Can a Computer Replace Your Doctor?

AS a former physician, I shivered a bit when I heard Dr. Vivek Wadhwa say he would rather have an artificial-intelligence doctor than a human one. “I would trust an A.I. over a doctor any day,” he proclaimed at a recent health innovation conference in San Francisco, noting that artificial intelligence provided “perfect knowledge.” When asked to vote, probably a third of those in attendance agreed.But it made sense: Dr. Wadhwa is a professor, entrepreneur and technology visionary. What’s more, the conference took place in San Francisco, where faith in the power of technology and data to solve problems holds unshakable sway. There was certainly plenty of innovation on display at the conference’s rooftop reception, called “Health by the Numbers”: One device attaches to your iPhone and turns it into an otoscope so you can see if your child has anear infection; another allows it to check your blood alcohol level. Attendees could check out home cholesterol test kits, and a wearable device to track the “quality” of their breathing.Silicon Valley is bringing a host of new data-driven technologies to health care, many of them with enormous potential. But before we rush to measure every human attribute in real time, it would be a good idea to ask: When is more data actually useful to promote and ensure better health? And when does technology add true value to health care? The results have been mixed.

“It holds great promise and excitement, but so far everyone is often disappointed with the outcomes,” said Steven J. Van Kuiken, a director at McKinsey and Company who studies technology and health care. “There are lots of interesting ideas, but how do you get data that’s useful to patients, physicians or regulators? And then how do you get them to act on it?”

While the proliferation of fitness trackers suggests there is commercial potential in consumer health data technology, utility may be limited. “I don’t doubt the wearable piece is going to be a productive business model for people,” Ian T. Clark, chief executive of Genentech, said at the conference. “I just don’t know whether it’s going to bend the curve in health outcomes.”

Last month Aetna announced it was discontinuing CarePass, its personalized health data platform for patients, because it hadn’t delivered on anticipated results. And some studies show that half the people who buy portable fitness trackers stop using them in a matter of months. That is probably because most people who wear them are already health-conscious and there may be little long-term value once they take note of their activity patterns, Mr. Van Kuiken suggested.

So how can we create innovative new technologies that will revolutionize health rather than end up as discarded Christmas presents?

One big challenge is that the elusive state we call “health” is not always easily measurable. Normal blood pressure jumps up and down in response to thoughts, hydration and stress. Some healthy people have low platelets or slight elevations of liver enzymes.

In other cases, the data can show up fine, even when the patient is not. You don’t always measure the right thing. When I was in medical school, there was a gallows joke that some patients die with “Harvard numbers.” In other words, the lab tests that were ordered were all perfect, but the patient died anyway.

On the other hand, the test results can look bad even when the patient is fine. Scans of the spine, for example, show that many people have big bulging discs but no back pain. So which do you treat, the M.R.I. or the patient?

One central rule of doctoring is that you only gather data that will affect your treatment. There are now devices that track the activity of your sympathetic nervous system as a measure of stress. But what do you do with that information? Other devices continuously monitor breathing forwheezing that isn’t noticed or audible. Does that matter? Some studies have shown that continuous monitoring isn’t useful for children hospitalized with bronchial infections.

If you were dieting, would stepping on the scale 1,000 times a day help you lose weight? Or consider the treatment of an abnormal heart rhythm. It’s true that constant monitoring for a few days can be highly useful to identify the pattern and what provokes the attacks. After that, though, for many patients a wearable cardiac tracker might simply record normal beats that normal people experience all the time, increasing anxiety for many patients.

Everyone agrees, of course, that useful technology can be lifesaving.

At the Mayo Clinic’s Transform symposium this month in Rochester, Minn., I heard Eric Dishman, a general manager at Intel, explain how he had used data to individualize his own cancer care. More than a decade ago, when he was only partly responding to chemotherapy for a rare kidney cancer, he used a step monitor to help figure out what provoked his pain and then worked with a physical therapist to treat it. More recently, scientists were able to analyze the genetic sequence of his tumor, identifying a medicine for treatment. He is now cancer free.

Likewise, continuous glucose monitors alert sleeping diabetics when their blood sugar drops too low. And some companies are developing chips and other technologies that can perform tests on a drop of blood — perfect for use in remote areas where sterile needles and full laboratories are not available.

There are also apps that provide data for researchers, including one that tracks the movement of asthma patients to see what provokes attacks. That could also help doctors better understand patterns of disease and allow them to adjust doses of medicine, Mr. Van Kuiken said.

So hurrah for technology. But it’s just a tool. Let’s hope we have the wisdom to ignore it, as we would a GPS device, when it leads us in the wrong direction — or nowhere at all.

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source New york times