A friend and former colleague of mine appeared on the ASCO Daily News podcast discussing artificial intelligence (AI) and its potential applications in oncology. https://podcasts.apple.com/us/podcast/ai-will-allow-doctors-to-reclaim-time-with-patients/id1101234896?i=1000623310373 A decade or so ago, I was playing Texas hold’em in his basement. Today, Dr. Doug Flora is the Executive Medical Director of St. Elizabeth Medical Center Oncology Services and the Editor-in-Chief of the upcoming journal AI in Precision Oncology. The podcast really got me thinking about AI in oncology.
At the risk of completely dating myself, my first memories of fictional depictions of AI came in two 180-degree different points of view. “Help me Obi-Won Kenobi, you’re my only hope.” That was the message entrusted to the droids R2-D2 and, unknowingly, his golden sidekick C-3PO by Princess Leia in the original Star Wars. A few decades later, Commander Data was the first android to be on the crew of the starship USS Enterprise in Star Trek: The Next Generation. Heroes. These self-contained “intelligent” computers were forces for good.
On the flipside, I have great memories of the 1983 Matthew Broderick and Ally Sheedy nerdy classic WarGames. https://www.imdb.com/title/tt0086567/ A computer programmer had successfully created a game playing system, really an AI system, that eventually was used as the backbone of the US nuclear weapons system. “Joshua,” named after the programmer’s son who had died tragically, believed it was simply playing games of thermonuclear war with a young computer hacker played by Broderick and almost inadvertently starts World War III. The other huge sci-fi hit that affected my early childhood was, of course, The Terminator. https://www.imdb.com/title/tt0088247/?ref_=vp_close At 2:14 AM EDT on 8/29/1997, the Skynet computer system became self-aware, at least in the movie it did. From then on, it tried very hard to end the human race, even resorting to time travel to murder the mother of the leader of the human rebellion.
When it comes to AI, this is something that humans have been thinking about well before me and my personal experience of fiction. Of course, today we aren’t talking purely about fiction. What is AI? Google defines it as “the theory and development of computer systems able to perform tasks that normally require human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages.” IBM, whose computer Deep Blue was able to beat chess world champion Garry Kasparov, defines AI as “leveraging computers and machines to mimic the problem-solving and decision-making capabilities of the human mind.”
All this Skynet becoming self-aware business and computers killing off the humans was truly fiction, right? Well, back in March, around “35,000 AI researchers, technologists, entrepreneurs, and concerned citizens signed an open letter from the nonprofit Future of Life Institute that called for a ‘pause’ on AI development, due to the risks to humanity…” according to a Wired story. https://www.wired.com/story/letter-prompted-talk-of-ai-doomsday-many-who-signed-werent-actually-doomers/ Well, it’s a complex issue. Apparently not all 35k signers are doomsdayers. I don’t think any one of them actually believes this is a threat for tomorrow, next month, next year, or even the next decade. For now, the humans are in control.
In health care and, specifically, in oncology, will AI be more R2-D2 or The Terminator? Frankly, there is probably no verifiable answer here and it could boil down more to the question, are you a pessimist or an optimist? Today, I choose optimist and therefore believe that AI can save health care in a broken system. I believe, as Dr. Flora does, that AI can save providers the precious commodity known as time. Patients don’t understand that when they are in a 15, 20, or even 30-minute visit slot, we are supposed to study the chart, do the visit, and write the note in that time period. If we don’t finish it all, the charting is often left to the end of the day or, worse, home. We don’t have to get into the burnout and other issues this causes. The AI known as ChatGPT can do a halfway decent job writing an article or term paper on a specific topic with a few well laid out prompts. It is not a stretch to believe that an AI designed for the purpose could listen in on a patient visit, write a good summary, place orders, and make a return appointment. Walt Disney and the songwriting brothers Richard and Robert Sherman once wrote, “There’s a great, big, beautiful tomorrow” in the theme song for the 1964 World Fair and later Disney World attraction, the Carousel of Progress. I can’t help feeling the same way.
Other ways AI is or will be helping in health care:
AI is being used to design new, perhaps less expensive, pharmaceuticals of tomorrow -
https://www.technologyreview.com/2023/02/15/1067904/ai-automation-drug-development/
AI-assisted mammography can increase breast cancer detection 20% TODAY –
https://www.cnn.com/2023/08/01/health/ai-breast-cancer-detection/
AI can help pathologists become more efficient and reduce errors –
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9688959/
An article Current Applications of AI in Oncology –
https://www.targetedonc.com/view/current-applications-of-artificial-intelligence-in-oncology
Deep Medicine by Eric Topol reference by Dr. Flora in the ASCO podcast –
https://a.co/d/0UfKE2G