How changing technology will dramatically effect the role physicians play in the future

1. How recent
changes in
technology
will change
medicine
Robert Miller, MD
August, 2016
www.aboutcancer.com
Video can be found at youtu.be/XCeepM-kUHU
or http://goo.gl/rH7fmO

2. Will doctors become obsolete?
1. They can use technology and the internet to better self educate and remain
current.
2. They can use apps, more sophisticated EMR (electronic medical records)
systems to try to run a more efficient practice.
3. They can use web sites and other social media outlets to better communicate
with their patients.
4. They can use ‘telemedicine or telehealth’ to try to reach patients more effectively
and efficiently.
But…. Even if you are an early adopter and a techie… most
physicians will be replaced by increasingly sophisticated soft
ware and AI programs and patients will turn to digital assistants
and robotics for the majority of their care in the not too distant
future!

3. After treatment for a woman suffering from leukemia proved ineffective, a team of Japanese doctors turned to IBM’s Watson for
help which was able to successfully determine that she actually suffered from a different, rare form of leukemia than the doctors had
originally believed. Watson managed to make its diagnosis after doctors from the University of Tokyo’s Institute of Medical Science
was fed it the patient’s genetic data, which was then compared to information from 20 million oncological studies.
This analysis found a different diagnosis for the type of leukemia from which the patient suffered, and it suggested a different form of
treatment, which proved far more effective than the original methods doctors had been using up to that point.

6. Smart Phones
The first iPhone was unveiled on
January 9, 2007 and released on June
29, 2007.
Apple released the first iPad in April
2010

7. Digital Assistant built into
Windows 10 from Microsoft
Siri (Speech Interpretation and Recognition
Interface) from Apple
The Rise of the Virtual
Assistant
Ask ‘Alexa’

8. The Rise of the Virtual Assistant
It seems highly probable that the public will become increasingly comfortable and
then dependent on a digital ‘virtual assistant’

9. What will become of doctors over the next 20 years?

10. 1. Exponential growth in information (and information
technology)
2. Complexity theory
3. Recent breakthroughs in AI (artificial intelligence, esp.
machine learning or deep learning)
Three important advances in science
and technology worth knowing about

11. Future Shock is a book written
by the futurist Alvin Toffler in 1970.
In the book, Toffler defines the
term "future shock" as a certain
psychological state of individuals
and entire societies.
His shortest definition for the term
is a personal perception of "too
much change in too short a period
of time".
Things are changing too quickly to make sense.

12. Chaos: Making a New Science is a
debut non-fiction book by James
Gleick that initially introduced the
principles and early development of
the chaos theory to the public. It was
a finalist for the National Book
Award]and the Pulitzer Prize in 1987
the branch of mathematics that deals
with complex systems whose
behavior is highly sensitive to slight
changes in conditions, so that small
alterations can give rise to strikingly
great consequences.

13. When a society gets overwhelmed by
complexity they can evolve, adapt or go
extinct.
Many cultures (e.g. the Mayans) abandoned
science and common sense and engaged in
crazy and self-destructive behaviors (like
human sacrifice) that led to their collapse
book was 2010

14. IBM Watson2.5 quintillion bytes of data per day

15. - The average person is likely to generate more than one million gigabytes
of health related data in their lifetime
- Medical data is expected to double every 73 days by 2020
- Less than 50% of medical decision meet evidence based standards
- Watson can read 40 million documents in 15 seconds
Welcome to the
Era of Cognitive
Health
Watson
Health

16. Moore's law is the observation that the number of transistors in a
dense integrated circuit doubles approximately every two years. The observation
is named after Gordon Moore, the co-founder of Intel and Fairchild
Semiconductor, whose 1965 paper described a doubling every year in the
number of components per integrated circuit
Curve shows transistor
count doubling every 2 Years

17. Exponential Growth of Computing for 110 Years
Calculation per Second per $1,000
Electromechanical Relay Vacuum Tube Transistor Integrated Circuit
Ray Kurzweil’s Law of
Accelerating Returns

18. Exponential
Growth of
Computing
Health and Medicine have now become information technology and are now subject
to Ray Kurzweil’s Law of Accelerating Returns

19. Complex
ity

20. Key cellular pathways in mantle cell lymphoma. The B-cell receptor complex is
constitutively activated, which through multiple downstream signaling pathways
results in cellular growth and survival. Novel therapies that inhibit critical elements
of this signaling pathway are shown in white boxes.

21. Complexity has proven to be a
fundamental feature to our world that
is not amenable to our traditional
methods of modern science.
Complexity theory emphasizes
interactions and the accompanying
feedback loops that constantly
change systems.

22. Isaac Newton invented calculus in 1666 at
the age of 23 to solve problems in
mathematical physics
We now need to use complexity theory to
solve modern problems
Calculus is the mathematical
study of change, in the same
way that geometry is the
study of shape and algebra is
the study of operations and
their application to solving
equations.

24. http://complexityacademy.io/

26. https://www.ted.com/playlists/310/talks_on_artificial_intelligen
https://goo.gl/rkW17g
Along with the exponential growth in information, the field of complexity theory are
the advances in AI that are transforming our world, and watching the TED talk
playlist on AI is a nice introduction to the subject.

27. We are getting very close to being outsmarted by computers
Advances in artificial intelligence which appeared to have stalled in the 1980’s has
recently taken off.

28. And as the industrial revolution eliminated most of the blue collar jobs, the
machine learning revolution will eliminate most of the white collar jobs

29. Recent Breakthroughs in AI (artificial intelligence) and the
money available to facilitate the rapid development
New York Times July 17, 2016
a new approach to deep learning, a machine learning method that is highly
effective for pattern recognition challenges like vision and speech.
Modeled on a general understanding of how the human brain works, it has
helped technologists make rapid progress in a wide range of A.I. fields.
0
500
1000
1500
2000
2500
2010 2011 2012 2013 2014 2015 2016 2017
Spendingin$Millions
Year
Artifical Intelligence
Social Media
Spending on Start-Ups

30. Deep
Learning

31. Google's Deep Mind Explained! - Self Learning A.I.
https://www.youtube.com/watch?v=TnUYcTuZJpM or http://goo.gl/TUCpxd
Rather than brute force it studied 100,000 human matches of Go and then played
itself for 30,000,000 games and using reinforcement learning to beat it’s earlier
versions Cold Fusion TV

32. A.I. Learns Nobel Prize Experiment in Just 1 Hour!
https://www.youtube.com/watch?v=lJcGzmsLRUo or http://goo.gl/CuO5Yn
AI system was able to recreate the complex quantum experiment to create from
scratch an extremely cold gas trapped in a laser beam (Bose-Einstein condensate) in
one hour that was the physics experiment that won the 2001 Nobel Prize in physics
Cold Fusion TV

33. Are We Approaching Robotic Consciousness's?
https://www.youtube.com/watch?v=JTOMNkZJRao or http://goo.gl/t4KmSF
A robot solved the “Wise Man Test” it is self aware that it is speaking
Cold Fusion TV

34. Jeremy Howard on AI with Machine Learning esp “Deep Learning Algorithm”
already beating Radiologists and Pathologists in making diagnoses. Company
enlitic
http://www.ted.com/talks/jeremy_howard_the_wonderful_and_terri
fying_implications_of_computers_that_can_learn
http://tinyurl.com/n2a6wl8 or http://goo.gl/WvclzB

35. Harvard radiologists have used Deep Learning to
improve CT diagnostics of cancer

36. Stanford Pathologists have used Deep Learning to improve pathological
diagnoses of cancer (better than human pathologists)

37. Non-medical computer scientists have used Deep Learning to improve
pathological diagnoses of cancer (as good as human pathologists)

38. Enlitic applies the state of the art in deep learning
technology to medicine

39. For Patients
Enlitic puts patients first by providing radiologists with a tool designed to help them
improve the accuracy of diagnostics, reduce wait times, and prevent unnecessary
follow up tests. As part of your doctor's visit at one of partner clinics, Enlitic
technology will automatically screen for hundreds of specific diseases within your
medical data (such as x-rays, MRIs, and more).

40. For Radiologists
Enlitic technology brings clinical intelligence and subspecialty expertise to any
radiology clinic. Automatic analysis across large numbers of disease types provides
to radiologists a tool with the potential to result in unparalleled diagnostic accuracy. It
also allows for dramatically reduced image read times, detection of co-morbidities
and incidental findings, and insights on treatment options.

41. For Healthcare Providers
Enlitic handles report generation for
you from end to end, through our:
Deep learning integrated workflow
Radiologists who are hand-picked
based on their accuracy and speed
using deep learning tools
Our target is:
Half the cost, twice the accuracy, twice
the speed of legacy approaches
Opportunity to provide rich, interactive
multimedia reports for greater
physician and patient understanding

44. https://www.ted.com/talks/blaise_aguera_y_arcas_how_computers_are_learning
_to_be_creative
https://goo.gl/GYjA07
A neural network trained to discriminate by perception of objects can be run in
reverse and create objects. Perception and Creativity are connected.

45. The way to survive is with Medical Aps

46. Running an Oncology practice with just 4 apps
1.ePSS ( Electronic Preventive Service Selector from
the US Preventative Task Force) : update guidance
for screening and prevention
2.NCCN (National Comprehensive Cancer Network)
constantly updated
treatment and testing and
follow up
3.Epocrates: to make sure
medication orders and
safe and appropriate
4.Up to Date: if I need more
detailed review of a subject

47. An interactive decision support tool

48. Will the internet and AI change medicine?
Patients and researchers will continue to amass massive quantities of health data
that only super computers will be able to make sense of in a timely manner.
Who ever controls and knows how to mine big data will have the power to control
health care in the future, which is just information technology.
Patients will be more and more comfortable accessing this data from virtual
assistants without the cost and delay involved with seeing a physician.
Doctors of the future will need to reinvent themselves to remain a relevant part of
the future health care delivery system.

49. Doctors have to anticipate and adapt to dramatic changes or the patients will
simply go right past the doctor and manage their care without them
Can you teach a doctor intellectual
flexibility?

50. The last doctor?
Will there be any role for physicians by the mid century?
Will there be a
shortage of doctors in
the future or a glut?

51. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1785 1835 1885 1935 1985
Whatever happened to farmers ?
Farmers as Percent of Workforce in the US from
1790 to Present
In 1790 Farmers made up 90% of the workforce and now 2%

52. Clustered regularly interspaced short palindromic repeats (CRISPR)
technique has many potential applications, including altering the germ line of
humans, animals, and food crops. The use of CRISPR for genome editing ]was
the AAAS choice for breakthrough of the year in 2015

54. The Singularity is Near
by Ray Kurzweil
a future period during which the pace of
technological advance will be so rapid,
its impact so deep, that human life will be irreversibly transformed... The
Singularity will represent the culmination of the merger of our biological thinking
and existence with our technology, resulting in a world that is still human but
transcends our biological roots. There will be no distinction, post-Singularity,
between human and machine or between physical and virtual. Kurzweil estimates
that the Singularity will happen in the year 2045.
The Borg

55. Future Doctors will
need to move up
the ‘intellectual
food chain’ or
reinvent their role
in the health care
system to remain
relevant in the
future
www.aboutcancer.com
http://goo.gl/rH7fmO