Broad Expectant Dreams and Iron Wills

Our vision for health care technology includes a steadfast determination to use AI to augment human intelligence — not contribute to a dystopian future some fear is already upon us.

By Paul Cerrato, MA, senior research analyst and communications specialist, Mayo Clinic Platform, and John Halamka, M.D., president, Mayo Clinic Platform.

In a soon-to-be published article in BMJ Health and Care Informatics, we point out that there have always been pivotal moments in the history of technology during which enthusiasm for a specific innovation outpaces our ability to dispassionately evaluate its strengths and weaknesses. We are at that moment in the history of machine learning and its application in patient care. As clinicians and health care executives attempt to determine the role of machine learning-enhanced algorithms in the diagnosis, treatment and prognosis of disease, many have raised this concern, questioning both the equity and accuracy of these sophisticated digital tools. With this challenge in mind, we created a national coalition of the renowned AI experts from government, academia and industry to author guidelines and guardrails for the transparency, explainability and testability of algorithms. 

While this initiative must move forward, we also need to appreciate the human side of the equation, including patient preferences about the use of AI and the potential harm that overreliance on technology can bring about, including the subtle effects that such reliance may have on the human psyche.   

During a recent phone conversation with historian Yuval Noah Harari, Ph.D., author of Sapiens: A Brief History of Humankind, we touched on several of these concerns. Dr Harari is worried that the pace of technology is greater than our ability to adapt to it, and what that tells us about the future of humankind. He states that “Today, the 4-billion-year-old regime of natural selection is facing a completely different challenge. In laboratories throughout the world, scientists are engineering living beings. They break the laws of natural selection with impunity, unbridled even by an organism’s original characteristics.” Similarly, he posits that “The field of artificial intelligence is seeking to create a new kind of intelligence based solely on the binary script of computers. Science fiction movies such as The Matrix and The Terminator tell of a day when binary script throws off the yoke of humanity. When humans try to gain control of the rebellious script, it responds by attempting to wipe out the human race.”

While many thought leaders doubt the likelihood of this dystopian future, Dr. Harari has raised more immediate concerns that need to be addressed. He points out that AI-enabled algorithms can solve many common problems much faster than humans, which only encourages us to simply give up our decision-making ability and let computers do all the heavy lifting. In this scenario, homo sapiens give up their role as agents of change because it’s the path of least resistance. Afterall, why manually analyze the complexities of making a medical diagnosis when there’s an algorithm that can make the decision for you — a temptation that a growing number of overworked clinicians are giving in to, ignoring their own cognitive skills, patient preferences and the socioeconomic consequences of the decision.

A closer look at everyday tasks suggests Dr. Harari may be right about the risks of surrendering our cognitive agency to a computer. Remember how skilled you once were at doing multiplication tables in your head. As we rely more heavily on calculators for virtually all of this arithmetic, most of us are losing that mental skill. The same can be said about our reliance on computer-generated spell checkers and a variety of other digital conveniences. Even more disturbing is the possibility that AI, machine learning and forms of binary data might be used to manipulate society and feed the ambitions of autocrats, rather than serve as tools to enhance human decision making and feed our dreams.

Over the decades, dreams have often found their way into popular culture. The author Philip Dick references them in Do Androids Dream of Electric Sheep? when he describes a post-apocalyptic, technological world in which blade runners tracked down dangerous, life-like robots. Contrast that to the lyrics of one singer/songwriter who described his forefathers’ broad expectant dreams of a more positive future for himself and his family as they moved from Scandinavia to the United States. Similarly, we envision a future in which health care technology is coupled with human intelligence, respect for others, integrity, and compassion to create a better world for our patients and ourselves. Granted, it will require an iron will to turn this dream into an everyday reality, but it will happen!

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