

IBM’s Watson Now A Second-Year Med Student - jmjerlecki
http://blogs.forbes.com/bruceupbin/2011/05/25/ibms-watson-now-a-second-year-med-student/

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robobenjie
When contemplating what jobs were going to be replaced by robots, I never
thought of doctors, but it now seems quite plausible, even probable.

(Not that doctors are going to be gone completely, just that their jobs will
be forever changed the way that CNC has completely changed the job of a
machinist)

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c0riander
I wonder if doctors would become more of a service industry -- doing "patient
care" (as customer service) instead of "disease care" now. Could be an
improvement for the experience of receiving healthcare; definitely interesting
to think about!

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_delirium
The doctors I know tend to think that it's at least 90% that way already (and
has been for a while), at least if you're a primary-care doctor seeing
patients in an office, rather than a surgeon or some kind of specialist. The
typical patient isn't presenting with a rare disease worthy of a medical TV
drama, and instead the main problems are patient-interaction ones: getting the
right information out of them, picking treatments that the patients will be
satisfied with and follow, figuring out what complicating lifestyle factors
they might have, building trust with the patient and family members, etc. With
the increasing influence of evidence-based medicine, where doctors are
supposed to follow experimentally validated rubrics, the diagnosis itself is
often semi-mechanical anyway even when done by a human.

~~~
aristus
Off-topic, but the phrase "evidence-based medicine" sounds very loaded. If not
evidence, what was it based on before?? Serious question.

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roel_v
Theory. "We think that X comes from Y and the reasoning is ..." and then
somebody else says the exact opposite, with an equally likely-sounding
reasoning, and then you don't know what to do. "Evidence-based" means "shown
to work - we may not know why, but at least it does".

On this topic, I recently realized the dangers in trying to propagate
"evidence-based" throughout all sectors of healthcare. A nurse was complaining
about a doctor questioning if a certain drug was safe for breast-feeding women
(well for the child, actually). Indignantly, the nurse said "but this manual
right here says it's safe! How much more evidence-based can it get!". To her,
"the book says so" was "evidence". 'Evidence-based medicine' is no panacea -
the principles maybe, but the hard part is in the implementation.

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bh42222
What's the alternative? Nurses don't trust manuals? Obviously as a society we
should always strive for better science. But just like lady justice wears a
blindfold, nurses should follow the manual.

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roel_v
Of course, that wasn't my point; my point is that when 'evidence based'
becomes a mantra that is malunderstood by many, its use in inappropriate
contexts devaluates the word and with that, the concept itself.

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CobraKai
As a specialist, I have to say: This makes me very glad I'm not a primary care
provider. The doctors of the future will be evaluated on bedside manner and
interpersonal skills - not on diagnostic ability or knowledge, because they'll
all have access to Watson. Which is scary because smooth talking idiots can
get into medical school, but get rapidly weeded out in the real world. It
scares me that stupidity can hide behind this computing beast. And there will
be situations where Watson cannot help (emergencies) where a doctor and his
smarts are all he has to go by.

If Watson makes a wrong diagnoses and a patient dies, who will be responsible?
The doctor? IBM? All it would take is one or two incorrect diagnoses leading
to large malpractice suits to really put the medical profession on edge about
this. Granted, many incompetent practitioners exist out there making all kinds
of dangerous decisions, but this would really stick out in the public eye.

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arohner
You don't really have to get the diagnosis correct, you just have to get the
error bars correct, and then disclose all of that.

"Watson believes the best treatment is Foo. It has an X% chance of working,
with a confidence interval of Y. The second most likely diagnosis is Bar, with
an expected loss of Z if the diagnosis is incorrect. Which would you like to
do?"

Besides, several specialties are already essentially classifiers
(radiologists, anesthesiologists). If machines can't beat humans at
classifying cancer from lung scans, they're not far behind. By the time Watson
is in production, I bet a computer will be replacing radiologists already.

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nradov
There is a saying in medical diagnosis: "When you hear hoofbeats behind you,
don't expect to see a zebra".
[https://secure.wikimedia.org/wikipedia/en/wiki/Zebra_%28medi...](https://secure.wikimedia.org/wikipedia/en/wiki/Zebra_%28medicine%29)
Most patients have common problems that are fairly easy for experienced
physicians to diagnose. So there is no point to entering a bunch of data into
Watson just to get back the same answer you already know. But it could
certainly be helpful for those rare edge cases where the physician can't
figure out the "zebra", or where the patient hasn't responded as expected to
treatment.

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astrofinch
I know this might sound a tad heretical, but if Watson gets to be as good as
or better than a doctor, do we really need doctors anymore?

The theoretical upper bound on Watson's ability is a lot higher than the
theoretical upper bound on a doctor's, since it can make inferences based on a
vastly larger data set.

~~~
lmkg
Watson may be able to recommend you get surgery, but he won't be able to
perform the surgery himself. He's only moving in on one aspect of medicine.
Matching symptoms to diagnoses is the thing that machines are most clearly
suited for in the entire medical profession, because of the vast volume of
possible measurements and diagnoses, and because humans' various cognitive
biases don't work well with the probabilistic nature of the work. That's still
a rather narrow range of work. Humans will remain superior at performing
medical work for quite a while. And until true Strong AI, humans will also
remain superior for quite a large amount of gathering information that Watson
requires, especially psychological measurements, and for making decisions that
involve quality-of-life and other ethical considerations beyond just
probability of success.

tl;dr Watson can, and will, exceed doctor's capability for a certain, somewhat
narrow, range of their function. Doctors will still be necessary for the other
things that they do.

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nostromo
Watson may not be able to perform surgery, but with "telesurgery" becoming a
reality, maybe we can offshore it and still save 80%.

~~~
smithian
I've always wondered about this. What happens when the network goes down in
the middle of open-heart surgery?

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robflynn
This reminds me of some work I did a few years ago in the oil and gas
industry. Not nearly as advanced as this, but we essentially read data from
sensors in off shore oil rigs and ran it through our system. We had some
pretty nifty pattern recognition stuff in place that would learn from previous
data in order to become advanced enough to predict imminent sand breaches
during drilling.

Given significant warning, it could save the drilling companies lots of money.

Katrina ended up severely damaging the rig we were using for testing and I'm
not sure we ever went anywhere with it after that.

We did do some similar work for detecting trace metals in oil sample analysis
records in order to recommend maintenance and detect possible future equipment
failures.

Anyway, interesting stuff here. I'd love to play around with it.

 _edit_ Sorry about the double post. I think I got it removed. Connection was
a bit flaky.

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PostOnce
It seems it must be a tool in a tool chain, rather than a physician
replacement. Tests must be run, and follow-up questions asked. Also, computers
take everything literally, they don't say "Well, that's not what your face is
telling me." or think the patient is lying, delusional, or misinformed. You
can ask the patient on a scale of 1-10 of their certainty, but again, there
are other problems.

"What are these red dots?" Also seems non-trivial to diagnose. They can be
tested, or more questions can be asked of them, but this seems like an awful
lot of work to be managed by a computer alone.

It's a good, or even great thing to research, but it seems far from
implementation, and that's just from an engineering perspective, imagine the
legislative hoops that will need to be leapt through!

~~~
sonoffett
I could definitely see it not as a replacement for a physician, but as sort of
a safeguard to check if the physician's decision regarding treatment for a
particular set of symptoms matches up watson's previously learned data. Watson
wouldn't preempt the physician, but rather raise an alarm if something looks
out of the ordinary.

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spc476
It looks like Watson is shaping up to the 21st century version of Mycin
(<http://en.wikipedia.org/wiki/Mycin>).

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sungam
As a physician I doubt this will have much of an impact on the cost of health
care. The limiting factor here is not technological but cultural. In the
majority of patient encounters a diagnosis has either already been made or is
obvious. In principle workers could be trained in the basic clinical skills
required in a short period of time and several supervised by a single doctor.
There are several reasons that this does not happen to a great extent: (i)
Patient's prefer to be assessed by a fully qualified doctor (ii) Medicolegal -
who is responsible if a mistake occurs? (iii) Trainee doctors on a per hour
basis are often cheaper than employing other workers to perform the same
tasks. (iv) For whatever reason Doctor's tend to see patients faster and make
decisions more rapidly than other staff e.g. nurses performing the same tasks.

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janesvilleseo
I can see Watson being very helpful to Sergey in his pet project -
<http://www.nytimes.com/2009/03/12/business/12gene.html>

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recampbell
More details: [http://www.ibm.com/developerworks/industry/library/ind-
watso...](http://www.ibm.com/developerworks/industry/library/ind-
watson/index.html)

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kds
_"Answering the question “What’s wrong with this patient given these set of
symptoms and this family history?” turns out to be a natural fit for the
computer."_

Well, wake me up when the natural-fit question becomes "What’s wrong with this
_planet_ given these set of _eco_ -symptoms and this _social_ history?"

I'd really like to see what the answer might be.

A Post Scriptum Edit/Addition Below ;)

 _The IBM Watson system that recently won on Jeopardy is thoroughly
probabilistic and statistical_ \--Norvig (see
news.ycombinator.com/item?id=2591154)

In a future far, far away when humanity will have gained experience with
millions of planets, stars, and human colonies and space-castaway societies -
_maybe then_ \- IBM Watson will be able to answer my question...

 _Submerging in cryogenic sleep... see you later... <yawning>_

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wensing
This is cool. When I was at IBM in Austin last week, one of the IBM-ers
mentioned that one of the first areas they hoped to use Watson was primary
care. Amazing. I think I'd rather go to Watson than most GP's.

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JulianMorrison
Put it on a public website.

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ryanlchan
Is this the beginning of companies using web 2.0 tech to solve 'big problems'?
Watson might be the first step towards using the social graph and big data for
things other than selling more widgets.

I'm keen to see how medical professionals start using this tool though.
Professional pride and the immense amount of inertia present in medicine could
hamper adoption. Worse yet, I can only imagine the level of legal liabilities
using a system like this could incur. I'd love to see this adopted and think
it could radically reduce costs and increase productivity in the medical
field, but I'm going to resign to simple cautious optimism.

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yid
There isn't too much "Web 2.0" tech behind building something Watson. Perhaps
the use of ontologies and semantic web datasets, but in academic circles at
least that's informally referred to "web 3.0" (that, too, is a bit of a
misnomer because Cycorp has been building semantic ontologies for a long, long
time).

