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November 23, 2011
The robot is in

There has been a lot of discussion about the news that Watson, the dry, mercurial computer who beat the best of the best in the game show "Jeopardy!" will enter the health care arena. If you haven't heard, Wellpoint, the health insurance emporium, announced that it is launching a partnership with IBM, Watson's creator, to "develop Watson-based solutions to help patient care through the delivery of up-to-date, evidence-based health care for millions of Americans." This is the obvious next step for Watson, for—as Sam Nussbaum, Wellpoint's chief medical officer, explained—the skill set of doctors and supercomputers are about the same: "[both] want to rapidly process information and provide the right answers."

At first glance, this may seem like a nice compliment, comparing physicians to machines that can perform billions of computational and data analyses in a fraction of a second. I know some of my colleagues will actually read that statement and think, "Mais, bien sur. We are the intellectual cream of the crop!"

No one ever accused us of being humble.

But the record of humans vs. computers is quite dismal. Both Brad Rutter, the biggest all-time money winner on Jeopardy!, and Ken Jennings, who holds the record for the show's longest championship streak, succumbed to Watson. Before those, there was Deep Blue's defeat of Garry Kasparov in chess. (Of note, Kasparov had beaten a previous version of Deep Blue, and later accused IBM of cheating with its newer version).

And that doesn't even take into account the many literary and cinematic battles in which the machines turn on their human creators and attempt to destroy them. (Think "Battlestar Galactica" on TV, and movies like "The Terminator," "I, Robot," "2001" and "The Matrix," just to name a few.) Funny how in fiction, the humans always end up defeating the machines, while so far in reality, the machines have kicked our collective butts.

In most science fiction, the machines achieve a level of computational dexterity to develop "an awareness"; they become "self-aware," develop "a consciousness," a "personality," or the capacity for "soul-searching" or "empathy," and "analyze data to achieve a moral solution" to their "achieved level of perception." Aren't all these great characteristics for your doctor to have?

Maybe having Watson earn an MD is not that bad of an idea. After all, who wants a doctor with a sense of humor, who can hold your hand while giving bad news, who actually examines you before relying on blood tests and X-rays? Actually, those doctors are in danger of becoming extinct.

New doctors want the fast solutions that only technology can offer. They want certainty in their deliberations, if only so they never have to utter those dreadful words—"I don't know"—that have become blasphemous in our day and age. They want to be in and out of a room because why do I have to explain things when they can read it on the Web? Dr. Google already gets plenty of hits and has many more explanations than a single doctor is able to offer.

Late one night at work, a dad asked to talk to me. He wanted me to explain the declining mental status of his son, who was having persistent subclinical seizures. I sat down and listened while the dad asked rhetorical questions, let loose all the thoughts he had, all the nagging doubts that were crowding his mind in the middle of a sleepless night.

I listened, because that was all he needed from me. Everyone else came into the room offering a lecture on side effects, mechanisms of action, and the value of changing or discontinuing medicines. But no one sat down and listened. Some will say, "Well, that's not my job. It's the social worker's, or the priest's or the counselor's or the nurse's. I am way too busy for that."

But we forget that those little initials at the end of our name, the ones we studied and worked so hard to earn, the ones we hope will let us score a free dessert at the country club or better seats at the opera house, mean a lot to patients. They mean we are a member of an ancient tradition of healers, and that healers not only deal with the pathology of the body but provide succor for the mind.

Otherwise, what's the use? Watson can analyze data faster than we can and provide ready answers to questions in the blink of an eye. Do our patients need Watson? Sure they do. But they need a human hand more.

Maybe we can learn from the "Three Laws of Robotics," created by Isaac Asimov, one of SciFi's demigods. Asimov first spelled out those rules in a story in 1942, and rules No. 2 and 3 establish that robots must obey orders given by humans and they must protect their own existence—as long as doing either of those doesn't contradict the all-important rule No. 1.

That first rule states that: "A robot may not injure a human being or, through inaction, allow a human being to come to harm."

Sounds a lot like the Hippocratic Oath, doesn't it?
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About Ruben J. Nazario, MD
Ruben J. Nazario, MD, is now medical director at Inovalon, a health care data analytics company, and is medical editor for Elsevier's First Consult. A pediatric hospitalist, Dr. Nazario is a veteran of both community and academic pediatric hospitalist programs. All material represents his own views and does not reflect the views of his employer.
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