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Big data, personalized medicine, artificial intelligence. String these three buzzphrases together, and what do you have?
A system that may revolutionize the future of healthcare, by bringing sophisticated health data directly to patients for them to ponder, digest, and act upon—and potentially stop diseases in their tracks.
At Singularity University’s Exponential Medicine conference in San Diego this week, Dr. Ran Balicer, director of the Clalit Research Institute in Israel, painted a futuristic picture of how big data can merge with personalized healthcare into an app-based system in which the patient is in control.
Dr. Ran Balicer at Exponential Medicine
Picture this: instead of going to a physician with your ailments, your doctor calls you with some bad news: “Within six hours, you’re going to have a heart attack. So why don’t you come into the clinic and we can fix that.” Crisis averted.
Following the treatment, you’re at home monitoring your biomarkers, lab test results, and other health information through an app with a clean, beautiful user interface. Within the app, you can observe how various health-influencing life habits—smoking, drinking, insufficient sleep—influence your chance of future cardiovascular disease risks by toggling their levels up or down.
There’s more: you can also set a health goal within the app—for example, stop smoking—which automatically informs your physician. The app will then suggest pharmaceuticals to help you ditch the nicotine and automatically sends the prescription to your local drug store. You’ll also immediately find a list of nearby support groups that can help you reach your health goal.
With this hefty dose of AI, you’re in charge of your health—in fact, probably more so than under current healthcare systems.
Sound fantastical? In fact, this type of preemptive care is already being provided in some countries, including Israel, at a massive scale, said Balicer. By mining datasets with deep learning and other powerful AI tools, we can predict the future—and put it into the hands of patients.
The Israeli Advantage
In order to apply big data approaches to medicine, you first need a giant database.
Israel is ahead of the game in this regard. With decades of electronic health records aggregated within a central warehouse, Israel offers a wealth of health-related data on the scale of millions of people and billions of data points. The data is incredibly multiplex, covering lab tests, drugs, hospital admissions, medical procedures, and more.
One of Balicer’s early successes was an algorithm that predicts diabetes, which allowed the team to notify physicians to target their care. Clalit has also been busy digging into data that predicts winter pneumonia, osteoporosis, and a long list of other preventable diseases.
So far, Balicer’s predictive health system has only been tested on a pilot group of patients, but he is expecting to roll out the platform to all patients in the database in the next few months.
Truly Personalized Medicine
To Balicer, whatever a machine can do better, it should be welcomed to do. AI diagnosticians have already enjoyed plenty of successes—but their collaboration remains mostly with physicians, at a point in time when the patient is already ill.
A particularly powerful use of AI in medicine is to bring insights and trends directly to the patient, such that they can take control over their own health and medical care.
For example, take the problem of tailored drug dosing. Current drug doses are based on average results conducted during clinical trials—the dosing is not tailored for any specific patient’s genetic and health makeup. But what if a doctor had already seen millions of other patients similar to your case, and could generate dosing recommendations more relevant to you based on that particular group of patients?
Such personalized recommendations are beyond the ability of any single human doctor. But with the help of AI, which can quickly process massive datasets to find similarities, doctors may soon be able to prescribe individually-tailored medications.
Tailored treatment doesn’t stop there. Another issue with pharmaceuticals and treatment regimes is that they often come with side effects: potentially health-threatening reactions that may, or may not, happen to you based on your biometrics.
Back in 2017, the New England Journal of Medicine launched the SPRINT Data Analysis Challenge, which urged physicians and data analysts to identify novel clinical findings using shared clinical trial data.
Working with Dr. Noa Dagan at the Clalit Research Institute, Balicer and team developed an algorithm that recommends whether or not a patient receives a particularly intensive treatment regime for hypertension.
Rather than simply looking at one outcome—normalized blood pressure—the algorithm takes into account an individual’s specific characteristics, laying out the treatment’s predicted benefits and harms for a particular patient.
“We built thousands of models for each patient to comprehensively understand the impact of the treatment for the individual; for example, a reduced risk for stroke and cardiovascular-related deaths could be accompanied by an increase in serious renal failure,” said Balicer. “This approach allows a truly personalized balance—allowing patients and their physicians to ultimately decide if the risks of the treatment are worth the benefits.”
This is already personalized medicine at its finest. But Balicer didn’t stop there.
We are not the sum of our biologics and medical stats, he said. A truly personalized approach needs to take a patient’s needs and goals and the sacrifices and tradeoffs they’re willing to make into account, rather than having the physician make decisions for them.
Balicer’s preventative system adds this layer of complexity by giving weights to different outcomes based on patients’ input of their own health goals. Rather than blindly following big data, the system holistically integrates the patient’s opinion to make recommendations.
Balicer’s system is just one example of how AI can truly transform personalized health care. The next big challenge is to work with physicians to further optimize these systems, in a way that doctors can easily integrate them into their workflow and embrace the technology.
“Health systems will not be replaced by algorithms, rest assured,” concluded Balicer, “but health systems that don’t use algorithms will be replaced by those that do.”
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It’s common to hear phrases like ‘machine learning’ and ‘artificial intelligence’ and believe that somehow, someone has managed to replicate a human mind inside a computer. This, of course, is untrue—but part of the reason this idea is so pervasive is because the metaphor of human learning and intelligence has been quite useful in explaining machine learning and artificial intelligence.
Indeed, some AI researchers maintain a close link with the neuroscience community, and inspiration runs in both directions. But the metaphor can be a hindrance to people trying to explain machine learning to those less familiar with it. One of the biggest risks of conflating human and machine intelligence is that we start to hand over too much agency to machines. For those of us working with software, it’s essential that we remember the agency is human—it’s humans who build these systems, after all.
It’s worth unpacking the key differences between machine and human intelligence. While there are certainly similarities, it’s by looking at what makes them different that we can better grasp how artificial intelligence works, and how we can build and use it effectively.
Central to the metaphor that links human and machine learning is the concept of a neural network. The biggest difference between a human brain and an artificial neural net is the sheer scale of the brain’s neural network. What’s crucial is that it’s not simply the number of neurons in the brain (which reach into the billions), but more precisely, the mind-boggling number of connections between them.
But the issue runs deeper than questions of scale. The human brain is qualitatively different from an artificial neural network for two other important reasons: the connections that power it are analogue, not digital, and the neurons themselves aren’t uniform (as they are in an artificial neural network).
This is why the brain is such a complex thing. Even the most complex artificial neural network, while often difficult to interpret and unpack, has an underlying architecture and principles guiding it (this is what we’re trying to do, so let’s construct the network like this…).
Intricate as they may be, neural networks in AIs are engineered with a specific outcome in mind. The human mind, however, doesn’t have the same degree of intentionality in its engineering. Yes, it should help us do all the things we need to do to stay alive, but it also allows us to think critically and creatively in a way that doesn’t need to be programmed.
The Beautiful Simplicity of AI
The fact that artificial intelligence systems are so much simpler than the human brain is, ironically, what enables AIs to deal with far greater computational complexity than we can.
Artificial neural networks can hold much more information and data than the human brain, largely due to the type of data that is stored and processed in a neural network. It is discrete and specific, like an entry on an excel spreadsheet.
In the human brain, data doesn’t have this same discrete quality. So while an artificial neural network can process very specific data at an incredible scale, it isn’t able to process information in the rich and multidimensional manner a human brain can. This is the key difference between an engineered system and the human mind.
Despite years of research, the human mind still remains somewhat opaque. This is because the analog synaptic connections between neurons are almost impenetrable to the digital connections within an artificial neural network.
Speed and Scale
Consider what this means in practice. The relative simplicity of an AI allows it to do a very complex task very well, and very quickly. A human brain simply can’t process data at scale and speed in the way AIs need to if they’re, say, translating speech to text, or processing a huge set of oncology reports.
Essential to the way AI works in both these contexts is that it breaks data and information down into tiny constituent parts. For example, it could break sounds down into phonetic text, which could then be translated into full sentences, or break images into pieces to understand the rules of how a huge set of them is composed.
Humans often do a similar thing, and this is the point at which machine learning is most like human learning; like algorithms, humans break data or information into smaller chunks in order to process it.
But there’s a reason for this similarity. This breakdown process is engineered into every neural network by a human engineer. What’s more, the way this process is designed will be down to the problem at hand. How an artificial intelligence system breaks down a data set is its own way of ‘understanding’ it.
Even while running a highly complex algorithm unsupervised, the parameters of how an AI learns—how it breaks data down in order to process it—are always set from the start.
Human Intelligence: Defining Problems
Human intelligence doesn’t have this set of limitations, which is what makes us so much more effective at problem-solving. It’s the human ability to ‘create’ problems that makes us so good at solving them. There’s an element of contextual understanding and decision-making in the way humans approach problems.
AIs might be able to unpack problems or find new ways into them, but they can’t define the problem they’re trying to solve.
Algorithmic insensitivity has come into focus in recent years, with an increasing number of scandals around bias in AI systems. Of course, this is caused by the biases of those making the algorithms, but underlines the point that algorithmic biases can only be identified by human intelligence.
Human and Artificial Intelligence Should Complement Each Other
We must remember that artificial intelligence and machine learning aren’t simply things that ‘exist’ that we can no longer control. They are built, engineered, and designed by us. This mindset puts us in control of the future, and makes algorithms even more elegant and remarkable.
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As artificial intelligence advances, we’re encountering the same old questions. How much of what we consider to be fundamentally human can be reduced to an algorithm? Can we create something sufficiently advanced that people can no longer distinguish between the two? This, after all, is the idea behind the Turing Test, which has yet to be passed.
At first glance, you might think music is beyond the realm of algorithms. Birds can sing, and people can compose symphonies. Music is evocative; it makes us feel. Very often, our intense personal and emotional attachments to music are because it reminds us of our shared humanity. We are told that creative jobs are the least likely to be automated. Creativity seems fundamentally human.
But I think above all, we view it as reductionist sacrilege: to dissect beautiful things. “If you try to strangle a skylark / to cut it up, see how it works / you will stop its heart from beating / you will stop its mouth from singing.” A human musician wrote that; a machine might be able to string words together that are happy or sad; it might even be able to conjure up a decent metaphor from the depths of some neural network—but could it understand humanity enough to produce art that speaks to humans?
Then, of course, there’s the other side of the debate. Music, after all, has a deeply mathematical structure; you can train a machine to produce harmonics. “In the teachings of Pythagoras and his followers, music was inseparable from numbers, which were thought to be the key to the whole spiritual and physical universe,” according to Grout in A History of Western Music. You might argue that the process of musical composition cannot be reduced to a simple algorithm, yet musicians have often done so. Mozart, with his “Dice Music,” used the roll of a dice to decide how to order musical fragments; creativity through an 18th-century random number generator. Algorithmic music goes back a very long way, with the first papers on the subject from the 1960s.
Then there’s the techno-enthusiast side of the argument. iTunes has 26 million songs, easily more than a century of music. A human could never listen to and learn from them all, but a machine could. It could also memorize every note of Beethoven. Music can be converted into MIDI files, a nice chewable data format that allows even a character-by-character neural net you can run on your computer to generate music. (Seriously, even I could get this thing working.)
Indeed, generating music in the style of Bach has long been a test for AI, and you can see neural networks gradually learn to imitate classical composers while trying to avoid overfitting. When an algorithm overfits, it essentially starts copying the existing music, rather than being inspired by it but creating something similar: a tightrope the best human artists learn to walk. Creativity doesn’t spring from nowhere; even maverick musical geniuses have their influences.
Does a machine have to be truly ‘creative’ to produce something that someone would find valuable? To what extent would listeners’ attitudes change if they thought they were hearing a human vs. an AI composition? This all suggests a musical Turing Test. Of course, it already exists. In fact, it’s run out of Dartmouth, the school that hosted that first, seminal AI summer conference. This year, the contest is bigger than ever: alongside the PoetiX, LimeriX and LyriX competitions for poetry and lyrics, there’s a DigiKidLit competition for children’s literature (although you may have reservations about exposing your children to neural-net generated content… it can get a bit surreal).
There’s also a pair of musical competitions, including one for original compositions in different genres. Key genres and styles are represented by Charlie Parker for Jazz and the Bach chorales for classical music. There’s also a free composition, and a contest where a human and an AI try to improvise together—the AI must respond to a human spontaneously, in real time, and in a musically pleasing way. Quite a challenge! In all cases, if any of the generated work is indistinguishable from human performers, the neural net has passed the Turing Test.
Did they? Here’s part of 2017’s winning sonnet from Charese Smiley and Hiroko Bretz:
The large cabin was in total darkness.
Come marching up the eastern hill afar.
When is the clock on the stairs dangerous?
Everything seemed so near and yet so far.
Behind the wall silence alone replied.
Was, then, even the staircase occupied?
Generating the rhymes is easy enough, the sentence structure a little trickier, but what’s impressive about this sonnet is that it sticks to a single topic and appears to be a more coherent whole. I’d guess they used associated “lexical fields” of similar words to help generate something coherent. In a similar way, most of the more famous examples of AI-generated music still involve some amount of human control, even if it’s editorial; a human will build a song around an AI-generated riff, or select the most convincing Bach chorale from amidst many different samples.
We are seeing strides forward in the ability of AI to generate human voices and human likenesses. As the latter example shows, in the fake news era people have focused on the dangers of this tech– but might it also be possible to create a virtual performer, trained on a dataset of their original music? Did you ever want to hear another Beatles album, or jam with Miles Davis? Of course, these things are impossible—but could we create a similar experience that people would genuinely value? Even, to the untrained eye, something indistinguishable from the real thing?
And if it did measure up to the real thing, what would this mean? Jaron Lanier is a fascinating technology writer, a critic of strong AI, and a believer in the power of virtual reality to change the world and provide truly meaningful experiences. He’s also a composer and a musical aficionado. He pointed out in a recent interview that translation algorithms, by reducing the amount of work translators are commissioned to do, have, in some sense, profited from stolen expertise. They were trained on huge datasets purloined from human linguists and translators. If you can train an AI on someone’s creative output and it produces new music, who “owns” it?
Although companies that offer AI music tools are starting to proliferate, and some groups will argue that the musical Turing test has been passed already, AI-generated music is hardly racing to the top of the pop charts just yet. Even as the line between human-composed and AI-generated music starts to blur, there’s still a gulf between the average human and musical genius. In the next few years, we’ll see how far the current techniques can take us. It may be the case that there’s something in the skylark’s song that can’t be generated by machines. But maybe not, and then this song might need an extra verse.
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