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Artificial Intelligence (AI) is no longer just a buzz word. It has reached to all of our domain in one form or other. People are very optimistic that AI will be capable of solving many of our issues. The recent resignation of Google’s AI Pioneer, Geoffrey Hinton, and his statement “He was worried about AI’s capacity to create convincing false images and texts, creating a world where people will not be able to know what is true anymore”. He is called “God Father of AI” and warned about the dangers of AI. In a recent statement, he cautioned of serious danger that we'll get things smarter than us fairly soon and that these things might get bad motives and take control. This has created confusion and apprehension in the mind of people on use of AI.
AI is defined as system’s ability to correctly to interpret external data and to use these learning to achieve specific goal and tasks through flexible adoption. AI has been rapidly expanding and has made significant in-roads in almost all aspects of human life including healthcare. Some of the examples of use of AI in healthcare include Computed Tomography (CT), TB screening using chest X-ray, and Mammography scanning. The introduction of AI into healthcare has the potential to be solutions for significant challenges faced in the healthcare like diagnosis and screening; therapeutics; preventive care; treatment; clinical decision making; public health surveillance; complex data analysis; and predicting disease outcomes. AI based technology might help reducing human errors and have the potential of enhancing known methods of screening and diagnosis of disease, improving diagnostic accuracy, and guiding evidence based treatment algorithms, predicting outcomes, identifying health system gaps, with an overall impact on human health and wellness.
Many countries including India are facing a shortage of skilled workforce. Advances in AI have opened up new opportunities to tackle this shortage. Telemedicine and self-care via interactive chatbots, digital monitoring devices like wearable watches are alternatives. The technology can assist in self-monitoring of personal health related parameters such as intake of nutrition, physical activity, blood pressure, glucose, lipids for identifying high risk group. It provides solution for medication non-adherence, motivation, remotely and building a care network. Chatbots and robotic assistants can empower patients in self-management of Non-Communicable Diseases (NCDs) and improve decision making. Chatbot is a software application that aims to mimic human conversation through text or voice interaction, typically online.
Realizing the potential of AIs, India’s Finance Minister in her budget speech for 2018-19 mandated the NITI Aayog to establish the National Programme on AI. NITI Aayog is the National Apex public policy think tank. The pilot study conducted in association with NITI Aayog has successfully demonstrated the feasibility of AI as a customised clinical decision-making tool. The study report is published as Healthcare Artificial Intelligence Catalyst (HAIC) Pilot Study: A feasibility study to assess the usability, usefulness, and adherence to standard treatment guidelines in Indian healthcare settings with the use of Elsevier’s “Arezzo” - a declarative artificial intelligence based Clinical Decision Support System (CDSS) and pathway technology. The study has convincingly proved the integration of this CDSS into local app is usable and useful to health workers in primary and secondary healthcare settings and is preferred by over three fourths of the users for continued adoption. We need to be careful before putting AI in clinical decision making. Accountability in case of errors is a primary concern for safe guarding and protection. Just like any other diagnostic tool, AI based solutions cannot be made accountable for its decision and judgement. The system should be made to have accountability and responsibility at all stages of its development and deployment of AI in health. Data safety, data sharing and data privacy are other concerns. AI empowers the masses by permitting easy and early diagnosis and access to health facilities but unsupervised use of such tools and techniques is potentially risky.
AI is not only useful in healthcare but is equally useful in healthcare education. One major use of AI is medical simulations where students get an opportunity to practice real world medical scenarios in a safe and controlled environment. It provides experiential learning experience, one of the best ways of learning. AI powered virtual patients can also provide individual feedback to the students. The individual feed back will help the students to identify the areas where improvement is needed. In short, the AI has the potential to provide more effective and efficient training to healthcare students.
There are many other issues. Cheap and powerful artificial intelligence tools would allow anyone to create fake images, video and audio that is realistic enough to fool voters and perhaps sway an election. The threat posed by AI and the so called deep fakes seemed a year or two away. AI presents political peril for 2024 with threat to mislead voters (United States of America). There seems to be apprehension that application of AI will take away many of our jobs. This will not happen as long as long as domain interpretation exists, says expert.
Despite potential benefits, there are several concerns: ethical, legal and social concerns pertaining to its development and deployment. The Indian Council of Medical Research (ICMR) has recently released “Ethical Guidelines for Application for Application of Artificial Intelligence in Biomedical Research and Healthcare”. These are applicable to all stakeholders involved in development, validation and deployment. It is important to protect citizens from the potential harms of AI technology by realising its safety and accountability. AI can influence health system or health of population imposing risk on society and patients. Even America has lot of concerns. The White House has called the two CEOs: Sundar Pichai of Google and Satya Nadella of Microsoft for discussion. These two companies have huge investment on AIs. The US administration has said “the tech giants have moral duty on AI”. Indian Institute of Technology, Madras, has recently launched a new department which blends engineering and medical science. This new department concentrates on understanding human body from the technology lens including use of AI in medicine. This is the testimony of our interest on AI and there is rapid resurgence of AI in our life. But, there is also growing apprehension on socio-political and economic implication of AI.
In Bill Gate’s version “This is the beginning of AI and is as revolutionary as mobile phone and internet. AI is filled with opportunities and responsibilities”. AI is the most remarkable new technology and it must be guarded against the risk and spread the benefits to as many as possible. AI is one of the promising technologies in years to come and healthcare is likely to have substantial benefits from integration of AI. It has enormous potential to overcome some of the biggest challenges: lack of adequate number of health professionals and infrastructure. The Government must regulate the use of AI in all sectors including healthcare. AIs are super intelligent and there is risk of run out of control. The NITI Aayog has recently released the discussion paper “Responsible AI - AI for All” but the government should come out with clear policy which can guide all stakeholders of artificial Intelligence.
(Authors are professors, C. L. Baid Metha College of Pharmacy, Thoraipakkam, Chennai – 600 097)
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