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Computers Shown To Be Better Than Docs At Diagnosing, Prescribing Treatment

Lucas123 writes "Applying the same technology used for voice recognition and credit card fraud detection to medical treatments could cut healthcare costs and improve patient outcomes by almost 50%, according to new research. Scientists at Indiana University found that using patient data with machine-learning algorithms can drastically improve both the cost and quality of healthcare through simulation modeling.The artificial intelligence models used for diagnosing and treating patients obtained a 30% to 35% increase in positive patient outcomes, the research found. This is not the first time AI has been used to diagnose and suggest treatments. Last year, IBM announced that its Watson supercomputer would be used in evaluating evidence-based cancer treatment options for physicians, driving the decision-making process down to a matter of seconds."

22 of 198 comments (clear)

  1. Modern luddites by MPAB · · Score: 5, Insightful

    An expected outcome. First machines become good and cheap at performing manual labor, then it's lowly qualified jobs such as sorting stuff or basic accounting.
    In a few years, liberal professions will fall. Our salaries (I'm a doctor) have been diving as more and more people around the world can afford a career and achieve a good enough level to perform as a doctor or an engineer.
    Creative and risk-taking careers will resist for a longer time.
    We can hope for a future of working machines and humans enjoying themselves. The other option will be cheap-ass humans with no way of earning a living whatsoever.

    1. Re:Modern luddites by Anonymous Coward · · Score: 3, Insightful

      except software and hardware designers. which is why i'm both. ;)

      but seriously, do you really think that's what the future will look like? all evidence from the past shows that as technology gets better, the amount of good jobs goes *up* not down. i don't see any reason why this would change. we're a LONG ways away from having machines do absolutely everything for us.

    2. Re:Modern luddites by Garridan · · Score: 5, Insightful

      Meh. You can be replaced by sufficiently advanced algorithms. I'm mathematician, FFS. There are already automated theorem provers which can solve undergrad-level problems. As computers evolve, they'll be just as good as people and loads cheaper than people at everything we do, up to and including the creation of art.

      If we progress to the point where all of our jobs can be done by computers... what should we do? At the point where artificial intelligence becomes genuine intelligence, it will rapidly outpace human intelligence. This is evolution. We are breeding our replacements.

  2. Interesting by Intrepid+imaginaut · · Score: 4, Interesting

    I find this interesting, I was wondering when we'd reach the point where the accumulation of knowledge available in any given field exceeded the ability of the human mind to completely grasp in a useful manner. It's going to reach a situation where multiple experts on a given subject with a fair idea about related subjects are going to be the only unit capable of actually doing anything sooner rather than later - apparently in medicine at least computers have come to the rescue.

    I suppose with the many specialisations in every area we're already there, the question is can we repeat the improved returns in areas like physics and chemistry.

    1. Re:Interesting by joh · · Score: 4, Insightful

      The problem is not in the decision making process, but in the fact finding process. THIS is the part computers and software are still very, very poor at.

    2. Re:Interesting by ColdWetDog · · Score: 4, Interesting

      We could start by getting some real information instead of the pair of nearly identical fluff pieces in the TFA. While it's nice they used Markov Decision Chains, as best as I can tell they did a bunch of simulations with pre existing data and came out with 'better' information than the docs who, unfortunately, were dealing with problems in real time.

      The lawyers have had this sort of thing for years. It's called a 'retrospectascope'. It tells you what you SHOULD have done after you know what the outcome is.

      Very, very helpful. To lawyers anyway, to doctors, not so much.

      I'd love to see some real computerized decision analysis that would be useful in real time medicine. I'd love to have "all" of the information about a patient in real time.

      I'd also like a Pony and one million dollars. Before I get worried about job security and before everyone goes all Star Trek, lets see if this works in a real clinical setting.

      --
      Faster! Faster! Faster would be better!
    3. Re:Interesting by loneDreamer · · Score: 3, Interesting

      I know something about machine learning, so let me tell you how it works. The input is partitioned in two sets, a training set and a test set. The training set is used to teach the algorithm, the test set to measure it's performance. So, while we know the outcome for the second set, the computer does not, he is literally seeing it for the first time, as if the patient has just came for a consultation. The decision accuracy is then computed comparing the new output with the known outcome we had reserved to ourselves to see it it matches. And it does it in real time. It IS a real clinical setting!

      So no, while I understand your fears, calling anything in ML a "retrospectascope" is completely wrong and ignorant. In fact, if you build such an algorithm it tends to have very poor behavior, since it looses the power to generalize for insight (the technical term is "overfitting").

      Truth is, it's a good think that you would love to get some of the things you mention, since the article is saying you'll get them (and I can attest to that). Very soon. Don't believe me? Look at Watson in action and think deep about what the computer is doing. It might seem a game, but really think what it is going on. It is not a movie script. It does not know the answers, it is UNDERSTANDING the questions and COMING UP WITH the right answers. Faster than the best humanity has to offer. Are you smarter/more knowledgeable than them? The truth is indeed astonishing and might look like science fiction, but it is not.

      The pony though might take some time ;-)

  3. Mycin by White+Flame · · Score: 4, Informative

    In the early 1970s, Mycin achieved 69% accuracy of prescribing a "correct" treatment for a patient's condition, which was deemed better than human specialists.

    The linked articles don't seem to include the absolute accuracy that it achieves, just the relative accuracy against doctors. I wonder if we've come any further than the basic expert system rules allowed 40 years ago.

    1. Re:Mycin by cbhacking · · Score: 4, Informative

      Came here to mention this. Medical "expert systems" (a class of AI) have existed, and been better than humans at some things, for literally decades. However, you almost never hear about them anymore. With the vast advances in processing power, miniaturization, and power usage, we can today build pocketable devices that tremendously exceed the capabilities of something like Mycin. With the improvements in sensor technology, we can feed those systems more and better data than ever before. With widely available wireless Internet connectivity plus incredible storage densities, we can provide these systems with all the info they could ever need. With the advances in the science of AIs over the last four decades, we can make these systems "smarter" than was possible before. Finally, with the plummeting cost of such electronics, we can make such systems affordable to middle-class individuals, rather than exclusively to large and well-funded organizations.

      Yet, they almost non-existent. We have a few smartphone apps that scratch the surface of what's possible. We have dedicated machines like continuous glucose monitors for diabetics, but they have very little in the way of smarts and no versatility. We have concepts and pseudo-prototypes of "medical tricorders" and such sci-fi devices, but they aren't generally set up to make recommendations. We have online web applications where users can input symptoms and be told what they might be, but those systems have no personal background or history of the user's health, and rely on the user measuring and providing data themselves.

      Why haven't these things been combined?

      --
      There's no place I could be, since I've found Serenity...
    2. Re:Mycin by 0123456 · · Score: 4, Insightful

      Why haven't these things been combined?

      Who could possibly be opposed to cheap, automated healthcare?

    3. Re:Mycin by AaronLS · · Score: 4, Interesting

      I'm believe they are in slightly diminished roles. The US military has triage lines, where family members call in about medical problems, a registered nurse answers and then decides if the patient should self-care, book a Dr. appointment, or go to emergency room. I handled appointment booking, and sometimes the nurse would call and no appointments would be available and they'd get annoyed at me and say "Well that's what the computer told me to do."

      I figured they had some sort of system that the nurse entered symptoms into, and it used the patient history+symptoms to suggest a self-treatment or triage to appointment/emergency room. I had also read about these systems in the book AI: A Modern Approach Even when the doctor doubted the diagnosis, the computer could even explain the conclusion(this is pretty advanced for an expert system) which would usually elicit a kind of "oh I didn't consider that factor" kind of realization from the Doctor.

      I assume a registered nurse must still be involved to meet legal requirements, to properly elicit symptom information, and serve as a sanity check for the system. The problem, demonstrated by their response and inability to troubleshoot problems, is that they become completely trustful of the system. I imagine the opposite problem is also common, where they don't trust the system at all.

    4. Re:Mycin by Tailhook · · Score: 4, Interesting

      No need to go overseas. The Veterans Administration under the US DOD uses so-called nurse triage lines with an expert system to direct patients to care over the phone. They're making a mobile, tablet based system now:

      The combined solution, called ER Mobile, will make it possible for nurses to perform timely, accurate triage on a mobile device anywhere in the ER, as well as create a comprehensive record that will be recorded in the VA EMR.

      Shazam. Tri-corder.

      The VA isn't nearly as slavishly obedient to the AMA as private practice, and they definitely don't have employer provided health insurance systems to bilk, so things like this (delegation to nurses) get traction.

      --
      Maw! Fire up the karma burner!
  4. GIGO by erice · · Score: 3, Insightful

    An expert system is only as good as the information it is fed. Until we get machines that can quickly scan a human body and tell us everything there is to know about it, we will still need doctors to talk to patients, vet what they say, observe what didn't mention and ask followup questions.

  5. Old tech by drcheap · · Score: 4, Funny

    I don't care what this article says, this is nothing new. My in-home psychiatrist in the 1990s was great at diagnosing my issues. Perhaps you were a patient of his, too? His name was Dr. Sbaitso.

  6. Because doctors are humans. by Anonymous Coward · · Score: 5, Insightful

    The problem with doctors is their ego. Being a nurse for quite some time Ive seen countless doctors come through the hospital that do not treat a patient properly, ignore patient complaints, dont treat problems aggresively enough, are too passive, and so on and the vast majority of them refuse to do otherwise because of their ego. They are doctors, no one should question them and they hate it when you do and when you do they dig their heels in and dont budge. Doctors are also human so they get tired of their job, they get lazy, they stop caring after awhile, they worry more about what they will do later than the problem at hand, they stay up too late.

    Ive also seen countless times people who swear by these doctors and will accuse of them of fault simply because the doctor has been nice to them. A doctor who is friendly can do no wrong in a patients eyes. Or a patient has some common problem that even a moron could treat, then when the doctor fixes them suddenly they become godlike.

    Personally I would trust the diagnosis of a machine that has more information programmed into it than a thousand doctors do collectively from allover the world.

    A machine can be a doctor because thats how doctors are trained, they are trained to be machines. They treat the problem, they do not treat the person. Treating the person is a nurses job. And treating the problem is simply nothing more than deduction. If patient has multiple problems then you take those numbers and it will lead you to the correct answer. Thats all being a doctor is, you look at the signs and symptoms, then you add them alltogether and you get the answer as to what the cause is. Its all a forumla and nothing more, there is no great mystery to it.

  7. Same old objection by pclminion · · Score: 5, Insightful

    Apart from doctors who will understandably not want to be rendered obsolete (and they won't be -- the computer can only prescribe a treatment, not administer it!), the main objection that would be raised to this is "What if the computer makes a mistake?" For some reason, people are really bad at understanding that even though the computer might make a mistake, it will make mistakes at a lower rate than a human. This is the same problem with computer-driven automobiles. Yes, the computer might screw something up and kill somebody, but this should happen at a much lower rate than caused by human drivers -- however, because the rate isn't EXACTLY ZERO it is seen as completely unacceptable, even though this is an irrational position to maintain.

  8. Drug Companies doing away with doctors by anthony_greer · · Score: 5, Interesting

    This sort of thing is just what big pharma wants, no human interaction and careful consideration, just a pill dispenser...symptom a + symptom B == Pill 2...
    How much you wanna bet this thing always prescribes expensive non generic drugs and never tries the 50-70 year old known treatments that are usually the first steps in treatment before new expensive drugs are prescribed.

    Also, anyone notice the change in medical advertising and communications, they never say "ask your doctor" any more, its ask your prescriber, or ask your provider...like they want to dis-intermediate doctors and are getting the public ready.

  9. It's just another tool by TheCrazyMonkey · · Score: 5, Interesting

    And will the system consider the patients age/cost to treat/insurance level/likelihood of patient paying future insurance premiums to make up for expenses?

    It will if you program it to. Things like this are tools. As a relatively young doctor (resident) I welcome things like this. Every doctor I know uses reference material, some are printed on dead trees and some are electronic. Today, there's not much difference. But the point it is that there's too much medical knowledge for one person to keep it all in their head at one time. If something like this were to come to market it wouldn't be replacing doctors, it would be augmenting them. Machines do what we tell them to, always have and (hopefully) always will. False rivalries like this completely miss the point. I would love to have a computer algorithm that could correctly diagnose 99% of the time even if it were flagrently wrong the other 1%. That's why humans are in the loop.

    1. Re:It's just another tool by quantumghost · · Score: 5, Interesting
      As an attending physician, I have several issues with this article.

      A) the slashdot title is a little sensationalistic....never did TFA mention diagnosis without a physician in the loop.

      B) by what standards was the final diagnosis discovered (i.e. the gold standard)? Another physician? Another program? Was the trial blinded?

      C) this article mentions only one disease process - depression, I fail to accept, blindly, that their results can be extrapolated - that is the crux of medical versus scientific research....see D. Not all diagnoses are obtained by just talking with a patient, in fact short of a psychiatric diagnosis, most require a physical exam....and a competent one. Suppose someone is obviously malingering and complaining about abdominal pain....this system would not pick up on malingering and would likely recommend an operation....a totally wrong diagnosis.

      D) this is a retrospective study...in medicine, this is not adequate proof of effectiveness.....you need to perform a prospective trial, preferably with randomization and blinding to adequately prove your hypothesis for treatment. Actually, upon re-reading TFA...it was _simulations_ that were performed. This is hardly world class evidence.

      E) cost savings were mentioned, but not long term outcomes....who cares if I saved 75% in the cost of treatment if the patient didn't get better in the end. (yes, short term were noted, but anyone who's ever been on long term therapy knows that the short term does not dictate the long term outcome.

      F) In life threatening situations - those that require the most expedient decisions, often with less than complete information, this system would be useless because the patient would die in the time it takes you to input the facts.

      G) not all situations are cut and dry. I am often consulted to make decisions about patients that are not addressed in any book. In fact, there may be only 1 or 2 journal articles about the problem, and often there are none. Making a decision treatment in the absence of an established precedent is not going to be one of this systems strengths...."Oh, I'm sorry, I can't help you....I just got the blue-screen of death from the program that was supposed to diagnose you!"

      H) would this program tolerate patient autonomy? What happens when the patient refuses some or all of the initial treatment plan?

      So, while I point out flaws, it is not to say that this is totally without merit....I am merely pointing out the obvious short coming of this article. In certain fields this could be very advantageous.

      I will tell you that in my field, this computer program borders on useless. There is very little doubt about what my diagnosis is, and when I am in doubt, my best evidence is collected by doing something. And computers are really a long way away from matching my skill set. A lot of my diagnosis is made by touching the patient during the physical exam. That exam can completely revamp my decision that started based on the history. And, since I am the one performing procedures, I also would not have a machine dictate the exact method that I use - I am the one performing the operation, I do it the way that I know will result in a safe and effective outcome. In my case, I just don't really don't know what this system would provide to me for patients.

    2. Re:It's just another tool by nbauman · · Score: 3, Interesting

      Those are all very good points. I just spent half an hour going through the articles, press release, and article itself (which is available here http://arxiv.org/abs/1301.2158 http://www.caseybennett.com/uploads/Bennett_AI_ClinicalDecisionMaking__Article_in_Press_.pdf ) trying to figure out how they determined that the program diagnosed patients better than doctors. I couldn't do it. And it didn't look like it was worth another hour of trying to figure it out.

      I invite anybody to explain that to me. What do they mean by a "30-35% increase in patient outcomes"?

      For example, the press release says:

      "This was at the same time that the AI approach obtained a 30 to 35 percent increase in patient outcomes," Bennett said. "And we determined that tweaking certain model parameters could enhance the outcome advantage to about 50 percent more improvement at about half the cost."

      What does that mean -- "a 30 to 35 percent increase in patient outcomes"? Does that mean the program treated patients with diabetes and got 30% fewer foot ulcers? Or 30% lower blood sugar? Or 30% longer survival? Or did they reduce the weight of overweight patients by 30%? Did they get 30% more patients to stop smoking? Did they diagnose 30% more cases of colon cancer?

      They don't seem to have defined their outcomes or endpoints.

      This is one of those times when you wish they had to publish in a peer-reviewed journal where an editor would have made them answer some obvious questions.

      It looks like an entirely theoretical study. I don't see where they compared their predictions to real-world data. And if they did, how would they decide that they're right and the doctors are wrong?

      They're like economists who come up with clever theories that ignore the real world.

      This reminds me of the story about the efficiency expert who heard a symphony orchestra. There's nothing here to indicate that they understand anything about medicine.

  10. The problem with a computer diagnosing... by CannonballHead · · Score: 4, Insightful

    ... is that the computer doesn't have, literally, hands-on experience.

    For example... you have stomach pain. Okay. Where? Does this hurt? Does it hurt if I poke this? Do you have a fever? How high? ("Oh, I don't know, maybe XX" ...)...

    In other words, you still need someone who *knows* what to do to help diagnose simply to *get* the information. You need someone trained to know where to poke, where to tap, where to see if something hurts. And then, of course, to try to wheedle the real information out rather than the confusing answers patients (note that I am not a doctor, I am a patient) give. :)

    As a diagnostic tool, I think it would be a huge benefit. An individual simply can't keep up to date on everything, don't know everything, and can't research everything. Having a diagnostic tool that *does* do all that would be a huge benefit. There would be options and diagnoses that perhaps the doctor had not thought about. Additionally, the diagnostic tool - I hope! - would not just say "Oh, it's this" but would perhaps say "Well, it could be this, and you need to find out this information first ... or it could be this, and for that you need to do these tests..."

    The idea that a patient, combined with a non-trained non-doctor, can somehow come up with all the right answers/information and a machine can simply diagnose it on the spot seems like a very simplistic view. Perhaps that works with colds, the flu, or warts... but for more complex things... it seems diagnoses tend to work on a "it could be this; let's do more specific tests to find out if it is" type of investigation.

  11. Re:Yeah, just like flying is safer than driving by Anonymous Coward · · Score: 3, Insightful

    Cars with human drivers are the only ones that suddenly swerves from the opposing traffic lane in front of you. And at least 1/4 of the time, those human drivers are drunk too! And quickly getting more than 1/4 of them distracted on their cell phones, as if one can read phone texts and type while they drive!

    I'd take my chances with a computer controlling a car any day over the current system of allowing human drivers who daily make mistakes and kill 40,000+ Americans PER YEAR on the highways and streets!