Medical AI: Promises and Perils at a Critical Moment

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SynopsisMedicine is entering a new era—one where artificial intelligence (AI) tools can interact directly with patients and outperform doctors on several clinical tasks. As AI capabilities and adoption advance with remarkable speed, we are running out of time to meaningfully influence how it is integrated into health care.This book offers a timely tour of real-world events and cutting-edge research on medical AI, highlighting both its successes and its failures. It examines the many technical, legal, and ethical challenges involved. It argues that, if left unchecked, AI development and integration may ultimately drive physician replacement.But there is still time. This book invites you to consider what kind of future you want. Throughout, it critically reviews proposed solutions and their limitations so that you can better understand what is at stake—and help shape what comes next.Praises for the book“Medical AI … is a sober, evidence-based examination of the challenges and promises we all face, and is essential reading for anyone who wants to help create a better future for medicine.”Adam RodmanDirector of AI Programs, Shapiro Center for Research and Education at Harvard Medical School and Beth Israel Deaconess Medical Center“Medical AI … provides a vital, clear-eyed roadmap for responsible integration… Dr. Tsuei offers an essential framework for ensuring that the next generation of medical tools enhances—rather than erodes—the standard of care.”Nigam ShahChief Data Scientist, Stanford Health Care“The book is a rare and urgent contribution that equips the general public, not just clinicians or technologists, to meaningfully engage in the decisions that will shape whether AI serves or subverts the mission of medicine.”Leo Anthony CeliSenior Research Scientist, Laboratory for Computational Physiology, Massachusetts Institute of TechnologyAuthorDr. Sian Tsuei is a Clinical Assistant Professor at University of British Columbia. He is a Canadian family physician with a PhD from Harvard University on health systems.Table of Contents Chapter 1. Introduction. 1.1 Objectives. 1.2 Why I Worry. 1.3 Structure of Book. 1.4 What I Hope You Will Do After Reading This Book. 1.5 Questions for Reflection. Chapter 2. What Is “Intelligence” and “Artificial Intelligence”? 2.1 Objectives. 2.2 What Is “Intelligence”?. 2.3 What Is “Artificial Intelligence”?. 2.4 Conclusion. 2.5 Summary. 2.6 Questions for Reflection. Chapter 3. Taking Stock of the Remarkable Speed of AI Development 3.1 Objectives. 3.2 AI’s Diverse Set of Skills. 3.3 Will the Pace of AI Development Continue (or Even Accelerate)? 3.4 Conclusion. 3.5 Summary. 3.6 Questions for Reflection. Chapter 4. How Is the Medical Industry Using AI? 4.1 Objectives. 4.2 State of AI Usage in Medicine. 4.3 Conceptualizing Medical Uses for AI Tools. 4.4 A Brief Note on AI Performance Terminology. 4.5 Risk Prediction. 4.6 Diagnostic Tasks During Visits that AI Tools Can Tackle. 4.7 Treatment Tasks During Visits that AI Tools Can Tackle. 4.8 Administrative Tasks that AI Tools Can Tackle. 4.9 Novel Frontiers. 4.10 Conclusion. 4.11 Summary. 4.12 Questions for Reflection. Chapter 5. Technical Considerations. 5.1 Objectives. 5.2 Model Complexity. 5.3 Potential Solutions. 5.4 Sycophancy Bias. 5.5 Hallucinations. 5.6 Algorithmic Bias. 5.7 Human-in-the-Loop as a Solution. 5.8 Conclusion. 5.9 Summary. 5.10 Questions for Reflection. Chapter 6. Patient–Provider Interaction Considerations. 6.1 Objectives. 6.2 Privacy. 6.3 Consent. 6.4 Conclusion. 6.5 Summary. 6.6 Questions for Reflection. Chapter 7. Standard of Practice Considerations. 7.1 Objectives. 7.2 Standard of Practice. 7.3 Behavioural Changes. 7.4 Adding to Behavioural Change Complexity: Model Drift. 7.5 Conclusion. 7.6 Summary. 7.7 Questions for Reflection. Chapter 8. Regulations, Governance, and Incentives Considerations. 8.1 Objectives. 8.2 State of AI Device Regulations. 8.3 Two Major Challenges and Potential Solutions. 8.4 Paying for AI Use in Health Care. 8.5 Conclusion. 8.6 Summary. 8.7 Questions for Reflection. Chapter 9. Downstream Health Equity and Environmental Consequences. 9.1 Objectives. 9.2 Introduction. 9.3 Health Equity Implications. 9.4 Environmental Impact. 9.5 Conclusion. 9.6 Summary. 9.7 Questions for Reflection. Chapter 10. How Will AI Affect Medical Services? 10.1 Objectives. 10.2 Implications of AI on Physicians’ Jobs. 10.3 Huang and Rust’s Theory About How AI Replaces Humans in Tasks. 10.4 Conditions for AI Replacement to Happen. 10.5 Potential Barriers for AI Tools’ Entry into Medical Services. 10.6 Conclusion. 10.7 Summary. 10.8 Questions for Reflection. Chapter 11. Conclusion. 11.1 Objectives. 11.2 Summary of State of Medical AI Applications and Problems. 11.3 What’s Your Preferred Vision? 11.4 Implications for Societal Actions. 11.5 Conclusion. 11.6 Questions for Reflection.

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