In the immortal words of Yogi Berra, if you don’t know where you’re going you’re going to end up some place else. Which is where I seem to have landed, at least these past months.
Again with the AI
The fascination with AI continues to irk, given that every second thing I read seems to be extolling the magic of AI and medicine and how It Will Change Everything. Which it will not, trust me. The essential issue of illness remains perennial and revolves around an individual for whom no amount of technology will solve anything without human contact. The change-everything reference, by the bye, is not to the “singularity” here, that point at which some thinkers believe power will shift dramatically and we will all end up serving our robot overlords. That is another story. (One with major movie potential thank you Skynet and Terminator.)
But in this world, or so we are told by AI proponents, radiologists will soon be obsolete. The adaptational learning capacities of AI mean that reading a scan or x-ray will soon be more ably done by machines than humans. The presupposition here is that we, the original programmers of this artificial intelligence, understand the vagaries of real life (and real disease) so wonderfully that we can deconstruct these much as we do the game of chess (where, let’s face it, Big Blue ate our lunch) and that analyzing a two-dimensional image of a three-dimensional body, already problematic, can be reduced to a series of algorithms.
Attempting to extrapolate what some “shadow” on a scan might mean in a flesh and blood human isn’t really quite the same as bishop to knight seven. Never mind the false positive/negatives that are considered an acceptable risk or the very real human misery they create.
It’s called Moravec’s paradox, the inability of humans to realize just how complex basic physical tasks are – and the corresponding inability of AI to mimic it. As you walk across the room, carrying a glass of water, talking to your spouse/friend/cat/child; place the glass on the counter and open the dishwasher door with your foot as you open a jar of pickles at the same time, take a moment to consider just how many concurrent tasks you are doing and just how enormous the computational power these ostensibly simple moves would require.
Researchers in Singapore taught industrial robots to assemble an Ikea chair. Essentially, screw in the legs. A person could probably do this in a minute. Maybe two. The preprogrammed robots took nearly half an hour. And I suspect programming those robots took considerably longer than that.
Commander Data (on Star Trek Next Gen) spent his life trying to emulate humans and understand the notion of having a “gut feeling” about something. Those, as most of us know, can be wrong but usually are based in experience. Something about the situation at hand reminds us of something. We may not remember the details but the feeling lingers and something in the present situation cues that memory. Personally I have great respect for my intuition, especially when it’s telling me not to buy into the hype.
Ironically, even Elon Musk, who has had major production problems with the Tesla cars rolling out of his high tech factory, has conceded (in a tweet) that “Humans are underrated.”
I wouldn’t necessarily go that far given the political shenanigans of Trump & Co. but in the grand scheme of things I tend to agree. But hey, who knows, perhaps soon we will all be Borg, far too involved in flying around the galaxy telling people resistance is useless to worry about petty nonsense like this.
Lean, mean and gene
On a somewhat similar note – given the extent to which genetics discourse has that same linear, mechanistic tone – it turns out all this fine talk of using genetics to determine health risk and whatnot is based on nothing more than clever marketing, since a lot of companies are making a lot of money off our belief in DNA. Truth is half the time we don’t even know what a gene is never mind what it actually does; geneticists still can’t agree on how many genes there are in a human genome, as this article in Nature points out.
Along the same lines, I was most amused to read about something called the Super Seniors Study, research following a group of individuals in their 80’s, 90’s and 100’s who seem to be doing really well. Launched in 2002 and headed by Angela Brooks Wilson, a geneticist at the BC Cancer Agency and SFU Chair of biomedical physiology and kinesiology, this longtitudinal work is examining possible factors involved in healthy ageing.
Turns out genes had nothing to do with it, the title of the Globe and Mail article notwithstanding. (“Could the DNA of these super seniors hold the secret to healthy aging?” The answer, a resounding “no”, well hidden at the very, the part most people wouldn’t even get to.) All of these individuals who were racing about exercising and working part time and living the kind of life that makes one tired just reading about it all had the same “multiple (genetic) factors linked to a high probability of disease”. You know, the gene markers they tell us are “linked” to cancer, heart disease, etc., etc. But these super seniors had all those markers but none of the diseases, demonstrating (pretty strongly) that the so-called genetic links to disease are a load of bunkum. Which (she said modestly) I have been saying for more years than I care to remember. You’re welcome.
The fundamental error in this type of linear thinking is in allowing our metaphors (genes are the “blueprint” of life) and propensity towards social ideas of determinism to overtake common sense. Biological and physiological systems are not static; they respond to and change to life in its entirety, whether it’s diet and nutrition to toxic or traumatic insults. Immunity alters, endocrinology changes, – even how we think and feel affects the efficiency and effectiveness of physiology. Which explains why as we age we become increasingly dissimilar.
This is important. It means that our personal histories matter more as we age and guidelines and evidence, as useful as they can be in a vague sort of way, need to be used with a large grain of salt, accompanied by a healthy dose of skepticism. Who we are, what we were like throughout our lives and what’s happened to us during that life are part and parcel of our health picture. As I’ve said before, much as we’d like to reduce medical decisions to a question of statistics and probabilities, it’s simply not possible. There are 89-year-olds for whom knee surgery is a perfectly viable alternative; 65-year-olds for whom it is not.
The circle of life seems to have come to a dead halt
Sadly, Super Seniors Study notwithstanding, our template for ageing is rather meager. Pathetic almost. As a sociologist told me many years ago when I was writing a story on geriatrics (when I myself was in my 30’s and didn’t have a clue), our mental picture of a “good” old age is essentially that of a 20-year-old with a few wrinkles and grey hair. We admire seniors who run marathons and lift weights and do all the things they did decades earlier. We don’t value the attributes that actually accompany ageing such as the ability to manage time, ideas and people better. Experience. Quicker thinking in deeper, more analytical subjects. Wisdom. Happiness.
Instead, we read that older folk react more slowly in tests where they’re shown some picture or asked to push a button on some video game; this is then used as some kind of bizarre proof that a 20-year-old brain is somehow superior. It may well be true that certain types of reaction time slow with age but my suspicion is that that’s because usually these are irrelevant in the grand scheme of things. Then again, what do I know. I couldn’t remember names or certain kinds of details when I was 25 and I still can’t. And I’m still here. Still can’t remember details but smart enough to look both ways before crossing the street (and putting my phone down before I step on to the curb, something I can’t say for way, way too many people.)
Life isn’t about one’s ability to do tests. Psychologists and educators finally realized several decades ago that IQ tests weren’t all that good at predicting future performance; all they measured was how well one did on IQ tests. And one’s ability to do well on those tests, all too often, was determined by extraneous factors like class and culture. (Something that I recall appeared to annoy researchers mightily, in the days of language/math IQ tests was the students in Sri Lanka did better on the language portion of the test than all other countries, including Britain and America. How could this be, researchers cried. Well, presumably Sri Lankan students spoke and read better English, geniuses.)
Just as we aim to declutter our living rooms and our lives, we want health and medical matters to be neat. Predictable. I wrote about this a while back but – amazingly – my one blog post doesn’t appear to have changed the world.
Ideally we will find a balance, us learning to live with the ambiguities of life – meanwhile, experts might try to realize that in the end people don’t care that you know – not unless they also know that you care.
He was a cool cat
Speaking of caring, Charlie, our noisy, furry friend died at the ripe old age of 17, which in human years is somewhere in the late 80’s. Not a bad age. He died peacefully at home, surrounded by the people he had bustled about managing all his life. For as we all know, while dogs have owners, cats have staff.
I wrote about Charlie some years ago when he was ill;. At the time I wasn’t sure he was going to survive the rigours of modern veterinary medicine. But he did and had what I found out is called a hospice death, according to that fount of all wisdom, the internet. Apparently more of us are opting to let our pets go gently into that good night, contrary to Dylan Thomas’s exhortation. And so the prism of life continues.
Perhaps strong drink is the only solution
To end on what I consider a more pragmatic note, I just heard a Dean Martin song I had never heard before – the chorus of which sounds as though it should perhaps be our new theme song.