Tuesday, September 13, 2011

WellPoint and IBM’s Watson: Why I Am Respectful but Skeptical

September 13, 2011- When WellPoint and IBM announced yesterday the two would be conducting pilot studies in 2012 to test the usefulness of IBM’s supercomputer Watson to “help” doctors make diagnoses and courses of treatment, I was respectful but skeptical.


• Respectful because WellPoint is a giant health plan with 42,500 employees covering 34 million Americans directly and 70 million through its subsidiaries, right up there with UnitedHealth care with 78,000 employees covering 70 million Americans.

• Respectful because IBM is the world’s largest computer powerhouse already deeply enmeshed in health care issues, especially in its promotion of the Medical Home concept through the work of Paul Grundy, MD. IBM Corporation's Global Director of IBM Healthcare Transformation.

• Respectful because computers are logic machines, capable of digesting and summarizing millions of articles and studies from the medical literature and suggesting diagnoses and best practices.


• Skeptical because of the nature of the American culture, which Garry Orren, a professor of political science at Brandeis, just outside Boston, who polls for the New York Times and Washington Post, said, “A good place to start is to remember we are pro-democracy and anti-government. It comes down to ideas that are essentially anti-authority and tend toward self-regulation.”

• Skeptical because of the profound limitations of the computer as a diagnostic and treatment tool Jerome Groopman, MD, a professor of internal medicine at Harvard, said it best in his book How Doctors Think,
“Clinical algorithms can be useful for run-of-the-mill diagnosis and treatment – distinguishing strep throat from viral pharyngitis, for example. But they quickly fall apart when a doctors needs to think outside their boxes, when symptoms are vague, or multiple and confusing or when test results are inexact. In such cases – the kinds of cases where we most need a discerning doctor – algorithms discourage physicians from thinking independently and creatively. Instead of expanding a doctor’s thinking, they constrain it.”

• Skeptical because it is one small step from using the computer for “helping “ doctors to monitoring them, judging them, dictating to them what to do, and withdrawing payment for computer non-compliance. The use of computer data is a multi-edged sword. It can be used for the “good,” facilitating diagnosis and treatment and making it more accurate and up-to-date, and for “evil,” invading privacy, inviting security breechs, and making decisions based on the opinions of remote authorities rather than those present at the patient-doctor encounter. Being victorious at “Jeopardy” does not necessarily translate into success at managing the patient-doctor relationship and improving its outcomes. Most clinical decision-making is gray, not black and white. What I would like to see is a comprehensive study is how computers affect issues in the gray world - how computers impact or improve the totality of decision-making on sociological and psychological problems, which may be more subjective rather than objective.

Tweet: WellPoint and IBM will conduct pilot studies to see if IBM’s supercomputer can suggest diagnoses and treatment. This has +’s and –‘s.

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