- Help Support Uncommon Sense — yes, $5 helps!
- Notice that the sources which follow are both recent, and in multiple countries.
- Shortages in the Healthcare Profession: “New Research Shows Increasing Physician Shortages in Both Primary and Specialty Care” (Association of American Medical Colleges, April 2018) and “Global Health Workforce Shortage to Reach 12.9 Million in Coming Decades” (WHO, November 2013)
- Oregon Tetanus Case: “Notes from the Field: Tetanus in an Unvaccinated Child — Oregon, 2017” (Centers for Disease Control, March 2019)
- AI in Lung Disease: “AI Improves Doctors’ Ability to Correctly Interpret Tests and Diagnose Lung Disease” (Medical Xpress, September 2018)
- AI in Brain Tumors: “China Focus: AI Beats Human Doctors in Neuroimaging Recognition Contest” (Xinhua, June 2018)
- Diagnosing by Voice: “Looking to Technology to Avoid Doctors’ Offices and Emergency Rooms” (New York Times, February 2019)
- EMPaSchiz: “Towards Artificial Intelligence in Mental Health by Improving Schizophrenia Prediction with Multiple Brain Parcellation Ensemble-learning” (Nature, January 2019)
- New AI Research Centers in the U.K.: “How Artificial Intelligence Is Revolutionising Medical Diagnostics” (The Engineer, February 2019)
- I thought there should also be a source for “there are six different outbreaks of measles” currently in the U.S., and found out I was wrong! There are now eleven — in California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New Jersey, New York, Oregon, Texas, and Washington. (CDC, February 28, 2019 [which page is subject to periodic updates].)
- No episode next week: I’ll be on travel.
Driving home from the theater with friends Friday night, my wife started a conversation about how difficult it is for modern medicine to diagnose thyroid problems. Both she and her friend in the back seat have that to differing degrees, and neither one of them has received a real diagnosis. And then I, and the friend’s husband, widened it out from there.
Welcome to Uncommon Sense, I’m Randy Cassingham.
Diagnosis is the first step toward treatment, or even a cure, for any disease, but getting it right takes expertise, experience, and something doctors have precious little of: time. So unless the problem is objectively obvious like, say, a heart attack where the myocardial infarction can be located, measured, and quickly treated with well-established protocols, then it gets complicated fast. How about chronic pain, gut issues, alteration of mental status, and, well, thyroid problems?
Those are difficult at best to sort through, and therefore awfully expensive to fully diagnose in an era of a shortage of the very professionals we need to help us. The Association of American Medical Colleges estimates that by 2030, the United States will have a shortage of 121,000 doctors. And it’s nothing new: in 2013, the World Health Organization estimated that “the world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million.” Again, that was 2013. Now, we’re short somewhere between 7.2 and 12.9 million healthcare workers: not just doctors, but nurses and the technicians that run the machines to give the doctors the data they base their diagnoses on!
“Our ability to do things, for example, cure a headache or treat anxiety,” says Dr. Alex John London, the director of the Center for Ethics and Policy at Carnegie Mellon University, “often comes before our ability to explain why what we do works.” So doctors often end up treating symptoms without any real clue as to what the underlying problem is. Oh, and sorry: your 8 minutes of face to face doctor time is over. If you have more questions, make another appointment on your way out. Well of course we have more questions! But that doesn’t mean the doctors have answers for us.
And then we have groups trying to throw doubt on even well-established science. Do vaccines cause autism? No — but the online hype over a tiny minorities’ objections give parents pause: what’s the best thing for my child? So going online to “Dr. Google” brings all sorts of conflicting opinions, with authoritative sources mixed with ridiculous conspiracy theories given equal weight, without context to make clear what the consensus really is: that the risk from vaccines is so tiny as to be ignored compared to the absolutely clear harm that the diseases they prevent cause.
As I was putting this together, one of the news stories I saw was about a 6-year-old boy in Oregon who had the misfortune to be born to anti-vax parents. As little boys do, while out playing he got a cut on his forehead. The parents stitched up the wound themselves, but he didn’t get the basic treatment that’s totally standard in such cases: he didn’t get a tetanus shot. When I was around his age, I stepped on an old nail, and my parents took me straight to the doctor not because of the inconsequential wound, but to get the shot because something dirty had been shoved an inch into my body.
Well, the Oregon boy didn’t get it. Several days later he got something else instead: tetanus. It started with him being unable to open his mouth because his jaw was clenched tight — the old name for tetanus is “lockjaw”. He then had more general muscle spasms, his neck and back arching painfully. At least his parents called 911! Thankfully, the medics who responded recognized how serious it was and called for a helicopter to take him straight to a pediatric hospital. The poor kid was having trouble breathing because yes, even his respiratory muscles were affected. Thanks to the medics’ quick action, the boy was saved — barely. His body temperature, blood pressure, and heart rate went wild, and he was admitted to intensive care.
Only on day 44 was he able to be taken off a respirator, and he was able to take his first sips of water. On day 47 he graduated out of intensive care. On day 50 he was finally able to walk a little — 20 whole steps. On day 57 he graduated to a rehab center, and finally got to go back home to his so-called loving parents 17 days after that. By the way: total costs for the hospital care alone: $811,929. That doesn’t include the air ambulance, rehab, or any follow-up care, so let’s round it out to about a million dollars, most of which will be on the backs of others.
And you know what? Reports say his parents still refused to let him have any vaccines — not even a tetanus shot. No wonder the really smart and aware kids are starting to go behind their obliviot parents’ backs to get vaccinations on their own!
The tetanus vaccine was developed in 1921, and since then the number of tetanus cases has dropped to nearly none. This little boy’s illness was the first case of tetanus in Oregon in more than 30 years. Why? Because parents and doctors know how bad tetanus is and most kids get their shots so they don’t have to go through this kind of agony, or worse. These days, a lot of parents have never heard of, let alone seen, tetanus — or measles, or polio, or diptheria, or Rubella, or …well, the list goes on. They don’t know the terror their ancestors had to go through. From 1915 through 1997, the infant mortality rate dropped more than 90 percent.
But what does that really mean? If turn-of-the-century infant mortality rates were not reduced, then in 1997, about half a million children born alive in the United States would have died in their first year. Instead, due to all causes, that number was dropped to 28,045 infant deaths. That’s huge! The problem? The number is going to go up again if the anti-vaccine movement continues: as I speak there are six different outbreaks of measles, a disease that was essentially eradicated in the U.S. around the year 2000.
But this is a tangent: luckily, that tetanus diagnosis was pretty quick and easy. How are we going to improve diagnosis in general? More and more and more studies are coming out with information, new treatments being figured out and old ones discarded as inadequate or worse. Even if there were enough doctors, they couldn’t possibly even glance at it all, let alone remember the details of what they might see in their careers.
If only there was some kind of technology that could somehow store every single known fact about every known disease and treatment, and keep a running tab on what’s working for, say, a brain tumor in a male Asian 9-year-old who has a prior history of leukemia that was treated with a bone marrow transplant. Because that will almost surely be different from the brain tumor treatment for a female Caucasian 17-year-old with a history of appendicitis!
You know, like a computer! And that’s what I said in the car when Tim was talking about how he and his wife are struggling to diagnose her thyroid problem. He’s been driving her from doctor to doctor around the region, trying to get an answer. And a treatment. If only there was a computer system to help, if only there was a comprehensive data base available.
It’s difficult to sort the hype from the promise of artificial intelligence, so maybe the first ambiguous problem that should be put on A.I. …is to sort out the hype from the promise in the A.I. field!
But seriously, why not have computers do the jobs that require enormous amount of data processing and sorting? Better yet, they can take care of more than one patient at a time. A lot more. And we’re at the level now to do it. Let me give you some of the early examples.
The Laboratory for Respiratory Diseases at the Catholic University of Leuven, Belgium, used quality data to train a computer to read pulmonary test results. They found that the system was more consistent and accurate in interpreting the tests, and making the diagnoses, than lung specialists. How much more accurate? Twice as good as their team of 120 pulmonologists from 16 hospitals.
In China, the Capital Medical University in Beijing built a system to diagnose brain tumors. They found it to be 87 percent accurate. Yeah, I know you were hoping for 99.9 percent accuracy, but I’d rather have the computer on my side: they compared the machine to a “team of 15 senior doctors,” whose accuracy was just 66 percent. Even better: it took the computer just 15 minutes to go through 225 cases.
A really interesting system being worked on right now uses A.I. to diagnose illnesses, like Alzheimer’s, heart disease, and sleep apnea from …how patients speak! It sorts through pitch, pauses, breathing, and hundreds of other factors. Rich Ross, health care research director at the research firm Gartner, explains, “The manner in which we speak and the word choices we make can be evaluated to accurately detect a growing list of clinical conditions.”
Which makes me think of people with mental conditions. There’s a lot of overlap, causing mixed symptoms. What treatments would help, or harm, the patient? We’re making strides there, too: computers can now diagnose schizophrenia with high accuracy. The system, called “EMPaSchiz”, or “Ensemble algorithm with Multiple Parcellations for Schizophrenia prediction” (say that three times fast!), is also 87 percent accurate.
All of that is surely just a start, and if you think about it, all the complexities just mentioned are pretty much true for any body system: overlap, mixed symptoms, differing treatment regimens. So isn’t it pretty much just Uncommon Sense to start working toward a more comprehensive A.I. solution to diagnosis?
Others think so: “You could look at almost any area of healthcare and see that advanced data science has an enormous amount to offer,” says Sir Mark Walport, chief executive of U.K. Research and Innovation, or UKRI. “This technology has huge potential right across the world of healthcare.” And what is the UKRI? The British government saw such promise in this field that they’re spending 50 million pounds — really, just a trifling sum considering the enormity of modern medical care — to establish five new research centers to get these systems up and running. “The potential here,” Wolpert says, “is to have a computer algorithm assisting humans in what are quite difficult diagnoses.”
How long do you think it will take before that 50 million quid, or about US$65 million, is paid back? My bet: less than a year from the systems going online in regular practice.
Are there worries about A.I. maybe taking over the world and enslaving humanity? To me, that sounds more like human insecurities talking there — doom and gloom science fiction. I consider that a very tiny risk compared to the enormous potential for relieving illness and improving life.
Funny, but that sounds just like vaccines!
In other words, going down this path isn’t just necessary, but smart. It really is Uncommon Sense in action.
The Show Page for this episode, which includes links to my sources, and a place to comment, is at thisistrue.com/podcast24
I’m Randy Cassingham … and I’ll talk at you later.
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