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Deep empathy: How AI can strengthen doctor-patient connections
Some experts may worry that AI will depersonalize health care, but others see its potential to deepen relationships.
- Today's rate of innovation and change has made it difficult for patients and physicians to effectively integrate technology into medical best practices.
- Experts agree that physicians need more time in their day to build bonds with patients.
- Dr. Eric Topol believes that artificial intelligence may help restore that time, creating what he calls "deep medicine."
Today's rate of technological change is as unprecedented as it is unpredictable. This speed of innovation has created medical marvels that improve and save lives. Other technologies, however, have proven more difficult for physicians and patients alike to integrate successfully into health care practices.
"Exhibit A is the electronic health record (EHR), which has made the blood of countless physicians boil with frustration," writes Michael Dowling, president and CEO of Northwell Health, in his book Health Care Reboot. Created to store, track and share patient records, "[t]he EHR can be a cruel taskmaster, demanding a doctor's attention during a patient visit and requiring numerous clicks to enter even basic data."
Physicians spend an average of six hours per workday logging clinical data into the EHR—and face-time with patients suffers. The average doctor-patient consultation clocks in at 18 minutes, and a fair amount of that time goes to logging information.
Like it or not, technology is part of the patient experience. One study found that barriers to widespread adoption of electronic personal health records will likely include computer anxiety and concerns for security and privacy.
For better or worse, technology is affecting the doctor-patient relationship. According to Eric Topol, executive vice president of Scripps Research, the most beneficial change can come if we properly navigate artificial intelligence.
Will AI replace doctors?
With AI taking on the routine work, doctors will have more time to be actively involved with patients and referring physicians.
Photo: Tom Werner/Getty Images
That may sound counterintuitive. Technology like EHRs have affected doctor-patient interactions, and when we speak of AI entering a job market, it's with premonitions of the robopocalypse. Consider America's roughly 2 million truckers, who may lose their jobs to self-driving vehicles.
Yet blue-collar jobs are not the only ones subject to AI takeover. Some jobs that require the most advanced education are more likely to become obsolete, according to entrepreneur Andrew Yang. "Doctors, lawyers, accountants, wealth advisers, traders, journalists, and even artists and psychologists who perform routine activities will be threatened by automation technologies," he writes in The War on Normal People.
Day-to-day workplace routines will determine whether AI can perform a job, because the technology can perform routine tasks faster and more accurately than people, without needing a break.
To pick one example from medical practice, radiologists spend much of their time analyzing patient films. It takes years of education to develop that skill. Even then, certain diagnoses can be tricky and human deficiencies, such as confirmation bias and inattentional blindness, can lead to mistakes.
Deep learning could streamline the process of analyzing medical images. One day, AI may be able to read more medical images more quickly and compare them to a catalog exponentially larger than anyone could memorize. It may also detect anomalies too fine for detection by the human eye. And you only have to develop an AI once, as opposed to the extensive costs of training and maintaining human radiologists.
AI is unlikely to eliminate the need for radiologists, but rather it may enable radiologists to be more actively involved with patients and referring physicians as part of the care team. We're years away from AI becoming commonplace in radiology departments. However, the principles are sound and the technology is already under development. Some day, when AI can manage standalone diagnosis for routine cases, radiologists will be free to focus on the most challenging cases.
AI will free up radiologists' time to work on the most challenging cases. Here, neuroradiologists in Paris operate on a patient affected with an arteriovenous deformation.
Photo GERARD JULIEN/AFP/Getty Images
Deep learning, deeper empathy
In Deep Medicine, Topol suggests that well-implemented AI can free physicians from repetitive tasks, providing more face time to meet, inform, reassure and follow up with patients. It can also minimize burnout and improve health care quality. Topol cites one study from the National Bureau of Economic Research that found for every extra minute a home visit lasts, risk of readmission was reduced by 8 percent.
The same gains may be possible with EHRs. Integrated AI can make it easier to log entries, consolidate records, and draw data from external sources such as a patient's smartwatch or mobile device.
"Human performance is unlikely to change materially over time. But machines will progressively outperform humans for various narrow tasks," Topol writes. "To take humans to the next level, we need to up our humanist qualities, that which will always differentiate us from machines." He calls deep learning's potential to support medical empathy and outcomes "deep empathy."
A humane pairing
Busywork and routine labor so severely cut into physician schedules that Danielle Ofri, an associate professor of medicine at New York University School of Medicine, has suggested imposing fines on hospitals that detract too much from patient face-time.
As the National Bureau of Economic Research survey suggests, health care is a field where literally every minute counts.
"Most importantly ... when people are sick, they need empathy," Topol told Big Think in an interview. "They need the person who is their doctor to be with them, to understand what they're going through, because being in pain and being sick is the loneliest thing in the world. And if you don't have a doctor that is empathic, that is the worst-case scenario. We've got to get that back."
But Topol indicates a caveat: Implementing AI in health care just as an efficiency tool would counteract potential gains in doctor-patient relationships.
Michael Dowling agrees. As he told Big Think in an interview: "A lot of publicity has been given to a lot of these [big tech] players. But the core of the care being delivered to people who are very sick is still being done at hospitals and doctors' and ambulatory sites."
And that core must be building a humane — and, indeed, human — doctor-patient relationship.
The meteorites suggest astronomers may have small, early planets wrong.
- A group of meteorites that have come down all over the Earth have something in common.
- They all come from one early-universe baby planet, or planetesimal.
- That planetesimal was apparently not what astronomers expected.
Before planets formed, astronomers believe, there were lots of mini-planets, or planetesimals, many of which eventually broke apart — they're believed to be the source of meteorites that strike Earth. Perhaps surprisingly, a group of meteorites all around the globe come from the very same planetesimal. Not only is that a bit weird, but the evidence suggests that this former baby planet was not what scientists thought a planetesimal could be.
The research, "Meteorite evidence for partial differentiation and protracted accretion of planetesimals," is published in ScienceAdvances. The research was partially funded by NASA.
Image source: Maria Starovoytova/Shutterstock
Some things are pretty much known about planetesimals. First, it's believed that they formed out of the swirling mass of gas and dust that was our universe roughly 4.5 billion years ago. As the universe cooled, bits began to crash into each other, forming these small bodies. It's been thought that they formed quickly as these things go — in less than a few million years.
Early planetesimals, forming in the first 1.5 billion years of our solar system, would have pulled in radiogenic materials from the hot universe. This material gave off heat as it decayed, and so the cosmic rubble comprising these planetesimals was melted into a relatively homogeneous achondritic mass. Radiogenic materials would less available to planetesimals formed later, and their rubble, though merged into a planetesimal, would be unmelted, or chondritic.
There may have been planetesimals that formed in the middle period, between early and late. The study notes, "This could have resulted in partially differentiated internal structures, with individual bodies containing iron cores, achondritic silicate mantles, and chondritic crusts." However, there's been little evidence of such "intermediate" planetesimals.
Until now, it's been basically a binary proposition: melted or unmelted. Which gets us to the family of meteorites.
Image source: Carl Agee, Institute of Meteoritics, University of New Mexico/MIT News
When meteorites are found and studied, the type of planetesimal from which they came is usually clear: melted or unmelted. Not so a family of meteorites called the "IIE irons." (IIE is their chemical type.)
As study co-author Benjamin Weiss of MIT's Department of Earth, Atmospheric, and Planetary Sciences (EAPS) explains, "These IIE irons are oddball meteorites. They show both evidence of being from primordial objects that never melted, and also evidence for coming from a body that's completely or at least substantially melted. We haven't known where to put them, and that's what made us zero in on them."
Researchers had previously established that all of these IIE iron outliers — which themselves can be either achondritic or chondritic — came from the same planetesimal, and that raises some intriguing questions.
As study lead author Clara Maurel, a grad student at EAPS, puts it, "This is one example of a planetesimal that must have had melted and unmelted layers." Did that baby planet perhaps have a solid crust over a liquid mantle? "[The IIE irons encourage] searches for more evidence of composite planetary structures," she says. "Understanding the full spectrum of structures, from nonmelted to fully melted, is key to deciphering how planetesimals formed in the early solar system."
Back to the planetesimal
Image source: Maurel, et al
One particularly interesting question was this, says Maurel: "Did this object melt enough that material sank to the center and formed a metallic core like that of the Earth? That was the missing piece to the story of these meteorites."
If that was the case, the scientists reasoned, mightn't such a core generate a magnetic field in the same way that Earth's core does? Some minerals in the planetesimal might have become oriented in the direction of the field, similarly to the way a compass works here. And if all that's the case, those same minerals in the IIE irons might still retain that orientation.
The researchers acquired two of the IIE iron meteorites, named Colomera and Techado, in which they detected iron-nickel minerals known for their ability to retain magnetic properties.
The team took their meteorites to the Lawrence Berkeley National Laboratory for analysis using the lab's Advanced Light Source that can detect minerals' magnetic direction using X-rays that interact with their grains.
The electrons in both IIE irons were pointed in the same direction, providing additional confirmation of their common source and suggesting their planetesimal indeed had a magnetic field, and it roughly equivalent in size to the Earth's.
The simplest explanation for the effect was that the planetesimal had a liquid metallic core that would have been a minimum of tens of kilometers wide. This implication suggests that previous assumptions regarding the speedy formation of planetesimals is, at least in the case of this one, wrong. This planetesimal must have formed over the course of several million years.
Back to the IIE irons
Colomera and Techado roughly agree on their planetesimal's cooling pattern.
Image source: Maurel, et al
All of this got the researchers wondering where in this surprisingly complex planetesimal the meteorites might've come from. They partnered with scientists from the University of Chicago to develop models of how this all might've gone down.
Maurel's team came to suspect that after the planetesimal cooled down and imprinted the magnetic field on the minerals, collisions with other bodies tore them away. She hypothesizes, "As the body cools, the meteorites in these pockets will imprint this magnetic field in their minerals. At some point, the magnetic field will decay, but the imprint will remain. Later on, this body is going to undergo a lot of other collisions until the ultimate collisions that will place these meteorites on Earth's trajectory."
It's impossible to know for now whether the planetesimal that produced the IIR irons was unusual, or if its history is typical for planetesimals. If so, the simple melted/unmelted dichotomy needs to be reconsidered.
"Most bodies in the asteroid belt appear unmelted on their surface. If we're eventually able to see inside asteroids," says Weiss, "we might test this idea. Maybe some asteroids are melted inside, and bodies like this planetesimal are actually common."
The planet is making a lot less noise during lockdown.
- A team of researchers found that Earth's vibrations were down 50 percent between March and May.
- This is the quietest period of human-generated seismic noise in recorded history.
- The researchers believe this helps distinguish between natural vibrations and human-created vibrations.
Earth is quieter as coronavirus lockdowns reduce seismic vibration<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="cc871d5d88a79ecc6605ce488c26a7c1"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/_yFF2MziwPA?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The team investigated seismic data from a global network of 268 stations spread out across 117 countries. As lockdown measures in different regions began, they tracked the drop in vibrations. Singapore and New York City recorded some of the biggest drops, though even Germany's Black Forest—famous for its association with the Brothers Grimm fairy tales—went quieter than usual.</p><p>The researchers also relied on citizen-owned seismometers in Cornwall and Boston, which recorded a 20 percent reduction from relatively quiet stretches in these college towns, such as school holidays. </p><p>The environmental impact of lockdown has been dramatic. Indian skylines are notoriously grey. This <a href="https://www.axios.com/coronavirus-lockdown-pollution-drops-india-156b4f1d-160b-44d9-885a-148960b9e469.html" target="_blank">collection of photos</a> shows how quickly nature recovers when humans limit travel and industry. Such photographs also make you wonder why we cannot control emissions to begin with, now that we know the stakes. </p><p>Lead author, Dr Thomas Lecocq, says their research could help seismologists suss out the difference between human-created vibrations and natural vibrations, potentially resulting in longer lead times when natural disasters are set to strike. </p><p style="margin-left: 20px;">"With increasing urbanisation and growing global populations, more people will be living in geologically hazardous areas. It will therefore become more important than ever to differentiate between natural and human-caused noise so that we can 'listen in' and better monitor the ground movements beneath our feet. This study could help to kick-start this new field of study."</p>
Stray puppies play in an abandoned, partially-completed cooling tower inside the exclusion zone at the Chernobyl nuclear power plant on August 18, 2017 near Chornobyl, Ukraine.
Photo by Sean Gallup/Getty Images<p>The Earth is much stronger than us; humans are its products. In his 2007 book, <em>The World Without Us</em>, Alan Weisman details just how quickly nature recovers from our insults. Chernobyl offers a <a href="http://www.bbc.com/earth/story/20160421-the-chernobyl-exclusion-zone-is-arguably-a-nature-reserve" target="_blank">real-world example</a>, while <a href="https://www.scientificamerican.com/article/even-if-injection-of-fracking-wastewater-stops-quakes-wont/" target="_blank">earthquakes caused by fracking-related wastewater injection</a> in Oklahoma are evidence of how much damage human "vibrations" cause.</p><p>Weisman's poetic homage imagines a symbiotic relationship with nature. This relationship depends on our cooperation, however. Weisman knows we aren't long for this world, nor is this world long for this universe: in just five billion years, give or take, Earth will implode. We all live on borrowed time. How we live during that time defines our character. </p><p>While he strikes a hopeful tone, Weisman knows nature will eventually have her way with us.</p><p style="margin-left: 20px;">"After we're gone, nature's revenge for our smug, mechanized superiority arrives waterborne. It starts with wood-frame construction, the most widely used residential building technique in the developed world. It begins on the roof, probably asphalt, or slate shingle, warranted to last two or three decades—but that warranty doesn't count around the chimney, where the first leak occurs." </p><p>The play-by-play of our demise continues, though Weisman offers plenty of proactive advice. The question is, will we be able to live up to it? Sadly, nothing in modern society hints at the possibility. </p><p>The only way we seem willing to pause our relentless pursuit of "progress" is when we're forced to do so, as in the current pandemic. The results, as the team in Belgium shows, are measurable. Whether or not we heed the call to slow our impact remains to be seen. Given precedent, it's unlikely, though as Weisman concludes, one can always dream. </p><p>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
A recent analysis of a 76-million-year-old Centrosaurus apertus fibula confirmed that dinosaurs suffered from cancer, too.
- The fibula was originally discovered in 1989, though at the time scientists believed the damaged bone had been fractured.
- After reanalyzing the bone, and comparing it with fibulas from a human and another dinosaur, a team of scientists confirmed that the dinosaur suffered from the bone cancer osteosarcoma.
- The study shows how modern techniques can help scientists learn about the ancient origins of diseases.
Centrosaurus apertus fibula
Royal Ontario Museum<p>In the recent study, the team used a combination of techniques to analyze the fibula, including taking CT scans, casting the bone and studying thin slices of it under a microscope. The analysis suggested that the dinosaur likely suffered from osteosarcoma, a type of bone cancer that affects modern humans, typically young adults.</p><p>For further evidence, the team compared the damaged fibula to a healthy fibula from a dinosaur of the same species, and also to a fibula that belonged to a 19-year-old human who suffered from osteosarcoma. Both comparisons supported the osteosarcoma diagnosis.</p>
Evans et al.<p style="margin-left: 20px;">"The shin bone shows aggressive cancer at an advanced stage," Evans said in a <a href="https://www.rom.on.ca/en/about-us/newsroom/press-releases/rare-malignant-cancer-diagnosed-in-a-dinosaur" target="_blank">press release</a>. "The cancer would have had crippling effects on the individual and made it very vulnerable to the formidable tyrannosaur predators of the time."</p><p style="margin-left: 20px;">"The fact that this plant-eating dinosaur lived in a large, protective herd may have allowed it to survive longer than it normally would have with such a devastating disease."</p><p>The fossilized fibula was originally unearthed in a bonebed alongside the remains of dozens of other <em>Centrosaurus </em><em>apertus</em>, suggesting the dinosaur didn't die from cancer, but from a flood that swept it away with its herd.</p>
Dinosaur fibula; the tumor mass is depicted in yellow.
Royal Ontario Museum/McMaster University<p>The new study highlights how modern techniques can help scientists learn more about the evolutionary origins of modern diseases, like cancer. It also shows that dinosaurs suffered through some of the same terrestrial afflictions humans face today.</p><p style="margin-left: 20px;">"Dinosaurs can seem like mythical creatures, but they were living, breathing animals that suffered through horrible injuries and diseases," Evans said, "and this discovery certainly makes them more real and helps bring them to life in that respect."</p>
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