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When it comes to the future of healthcare, perhaps the only technology more powerful than CRISPR is artificial intelligence.
Over the past five years, healthcare AI startups around the globe raised over $4.3 billion across 576 deals, topping all other industries in AI deal activity.
During this same period, the FDA has given 70 AI healthcare tools and devices ‘fast-tracked approval’ because of their ability to save both lives and money.
The pace of AI-augmented healthcare innovation is only accelerating.
In Part 3 of this blog series on longevity and vitality, I cover the different ways in which AI is augmenting our healthcare system, enabling us to live longer and healthier lives.
In this blog, I’ll expand on:
Machine learning and drug design
Artificial intelligence and big data in medicine
Healthcare, AI & China
Let’s dive in.
Machine Learning in Drug Design
What if AI systems, specifically neural networks, could predict the design of novel molecules (i.e. medicines) capable of targeting and curing any disease?
Imagine leveraging cutting-edge artificial intelligence to accomplish with 50 people what the pharmaceutical industry can barely do with an army of 5,000.
And what if these molecules, accurately engineered by AIs, always worked? Such a feat would revolutionize our $1.3 trillion global pharmaceutical industry, which currently holds a dismal record of 1 in 10 target drugs ever reaching human trials.
It’s no wonder that drug development is massively expensive and slow. It takes over 10 years to bring a new drug to market, with costs ranging from $2.5 billion to $12 billion.
This inefficient, slow-to-innovate, and risk-averse industry is a sitting duck for disruption in the years ahead.
One of the hottest startups in digital drug discovery today is Insilico Medicine. Leveraging AI in its end-to-end drug discovery pipeline, Insilico Medicine aims to extend healthy longevity through drug discovery and aging research.
Their comprehensive drug discovery engine uses millions of samples and multiple data types to discover signatures of disease, identify the most promising protein targets, and generate perfect molecules for these targets. These molecules either already exist or can be generated de novo with the desired set of parameters.
In late 2018, Insilico’s CEO Dr. Alex Zhavoronkov announced the groundbreaking result of generating novel molecules for a challenging protein target with an unprecedented hit rate in under 46 days. This included both synthesis of the molecules and experimental validation in a biological test system—an impressive feat made possible by converging exponential technologies.
Underpinning Insilico’s drug discovery pipeline is a novel machine learning technique called Generative Adversarial Networks (GANs), used in combination with deep reinforcement learning.
Generating novel molecular structures for diseases both with and without known targets, Insilico is now pursuing drug discovery in aging, cancer, fibrosis, Parkinson’s disease, Alzheimer’s disease, ALS, diabetes, and many others. Once rolled out, the implications will be profound.
Dr. Zhavoronkov’s ultimate goal is to develop a fully-automated Health-as-a-Service (HaaS) and Longevity-as-a-Service (LaaS) engine.
Once plugged into the services of companies from Alibaba to Alphabet, such an engine would enable personalized solutions for online users, helping them prevent diseases and maintain optimal health.
Insilico, alongside other companies tackling AI-powered drug discovery, truly represents the application of the 6 D’s. What was once a prohibitively expensive and human-intensive process is now rapidly becoming digitized, dematerialized, demonetized and, perhaps most importantly, democratized.
Companies like Insilico can now do with a fraction of the cost and personnel what the pharmaceutical industry can barely accomplish with thousands of employees and a hefty bill to foot.
As I discussed in my blog on ‘The Next Hundred-Billion-Dollar Opportunity,’ Google’s DeepMind has now turned its neural networks to healthcare, entering the digitized drug discovery arena.
In 2017, DeepMind achieved a phenomenal feat by matching the fidelity of medical experts in correctly diagnosing over 50 eye disorders.
And just a year later, DeepMind announced a new deep learning tool called AlphaFold. By predicting the elusive ways in which various proteins fold on the basis of their amino acid sequences, AlphaFold may soon have a tremendous impact in aiding drug discovery and fighting some of today’s most intractable diseases.
Artificial Intelligence and Data Crunching
AI is especially powerful in analyzing massive quantities of data to uncover patterns and insights that can save lives. Take WAVE, for instance. Every year, over 400,000 patients die prematurely in US hospitals as a result of heart attack or respiratory failure.
Yet these patients don’t die without leaving plenty of clues. Given information overload, however, human physicians and nurses alone have no way of processing and analyzing all necessary data in time to save these patients’ lives.
Enter WAVE, an algorithm that can process enough data to offer a six-hour early warning of patient deterioration.
Just last year, the FDA approved WAVE as an AI-based predictive patient surveillance system to predict and thereby prevent sudden death.
Another highly valuable yet difficult-to-parse mountain of medical data comprises the 2.5 million medical papers published each year.
For some time, it has become physically impossible for a human physician to read—let alone remember—all of the relevant published data.
To counter this compounding conundrum, Johnson & Johnson is teaching IBM Watson to read and understand scientific papers that detail clinical trial outcomes.
Enriching Watson’s data sources, Apple is also partnering with IBM to provide access to health data from mobile apps.
One such Watson system contains 40 million documents, ingesting an average of 27,000 new documents per day, and providing insights for thousands of users.
After only one year, Watson’s successful diagnosis rate of lung cancer has reached 90 percent, compared to the 50 percent success rate of human doctors.
But what about the vast amount of unstructured medical patient data that populates today’s ancient medical system? This includes medical notes, prescriptions, audio interview transcripts, and pathology and radiology reports.
In late 2018, Amazon announced a new HIPAA-eligible machine learning service that digests and parses unstructured data into categories, such as patient diagnoses, treatments, dosages, symptoms and signs.
Taha Kass-Hout, Amazon’s senior leader in health care and artificial intelligence, told the Wall Street Journal that internal tests demonstrated that the software even performs as well as or better than other published efforts.
On the heels of this announcement, Amazon confirmed it was teaming up with the Fred Hutchinson Cancer Research Center to evaluate “millions of clinical notes to extract and index medical conditions.”
Having already driven extraordinary algorithmic success rates in other fields, data is the healthcare industry’s goldmine for future innovation.
Healthcare, AI & China
In 2017, the Chinese government published its ambitious national plan to become a global leader in AI research by 2030, with healthcare listed as one of four core research areas during the first wave of the plan.
Just a year earlier, China began centralizing healthcare data, tackling a major roadblock to developing longevity and healthcare technologies (particularly AI systems): scattered, dispersed, and unlabeled patient data.
Backed by the Chinese government, China’s largest tech companies—particularly Tencent—have now made strong entrances into healthcare.
Just recently, Tencent participated in a $154 million megaround for China-based healthcare AI unicorn iCarbonX.
Hoping to develop a complete digital representation of your biological self, iCarbonX has acquired numerous US personalized medicine startups.
Considering Tencent’s own Miying healthcare AI platform—aimed at assisting healthcare institutions in AI-driven cancer diagnostics—Tencent is quickly expanding into the drug discovery space, participating in two multimillion-dollar, US-based AI drug discovery deals just this year.
China’s biggest, second-order move into the healthtech space comes through Tencent’s WeChat. In the course of a mere few years, already 60 percent of the 38,000 medical institutions registered on WeChat allow patients to digitally book appointments through Tencent’s mobile platform. At the same time, 2,000 Chinese hospitals accept WeChat payments.
Tencent has additionally partnered with the U.K.’s Babylon Health, a virtual healthcare assistant startup whose app now allows Chinese WeChat users to message their symptoms and receive immediate medical feedback.
Similarly, Alibaba’s healthtech focus started in 2016 when it released its cloud-based AI medical platform, ET Medical Brain, to augment healthcare processes through everything from diagnostics to intelligent scheduling.
As Nvidia CEO Jensen Huang has stated, “Software ate the world, but AI is going to eat software.” Extrapolating this statement to a more immediate implication, AI will first eat healthcare, resulting in dramatic acceleration of longevity research and an amplification of the human healthspan.
Next week, I’ll continue to explore this concept of AI systems in healthcare.
Particularly, I’ll expand on how we’re acquiring and using the data for these doctor-augmenting AI systems: from ubiquitous biosensors, to the mobile healthcare revolution, and finally, to the transformative power of the health nucleus.
As AI and other exponential technologies increase our healthspan by 30 to 40 years, how will you leverage these same exponential technologies to take on your moonshots and live out your massively transformative purpose?
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As if stand-alone technologies weren’t advancing fast enough, we’re in age where we must study the intersection points of these technologies. How is what’s happening in robotics influenced by what’s happening in 3D printing? What could be made possible by applying the latest advances in quantum computing to nanotechnology?
Along these lines, one crucial tech intersection is that of artificial intelligence and genomics. Each field is seeing constant progress, but Jamie Metzl believes it’s their convergence that will really push us into uncharted territory, beyond even what we’ve imagined in science fiction. “There’s going to be this push and pull, this competition between the reality of our biology with its built-in limitations and the scope of our aspirations,” he said.
Metzl is a senior fellow at the Atlantic Council and author of the upcoming book Hacking Darwin: Genetic Engineering and the Future of Humanity. At Singularity University’s Exponential Medicine conference last week, he shared his insights on genomics and AI, and where their convergence could take us.
Life As We Know It
Metzl explained how genomics as a field evolved slowly—and then quickly. In 1953, James Watson and Francis Crick identified the double helix structure of DNA, and realized that the order of the base pairs held a treasure trove of genetic information. There was such a thing as a book of life, and we’d found it.
In 2003, when the Human Genome Project was completed (after 13 years and $2.7 billion), we learned the order of the genome’s 3 billion base pairs, and the location of specific genes on our chromosomes. Not only did a book of life exist, we figured out how to read it.
Jamie Metzl at Exponential Medicine
Fifteen years after that, it’s 2018 and precision gene editing in plants, animals, and humans is changing everything, and quickly pushing us into an entirely new frontier. Forget reading the book of life—we’re now learning how to write it.
“Readable, writable, and hackable, what’s clear is that human beings are recognizing that we are another form of information technology, and just like our IT has entered this exponential curve of discovery, we will have that with ourselves,” Metzl said. “And it’s intersecting with the AI revolution.”
Learning About Life Meets Machine Learning
In 2016, DeepMind’s AlphaGo program outsmarted the world’s top Go player. In 2017 AlphaGo Zero was created: unlike AlphaGo, AlphaGo Zero wasn’t trained using previous human games of Go, but was simply given the rules of Go—and in four days it defeated the AlphaGo program.
Our own biology is, of course, vastly more complex than the game of Go, and that, Metzl said, is our starting point. “The system of our own biology that we are trying to understand is massively, but very importantly not infinitely, complex,” he added.
Getting a standardized set of rules for our biology—and, eventually, maybe even outsmarting our biology—will require genomic data. Lots of it.
Multiple countries already starting to produce this data. The UK’s National Health Service recently announced a plan to sequence the genomes of five million Britons over the next five years. In the US the All of Us Research Program will sequence a million Americans. China is the most aggressive in sequencing its population, with a goal of sequencing half of all newborns by 2020.
“We’re going to get these massive pools of sequenced genomic data,” Metzl said. “The real gold will come from comparing people’s sequenced genomes to their electronic health records, and ultimately their life records.” Getting people comfortable with allowing open access to their data will be another matter; Metzl mentioned that Luna DNA and others have strategies to help people get comfortable with giving consent to their private information. But this is where China’s lack of privacy protection could end up being a significant advantage.
To compare genotypes and phenotypes at scale—first millions, then hundreds of millions, then eventually billions, Metzl said—we’re going to need AI and big data analytic tools, and algorithms far beyond what we have now. These tools will let us move from precision medicine to predictive medicine, knowing precisely when and where different diseases are going to occur and shutting them down before they start.
But, Metzl said, “As we unlock the genetics of ourselves, it’s not going to be about just healthcare. It’s ultimately going to be about who and what we are as humans. It’s going to be about identity.”
Designer Babies, and Their Babies
In Metzl’s mind, the most serious application of our genomic knowledge will be in embryo selection.
Currently, in-vitro fertilization (IVF) procedures can extract around 15 eggs, fertilize them, then do pre-implantation genetic testing; right now what’s knowable is single-gene mutation diseases and simple traits like hair color and eye color. As we get to the millions and then billions of people with sequences, we’ll have information about how these genetics work, and we’re going to be able to make much more informed choices,” Metzl said.
Imagine going to a fertility clinic in 2023. You give a skin graft or a blood sample, and using in-vitro gametogenesis (IVG)—infertility be damned—your skin or blood cells are induced to become eggs or sperm, which are then combined to create embryos. The dozens or hundreds of embryos created from artificial gametes each have a few cells extracted from them, and these cells are sequenced. The sequences will tell you the likelihood of specific traits and disease states were that embryo to be implanted and taken to full term. “With really anything that has a genetic foundation, we’ll be able to predict with increasing levels of accuracy how that potential child will be realized as a human being,” Metzl said.
This, he added, could lead to some wild and frightening possibilities: if you have 1,000 eggs and you pick one based on its optimal genetic sequence, you could then mate your embryo with somebody else who has done the same thing in a different genetic line. “Your five-day-old embryo and their five-day-old embryo could have a child using the same IVG process,” Metzl said. “Then that child could have a child with another five-day-old embryo from another genetic line, and you could go on and on down the line.”
Sounds insane, right? But wait, there’s more: as Jason Pontin reported earlier this year in Wired, “Gene-editing technologies such as Crispr-Cas9 would make it relatively easy to repair, add, or remove genes during the IVG process, eliminating diseases or conferring advantages that would ripple through a child’s genome. This all may sound like science fiction, but to those following the research, the combination of IVG and gene editing appears highly likely, if not inevitable.”
From Crazy to Commonplace?
It’s a slippery slope from gene editing and embryo-mating to a dystopian race to build the most perfect humans possible. If somebody’s investing so much time and energy in selecting their embryo, Metzl asked, how will they think about the mating choices of their children? IVG could quickly leave the realm of healthcare and enter that of evolution.
“We all need to be part of an inclusive, integrated, global dialogue on the future of our species,” Metzl said. “Healthcare professionals are essential nodes in this.” Not least among this dialogue should be the question of access to tech like IVG; are there steps we can take to keep it from becoming a tool for a wealthy minority, and thereby perpetuating inequality and further polarizing societies?
As Pontin points out, at its inception 40 years ago IVF also sparked fear, confusion, and resistance—and now it’s as normal and common as could be, with millions of healthy babies conceived using the technology.
The disruption that genomics, AI, and IVG will bring to reproduction could follow a similar story cycle—if we’re smart about it. As Metzl put it, “This must be regulated, because it is life.”
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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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