July 15, 2024 • 1hr 55min
#309 ‒ AI in medicine: its potential to revolutionize disease prediction, diagnosis, and outcomes, causes for concern in medicine and beyond, and more | Isaac Kohane, M.D., Ph.D.
The Peter Attia Drive
Key Takeaways
- AI has evolved through three major waves, with the current third wave enabled by large datasets, advanced neural networks, and powerful GPU technology
- AI is already transforming medicine, particularly in image-based specialties like radiology, pathology, and dermatology
- GPT-4 and large language models represent a major leap forward in AI capabilities, including medical diagnosis and analysis
- AI has potential to augment clinicians and address physician shortages, especially in primary care
- Autonomous robotic surgery may be possible within 10 years for routine procedures like prostatectomies
- AI could revolutionize early disease diagnosis and prediction for conditions like Alzheimer's, cardiovascular disease, and autism
- Ethical concerns and regulation of AI in medicine are important considerations as the technology advances
- AI may disrupt traditional medical business models and face resistance from established institutions
- The potential for AI to achieve human-like creativity and expertise raises philosophical questions about the nature of intelligence and consciousness
Introduction
Dr. Isaac "Zak" Kohane is a pioneering physician-scientist and chair of the Department of Biomedical Informatics at Harvard Medical School. In this episode, he explores the evolution of artificial intelligence (AI) from its early iterations to the current third generation, illuminating how it is transforming medicine today and unlocking possibilities for the future. Kohane shares insights from his unconventional journey in the field and discusses significant AI advancements in medical specialties, early disease diagnosis, and the potential for autonomous robotic surgery. He also delves into the ethical concerns and regulatory challenges of AI, its potential to augment clinicians, and the broader implications of AI achieving human-like creativity and expertise.
Topics Discussed
Evolution of AI and Kohane's Background (2:15)
Kohane describes his unconventional journey to becoming a pioneering physician-scientist:
- Grew up in Switzerland, studied biology and computer science in the US
- Realized during medical school that medicine was more art than science
- Completed a PhD in computer science during a break from medical school
- Finished clinical training but returned to computing research
He outlines the three major waves of AI development:
- First wave: Rule-based systems following World War II
- Second wave: Expert systems and neural networks in the 1980s
- Third wave: Deep learning and large language models from 2012 onward
Breakthroughs Enabling Current AI Capabilities (19:00)
Kohane identifies three key factors that enabled the current AI revolution:
- Large datasets: Availability of massive online data for training AI models
- Advanced neural networks: Deep learning architectures with multiple layers
- Powerful GPU technology: Parallel processing capabilities originally developed for video games
He highlights the importance of transfer learning, where models trained on general data can be fine-tuned for specific medical applications.
AI Breakthroughs in Medicine (29:00)
Kohane discusses early successes of AI in medicine:
- Retinopathy diagnosis: Google's 2018 paper demonstrating expert-level recognition of eye diseases
- Echocardiogram interpretation: Recent study using 1 million echocardiograms to train AI models
He emphasizes how these developments are changing the role of doctors in research and diagnosis.
Third Generation AI and Natural Language Processing (32:00)
Kohane explains the significance of transformer models and attention mechanisms in advancing natural language processing capabilities. He describes his early interactions with GPT-4 and its impressive performance on complex medical cases.
AI Concerns and Regulation (37:30)
The discussion covers various concerns about AI development:
- Potential misuse by individuals for harmful purposes
- Military applications and autonomous weapons
- Job displacement, particularly in white-collar professions
- Existential risks posed by highly advanced AI systems
Kohane notes the calls for AI regulation from industry leaders like Sam Altman of OpenAI, while questioning whether this could lead to regulatory lock-in favoring established companies.
AI Enhancing Image-Based Medical Specialties (49:15)
Kohane discusses how AI is impacting radiology, pathology, and dermatology:
- AI models performing at expert level in image interpretation
- Integration of clinical context and patient history with image analysis
- Potential for AI to address radiologist shortages
AI Use by Patients and Doctors (55:45)
Kohane highlights how patients are using AI tools like GPT-4 to research their symptoms and find diagnoses missed by doctors. He notes that many clinicians are not yet routinely using AI in their practice, partly due to time constraints and regulatory concerns.
AI Augmenting Clinicians and Addressing Physician Shortages (1:02:45)
The conversation explores how AI could help address the shortage of primary care physicians:
- Augmenting nurse practitioners and physician assistants with AI tools
- Potential for AI to perform at the level of entry-level doctors
- Challenges in integrating AI into clinical workflows and reimbursement models
AI Revolutionizing Early Diagnosis and Disease Prediction (1:08:00)
Kohane discusses the potential for AI to predict diseases years before clinical onset:
- Using retinal scans to predict cardiovascular risk and other health factors
- Analyzing voice, gait, and other data to detect early signs of neurodegenerative diseases
- Identifying subgroups of patients with distinct disease characteristics
Future of AI in Healthcare (1:17:00)
The discussion covers several aspects of AI's future in healthcare:
- Integration of patient data from various sources
- Improved diagnostics and personalized treatment recommendations
- Challenges of data accessibility and regulatory compliance
- Potential for new business models and disruption of traditional healthcare institutions
Autonomous Robotic Surgery (1:25:00)
Kohane predicts that autonomous robotic surgery for routine procedures like prostatectomies could be possible within 10 years. He compares the challenge to self-driving cars and notes that robotic systems may eventually be safer than human surgeons.
AI and Mental Health Care (1:31:30)
The conversation touches on the potential for AI in mental health:
- AI chatbots providing therapy and support
- Historical examples of patients forming connections with simple AI programs
- Potential for AI to deliver cognitive behavioral therapy at scale
AI Transforming and Disrupting the Medical Industry (1:34:45)
Kohane discusses how AI could lead to new business models in healthcare:
- Companies leveraging patient data rights to create alternative care delivery systems
- Potential resistance from established medical institutions
- Challenges in data interoperability and access
Potential Impacts of AI Outside Medicine (1:38:30)
Kohane shares his thoughts on AI's broader impacts:
- Concerns: Amplification of social media problems, spread of misinformation
- Positive potential: Expanding human creative expression in various fields
AI Achieving Human-Like Creativity and Expertise (1:42:00)
The discussion explores philosophical questions raised by highly capable AI:
- Potential for AI to produce work rivaling human experts in various fields
- Implications for how we view human creativity and achievement
- Possibility of AI systems becoming recognized "entities" alongside humans
Digital Immortality and Legacy (1:45:45)
Kohane and Attia discuss the potential for AI to emulate an individual's personality and responses after death:
- Technical feasibility of creating AI "versions" of deceased individuals
- Ethical questions surrounding such technology
- Potential benefits and drawbacks of digital "immortality"
Conclusion
Dr. Isaac Kohane provides a comprehensive overview of AI's rapid evolution and its transformative potential in medicine and beyond. While highlighting the significant advancements and opportunities AI presents, he also emphasizes the importance of addressing ethical concerns, regulatory challenges, and potential disruptions to established systems. The conversation underscores the need for healthcare professionals and institutions to adapt to and harness AI technologies responsibly to improve patient care and address systemic challenges in healthcare delivery.