Artificial Intelligence in Medicine: The Stealthy Rise of Engineers

During my medical studies, along with several colleagues, I paid for a homeopathy course. It was led by the personal physician of Mrs. Havlová, the former Czech first lady. I will likely never become a homeopath, but we were all amused by the concept where homeopaths categorize patients into "Bombardiers" and "Whiners". Bombardier is always healthy and experiences even the slightest health fluctuation as a major tragedy, reacting strongly to treatment and any recommendations. On the other hand, the Whiner are perpetually ill and another illness isn’t a surprise to them. I didn't apply this concept much in my practice as it seemed a bit derogatory. But it made me realize that there likely exist various patient phenotypes differing in their approach to life, medicine, and motivations. One such phenotype is the technically minded patient, which I'll simply call the Engineer. When I prescribed antihypertensive therapy to my patients and advised them to occasionally measure at home, the typical patient would bring a few measurements after six months. The Engineer, however, comes with an Excel spreadsheet and 3,758 measurements, pointing out a slight spike on February 5th at 2:30 pm, and asking me what I intend to do about it. For Engineers, there's no such thing as redundant information or data. They only see data and information in their worldview. Nothing is considered redundant to them.

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With the advent of new information technologies in medicine and the development of artificial intelligence (AI), many individuals without a medical background began to dabble in the medical field. One company even refused to hire me for a medical position, justifying their decision by saying that doctors and chefs who talk too much are the worst— doctors about medicine and chefs ?about cooking. For engineers, a patient isn't a suffering individual but a fascinating source of gigabytes or terabytes of data that can easily be monetized. Once, an "engineer" approached me. He had become wealthy and demanded a full-body MRI scan from head to toe. He couldn’t comprehend any objections, especially when he was willing to pay. He wouldn’t be dissuaded by the notion that medicine doesn’t operate that way. We examine patients with a specific purpose, mainly when they have a health issue. This Engineer was a picture of health. Nevertheless, I conducted a comprehensive oncological examination, including biomarkers and fecal occult blood tests, all of which turned out negative. To be sure, I referred him for a colonoscopy, which I assisted with. We found a dysplastic polyp. It was a save on the goal line, as our professor used to say. It's thought-provoking. Had my Engineer waited until the first symptoms appeared, the treatment might not have been as straightforward. And who knows what could've happened? Yet, we often find ourselves making these saves on the goal line, and we lack the time for prevention. Healthcare, due to its overwhelming workload, primarily focuses on diseases, neglecting overall health. And health is a business which Engineers are stealthily seizing.

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I recently attended a lecture by a renowned neurologist and sports doctor, claiming that hypertension or diabetes can be easily cured through diet, weight loss, and exercise. Just no drugs or chemicals. It's all about willpower. He was met with enthusiastic applause. However, he showed case studies that never really happened. He primarily dealt with healthy elite athletes, so this was merely his theory on how general practitioners should treat these diseases. Perhaps you’ve had success with this approach, but from my experience, I only recall two patients who, due to fairly drastic lifestyle changes, completely rid themselves of hypertension medication. When Engineers hear this, everything seems crystal clear to them. They believe that if they measure 200-300 parameters for a patient, the patient, upon seeing the data table, will immediately quit smoking and meticulously jot down their calorie intake.

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Insurances and health providers (led by Engineers), healthcare investors (mostly Engineers), and owners of medical technology companies think similarly. You can probably guess who owns these companies. The engineering approach is transforming medicine: big data analysis, Web3 technologies, and predictive models all seem to have sprouted overnight. When patients were recently asked in which parameters they prefer AI over their GPs, AI won in a purely human discipline – empathy. Patients preferred talking to AI over their (overburdened and understandably frustrated) treating doctors. Maybe the engineering approach to medicine has some merit. For instance, a Czech company, Carebot, has introduced a splendid AI technology that can detect metastases in X-rays better than our inadequately trained eyes. Who wouldn’t welcome consultation for such a severe condition? Especially from someone who operates 24/7 and doesn’t marvel that you might've missed something so obvious which you should know since your medical school years. Unfortunately, we might get so accustomed to this that future generations of doctors won’t function without AI. The generation after them might only know the "engineering medicine".

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What to do? You can't stop progress... Sometimes unfortunately. Perhaps our role will be to ensure that amidst all these technologies, the patient and care for them are not lost. We might be the last generation to see medicine as an art. We’re witnessing the rapid technologization of health, an increase in individual responsibility, and patients' autonomy in medicine. Patients trust the information they find themselves more than that from medical authorities and official institutions. We see a similar trend in banking (cryptocurrencies), tourism (Airbnb), and transportation (Uber). It's called distributed trust. People are more interested in what was once considered elite longevity. According to one Prague clinic specializing in longevity, their most frequent clients are men in their 20s and 30s from the IT sector. Engineers... Hopefully, we’ll outlive them in good health.