JAMA essay argues that AI will be better than docs; Docs upset; What’s the reality?
And: does it make sense to publish peer review articles about what AI will do?
A new JAMA Viewpoint makes the claim that AI will exceed humans when it comes to some— perhaps most— of medicine. The response online from physicians has been fierce. I haven’t seen doctors this angry since they were called providers.
I have just 5 points to make:
The essay’s central claim is: AI will make some— perhaps many— medical decisions better than most doctors, and doctor+AI is actually (or will be) worse than AI alone. Is this possible? Or science fiction?
Of course, yes, this is absolutely possible. I am surprised anyone would disagree. AI is already solving mathematical proofs that no human has been able to. AI can run statistical simulations that used to take a good statistician a week. AI can do the work of 10 medical students in gathering research information. What would take 1 months, is done in 1 hour.
And the corollary, it is possible that doctors override AI and worsen outcomes. Absolutely, this is possible. The authors give many examples. This is definitely a possible, plausible point of view. We can debate how fast and how extensive.
What about the human touch? Won’t patients always need a shoulder to cry on?
Of course this is also true, but we need to be honest: in the course of an oncologist’s week, what percentage of the time do you spend an hour talking about end of life care? 5%? And how much of that time does the person consoling the patient have to be a board certified oncologist vs. a palliative care doctor, or a general doctor, or an oncology nurse, or a medical student— my point is simply that they need to have a human touch in oncology does mean having oncologist exactly as they are today. I would imagine the JAMA authors saying AI + a local oncology nurse selected for best bedside manner visiting you at home is greater than going to see Jame in his cold Cleveland clinic office, waiting in the lobby, etc etc.
What about the author’s conflicts of interest? They profit from AI companies. Yes, I see that. I hate to break it to you, but the vast majority of essays in JAMA are written by people who profit from what they are recommending/ promoting. When drugs are recommended for on and off label uses, the doctors are often consultants. When devices are recommended, the doctors often make money by placing those devices. I have been a critic of much of this, but this is not unique to this piece. Also some of the disclosures are ridiculous. Zeke received an honoraria for speaking at UCSF grand rounds? Who cares? Disclosing everything means hiding what’s relevant. I am happy to have every conflicted article have a rebuttal written by someone with no conflict— but let us apply that everywhere in JAMA. (Good luck oncology).
Why are the authors writing in JAMA at all? AI is so wonderful, and modern communication is so amazing, and yet the authors are still writing about what AI will do in an old fashioned peer reviewed medical journal that mostly collects dust on coffee tables. And frankly a journal that is not fit for the times, and actually pretty boring. To be honest, this is the biggest mystery. I see no value to the authors for writing this article at all— they don’t need the line for the CV, they could publish this on a website and get more views, I see no reason for them to write this, which leads me to…
Why argue about what AI will do. Both the authors, and their critics are arguing about what AI might or might not do. This is in contrast with useful medical debates about what you should do in clinic tomorrow. Should you extend anticoagulation therapy? Give chemo and a TKI or TKI alone? Try a new pain pill? I get medical debates about decisions we make daily, but fighting over the future— I don’t get it.
I did find this one funny though. It’s tough to make predictions, especially about the future.
In short: Providers shouldn’t be upset at the idea that AI will steal some— perhaps all of their work. Ok, Doctors, I mean doctors. That was just to get your blood pressure up. How much work will AI take from me— I am curious to find out. Only way to do that is to stick around for a while. In the meantime, publishing viewpoints about the future in JAMA is about as valuable as reading and getting mad about it.