Humans and AI, Not Humans versus AI

“I hold out hope that artificial intelligence and machine-learning algorithms will transform our experience, particularly if natural-language processing and video technology allow us to capture what is actually said and done in the exam room,” writes Abraham Verghese, MD, professor of medicine and founding faculty director of the Stanford Presence Center.

“The physician focuses on the patient and family, and if there is a screen in the room, it is to summarize or to share images with the patient; by the end of the visit, the progress notes and billing are done. But AI applications will help us only if we vet all of them for their unintended consequences. Technology that is not subject to such scrutiny doesn’t deserve our trust, nor should we ever allow it to be deeply integrated into our work,” Verghese continues in a May 2018 article that appeared in The New York Times Magazine.

That sentiment is behind a key focus for Presence, a center that emphasizes the value of the human connection in the high-wire balancing act between high tech and high touch.

Presence aims to ensure that patients, clinicians, funders, legislators, and other stakeholders are at the table as equitable and inclusive AI solutions are created and deployed in health care.

To that end, Presence presented two symposia during 2018. In April, Jonathan Chen, MD, assistant professor of biomedical informatics, was a leader of the first symposium, “Human Intelligence and Artificial Intelligence in Medicine,” which addressed augmented intelligence of humans and machines for diagnostics. The 350 physicians, business leaders, policymakers, social and behavioral scientists, venture capitalists, and political activists in attendance were challenged to determine how to ensure that humans are augmented by AI in defining and delivering compassionate services.

On that subject Verghese says, “Pitting humans against machines is not the point. Rather, how best to relevantly engage both for the sum to be greater than the parts should be the focus.”

“Machines do many things very well, but they really can’t do the caring work, so how do we augment the two preemptively, proactively, and equitably for the outcome that we all seek?” he asks.

Pitting humans against machines is not the point. Rather, how best to relevantly engage both for the sum to be greater than the parts should be the focus

“Artificial Intelligence in Medicine: Inclusion and Equity” was the second symposium in August, which drew 275 attendees from around the world. Presence executive director Sonoo Thadaney, MBA, co-chair of the National Academy of Medicine’s Working Group on AI in Healthcare, was one of the symposium leaders. Acknowledging the potential unintended consequences of AI in medicine, she examined how to prevent and manage the possible exacerbation of inequity and exclusion in health care.

Thadaney speaks of a huge inequity that looms depending on an individual’s circumstances, saying: “We cannot have a world where technology creates greater inequity such that those of us with privilege have access to second opinions and concierge physicians, and the rest of the planet ends up with medicine that is meted out with the efficiency and emptiness of fast food. We cannot afford a health care apartheid.”

The Gordon and Betty Moore Foundation and the Robert Wood Johnson Foundation support Presence by funding the symposia as well as another innovative program that began at the end of 2018: the AI in Medicine Inclusion & Equity (AiMIE) 2018 Seed Grants Program. The AiMIE program provides initial funding for projects seeking equitable and inclusive frameworks for AI in medicine.