Abu Dhabi, UAEFriday 21 September 2018

There's much more to medicine than cold rationalism

Until machines can learn to care about our lives and welfare, doctors and nurses will remain irreplaceable

A doctor tests the eyesight of a young girl in Idlib province, Syria.

In his 1759 book The Theory of Moral Sentiments, Adam Smith discussed the psychological and philosophical dimensions of the conflict between emotion and rationality in decision making. Smith was far from the first person to recognise this internal struggle. It has been a topic of debate since the classical period. However, even now, many leaders in business and politics still believe that simply furnishing people with enough factual data is sure to elicit rational decisions from them. In reality, this is far from the case.

Take doctors and nurses for example. They are, after years of study and practical medical experience, far better informed than most as to the dangers of smoking. If knowledge was the real key to rational decision making, none of them would ever even consider picking up a cigarette. However, not only do many health care professionals smoke, but in countries such as Italy, the ratio of smokers among doctors is higher than in the general population. This is not meant to point out a specific failing of this particular demographic, it just means that doctors and nurses are like the rest of us and experience the same tug-of-war between emotion and rationality.

Along with many other professions, doctors and nurses are also facing a digital revolution, in which data science and artificial intelligence (AI) are combining to provide previously unimaginable tools and strategies for evidence-based decision making. In recent years, the number of start-ups providing digital health care solutions has been booming. Almost every day, new and cost-effective methods of patient care are emerging, from robots that perform surgery, to algorithms that use billions of data points to do the job of radiologists in a few seconds, and urine analysis facilitated by a mobile phone.

The idea that technological innovations will allow machines to perform many of the tasks on which our livelihoods depend faster, more accurately and cheaper than we ever could is obviously both inspiring and a cause for concern. This applies to doctors and nurses as much as anyone else. The very innovations that will help improve health care delivery to their patients also have the potential to one day replace their professions entirely.

In April this year, a significant step was made in AI-based health care provision. The US Food and Drug Administration (FDA), allowed for the first time the marketing of a AI-based device that can detect a mild level of the eye disease diabetic retinopathy. This condition is the result of high levels of blood sugar that alter the retina’s blood vessels as well as light-sensitive tissue in the back of the eye, resulting in vision impairment and even blindness. The benefits are obvious when one considers that more than 30 million American adults currently live with diabetes.

The FDA has stated that its decision was made because use of the device will “improve patient access to health care”. At this point, this is how we should view technological innovations in the medical field. Rather than sinister developments that will eventually replace human beings, they provide a way to relieve doctors of time-consuming mechanical tasks and allow them to spend more time with their patients.

Increased doctor-patient time is extremely valuable. This is something that Tuka Al Hanai, an Emirati PhD candidate at the Massachusetts Institute of Technology and her colleagues have been working to better understand. The team developed an algorithm to carry out a “sentiment analysis” on 60,000 sets of medical records from a Boston hospital. The results showed that gut feeling has a big part to play in patient care.

So, while we rely on health care professionals to draw on years of rational knowledge when treating us and AI undoubtedly has many benefits to offer, emotion also has a vital role to play in medical diagnosis and pastoral care. Before we think of replacing human beings, we will have to build a robot that can hold the hand of a patient and be genuinely concerned about their welfare. Until then, doctors will remain a very much a thing of the present.

Professor Olivier Oullier is the president of Emotiv, a neuroscientist and a DJ