2018: The medical odyssey

It's been 50 years since the release of 2001: The Space Odyssey when HAL 9000 uttered those famous words: "I'm sorry,Dave, I'm afraid I can't do that". There is a reason he sounds like a therapist.

Have you wondered what Alexa and Siri are going to do with all that stuff you are telling them?

Now we are embarked on the Medical Odyssey: 2018, where robots, AI , machine learning and all the rest threaten to assist, if not control, medical decision making and sick care.

Of course, Man v Machine, is a very old story, and, in it's most famous form to English speaking readers,, dates back 200 years. Frankenstein; or, The Modern Prometheus is a novel written by English author Mary Shelley (1797–1851) that tells the story of Victor Frankenstein, a young scientist who creates a grotesque but sapient creature in an unorthodox scientific experiment. Shelley started writing the story when she was 18, and the first edition of the novel was published anonymously in London on 1 January 1818, when she was 20. Her name first appeared on the second edition, published in France in 1823.

Here is the history behind Galvanism.

Now people are predicting that AGI (Artificial General Intelligence) will likely arrive sometime in the 2020s or 2030s due to the Law of Accelerating Returns. The next step is ASI: Artificial Super Intelligence.

One thing that might delay AGI is the fact that there is no Moore's Law in medical care, nor given the incentives to keep things just like they are, is it likely to change soon.

Despite advances in computer technology and other parts of the 4th industrial revolution, there are many barriers to overcome before machine learning crosses the chasm. Here are some things you should know about dissemination and implementation, and innovation diffusion basics.

There are three basic categories of barriers: 1) technical, 2) human factors, and 3) environmental, including legal, regulatory, ethical, political, societal and economic determinants.

A recent Deloitte report highlighted the technical barriers. Here are the vectors of progress:

Human factors, like how and whether doctors will use AI technologies, can be reduced to the ABCDEs of technology adoption. Research suggests the reasons more ideas from open innovation aren’t being adopted are political and cultural, not technical. Multiple gatekeepers, skepticism regarding anything “not invented here,” and turf wars all hold back adoption.

Attitudes: While the evidence may point one way, there is an attitude about whether the evidence pertains to a particular patient or is a reflection of a general bias against “cook book medicine”

Biased Behavior: We’re all creatures of habit and they are hard to change. Particularly for surgeons, the switching costs of adopting a new technology and running the risk of exposure to complications, lawsuits and hassles simply isn’t worth the effort.

Cognition: Doctors may be unaware of a changing standard, guideline or recommendation, given the enormous amount of information produced on a daily basis, or might have an incomplete understanding of the literature. Some may simply feel the guidelines are wrong or don not apply to a particular patient or clinical situation and just reject them outright.

Denial: Doctors sometimes deny that their results are suboptimal and in need of improvement, based on “the last case”. More commonly, they are unwilling or unable to track short term and long term outcomes to see if their results conform to standards.

Emotions: Perhaps the strongest motivator, fear of reprisals or malpractice suits, greed driving the use of inappropriate technologies that drive revenue, the need for peer acceptance to “do what everyone else is doing” or ego driving the opposite need to be on the cutting edge and winning the medical technology arms race or create a perceived marketing competitive advantage.

Finally. the parts of the environmental SWOT analysis are more wild cards in the game.

Excuse me, but I need to check with my medical assistant.

I'm sorry, doctor, but I'm afraid I can't do that.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs