is now cancer free.
Likewise, continuous glucose monitors alert sleeping
diabetics when their blood sugar drops too low. And some companies are
developing chips and other technologies that can perform tests on a drop of
blood — perfect for use in remote areas where sterile needles and full
laboratories are not available.
There are also apps that provide data for researchers,
including one that tracks the movement of asthma patients to see what provokes
attacks. That could also help doctors better understand patterns of disease and
allow them to adjust doses of medicine, Mr. Van Kuiken said.
So hurrah for technology. But it’s just a tool. Let’s
hope we have the wisdom to ignore it, as we would a GPS device, when it leads
us in the wrong direction — or nowhere at all.
Elisabeth Rosenthal is a reporter for The New York Times
who is writing a series about the cost of health care, “Paying Till It Hurts.”
A version of this news analysis appears in print on
September 21, 2014, on page SR4 of the New York edition with the headline: Can
a Computer Replace Your Doctor?.
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