Enigma: Intelligent Use of Intelligent Machines to Reform Health Care

It is a riddle wrapped in a mystery inside an enigma.

Winston Churchill (1874-1965)

Yesterday I saw The Imitation Game. The movie tells the story of how mathematician Alan Turing created intelligence machines to decrypt and translate the German military’s coded radio transmissions during World War II. The setting for the movie is Bletchley Park in England, as that nation, with Winston Churchill as its leader, struggled to survive using artificial intelligence as one of its principle weapons.

Throughout the movie, questions are raised: Can machines think? Can they imitate the human mind? Indeed, can they, will they, and should they eventually replace humankind?

The answers, according to the movie script, are No, No, No, except. of course, when machine logic is needed to supplement human intelligence when it fails or falters and when it comes to winning the war.

Today, smartphones are immensely more powerful and more imitative human intelligence t han Turing’s machine. But the messages being decoded are more complicated too.

So are the issues. In the case of health care: Can computer intelligence replace, or overrule, human intuitive diagnosis and treatment judgments? Can computers decode and simplify the millions of federal regulations and unravel the demands of individual and employer mandates? And if so, in what circumstances?

To complicate matters, the enemies are not evil, bent on destruction. The enemies are trying to help us, not harm us. The enemies are high health costs, unnecessary care, unrealistic hopes for cure, exploitative special interests, and wasteful bureaucracies.

In many instances, as Pogo has said, “ I have met the enemy, and he is us.”

We want what is impossible to have or to afford on a universal scale, especially when you consider we shall all age, sicken, and have limited life spans even with the most advanced intelligent information technologies.

What is the answer to this most intriguing of all enigmas? The answer is using computers as supplements to human intelligence in selected circumstances, not as a do-all, be-all, one-size-fits-all solution. Computers are our tools, circumscribed to work in limited circumstances, not our masters all they behold.

Computers, for example, are and will be indispensable for unraveling the mysteries of the genetic codes that dictate what diseases we might get in our lifetime, for evaluating what treatments work best for some diseases, for diagnosing certain rare diseases, for turning malignancies and other fatal condition into chronic disorders, for treating certain immunological diseases, for empowering patients to find the information and providers they need to address their individual conditions.

Computers will not be useful for those patients seeking dire personal contact with a physician, for obvious maladies requiring obvious commonsensical solutions, for avoiding proven treatments that everybody agrees work, for replacing skilled diagnosticians who can cut to the heart of a problem quickly without computer generated information, for human emotional , mental, and economic dilemmas that beset us all at certain times in our lives.
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I close with comments from Leon Wieseltier (born 1952), critic and contributing editor at the Atlantic, in today’s New York Times in a piece entitled “Among the Disrupted.”

“The discussion if culture is being steadily absorbed into the discussion of business. There are ‘metrics’ for phenomena that cannot be metrically measured. Numeric values are assigned to things that cannot be captured by numbers. Economic concepts go rampaging through noneconomic realms. Where wisdom once was, quantification will now be. Quantification is the most overwhelming understanding of, well, everything…There is no more urgent task than to think critically about the salience, even the tyranny of technology…Every technology is used before it is completely understood. We are living in that lag, and it is the a right time to keep our heads."

Amen