How recent changes in technology will change medicine

Robert Miller, MDAugust, 2016www.aboutcancer.com

Video can be found at youtu.be/XCeepM-kUHU

or http://goo.gl/rH7fmO

Will doctors become obsolete?

1. They can use technology and the internet to better self educate and remain current.

2. They can use apps, more sophisticated EMR (electronic medical records) systems to try to run a more efficient practice.

3. They can use web sites and other social media outlets to better communicate with their patients.

4. They can use ‘telemedicine or telehealth’ to try to reach patients more effectively and efficiently.

But…. Even if you are an early adopter and a techie… most physicians will be replaced by increasingly sophisticated soft ware and AI programs and patients will turn to digital assistants and robotics for the majority of their care in the not too distant future!

After treatment for a woman suffering from leukemia proved ineffective, a team of Japanese doctors  turned to IBM’s Watson for help which was able to successfully determine that she actually suffered from a different, rare form of leukemia than the doctors had originally believed. Watson managed to make its diagnosis after doctors from the University of Tokyo’s Institute of Medical Science was fed it the patient’s genetic data, which was then compared to information from 20 million oncological studies.This analysis found a different diagnosis for the type of leukemia from which the patient suffered, and it suggested a different form of treatment, which proved far more effective than the original methods doctors had been using up to that point.

Smart PhonesThe first iPhone was unveiled on January 9, 2007 and released on June 29, 2007.

Apple released the first iPad in April 2010

Digital Assistant built into Windows 10 from Microsoft

Siri (Speech Interpretation and Recognition Interface) from Apple 

The Rise of the Virtual Assistant

Ask ‘Alexa’

The Rise of the Virtual Assistant

It seems highly probable that the public will become increasingly comfortable and then dependent on a digital ‘virtual assistant’

What will become of doctors over the next 20 years?

1. Exponential growth in information (and information technology)2. Complexity theory3. Recent breakthroughs in AI (artificial intelligence, esp. machine learning or deep learning)

Three important advances in science and technology worth knowing about

Future Shock is a book written by the futurist Alvin Toffler in 1970. In the book, Toffler defines the term "future shock" as a certain psychological state of individuals and entire societies.

His shortest definition for the term is a personal perception of "too much change in too short a period of time". 

Things are changing too quickly to make sense.

Chaos: Making a New Science is a debut non-fiction book by James Gleick that initially introduced the principles and early development of the chaos theory to the public. It was a finalist for the National Book Award]

and the Pulitzer Prize in 1987

the branch of mathematics that deals with complex systems whose behavior is highly sensitive to slight changes in conditions, so that small alterations can give rise to strikingly great consequences.

When a society gets overwhelmed by complexity they can evolve, adapt or go extinct.

Many cultures (e.g. the Mayans) abandoned science and common sense and engaged in crazy and self-destructive behaviors (like human sacrifice) that led to their collapse

book was 2010

IBM Watson2.5 quintillion bytes of data per day

- The average person is likely to generate more than one million gigabytes of health related data in their lifetime

- Medical data is expected to double every 73 days by 2020- Less than 50% of medical decision meet evidence based standards- Watson can read 40 million documents in 15 seconds

Welcome to the Era of Cognitive Health

Watson Health

Moore's law  is the observation that the number of transistors in a dense integrated circuit doubles approximately every two years. The observation is named after Gordon Moore, the co-founder of Intel and Fairchild Semiconductor, whose 1965 paper described a doubling every year in the number of components per integrated circuit

Curve shows transistorcount doubling every 2 Years

Exponential Growth of Computing for 110 Years Calculation per Second per $1,000

Electromechanical Relay Vacuum Tube Transistor Integrated Circuit

Ray Kurzweil’s Law of Accelerating Returns

Exponential Growth of Computing

Health and Medicine have now become information technology and are now subject to Ray Kurzweil’s Law of Accelerating Returns

Complexity

Key cellular pathways in mantle cell lymphoma. The B-cell receptor complex is constitutively activated, which through multiple downstream signaling pathways results in cellular growth and survival. Novel therapies that inhibit critical elements of this signaling pathway are shown in white boxes. 

Complexity has proven to be a fundamental feature to our world that is not amenable to our traditional methods of modern science.

Complexity theory emphasizes interactions and the accompanying feedback loops that constantly change systems.

Isaac Newton invented calculus in 1666 at the age of 23 to solve problems in mathematical physics

We now need to use complexity theory to solve modern problems

Calculus is the mathematical study of change, in the same way that geometry is the study of shape and algebra is the study of operations and their application to solving equations.

http://complexityacademy.io/

https://www.ted.com/playlists/310/talks_on_artificial_intelligen

https://goo.gl/rkW17g

Along with the exponential growth in information, the field of complexity theory are the advances in AI that are transforming our world, and watching the TED talk playlist on AI is a nice introduction to the subject.

We are getting very close to being outsmarted by computers

Advances in artificial intelligence which appeared to have stalled in the 1980’s has recently taken off.

And as the industrial revolution eliminated most of the blue collar jobs, the machine learning revolution will eliminate most of the white collar jobs

Recent Breakthroughs in AI (artificial intelligence) and the money available to facilitate the rapid development

New York Times July 17, 2016

a new approach to deep learning, a machine learning method that is highly effective for pattern recognition challenges like vision and speech.

Modeled on a general understanding of how the human brain works, it has helped technologists make rapid progress in a wide range of A.I. fields.

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Deep Learning

Google's Deep Mind Explained! - Self Learning A.I. https://www.youtube.com/watch?v=TnUYcTuZJpM or http://goo.gl/TUCpxd

Rather than brute force it studied 100,000 human matches of Go and then played itself for 30,000,000 games and using reinforcement learning to beat it’s earlier versions Cold Fusion TV

A.I. Learns Nobel Prize Experiment in Just 1 Hour!https://www.youtube.com/watch?v=lJcGzmsLRUo or http://goo.gl/CuO5Yn

AI system was able to recreate the complex quantum experiment to create from scratch an extremely cold gas trapped in a laser beam (Bose-Einstein condensate) in one hour that was the physics experiment that won the 2001 Nobel Prize in physics

Cold Fusion TV

Are We Approaching Robotic Consciousness's?https://www.youtube.com/watch?v=JTOMNkZJRao or http://goo.gl/t4KmSF

A robot solved the “Wise Man Test” it is self aware that it is speaking

Cold Fusion TV

Jeremy Howard on AI with Machine Learning esp “Deep Learning Algorithm” already beating Radiologists and Pathologists in making diagnoses. Company enlitic

http://www.ted.com/talks/jeremy_howard_the_wonderful_and_terrifying_implications_of_computers_that_can_learn

http://tinyurl.com/n2a6wl8 or http://goo.gl/WvclzB

Harvard radiologists have used Deep Learning to improve CT diagnostics of cancer

Stanford Pathologists have used Deep Learning to improve pathological diagnoses of cancer (better than human pathologists)

Non-medical computer scientists have used Deep Learning to improve pathological diagnoses of cancer (as good as human pathologists)

Enlitic applies the state of the art in deep learning technology to medicine

For Patients

Enlitic puts patients first by providing radiologists with a tool designed to help them improve the accuracy of diagnostics, reduce wait times, and prevent unnecessary follow up tests. As part of your doctor's visit at one of partner clinics, Enlitic technology will automatically screen for hundreds of specific diseases within your medical data (such as x-rays, MRIs, and more).

For Radiologists

Enlitic technology brings clinical intelligence and subspecialty expertise to any radiology clinic. Automatic analysis across large numbers of disease types provides to radiologists a tool with the potential to result in unparalleled diagnostic accuracy. It also allows for dramatically reduced image read times, detection of co-morbidities and incidental findings, and insights on treatment options.

For Healthcare Providers

Enlitic handles report generation for you from end to end, through our:Deep learning integrated workflowRadiologists who are hand-picked based on their accuracy and speed using deep learning tools

Our target is:Half the cost, twice the accuracy, twice the speed of legacy approachesOpportunity to provide rich, interactive multimedia reports for greater physician and patient understanding

https://www.ted.com/talks/blaise_aguera_y_arcas_how_computers_are_learning_to_be_creative

https://goo.gl/GYjA07

A neural network trained to discriminate by perception of objects can be run in reverse and create objects. Perception and Creativity are connected.

The way to survive is with Medical Aps

Running an Oncology practice with just 4 apps

1.ePSS ( Electronic Preventive Service Selector from the US Preventative Task Force) : update guidance for screening and prevention

2.NCCN (National Comprehensive Cancer Network) constantly updated treatment and testing and follow up

3.Epocrates: to make sure medication orders and safe and appropriate

4.Up to Date: if I need more detailed review of a subject

An interactive decision support tool

Will the internet and AI change medicine?

Patients and researchers will continue to amass massive quantities of health data that only super computers will be able to make sense of in a timely manner.

Who ever controls and knows how to mine big data will have the power to control health care in the future, which is just information technology.

Patients will be more and more comfortable accessing this data from virtual assistants without the cost and delay involved with seeing a physician.

Doctors of the future will need to reinvent themselves to remain a relevant part of the future health care delivery system.

Doctors have to anticipate and adapt to dramatic changes or the patients will simply go right past the doctor and manage their care without them

Can you teach a doctor intellectual flexibility?

The last doctor?

Will there be any role for physicians by the mid century?

Will there be a shortage of doctors in the future or a glut?

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Whatever happened to farmers ?

Farmers as Percent of Workforce in the US from 1790 to Present

In 1790 Farmers made up 90% of the workforce and now 2%

Clustered regularly interspaced short palindromic repeats (CRISPR) technique has many potential applications, including altering the germ line  of humans, animals, and food crops. The use of CRISPR for genome editing ]was the AAAS choice for breakthrough of the year in 2015

The Singularity is Near

by Ray Kurzweil

a future period during which the pace of technological advance will be so rapid, its impact so deep, that human life will be irreversibly transformed... The Singularity will represent the culmination of the merger of our biological thinking and existence with our technology, resulting in a world that is still human but transcends our biological roots. There will be no distinction, post-Singularity, between human and machine or between physical and virtual. Kurzweil estimates that the Singularity will happen in the year 2045.

The Borg

Future Doctors will need to move up the ‘intellectual food chain’ or reinvent their role in the health care system to remain relevant in the future

www.aboutcancer.comhttp://goo.gl/rH7fmO