The so-called artificial intelligence is having a great impact on public health in general due to its capacity for organization, communication and attention in the daily practice of Medicine.
Regarding terminology, Manuel Alfonseca Moreno, Dr. Telecommunications Engineer, graduate in Computer Science and Professor at the Autonomous University of Madrid, reminds us in his blog Dissemination of Science, some interesting issues that should be remembered. What is now called artificial intelligence is what had always been called computing, a name that has been displaced by the greater impact caused by the word intelligence. The term Artificial Intelligence began to be used in 1956, in a seminar on computers at Dartmouth College, a private university in New Hampshire, the USA, in which intelligent programs were discussed.
Since then, Artificial Intelligence has been defined as computer programs that process symbolic information through empirical or inquiry rules, not based on exact mathematical deductions, but on the accumulation of data and experiences. Of course, Manuel Alfonseca questions the appropriateness of the denomination adopted, since by calling it that way an underlying problem arises. If the goal is to achieve artificial intelligence, which even surpasses natural intelligence, we will have to start by knowing what nature it has, and what we want to imitate and even surpass. Do we know what natural intelligence is? That is the mind.
observatoriobioeticaIt does not seem appropriate to compare artificial intelligence with human intelligence, nor to think that our mind works like computer hardware. Simply said, the thoughts, the mind, is not an epiphenomenon of the brain nor is it equivalent to the brain. It is not made up of matter, nor do the chips or their connections work like our neural networks. From neurophysiological and metaphysical dualism, in accordance with the Christian tradition on the concept of person, the body and soul, brain and mind, are different realities, although hypostatically united in each human being.
That said, traditionally we talk about weak artificial intelligence and strong artificial intelligence.
The so-called weak artificial intelligence is that of the computer media that is progressing and we use to solve in an effective, concrete, and automatic way, problems that obey routines adhered to logical algorithms that the human being himself has provided to the machines, training them to resolve questions or address issues based on experiences for which the programs are trained (deep learning). It is not intelligence comparable to human intelligence, since machines do not think for themselves, but rather they react to what is asked of them, responding in a concrete, automatic way to orders previously provided by the person who designed them.
Among its many applications, there are great importance in Medicine for: organizing large volumes of data (creating databases); look for patterns and support personalized diagnosis; recognize images (radio-echo-mammograms, etc.); provide remote care (telemedicine); assist surgery (robot-assisted surgery); etc. In addition to these more direct applications in Medicine, there are others of special interest in medical research, such as: analyzing data and solving problems; discover new drugs; translate texts; process texts; recognize sounds or the spoken word, sounds, etc.
All these applications represent great achievements and new resources, which have made it possible to facilitate human intellectual and manual work, with even greater precision. In any case, machines or computers do not work on their own, nor is their operation autonomous, but rather they depend on algorithms and previous experiences that their creators have provided them. Therefore, in a field as sensitive as health, in the end the decisions must be human, in applications in Medicine they must be made by the doctor.
As for strong artificial intelligence, which some think would be equated to natural human intelligence, it continues to be dependent on algorithms and prior information accumulated in the memory of computers. Machines do not think for themselves, like a human with all their abilities and feelings. Their intelligence is not abstract, like human intelligence, but concrete; they are capable of managing, recognizing and coordinating data in accordance with previously accumulated records and offering possible answers to the problems that arise. There are many computer scientists who deny that artificial intelligence will ever be comparable to natural human intelligence and at most grant it some differences, such as the great capacity to store and relate accumulated data more effectively.
However, followers of transhumanist and posthumanist currents think that there will come a time when what they call a “point of singularity” will be reached, a point of equality between artificial intelligence and natural intelligence. For those who hold these ideas, the battle is in full swing and while human intelligence remains in its natural state, with no advances other than the accumulation of knowledge, artificial intelligence progresses exponentially.
However, realistic computer scientists do not believe that the autonomy of thought of artificial intelligence will be achieved. For example, computer engineer Jeff Hawkins, one of the pioneers of mobile telephony, says that: “scientists in the field of artificial intelligence have argued that computers will be intelligent when they become sufficiently powerful. I don’t think so…: brains and computers do fundamentally different things”.
In a similar way, Dr. Ramón López Mantarás, director of the Artificial Intelligence Research Institute of the CSIC, says that: “the great challenge of artificial intelligence is to provide common sense to machines”… No matter how sophisticated they may be some artificial intelligences in the future, within 100,000 or 200,000 years, will be different from human ones.
Telemedicine
The Spanish Bioethics Committee, shortly before its last renewal in June 2022, issued a report regarding the topic of “Bioethical aspects of telemedicine in the context of the clinical relationship” [1].
The current golden age of health sciences has made specific, effective and radical treatments possible with the proliferation of research and clinical trials, which have allowed the development of new technologies (chemotherapy, imaging techniques, genomics, genetic, etc.), although the traditional body of the medical profession continues to be the doctor-patient relationship in which principles such as compassion, listening, care, encouragement, respect for the decisions made, accompaniment in the disease process and emotional support.
In any case, in order to meet the increasingly complex health care needs, everything offered by the world of so-called ICTs, computer and communication technologies, is of great support. The World Economic Forum speaks of the fourth industrial revolution as the one generated by the fusion of the physical, biological and digital world, which is globally changing society at breakneck speed and which impacts all systems, including healthcare. Information and communication technologies have become useful tools in the context of health, focused on the best care for the patient, with the possibility of even transferring part of the health care to their home. AI is key to progress towards not only more efficient medicine, but especially more personalized, participatory, preventive and precision medicine. According to the CBE report, AI has a prominent role in the development of so-called personalized medicine, with solutions tailored to the health profile of each patient.
On the other hand, the UNESCO International Bioethics Committee issued a report on Big Data in relation to health, in September 2017, in which it pointed out three fundamental ethical problems to be resolved: autonomy, privacy and justice, this last in terms of accessibility and solidarity; and stressed the importance of establishing effective guarantees so that both the dignity and freedom of patients, especially the most vulnerable, are protected.
But if there is a chapter that is becoming increasingly important in the use of computing and communication technologies, it is that of telemedicine, which consists of the provision of health care services in which distance is a critical factor. The use of telemedicine first of all facilitates the doctor-patient relationship (telecare or teleconsultation), and its launch took place recently with the Covid-19 pandemic. In any case, the World Medical Association, in its 2018 Declaration, recalled that: “face-to-face consultation is the golden rule in the doctor-patient relationship.” Today, telematic consultation is accepted as a replacement for in-person consultation in certain circumstances, but both types of consultations must be governed by the same principles of medical ethics: preserving autonomy; respect the patient’s dignity by seeking their well-being and avoiding harm to them; guarantee the security of data, procedures and the right to privacy and facilitate access to all healthcare services (principle of justice).
In addition, telemedicine facilitates communication between doctors, or with other health professionals such as nursing staff, rehabilitators or pharmacists. Among its functions are those of facilitating the exchange of data to make diagnoses, recommend treatments and prevent diseases, and mobilize resources. It also constitutes a great resource to expand the ongoing training of health professionals, research and evaluation tasks, etc.
But, in the relationship with patients, what remains fundamental is the need to maintain trust in the doctor-patient relationship. Dr. Pedro Laín Entralgo (1908-2001) defined the clinical relationship as a particular and unique type of relationship between people whose axis is trust, which he based on three aspects: in the technique to cure, in the professional knowledge to apply it. , and in the values of the doctor’s person [2]. For this reason, we must fight so that the dehumanization that is permeating many sectors of society and in which artificial intelligence is involved to some extent does not affect the doctor-patient relationship. Trust is intrinsically linked to a close, human relationship. Dr. Warner Slack (1933-2018), a doctor who pioneered digital medical records, said that: “if a doctor can be replaced by a computer, he deserves to be replaced by a computer.”
According to this, the potential dehumanization associated with telemedicine becomes one of its main challenges to overcome and in its potential enemy. Therefore, it is necessary to move forward in focusing telematic care on the patient, preserving humanization and their specific needs. We must flee from what is known as technological solutionism, a trap of a super-technical world, which offers us automatic and seamless solutions [3].
Telemedicine cannot become an element of convenience that puts patient safety at risk, but rather an ally of the doctor that helps him in his work to address safety, risks and possible adverse events.
Therefore, the report of the Spanish Bioethics Committee proposes the following recommendations:
- Be governed, at least, by the same bioethical principles as traditional medicine. Take into account the sacred dignity of each person.
- Telemedicine, and teleconsultation, should be understood as complementary and never an absolute substitute for in-person consultation.
- Use telemedicine when it presents an opportunity to improve people’s health care and assistance.
- Have an evaluation plan that allows adjustments to be made based on the results and consequences of the different modalities.
- Carry out quality studies about the repercussions of telemedicine in different pathologies and in different populations.
- Promote the training of professionals in the use of telemedicine.
- Do not use non-face-to-face consultations in order to make the work day more profitable and reduce the hiring of professionals.
- Promote the training of citizens and make it accessible to the most vulnerable or underserved populations.
- Provide telemedicine with regulatory and legal support that guarantees its proper use, security, confidentiality and data protection.
- Promote a rigorous social, ethical and legal analysis of the impact of telemedicine on social and health care.
A fundamental point of the use of artificial intelligence in Medicine is the protection of confidentiality, a duty of health ethics. With the incorporation of personal data about patients’ health into computer media, the risk of losing privacy and confidentiality increases. All technology and data storage used in telemedicine must meet security and certification criteria by health authorities, which prevent security breaches and improper access to information. According to the nature of the information that is recorded in the computer media, it may be necessary to use data traceability systems, where appropriate, the data duly anonymized for authorized access only to professionals, for use in institutions or research projects. . In any case, all of this requires establishing identity confirmation procedures for users, legal representatives and professionals with access to medical data, treatment results, medication, etc. but never to the identity data of the patients.
Nicolás Jouve – Member of the Bioethics Observatory – Emeritus Professor of Genetics – Former member of the Bioethics Committee of Spain
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[2] Laín Entralgo P. The doctor-patient relationship. Madrid: Western Magazine; 1964
[3] Evgeny Morozov, The madness of technological solutionism, Katz, Madrid, 2017
