How AI is transforming the NHS

Ian Sample
The Guardian
Originally posted July 4, 2018

Here is an excerpt:

With artificial intelligence (AI), the painstaking task can be completed in minutes. For the past six months, Jena has used a Microsoft system called InnerEye to mark up scans automatically for prostate cancer patients. Men make up a third of the 2,500 cancer patients his department treats every year. When a scan is done, the images are anonymised, encrypted and sent to the InnerEye program. It outlines the prostate on each image, creates a 3D model, and sends the information back. For prostate cancer, the entire organ is irradiated.

The software learned how to mark up organs and tumours by training on scores of images from past patients that had been seen by experienced consultants. It already saves time for prostate cancer treatment. Brain tumours are next on the list.

Automating the process does more than save time. Because InnerEye trains on images marked up by leading experts, it should perform as well as a top consultant every time. The upshot is that treatment is delivered faster and more precisely. “We know that how well we do the contouring has an impact on the quality of the treatment,” Jena says. “The difference between good and less good treatment is how well we hit the tumour and how well we avoid the healthy tissues.”

The article is here.

Groundhog Day for Medical Artificial Intelligence

Alex John London
The Hastings Report
Originally published May 26, 2018

Abstract

Following a boom in investment and overinflated expectations in the 1980s, artificial intelligence entered a period of retrenchment known as the “AI winter.” With advances in the field of machine learning and the availability of large datasets for training various types of artificial neural networks, AI is in another cycle of halcyon days. Although medicine is particularly recalcitrant to change, applications of AI in health care have professionals in fields like radiology worried about the future of their careers and have the public tittering about the prospect of soulless machines making life‐and‐death decisions. Medicine thus appears to be at an inflection point—a kind of Groundhog Day on which either AI will bring a springtime of improved diagnostic and predictive practices or the shadow of public and professional fear will lead to six more metaphorical weeks of winter in medical AI.

The brief perspective is here.

Can We Reimagine Our Approach To Treating Disease?

Siddhartha Mukherjee
TED Talk
Posted December 22, 2017

When it comes to medicine, one rule of thinking has generally prevailed: Have disease, take pill, kill something. But physician Siddhartha Mukherjee says treatment should take a broader approach.

President Trump’s Mental Health — Is It Morally Permissible for Psychiatrists to Comment?

Claire Pouncey
The New England Journal of Medicine
December 27, 2107

Ralph Northam, a pediatric neurologist who was recently elected governor of Virginia, distinguished himself during the gubernatorial race by calling President Donald Trump a “narcissistic maniac.” Northam drew criticism for using medical diagnostic terminology to denounce a political figure, though he defended the terminology as “medically correct.” The term isn’t medically correct — “maniac” has not been a medical term for well over a century — but Northam’s use of it in either medical or political contexts would not be considered unethical by his professional peers.

For psychiatrists, however, the situation is different, which is why many psychiatrists and other mental health professionals have refrained from speculating about Trump’s mental health. But in October, psychiatrist Bandy Lee published a collection of essays written largely by mental health professionals who believe that their training and expertise compel them to warn the public of the dangers they see in Trump’s psychology. The Dangerous Case of Donald Trump: 27 Psychiatrists and Mental Health Experts Assess a President rejects the position of the American Psychiatric Association (APA) that psychiatrists should never offer diagnostic opinions about persons they have not personally examined. Past APA president Jeffrey Lieberman has written in Psychiatric News that the book is “not a serious, scholarly, civic-minded work, but simply tawdry, indulgent, fatuous tabloid psychiatry.” I believe it shouldn’t be dismissed so quickly.

The article is here.

Dangers of neglecting non-financial conflicts of interest in health and medicine

Wiersma M, Kerridge I, Lipworth W.
Journal of Medical Ethics 
Published Online First: 24 November 2017.
doi: 10.1136/medethics-2017-104530

Abstract

Non-financial interests, and the conflicts of interest that may result from them, are frequently overlooked in biomedicine. This is partly due to the complex and varied nature of these interests, and the limited evidence available regarding their prevalence and impact on biomedical research and clinical practice. We suggest that there are no meaningful conceptual distinctions, and few practical differences, between financial and non-financial conflicts of interest, and accordingly, that both require careful consideration. Further, a better understanding of the complexities of non-financial conflicts of interest, and their entanglement with financial conflicts of interest, may assist in the development of a more sophisticated approach to all forms of conflicts of interest.

The article is here.

The Specialists’ Stranglehold on Medicine

Jamie Koufman
The New York Times - Opinion
Originally posted June 3, 2017

Here is an excerpt:

Neither the Affordable Care Act nor the Republicans’ American Health Care Act addresses the way specialists are corrupting our health care system. What we really need is what I’d call a Health Care Accountability Act.

This law would return primary care to the primary care physician. Every patient should have one trusted doctor who is responsible for his or her overall health. Resources must be allocated to expand those doctors’ education and training. And then we have to pay them more.

There are approximately 860,000 practicing physicians in the United States today, and too few — about a third — deliver primary care. In general, they make less than half as much money as specialists. I advocate a 10 percent to 20 percent reduction in specialist reimbursement, with that money being allocated to primary care doctors.

Those doctors should have to approve specialist referrals — they would be the general contractor in the building metaphor. There is strong evidence that long-term oversight by primary care doctors increases the quality of care and decreases costs.

The bill would mandate the disclosure of procedures’ costs up front. The way it usually works now is that right before a medical procedure, patients are asked to sign multiple documents, including a guarantee that they will pay whatever is not covered by insurance.  But they will have no way of knowing what the procedure actually costs. Their insurance may cover 90 percent, but are they liable for 10 percent of $10,000 or $100,000?

We also need more oversight of those costs. Instead of letting specialists’ lobbyists set costs, payment algorithms should be determined by doctors with no financial stake in the field, or even by non-physicians like economists. An Independent Payment Advisory Board was created by Obamacare; it should be expanded and adequately funded.

The article is here.

Why You Should Donate Your Medical Data When You Die

By David Martin Shaw, J. Valérie Gross, Thomas C. Erren
The Conversation on February 16, 2017

Here is an excerpt:

But organs aren’t the only thing that you can donate once you’re dead. What about donating your medical data?

Data might not seem important in the way that organs are. People need organs just to stay alive, or to avoid being on dialysis for several hours a day. But medical data are also very valuable—even if they are not going to save someone’s life immediately. Why? Because medical research cannot take place without medical data, and the sad fact is that most people’s medical data are inaccessible for research once they are dead.

For example, working in shifts can be disruptive to one’s circadian rhythms. This is now thought by some to probably cause cancer. A large cohort study involving tens or hundreds of thousands of individuals could help us to investigate different aspects of shift work, including chronobiology, sleep impairment, cancer biology and premature aging. The results of such research could be very important for cancer prevention. However, any such study could currently be hamstrung by the inability to access and analyze participants’ data after they die.

The article is here.

Structural Racism and Supporting Black Lives — The Role of Health Professionals

Rachel R. Hardeman, Eduardo M. Medina, and Katy B. Kozhimannil
The New England Journal of Medicine
Originally posted October 12, 2016

Here is an excerpt:

Structural racism, the systems-level factors related to, yet distinct from, interpersonal racism, leads to increased rates of premature death and reduced levels of overall health and well-being. Like other epidemics, structural racism is causing widespread suffering, not only for black people and other communities of color but for our society as a whole. It is a threat to the physical, emotional, and social well-being of every person in a society that allocates privilege on the basis of race.  We believe that as clinicians and researchers, we wield power, privilege, and responsibility for dismantling structural racism — and we have a few recommendations for clinicians and researchers who wish to do so.

First, learn about, understand, and accept the United States’ racist roots. Structural racism is born of a doctrine of white supremacy that was developed to justify mass oppression involving economic and political exploitation.3 In the United States, such oppression was carried out through centuries of slavery premised on the social construct of race.

Our historical notions about race have shaped our scientific research and clinical practice. For example, experimentation on black communities and the segregation of care on the basis of race are deeply embedded in the U.S. health care system.

The article is here.

Big data, Google and the end of free will

Yuval Noah Harari
Financial Times
Originally posted August August 26, 2016

Here are two excerpts:

This has already happened in the field of medicine. The most important medical decisions in your life are increasingly based not on your feelings of illness or wellness, or even on the informed predictions of your doctor — but on the calculations of computers who know you better than you know yourself. A recent example of this process is the case of the actress Angelina Jolie. In 2013, Jolie took a genetic test that proved she was carrying a dangerous mutation of the BRCA1 gene. According to statistical databases, women carrying this mutation have an 87 per cent probability of developing breast cancer. Although at the time Jolie did not have cancer, she decided to pre-empt the disease and undergo a double mastectomy. She didn’t feel ill but she wisely decided to listen to the computer algorithms. “You may not feel anything is wrong,” said the algorithms, “but there is a time bomb ticking in your DNA. Do something about it — now!”

(cut)

But even if Dataism is wrong about life, it may still conquer the world. Many previous creeds gained enormous popularity and power despite their factual mistakes. If Christianity and communism could do it, why not Dataism? Dataism has especially good prospects, because it is currently spreading across all scientific disciplines. A unified scientific paradigm may easily become an unassailable dogma.

The article is here.

Lay attitudes toward deception in medicine: Theoretical considerations and empirical evidence

Jonathan Pugh, Guy Kahanea, Hannah Maslena & Julian Savulescua
AJOB Empirical Bioethics
Volume 7, Issue 1, 2016

Here is an excerpt:

In these cases, two fundamental principles of medical ethics—the principle of beneficence and the principle of respect for autonomy—appear to conflict (Beauchamp and Childress 2009). While ethicists have long been interested in the conflict between these two principles in cases of deception in medical practice, there is comparatively little empirical evidence concerning whether lay people—the potential targets of such deception—regard deception as morally acceptable across different medical contexts. Empirical studies that have been carried out thus far have concerned patient attitudes toward deception in specific medical contexts, such as cancer treatment (Jenkins, Fallowfield, and Saul, 2001; Yu and Bernstein 2011), palliative care, (Fallowfield, Jenkins, and Beveridge 2002), or more generally the use of placebo treatments in medical practice (Chen and Johnson, 2009; Hull et al. 2013). Similar studies have also been carried out on physician attitudes toward deception in these contexts (Howick et al. 2013; Lynöe, Mattsson, and Sandlund 1993).

However, several important dimensions of deception in medicine have not yet been addressed. Previous empirical studies have not directly compared patient attitudes toward deception across different medical contexts, nor have they investigated the relationship between patient attitudes toward deception in medicine and their attitudes toward truthfulness in nonmedical contexts. It remains unclear whether observed attitudes to deception reflect more general views about deception or whether they are specific to the medical sphere or even to particular medical contexts.

The article is here.

When Doctors Should Say 'I Don't Know'

By Julie Beck
The Atlantic
Originally published February 29, 2016

Here is an excerpt:

Doctors’ tools, knowledge, and treatments have improved since the bloodletting days, and we now have the ability to scan and analyze the body down to the cellular level. But “precision is not the same thing as certainty,” Hatch writes, and often, doctors are just making guesses based on the best evidence they have—a measuring of risks and benefits and probabilities that can be easily influenced by their preconceptions.

Medicine is a high-stakes game of uncertainty, complicated by the fact that people are naturally predisposed to seek certainty whenever possible. If you don’t know what something is, it could be a threat, out there on the ancient savannah of evolutionary psychology logic. That goes for patients and doctors alike, and if both parties are in agreement that certainty is best, it’s possible that they’ll just blow past the risks of a treatment, or the dubiousness of a diagnosis, for the sake of having an answer.

The article is here.

Opponents fail to derail the state's right-to-die measure, but they may yet try again in court

By The Times Editorial Board
The Los Angeles Times
Originally posted January 7, 2016

Here is an excerpt:

The group behind the referendum attempt, known as Seniors Against Suicide, says it is now contemplating a lawsuit to stop the law's implementation. The law is set to go into effect 90 days after the state Legislature concludes the still-open special session on healthcare.

We respect the law's opponents, including the Roman Catholic Church and some disability-rights advocates; they waged a passionate battle — both moral and practical — against it. But we don't share their fears. There is no evidence that a law this narrow would lead uncaring health insurers or family members to coerce sick patients to kill themselves in order to save on medical costs.

To the contrary, two decades of experience with Oregon's landmark Death with Dignity Act suggests that it will be used sparingly. In the first 17 years, just 1,327 people in Oregon requested a life-ending prescription from a doctor. More than a third of them then chose not to use the prescription.

The article is here.

How can healthcare professionals better manage their unconscious racial bias?

By April Dembosky
MedCity News
Originally published August 21, 2015

Here is an excerpt:

Racial Disparity In Medical Treatment Persists

Even as the health of Americans has improved, the disparities in treatment and outcomes between white patients and black and Latino patients are almost as big as they were 50 years ago.

A growing body of research suggests that doctors’ unconscious behavior plays a role in these statistics, and the Institute of Medicine of the National Academy of Sciences has called for more studies looking at discrimination and prejudice in health care.

For example, several studies show that African-American patients are often prescribed less pain medication than white patients with the same complaints. Black patients with chest pain are referred for advanced cardiac care less often than white patients with identical symptoms.

Doctors, nurses and other health workers don’t mean to treat people differently, says Howard Ross, founder of management consulting firm Cook Ross, who has worked with many groups on diversity issues. But all these professionals harbor stereotypes that they’re not aware they have, he says. Everybody does.

The entire article is here.

Rein It In, Dr Oz

By Art Caplan
MedScape
Originally published April 30, 2015

Dr Mehmet Oz is in trouble again. He was accused by 10 physicians in a letter of promoting quackery. They demanded that Columbia University Medical Center fire Dr Oz. Now, I can say with some authority that as "America's Doctor"—the person who, for many Americans, is the voice of medicine—he is not going to be fired. His show is not going to end. That isn't going to happen.

Dr Oz has evoked this response from these 10 physicians because he continues to push the border of legitimacy on his shows with respect to touting things for which there isn't much evidence. And that is a problem. Many doctors tell me that when Dr Oz endorses something—green coffee beans, some neti pot to cure the common cold—whatever it is, they are going to be asked about it, and their patients run out and buy it. He has enormous power when it comes to the platform he has built. And let's face it: He is an effective communicator. His show is fun to watch. I understand why the American people are paying attention to Dr Oz.

The entire article is here.

“Should I feel badly that I acted unethically?”

By Craig Klugman
bioethics.net
Originally posted May 29, 2015

Here is an excerpt:

At the base of this whole scenario is the concept that medicine is a business and businesses need to know what their competitors are doing. Unethical businesses try to increase market share not by producing a better product or service, but by undermining their competition. Aside from the medical ethics issues in this case, there is a very basic business ethics concern: Do not harm another to further your own interest. One of the most important professional values in medicine is altruism—that your choices and behaviors are for the benefit of another, not yourself. Roger loses sight of that when he only sees a problem when he feels personally threatened. Altruism is a basic component of a profession. Medicine is a profession. Business is not. Thus, in this situation the values of medicine and the values of business collide.

The corporatization of medicine as a center of profit has lost sight of the goal, which is to help people in need. That a non-medical professional would open a clinic “as a side business” is disturbing. Medicine should not be a way for one to achieve wealth, but rather be a way to be a servant to the community. Business ethics should always come second to medical ethics in a healing environment.

The entire article is here.

Stigma Around Physician-Assisted Dying Lingers

By Clyde Haberman
The New York Times
Originally posted on March 22, 2015

Here is an excerpt:

Arguments, pro and con, have not changed much over the years. Assisted dying was and is anathema to many religious leaders, notably in the Roman Catholic Church. For the American Medical Association, it remains “fundamentally incompatible with the physician’s role as healer.”

Some opponents express slippery-slope concerns: that certain patients might feel they owe it to their overburdened families to call it quits. That the poor and the uninsured, disproportionately, will have their lives cut short. That medication might be prescribed for the mentally incompetent. That doctors might move too readily to bring an end to those in the throes of depression. “We should address what would give them purpose, not give them a handful of pills,” Dr. Ezekiel Emanuel, a prominent oncologist and medical ethicist, told Retro Report.

The entire article is here.

The Concept of a Feminist Bioethics

By Mary C. Rawlinson
Journal of Medicine and Philosophy
(2001), Vol. 26, No. 4, pp 405-416.

Abstract

Feminist bioethics poses a challenge to bioethics by exposing the masculine marking of its
supposedly generic human subject, as well as the fact that the tradition does not view women's
rights as human rights. This essay traces the way in which this invisible gendering of the
universal renders the other gender invisible and silent. It shows how this attenuation of the
human in `man' is a source of sickness, both cultural and individual. Finally, it suggests several
ways in which images drawn from women's experience and women's bodies might contribute
to a constructive rethinking of basic ethical concepts.

The entire paper is here.

Does religion deserve a place in secular medicine?

By Brian D. Earp
BMJ Blogs
Originally posted February 26, 2015

The latest issue of the Journal of Medical Ethics is out, and in it, Professor Nigel Biggar—an Oxford theologian—argues that “religion” should have a place in secular medicine.

Some people will feel a shiver go down their spines—and not only the non-religious. After all, different religions require different things, and sometimes they come to opposite conclusions. So whose religion, exactly, does Professor Biggar have in mind, and what kind of “place” is he trying to make a case for?

The entire article is here.

Bias, Black Lives, and Academic Medicine

By David A. Ansell and Edwin K. McDonald
The New England Journal of Medicine
Originally published February 18, 2015

Here is an excerpt:

First, there is evidence that doctors hold stereotypes based on patients' race that can influence their clinical decisions.  Implicit bias refers to unconscious racial stereotypes that grow from our personal and cultural experiences. These implicit beliefs may also stem from a lack of day-to-day interracial and intercultural interactions. Although explicit race bias is rare among physicians, an unconscious preference for whites as compared with blacks is commonly revealed on tests of implicit bias.

Second, despite physicians' and medical centers' best intentions of being equitable, black–white disparities persist in patient outcomes, medical education, and faculty recruitment.

The entire article is here.

A Little Girl Died Because Canada Chose Cultural Sensitivity Over Western Medicine

By Jerry Coyne
The New Republic
Originally published

On Monday, Makayla Sault, an 11-year-old from Ontario and member of the Mississauga tribe of the New Credit First Nation, died from acute lymphoblastic leukemia after suffering a stroke the previous day. This would normally not be big news in Canada or the U.S.—except for the fact that Makayla's death was probably preventable and thus unnecessary.

Makayla died not only from leukemia, but from faith—the faith of her parents, who are pastors. They not only inculcated her with Christianity, but, on religious grounds, removed her from chemotherapy to put her in a dubious institute of “alternative medicine” in Florida.

The entire article is here.