Sir Tony Blair popped up on BBC Radio 4’s Today Programme’s 8.10 am slot one day last week, en route to opening a conference of his highly influential think tank. He was full of enthusiasm for Artificial Intelligence (AI). It’s The Next Big Thing. We in the UK are already pioneers. We must grasp this opportunity with both hands. Sir Tony was particularly interested in the application of AI to the running of the National Health Service. We need to digitise all our data and make it available, as an inexhaustible well of resource. He was particularly interested in preventative medicine. Prevention is better than cure. Your genome, for example, might tell you what awaits you. Then you can cut the grim reaper off at the pass. Your laboratory results might lie slightly outwith the quoted “normal” levels. Therefore you must have a “pre-” condition. Treat it now. Big Pharma have sensed this enormous commercial opportunity for quite some time. Drive your cholesterol down as low as you can; drive your blood pressure down as low as you can; take a poly-pill, and treat half a dozen conditions that you don’t actually have.
I suppose this is what politicians, or ex-politicians, do. Finger in the air. See what’s coming round the corner, get on the front foot, and don’t be left behind.
It all reminded me of the digital revolution in health that started around the beginning of the millennium. It was seen as an unstoppable force. The computer infiltrated the consultation room, like a nanny in a horror movie, taking up residence in the family home, to care for the children, apparently all sweetness and light, but in reality a deeply malignant emissary of the devil. Everything was going to run smoothly – I was going to say “like clockwork”, but of course it’s not like clockwork at all. Now, there are 7.5 million people waiting for an outpatient hospital appointment, and that’s just south of the border. People who can afford it elect to go privately. I confess when in practice I would sometimes encourage my patients so to do, or at least I would give them the option, and tell them how it was. The neurologist will see you in eighteen months, or, if you elect to go privately, this afternoon.
You might imagine Sir Tony’s think tank might pause to consider we may have taken a wrong turn. But no. Rather, they are “doubling down”. AI is the next cure-all. Here we go again. Naturally I wrote to The Herald:
Dear Sir,
Artificial Intelligence (AI), according to Sir Demis Hassabis and Sir Tony Blair, “could be one of humanity’s biggest ever inventions” (The Herald, July 10), but I think we should find an alternative name for this entity.
During my 13 years in emergency medicine in New Zealand, the junior doctors went on strike twice, and the emergency department was run by consultants. As a group, they were highly intelligent. They didn’t spend much time perusing data, and their use of investigative technology was spare, and extremely targeted. Instead, they spent a lot of time taking a very careful history from the patient. They never thought algorithmically; they used a combination of knowledge, skill, and wisdom, as captured in the motto of the Royal College of General Practice: cum Scientia caritas. Their approach was not remotely robotic.
On their watch, the recourse to laboratory and imaging diagnostic facilities, and the hospital admission rate, all went down. Medicine, well-practised, has got nothing to do with Big Data. Accurate diagnosis is all about filtering out white noise. AI will no doubt be a very lucrative gravy train for somebody, but it won’t benefit the doctors and nurses, and it certainly won’t benefit the patients.
Sincerely…
For the remainder of the week I perused my daily paper for my letter. But it never appeared. When this happens, I usually try and shrug it off. After all, the newsprint will be wrapping the fish and chips by tea-time. But I cannot deny my disappointment. I have been dismissed as a Luddite. Yesterday’s man.
But I was taught never to practise Blunderbuss Medicine. There is no such thing as a “routine” blood test. You order a test to answer a specific question that has been posed by the patient’s history and examination. The result may or may not help you to make a clinical diagnosis. Making a diagnosis is making a decision, and it has to be clear-cut. There is no such thing as “a touch of diabetes” – much as Big Pharma would like you to think so. You might as well suffer from a touch of pregnancy. Think diagnostically. I call this “the broad brush strokes of medicine”. Example: don’t conclude somebody has pernicious anaemia just because they have a borderline low vitamin B12 level. If the patient is well, that result is perfectly normal. The last time I made a diagnosis of pernicious anaemia, I measured the patient’s B12, and the result came back: zero. But I wax too technical.
If you put the entire population on a spectrum of ill health, if everybody is on the borderline of something, then you effectively kill off the art of diagnosis, and the waiting lists for access to health care can do nothing other than sky-rocket.
By Saturday I had given up on my letter. And the world moves on. Mr Trump took a bullet in the ear. Conspiracy theories abound. Apparently he said to the welter of secret service personnel on top of him, “Where are my shoes? I need my shoes.” I suppose it’s the sort of thing that preoccupies you when you are inches away from death. It remains to be seen whether this is an “inflection point” signalling a return of good manners to public life or, rather, the continuation of a downward spiral.
Sunday was at last a beautiful summer’s day and I found myself amid the rolling hills of Ayrshire, having a delightful lunch with family in The Blair (no relation to Sir Tony as far as I know) in Auchentiber. Then in the evening, it became evident that football, on this occasion, was not coming home. I watched the match. I don’t belong to the “Anyone but England” camp; I supported my good neighbour, particularly because the fans had given the mild-mannered Gareth Southgate such a hard time. I’d heard England were performing below par throughout the competition, but I thought they played very well, even if Spain were the better team. If a Spaniard hadn’t headed the ball off the goal line it might have gone to extra time, thence to penalties. But these are all counterfactuals.
So life goes on. This morning I got my paper as usual and opened the letters page with no great expectation.
I’m in!
jamescalumcampbell 