How A.I. will liberate doctors from keyboards and basements

Giving A.I. a role in health care can help both doctors and patients.

ERIC TOPOL: Technology can't enhance humanity, that it's depersonalizing, that it's going to detract. I actually think it's just the opposite in medicine, because if we can outsource to machines and technology, we can restore the human bond, which has been eroding for decades. So what I mean by deep medicine is really a three part story: The first is what we call deep phenotyping. And that is a very intensive, comprehensive understanding of each person at every level. So that's the idea of knowing all about their biology, not just their genome, their microbiome, and all the things the different layers of the person, but also their physiology through sensors, their anatomy through scans, their environment through sensors as well, and then traditional data.

So that's deep phenotyping. Now, no human being can process all that data, because it's dynamic, and it's actually quite large to deal with. That's why we have deep learning. That's a type of artificial intelligence which takes all of these inputs and it really crystallizes, distills it all. And that gets us to deep empathy. And the deep empathy is when we have this outsourcing to machines and algorithms. We have all of this data, and we now can get back to the human side of this connection. Well, where deep learning works the best today is with images. And so medical images are especially ideal because it turns out that radiologists miss things in more than 30 percent of scans that are done today. So in order to not miss these things, you can train machines to have vision better than humans. The difference here is that the radiologists can put more context in it, but the machines, they're very complementary.

They can pick up things that radiologists wouldn't see, like a nodule on a chest X-ray or an abnormality on an MRA that would be missed because radiologists read 50 to 100 scans per day. There's many times that we just don't see things. So when you bring the two together, you get the best economy. It doesn't mean we're going to eliminate the need for radiologists. It's going to make the accuracy and the speed much better. And what I project is that we're going to see a time when radiologists move out of the basement in the dark and actually connect with patients, because they want to see patients. They want to be able to share their expertise, and they don't have a vested interest about doing an operation or procedure. They just want to report what they find and communicate that. So I think we're going to see a reshaping of radiology because of this remarkable performance enhancement through AI.

There's a lot of use of AI in the hospital setting, because when patients come in, and trying to predict what's going to happen, we're not so good at that generally in medicine. So almost everything you can think of there have been algorithms tested. One example is sepsis. So what's going to happen? Does the person have sepsis, a serious infection? Are they going to decompensate and possibly die from sepsis? We're not so great at that, it turns out, by algorithm. But what we have learned is that we can use the same machine vision, whether it's nurses, doctors, people who are circulating in a room of a hospital, to see whether or not they're doing appropriate handwashing, and to set off a signal that, no, it wasn't done and needs to be done. So there's lots of things about patient safety with machine vision.

So for example, preventing falls, seeing that someone's walking is unsteady. Another great example is in the intensive care unit. Some people can pull out their breathing tube, and now we have machine vision that can monitor that so that we don't have a nurse that has to be in the room all of the time. Well, the biggest thing that we need down is the gift of time. Rather than to have this AI support? And it's at two levels. So if you can get rid of keyboards, or liberate from keyboards, reestablish face-to-face eye contact, that's a good start. It's going to happen. But also the patients now can have algorithms generating their own data, whether it's their heart rhythm, or their skin rash, or a possible urinary tract infection, they can get that diagnosed now by an algorithm. That frees up, again, doctors to take care of more serious matters, and that's what is so exciting if we grab this opportunity, which I don't know if we'll see it again for generations, if ever, because this technology offers that potential. But it won't happen by accident.

If we're not taking on this, really, activism to promote the gift of time and turning inward, as the medical community, if we don't do this, we're going to see even worse squeeze than we have now. This is an opportunity that we just can't miss.

  • Machines can help doctors by spotting abnormalities in X-rays or MRA scans that the physicians themselves may have missed.
  • A.I. can also help physicians by analyzing data and, through the use of algorithms, produce possible diagnoses.
  • The freed up time, as doctors make their rounds, can help physicians establish better connections with their patients, which in turn can lead to better treatment plans.

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Image source: Christian Zimmerman/USGS/Big Think
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The Barry Glacier gives its name to Alaska's Barry Arm Fjord, and a new open letter forecasts trouble ahead.

Thanks to global warming, the glacier has been retreating, so far removing two-thirds of its support for a steep mile-long slope, or scarp, containing perhaps 500 million cubic meters of material. (Think the Hoover Dam times several hundred.) The slope has been moving slowly since 1957, but scientists say it's become an avalanche waiting to happen, maybe within the next year, and likely within 20. When it does come crashing down into the fjord, it could set in motion a frightening tsunami overwhelming the fjord's normally peaceful waters .

"It could happen anytime, but the risk just goes way up as this glacier recedes," says hydrologist Anna Liljedahl of Woods Hole, one of the signatories to the letter.

The Barry Arm Fjord

Camping on the fjord's Black Sand Beach

Image source: Matt Zimmerman

The Barry Arm Fjord is a stretch of water between the Harriman Fjord and the Port Wills Fjord, located at the northwest corner of the well-known Prince William Sound. It's a beautiful area, home to a few hundred people supporting the local fishing industry, and it's also a popular destination for tourists — its Black Sand Beach is one of Alaska's most scenic — and cruise ships.

Not Alaska’s first watery rodeo, but likely the biggest

Image source: whrc.org

There have been at least two similar events in the state's recent history, though not on such a massive scale. On July 9, 1958, an earthquake nearby caused 40 million cubic yards of rock to suddenly slide 2,000 feet down into Lituya Bay, producing a tsunami whose peak waves reportedly reached 1,720 feet in height. By the time the wall of water reached the mouth of the bay, it was still 75 feet high. At Taan Fjord in 2015, a landslide caused a tsunami that crested at 600 feet. Both of these events thankfully occurred in sparsely populated areas, so few fatalities occurred.

The Barry Arm event will be larger than either of these by far.

"This is an enormous slope — the mass that could fail weighs over a billion tonnes," said geologist Dave Petley, speaking to Earther. "The internal structure of that rock mass, which will determine whether it collapses, is very complex. At the moment we don't know enough about it to be able to forecast its future behavior."

Outside of Alaska, on the west coast of Greenland, a landslide-produced tsunami towered 300 feet high, obliterating a fishing village in its path.

What the letter predicts for Barry Arm Fjord

Moving slowly at first...

Image source: whrc.org

"The effects would be especially severe near where the landslide enters the water at the head of Barry Arm. Additionally, areas of shallow water, or low-lying land near the shore, would be in danger even further from the source. A minor failure may not produce significant impacts beyond the inner parts of the fiord, while a complete failure could be destructive throughout Barry Arm, Harriman Fiord, and parts of Port Wells. Our initial results show complex impacts further from the landslide than Barry Arm, with over 30 foot waves in some distant bays, including Whittier."

The discovery of the impeding landslide began with an observation by the sister of geologist Hig Higman of Ground Truth, an organization in Seldovia, Alaska. Artist Valisa Higman was vacationing in the area and sent her brother some photos of worrying fractures she noticed in the slope, taken while she was on a boat cruising the fjord.

Higman confirmed his sister's hunch via available satellite imagery and, digging deeper, found that between 2009 and 2015 the slope had moved 600 feet downhill, leaving a prominent scar.

Ohio State's Chunli Dai unearthed a connection between the movement and the receding of the Barry Glacier. Comparison of the Barry Arm slope with other similar areas, combined with computer modeling of the possible resulting tsunamis, led to the publication of the group's letter.

While the full group of signatories from 14 organizations and institutions has only been working on the situation for a month, the implications were immediately clear. The signers include experts from Ohio State University, the University of Southern California, and the Anchorage and Fairbanks campuses of the University of Alaska.

Once informed of the open letter's contents, the Alaska's Department of Natural Resources immediately released a warning that "an increasingly likely landslide could generate a wave with devastating effects on fishermen and recreationalists."

How do you prepare for something like this?

Image source: whrc.org

The obvious question is what can be done to prepare for the landslide and tsunami? For one thing, there's more to understand about the upcoming event, and the researchers lay out their plan in the letter:

"To inform and refine hazard mitigation efforts, we would like to pursue several lines of investigation: Detect changes in the slope that might forewarn of a landslide, better understand what could trigger a landslide, and refine tsunami model projections. By mapping the landslide and nearby terrain, both above and below sea level, we can more accurately determine the basic physical dimensions of the landslide. This can be paired with GPS and seismic measurements made over time to see how the slope responds to changes in the glacier and to events like rainstorms and earthquakes. Field and satellite data can support near-real time hazard monitoring, while computer models of landslide and tsunami scenarios can help identify specific places that are most at risk."

In the letter, the authors reached out to those living in and visiting the area, asking, "What specific questions are most important to you?" and "What could be done to reduce the danger to people who want to visit or work in Barry Arm?" They also invited locals to let them know about any changes, including even small rock-falls and landslides.

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