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Impact of artificial intelligence and language models in medicine
El impacto de la inteligencia artificial y los modelos de lenguaje en medicina
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Valentín Bravo, E. Mateos Álvarez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "F.J." "apellidos" => "Valentín Bravo" "email" => array:1 [ 0 => "fjvb90@icloud.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E." "apellidos" => "Mateos Álvarez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "The Retina Clinic London, Londres, United Kingdom" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital Clínico Universitario de Valladolid, Valladolid, Castilla y León, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El impacto de la inteligencia artificial y los modelos de lenguaje en medicina" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Since Alan Turing laid the foundations of artificial intelligence (AI) in the 1950s, the exploration and study of the different possibilities of AI performance has been developing at an astonishing pace.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Said development means that AI is changing paradigms in disciplines such as medicine. The advantages of AI in daily clinical practice are multiple and very diverse.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This novel technology supplements the clinician's approach by providing data for better diagnostic and therapeutic accuracy, even in diseases as complex as cancer.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Similarly, AI is having a significant impact on ophthalmology practices due to the technological capacity to process large amounts of data and images as well as perform complex analyses that establish preference of care.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This enables ophthalmologists to improve the detection, diagnosis and treatment of eye diseases. This technology can also be widely integrated into administrative tasks, such as appointment scheduling and the ability to generate reports that improve doctor-patient communication (thus improving adherence to consultations and treatment). This would reduce the clinician's work overload, enabling an increase of the time spent with and for the patient.</p><p id="par0020" class="elsevierStylePara elsevierViewall">One of the main applications of AI in our speciality is the early detection of eye diseases through image analysis. The high capacity of information analysis helps in the detection of early signs of highly prevalent diseases such as age-related macular degeneration, diabetic retinopathy and primary open-angle glaucoma.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This may allow early treatment, thus increasing the chances of therapeutic success and the development of new targets for the different pathologies.</p><p id="par0025" class="elsevierStylePara elsevierViewall">AI is also a key process in the customisation of treatment. This technology can be used to determine the correct dose of a drug, or even the amount of laser to give to a particular patient, in order to reduce potential adverse effects.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In addition, AI can be used to improve the planning and execution of surgical procedures by producing detailed maps of the ocular structure. This can allow ophthalmologists to plan their surgical procedures so that they can be performed more accurately and safely, shortening surgery times.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Less well known, however, is the capability of AI in the field of scientific research. AI allows professionals to access scientific content more quickly and efficiently.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It can also be used in clinical studies or trials to select the right patients, in order to increase the accuracy of our results.</p><p id="par0040" class="elsevierStylePara elsevierViewall">On the other hand, new language models are being produced that use AI algorithms to understand and automatically generate text about any discipline in a consistent, detailed and accurate way. One of the latest and most comprehensive language models using AI algorithms is ChatGPT, launched by OpenAI in November 2022.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This system allows virtual interaction with the user and “obeys” their commands. In addition to enabling quick access to relevant information, ChatGPT can generate text structures in any language that are subsequently used for the production of summaries or articles, and even the production of tables or diagrams that accurately illustrate our research data. This is a significant time saver for professionals who want to be active in the field of research. Due to the overwhelming care burden that clinicians are being subjected to, this tool can help to increase adherence to basic or clinical research in our discipline. In addition, these systems can automatically analyse our research, providing feedback to the author regarding grammatical or formatting errors, as well as showing possible improvements in content.</p><p id="par0045" class="elsevierStylePara elsevierViewall">However, there are still many important challenges and drawbacks that are creating consternation about the use of AI-based language models. A major challenge in incorporating AI-generated texts into our publications is plagiarism and privacy of patient data.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Similarly, it is critical to ensure the accuracy and reliability of the information generated, as there may be errors and biases built into its design or the data it was trained on.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Another limitation observed in this technology is that it does not have the capacity to access external resources and cite the articles from which it draws information. This poses a problem when writing scientific publications solely using AI, because they must be referenced, relevant and up-to-date. The ChatGPT's knowledge is limited to the year 2021, so its information should be interpreted with caution and confirmed with the most recent publications.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Therefore, researchers should always monitor and review all work generated by AI tools prior to publication.</p><p id="par0050" class="elsevierStylePara elsevierViewall">These drawbacks mean that our next publications cannot be completely written by AI-based language methods. However, ChatGPT is able to provide very valuable and highly reliable information about numerous pathologies and surgical procedures in the area of ophthalmology, facilitating training in our speciality.</p><p id="par0055" class="elsevierStylePara elsevierViewall">It can be concluded that the irruption of AI will have a clear impact in the short term on clinical and research activity within specialties such as ophthalmology, with some of the work being replaced by this technology.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Furthermore, these language models such as ChatGPT can change the world we know today in scientific research forever, which could mean an exponential increase in the number of publications in scientific journals. It is therefore important for physicians to be aware of the limitations of these models and more than ever to be critical of the information available to us.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The essential Turing: seminal writings in computing, logic, philosophy, artificial intelligence, and artificial life, plus the secret of enigma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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