
And then the machines came for the doctors - mooreds
http://digbysblog.blogspot.com/2013/10/and-then-machines-came-for-doctors-and.html
======
mwsherman
As with other technical advances, it’s unlikely to cause direct job loss, and
more likely to make the existing workforce more productive and the product
better and cheaper.

It might, at the margins, make ‘miracle-worker’ doctors less so. Those doctors
will be less able to demand exorbitant fees.

It will also make more-accurate cancer diagnosis available to more doctors,
and therefore to more patients. But no one (in the medium term) will _not_ use
an oncologist because Watson exists.

These are all good things. In finance, the computers are doing most of the
work but employment hasn’t waned (at least not because of the computers).

The underlying reason is that demand for improved results, in both fields, has
no foreseeable upper bound. Demand grows to consume the new capacity. There is
no upper limit on ‘better cancer diagnosis’, as there is no upper limit on
‘better financial returns’.

Put another way, Watson-assisted diagnosis should be thought of as a ‘new’
product, stoking new demand, in the same way better Macs drive demand every
year.

Someday you’ll buy a cheap health robot at Walmart, but this development is
not that.

(ps Tyler Cowen’s new book has some interesting stuff on this topic.)

~~~
malandrew
My mom is suffering from end-stage cancer and my experience with modern cancer
medicine is that it is farce compared to the things we do in our profession in
the name of getting someone to click on a banner ad. Given the rate at which
this is progressing, I'd be more than happy to let Watson handle my care
within 3-4 years time. The point at which something like Watson can wholly
replace doctors is much closer than you think if these claims are truly valid
and not being excessively pumped up for PR purposes.

Don't get me wrong, her doctor is a wonderful person that is very
knowledgeable, but the way cancer medicine is done today is a lot of guess
work and experimentation, with long lead times between measurements (blood
tests and whatnot) that are hardly statistically valid and uber prone to
tampering (used loosely in the quality control sense).

The existing workforce that will become far more productive are not the
doctors. It's the nurses and physician's assistants. They provide value that
is much harder to automate, although the Japanese certainly are trying to make
progress in this area with humanoid robots to care for patients.

~~~
crusso
_the way cancer medicine is done today is a lot of guess work and
experimentation_

On top of the things you point out, cancer is all about the genes - the genes
in the host as well as the myriad of mutations in the cancer.

Cancer treatment of the future will involve sequencing of the patient's genome
and repeated sequencing of samples of the cancer itself. The computer will be
needed to dynamically account for mutations and prescribe treatment for each
one as it arises. Networks of medical computer systems will be able to consult
at internet speeds on specific mutations to get suggestions for treatment that
are built upon results of other computer prescriptions whose efficacy is much
better recorded, processed, and correlated.

As you say, it will be the second tier of the medical industry that most
benefits from this revolution. Any nurse who can follow the instructions given
by the computer for gathering information, administering tests, feeding
results back to the computer, and providing treatment could become a world
class oncologist.

Probably doctors will still play a role in some level of oversight of what the
computers are prescribing -- but that will fade as our trust level increases
over time. Within ten years, computers will be assisting doctors on every
diagnosis. Within twenty, they'll be assisting nurses, mostly replacing the
need for doctor time. Within thirty years, you'll be able to perform your own
interactions with a medical computer as easily as you Google today -- probably
easier since it will interact with you using natural language.

------
cowsandmilk
I'm all for machines replacing doctors, but I think it is important to
remember that medical centers that make big bets on expensive machines
frequently spin the truth to justify their purchases.

5 years ago, I was constantly being told about robot surgery and how it would
make surgery safer by reducing mistakes. Hospitals that made these purchases
made grand claims in an effort to attract patients. Unfortunately, the da
vinci robot has continuously injured patients[1][2] while the marketing has
made it so the machines continue to be installed in more hospitals as patients
demand the robot surgeons.

Hospitals that have purchased a da vinci machine are very unlikely to come out
and say it was a waste of money and is injuring patients, it makes them look
like they are fools, and increases their liability. I really hope Watson is as
advanced as described in the Wired article, but there have been plenty of
popular science rags that similarly pimped robots as making surgery safer.

I think eventually robots will eventually make surgery safer, and watson-like
computing will make better diagnoses, but there clearly was a mistake made in
evaluating robots for surgery that I would rather not see made again.

[1] [http://www.bloomberg.com/news/2013-10-08/robot-surgery-
damag...](http://www.bloomberg.com/news/2013-10-08/robot-surgery-damaging-
patients-rises-with-marketing.html) [2]
[http://online.wsj.com/news/articles/SB1000142405270230470310...](http://online.wsj.com/news/articles/SB10001424052702304703104575173952145907526)

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bayesianhorse
People who don't understand either artificial intelligence or medicine, or
neither, tend to overlook the fine point that the particular tasks AI is
suited for in medicine generally are those tasks the doctors like the least.

Doctors might like reading research every once in a while. They don't like
spending all their time on it. An overworked doctor should not care if he
refers a patient to an overworked oncologist or asks watson first.

Computer vision applied in health care also automates tasks that are mind-
numbing. Is it really necessary for highly-skilled doctors with decades of
experience to look through a microscope?

Doctors also complain that they don't have enough time for their patients.
Watson seems to be excellent at completing paperwork. Given that we hardly
have enough doctors anywhere in the world, more AI will be good thing.

~~~
hershel
I don't believe this is true. there was an attempt to add AI(sort of) to
medicine in the form of decision support tools , but doctors didn't like them
because it took autonomy from their job and made it boring: instead of
figuring all kinds of stuff, suddenly doctors are being told what do by a
machine.

~~~
PeterisP
It would be even worse psychologically - if some machine comes up and makes
better diagnoses, then it means a multitude of cases where the doctor will
violently disagree with the machine, (s)he will _know_ what's right for the
patient.. and still be wrong in most, but not all the cases, so listening to
the doctor would, on average, mean harming patients. So much potential for
conflict.

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jared314
While I think IBM Watson will become a powerful tool for querying and
hospital/insurance risk management, I'm not sure it will be replacing a doctor
until MRI machines are a dime a dozen. What good is a medical query engine if
the patient doesn't know how to describe what is wrong? If you are planning
your child's career, take this into account; otherwise, it is just something
new for the doctors to learn, like engineers learning CAD tools.

~~~
PeterisP
How big is a market for an expensive senior oncologist, if a doctor with twice
shorter training (and half the school debt) can give the same results (by
using the same Watson) while competing on price and friendliness?

~~~
cowsandmilk
the increased emphasis on bed side manner at many of the top med schools
indicates they agree with you.

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yourapostasy
What obstacles are there in various nations to people opting to waive all
medical liability in exchange for ultra-cheap access to Watson-based or -like
diagnoses and robot-guided physical diagnostics and treatment? If I was
indigent or a low socioeconomic participant in a Third World nation, then
$0.10 USD visits to an autodoc that also dispenses the suggested curative
treatment if I sign a waiver would be awfully attractive. Even a 30% success
rate would be an astounding improvement against the _status quo_ in many parts
of the world, and many people would take it. And the autodoc software devs
would get a constant stream of patient data to improve future versions upon.
Not an especially pretty situation to contemplate (cue cries of exploitation
of the desperate), but one we likely will have to face as these technologies
continue to improve.

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sashanna
Legal automation faces one giant hurdle. As any first year law student knows
most of the time there is no "correct" answer. This isn't Jeopardy where the
correct answer is "who is Winston Churchill". Law is a negotiation about
whether or not the wife gets to keep the dog, whether or not the seller takes
the risk of the shipment being held up in customs, or whether or not the
purchase of A tech company should be subject to an earn out. None of these
questions can (as yet) be readily answered by a formula. I very seriously
doubt Watson can answer any of these questions.

Don't get me wrong - legal automation is coming but it is only replacing the
least skilled. Paralegals, procurement officers and law students have the most
to fear.

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mooreds
I'm interested in the fact that most of the discussion has centered around the
possibility of Watson and other expert systems doing what is outlined in the
article, rather than the societal ramifications mentioned (~70% "full"
employment).

Perhaps I'm a luddite, but I wonder if this time it really "is different" or
if we'll discover new ways to put human labor to work, just as we did when
farmers left the land or when services overtook manufacturing as the primary
sector creating jobs (in the developed world, at least).

------
Pxtl
Anybody else read "Player Piano"?

~~~
mooreds
A novel by Kurt Vonnegut:
[http://en.wikipedia.org/wiki/Player_Piano_%28novel%29](http://en.wikipedia.org/wiki/Player_Piano_%28novel%29)
(for those of us not in the know).

------
yetanotherphd
It's hard to take seriously the opinions of someone who knows nothing about AI
and is therefore unable to critically evaluate the made about Watson. To go
from any kind of parsing/understanding of medical articles, to actual
diagnoses of patients, is absolutely impossible with today's technology

~~~
crusso
I'm not sure what you're talking about. I know something about AI. A couple of
years ago when Watson destroyed the best human Jeopardy champions, I
immediately saw its near-term applicability in sifting through the enormous
space of medical data/research and correlating it with patient information to
yield amazingly accurate and insightful diagnoses.

This isn't after-the-singularity type science fiction where we're adding
assumption upon assumption to several levels beyond what is possible.

This is applying a technology (that's already proven at performing similar
complex deductive analysis over massive quantities of data) to a new
discipline. Any assumptions about what we can do in the new discipline with
the current technology are minimal and extremely likely overcomable.

Even if Watson isn't quite there, the way is pretty clear now. Linear
improvements in the Watson approach will yield results.

~~~
recuter
I used to think that until I dated a medical student. It is heartbreaking to
me and I'd grasp at any reason or bit of information to be more optimistic but
honestly, get real... How do you think a Venn diagram for medical and computer
science (and/or statistics) students looks like?

Unlike with jeopardy, you do not have a huge well organized catalog of
information lovingly curated by trivia worshiping nerds. It is a ridicules
stumbling block but there you have it. Health records are not normalized and
you can't touch them anyway, research is closer to human readable prose and
filled with jargon - good luck developing NLP for it if you're "just a
programmer". Hell, look at their textbooks and the way they study and are
trained, that screams for computerized improvement and is _still_ a tall
order.

~~~
crusso
You misunderstand how Watson was created. A bunch of trivia worshiping nerds
didn't organize and catalog all of its information in the way you're implying.
Watson doesn't need perfectly digested raw materials to work with.

Watson is able to parse natural language and pull out possibly important
information. It then applies some very state-of-the-art machine learning to
derive the most likely contextual meaning of that information. That contextual
meaning can be cross-referenced with billions of other pieces of weighted
information to derive further insights.

I come from a family full of doctors. They tend to be smart people, but as
Jeopardy showed, even the best player on earth is no match for a machine
trained at that discipline.

Once we start adding in genetic information, that will allow machines like
Watson to customize diagnoses and treatments based upon your specific genetic
profile.

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maaku
So we might end up with better treatment, healthier lives, and lower
preemiums. What, exactly, is the big scary downside? We are no longer
subsidizing the luxurious high life of a particular educated elite?

~~~
Yaa101
Who do you think that the owners of said machines are? More and more you will
be owned by the rich, so prepare for living in a total dictatorship within
your lifespan.

~~~
maaku
I think you misunderstand my point. Health care is an economic rent - a forced
payment into a system that does nothing to advance society. It's like a thug
who has seized the water supply and is demanding ever higher prices. What are
you going to do? Not pay and die? The double-digit percentage of my salary
that spend on fixing and maintaining the frail, degenerating body that
evolution handed me I would _rather_ spend on something else, if I could.

I would rather stay perfectly healthy, young forever, and not pay a cent.
Wouldn't you? If moving towards that goal puts some doctors out of a job, well
so be it. The end goal doesn't include their job anyway. Maybe they can go
become engineers and create value, or go make better medical machines.

~~~
Yaa101
I do understand your point, but the prices will go up either way because the
machines are owned by the ones that I was talking about.

My problem with machines is that sooner or later people cause changes while
machines imprint status quo.

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danielharan
This has a very interesting secondary use: find studies or facts that most
effect the diagnostics or prescriptions. Studies that are most relied on would
benefit from replication attempts.

~~~
jared314
> find studies or facts that most effect the diagnostics or prescriptions

You could also expand that idea to having it acting as a spam filter for
medical publications. It could scan every old and new published paper for
basic validity. This wouldn't prevent fraud, but it might raise the bar for
publishing bad science.

