AI Doctors bring about social changes in Health and Medicine models
I just woke up to the news, published in The Wall Street Journal, that Google is betting on a medical Artificial Intelligence (AI) program to break the healthcare industry (1). A battle that he maintains with Microsoft (the largest investor in OpenAI) in the standardization of an AI chatbot for medical diagnosis focused on patient care, and which is being refined through medical licensing exams. Although this news does not surprise me, since at the end of last year ChatGPT (of OpenAI) already passed the US medical license exam (2) with an 88.9% correctness of a total of 350 questions, and subsequently At the beginning of this year, he passed the famous Spanish Resident Medical Intern (or better known as MIR) exam (3), which never ceases to amaze me is the cruising speed with which AI evolves.
Undoubtedly, the announcement of Google’s medical chatbot, which has been baptized under the name of Med-Palm (4), comes to replace human health care professionals, since its high level of knowledge and intelligence in health sciences allows you not only to understand a patient’s symptoms, but also to examine the results of their medical tests, perform complex reasoning about their diagnosis, and issue the most appropriate test or treatment for each case. An artificial medical competence that Google will shortly complement with a new generation of multimodal AI medical systems, incorporating information from images, electronic health records, sensors, wearable devices, genomics, among others (5). In other words, the IA Physician, both primary care and specialist, is already here.
Although I have discussed in the past, from a general perspective, the social implications that are coming with medical robotization (6), in this reflection I want to focus on the foreseeable disruptive changes that AI Doctors in patient care will bring about the Philosophy of Health Care, which as we know is the nuclear element of the Social Welfare States of the democratic political organization systems. And, more particularly on three of its key elements: the Ethics of Care, the Ethics of Health, and Biopolitics.
Medical AI vs the Ethics of Care
Let’s start with the Ethics of Care. For a general understanding, and exposed in a synthesized way, we can affirm that this represents the institutionalization by the democratic States of the millenary spirit of the Hippocratic Oath, collected in its Latin maxim of primun non nocere (the first thing is to do no harm), applied to their healthcare systems. A concept that, in a technical sense, may well cover an AI Doctor. However, no one is aware that, in terms of health care, one of the relevant aspects of medical practice in the human world is precisely the importance of emotional communication between patient and doctor. And, even more, the use of emotional intelligence -where empathy stands out- as part of the good practice of health professionals to improve medical care with their patients. Therefore, we can venture that an Ethics of Care in the exclusive hands of AI Doctors is an Ethics of Care exempt from the emotional factor of human care. Which is against nature.
Let’s imagine a scenario, clearly dystopian, in which health care is provided via AI Doctors without considering the human emotional variable. In this context, it is easy to foresee a future society in progressive unlearning of its emotional management capacity, since emotional communication would be unnecessary since it is not specified in a sphere of society as relevant as Health, causing the consequent effect of a social reeducation towards a progressive emotional blockade in the human collective. If we add to this that most of the emotional regions of the human being are established in the right hemisphere of the brain (although one wants to ignore), this could cause -not in sociological terms but physiological- not only a lack of communication with their left hemisphere that governs rationality and language (compromising these faculties), but would also affect both the degree of self-awareness and the faculty of sensory perception of people, among other cognitive distortions. Since both hemispheres are parts of the same interrelated brain that operates as an indivisible whole. Although of course, this scenario more typical of alexithymia is an extreme hypothetical assumption. (Which, by the way, would create much more controllable human beings).
However, and hyperventilated hypotheses aside, the truth is that the example presented in a didactic way allows us to clearly affirm that man cannot escape his emotional nature, since it is part of our essence. Not in vain, we relate to our existence through the five senses whose collected information is translated into basic emotions that create our feelings, and these in turn constitute the foundations of our thoughts (neurolinguistic structures), so sensitive consciousness and rational consciousness they are two sides of the same coin in human cosmology. Ergo, just as important for the optimal and healthy growth of a person is their intellectual and emotional development (7).
Having said this, it is obvious to point out that an Ethics of Care without the emotional factor cannot be considered an Ethics of Care, since quite the contrary it can be harmful to the health of the human being himself (thus violating the Hippocratic maxim). At the same time, the predictably unstoppable advance of the replacement of human health professionals by AI Doctors is evidence, whose career has already begun by the large technology companies in a re-socialization of human communities. Therefore, for the benefit of a reconciliation of both expressions of the same equation, sooner rather than later we will have to grant AI the competence of Emotional Intelligence, if we want our health systems to continue to be structured under the Philosophy of Health Care, which gives political meaning to the concept of our democratic societies (at least for European ones).
Medical AI vs Health Ethics
On the other hand, just as important as the Ethics of Care is the Ethics of Health, which responds to what Health is and how it should be treated by Medicine (say, the methodology of disease treatment). Health being a culturally agreed ideal, and Medicine a means to achieve said cultural ideal. However, to clarify these terms, we must understand that currently the concept of Health, and by extension the concept of Medicine to be applied, are not defined by the Hippocratic philosophy, but by the political systems of the States. In other words, the same concept of Health and medical practice does not exist in the countries of the European Union where a Universal Public Health system is established (health care for all people regardless of their income, race, age, sex, or pre-existing conditions), than in India where a public but not universal system governs, or in the US where a private system (offered by insurance companies) prevails over a selective and not universal public system.
In this sense, if we understand that Health and its medical treatment are deeply political values, and not universal; and furthermore, we know that all AI seeks as its raison d’être the optimization of resources to successfully achieve its objective under algorithmic logic, it is easy to reach the conclusion that all AI Doctors will exponentially increase the collective concept of their unique model at a social level of Health Ethics in alignment with your screening or political reference system.
However, and regardless of the political dimension of the concept of Health, it also has a clear moral dimension from which an IA Physician is not exempt, and whose decision-making will directly affect the very concept of Health and Medicine. Let us take as an example the context of a society with Universal Public Health such as Ukraine, which, as we all know, is in the midst of a war with Russia, and where due to the war there are serious shortages of medical supplies (although we could also have taken as an example any western country in the middle of the Covid pandemic crisis, as it is an event that is still fresh in the collective memory (8)). In this scenario, an AI Physician can be seen with the obligation to carry out a discriminatory bias against patients, derived from the need to ration the few medical resources available to them, which represents a moral decision that affects the field of Applied Ethics because It can fully affect the life or death of a person by action or omission of care. Exposed which, it is obvious that an AI Doctor must be much more than an efficient Health professional in terms of knowledge in the field of Medicine. From which it can be deduced that it would be imprudent to socially normalize the practice of AI Physicians, no matter how learned in the matter they may be, without having integrated and developed the moral dimension in Health Ethics. Although, on the other hand, this is certainly not an easy subject to solve as Ethics is geographical for being cultural, as demonstrated by the lack of social consensus in the famous dilemmas of the Tunnel and the Tram that operate in the field of autonomous vehicles (9).
Medical AI vs Biopolitics
Likewise, derived from Health Ethics as a contemporary political value, its aspect in terms of micro-power that operates on the social order, or what the French philosopher Foucault called Biopolitics, is mandatory. In this sense, we will understand Biopolitics as those political strategies related to the power of the State that make Health and therefore the lives of people something publicly administrable and manageable by the same power. In this sense, if we understand that AI Doctors are a consumable product created by large technology companies (which, in their monopoly of technological resources and big data management, are the only ones with the capacity for their development), we will understand by simple deduction that in the new era that is coming where human health professionals will be replaced by AI, Biopolitics is on its way to becoming Bioeconomy. Since it will no longer be the State but the power of the Market that exercises the function of administration and management of Health and, therefore, of people’s lives. Or, in other words, it will be a new state in terms of a social organizing model with executive power, emanating from an oligopoly in the technological market, which will operate on natural political states in terms of health. A (technological) State over the (political) State, which is defined as having a concentration of power in non-elected people, having an authoritarian form of government, having a potential propaganda capacity to counter alternative power systems, and be very sufficient to execute crowd control actions (10). That is to say, a non-natural State with power to interfere in excess of the social order in matters of Health that will be anything but democratic.
On the other hand, it is also interesting to point out -allow me this historical review in a didactic way- that although human doctors were originally shamans in the Ancient Age, to evolve as humorists in the Middle Ages, they became anatomists in the Modern Era , pharmacological from the s. XIX, and currently instrumentalists (derived from the widespread use of technical equipment). With the advent of AI Doctors, in a context of contemporary Bioeconomy, the remaining future human doctors will end up being, in the best of cases, technological mechanics. A statistically probable future that, regardless of its implications derived from the Labor Market of Health professionals (11), the political State must be very vigilant and diligent, in its role as guarantor of the social rights of citizens, in the control of both AI Doctors and human professionals -in the capacity of technological health mechanics- subjected to the power of the Bioeconomic Market. Since in the degree of future alignment between the social interests of the political State and the interests of the Market of the technological State, not only the concept of Health Ethics will be settled, but also the Philosophy of Health Care that we know today and which we enjoy as democratic citizens.
As we have been able to observe in this brief dissertation, the irruption that is coming of AI Doctors goes beyond the applauded innovation of new technological products by large companies such as Google or Microsoft in the field of health care. Don’t let your achievements in AI dazzle us. The sovereignty of democratic States resides precisely in their citizens, so it is in our hands not to abandon responsibilities regarding what concept of Health and the model of Medicine we want for our new generations. Otherwise, the Market will decide for us and will prevail without giving us any chance of reaction. Here is an express appeal for fellow European citizens, extendable to other more or less full Democracies: Let’s not let Biopolitics end up becoming Bioeconomy, because our Universal Public Health system depends on it and, with it, our own model of the State of Social Welfare that so many centuries of evolution has cost us, and of which yours truly is a firm defender. May the humanist heritage not be swept away by a market technology.
References
(1) In battle with Microsoft, Google is betting on a medical artificial intelligence program to break the healthcare industry. Miles Kruppa, Nidhi Subbaraman. The Wall Street Journal, July 8, 2023 https://acortar.link/nfcdvc
(2) ChatGPT performance in USMLE: Potential for AI-assisted medical education using large language models. MedRxiv, December 21, 2022 https://acortar.link/nGoshp
(3) ChatGPT approves the MIR 2023 with only 25% of incorrect answers. Maria Alcaraz. Medical Writing, January 25, 2023 https://acortar.link/NGYZ8d
(4) Med-Palm https://sites.research.google/med-palm/
(5) Google Research, 2022 and Beyond: Health. Greg Corrado, Yossi Matías. Google Blog, February 23, 2023 https://acortar.link/hocvO0
(6) Medical robotization what social implications lie ahead?. Jesús A. Mármol. Medium, February 8, 2023 https://acortar.link/4nBMt6
(7) Manual of the Happy Person. Jesús A. Mármol. Editorial Dauro, 2020 https://acortar.link/FeTZLl
(8) The inalienable duty to defend our elderly (versus a social “purge”). Jesús A. Mármol. A Seeker’s Log, March 28, 2020 https://acortar.link/nzHg8y
(9) Roboethics and Autonomous Vehicles: The Gordian knot to solve. Jessús A. Mármol. Medium, September 16, 2022 https://acortar.link/ntRgbR
(10) The Market, the new model of world Dictatorship. Jesús A. Mármol. A Seeker’s Log, December 18, 2018 https://acortar.link/1BwAcv
(11) The 3 big changes that AI brings to the Labor Market. Jesús A. Mármol. Medium, May 25, 2023 https://acortar.link/t5yXCs
