Editorial
Medicine in times of artificial intelligence
La medicina en tiempos de inteligencia artificial
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Dirección de la Fundació TIC Salut i social, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La medicina en tiempos de inteligencia artificial" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The evolution of medicine as a science and also as an art and profession has not been unaffected by the changes that have taken place in all the successive stages of human history. Although it is fair to say that, in the last 100 years, we have experienced an accelerated progress that far exceeds what had been achieved since the beginning of mankind’s history. A prestigious mid-20th century doctor, Pedro Farreras Valentí, in the prologue to his book,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> said: “<span class="elsevierStyleItalic">The generations after us will hardly be able to grasp de novo or absorb, out of the blue, the wealth of overwhelming knowledge which has been established over the last five decades during the ten years usually devoted to undergraduate and postgraduate education</span>”. It was a brilliant premonition; he himself would be surprised to see how fast his statement is coming true.</p><p id="par0010" class="elsevierStylePara elsevierViewall">On 17 August 2000, a general newspaper published an article with a provocative title: Will robots finish off doctors?.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Barely a quarter of a century has passed and the technological breakthrough that has led to today's breakneck growth is evident in the consolidation of the artificial intelligence (AI) fever. In contrast to what happened in those times, AI now occupies a very prominent place in the daily press and everything indicates that this trend will continue.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> One of the fields most immersed in this frenzy is health and, therefore, medicine in all its aspects: clinical care, research, medical education at all levels and health policy and management. There are many indicators of this unstoppable growth of information on AI: just enter any digital search engine, of varying quality, or note how some prestigious medical publishing groups are creating specialised journals exclusively on the subject.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">No one who has had experience or curiosity about the subject can doubt that AI brings irreversible benefits for the improvement of both population health and individual health. In practice, this is already the case in many medical specialties such as surgery, diagnostic imaging, anaesthesiology and many others where clear benefits have been consolidated and incorporated in the diagnostic and therapeutic procedures of past times. These benefits are based on the indisputable fact that they efficiently surpass some of the abilities of human beings. Human intelligence is based on complex biological and neurochemical processes in the brain, whereas AI is developed through algorithms and software designed by human experts.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Some of the advantages attributable to AI applied to medicine are: its technical skills, the advantageous ability to interpret results 24 h a day by handling large amounts of data, the detection of errors for the benefit of patient safety, and the support of clinical decision-making, an essential act in any modern healthcare system.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It also brings undoubted benefits to patients, as they can constantly consult the necessary information indicated by the professionals in charge of their health. So, those are some of the advantages associated with the use of this technology which can help professionals, patients and health systems as long as they use it properly.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On the other hand, it is undeniable that AI has enabled progress in research and in the education of healthcare professionals. It facilitates the collection of data for the generation and transfer of knowledge, speeds up the discovery of new drugs or vaccines, improves the efficiency of clinical trials, and contributes to the training and assessment of future healthcare professionals in general, and doctors in particular, at any stage of their training.</p><p id="par0025" class="elsevierStylePara elsevierViewall">However, more disturbing questions about the future of the use of AI in medicine are raised regarding how it may allow the day to come when robotisation, as in other trades or professions, replaces humans. How it will influence in the long term the doctor-patient relationship that remains the basis of good clinical practice, an untouchable principle since the earliest days of medicine<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and one that no one has, to date, explicitly stated should disappear.</p><p id="par0030" class="elsevierStylePara elsevierViewall">When a doctor interacts with a patient, whether in a consulting room, in a hospital ward, in a diagnostic or therapeutic techniques office, in an operating theatre or delivery room, or by telematic means, his or her professional competence is put to the test, based on his or her skills. The aim of these skills is to help patients to prevent, diagnose, treat or alleviate their active or potential health problems and to promote their well-being. So far, these competencies are inherent to health professionals, and specifically to physicians, and include a wide variety of situations that require skilled human beings. At the same time, the patient trusts that these skills will lead to certain decisions, advice or procedures that will help him/her to solve or alleviate the problem for which he/she has sought care and in which he/she wants to be involved to a greater or lesser degree, depending on the individual.</p><p id="par0035" class="elsevierStylePara elsevierViewall">This is the basis of the clinical encounter, an exciting mixture of knowledge, skills, attitudes and values that put two people to the test in an environment that is decisively influenced by educational, social, economic and all kinds of conditioning factors, ranging from routine problems to others of great complexity, not only of a technical nature but, essentially, of a philosophical nature.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Our profession develops between successive principles that generate concepts such as the classic concept of 'evidence-based' decision making, the later 'personalised medicine' or the more recent 'narrative medicine'. The advent of AI has therefore met with a very human-based profession that does not reject technology as long as it is for the benefit of its raison d'être, which is none other than the people to whom it owes its existence.</p><p id="par0040" class="elsevierStylePara elsevierViewall">How will AI enable this complex web to be updated? How will AI contribute to finding the solution to the puzzle that it itself poses? Will there be too many or too few pieces missing? The right answers to these and many other possible questions should help medicine to evolve in parallel with the evolving needs of today's and tomorrow's globalised world, hopefully without traumatic ruptures and ensuring that the advances of AI alongside medicine lead to an improvement in global health without adverse effects for its stakeholders and, above all, for its beneficiaries. Beneficiaries who, as long as humanity is made up of human beings, would not understand their disappearance in this doctor-patient pairing. But this, only time will tell, and forecasting the future is no easy task. Even the impact of the conscientious predictions of visionaries has not been able to measure the consequences of these forecasts. Neither has AI. There are many examples in the world in general and specifically in medicine. Some natural disasters or the prediction of the severity of pandemics to give recent examples.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">There is a need to properly assess the benefits that AI brings and will bring to medicine and the risks that need to be identified in order to deal with and avoid them. Here, human intelligence and AI must work as a team on the basis that, at present, it is humans who govern machines and it is humans who benefit from their proper use.</p><p id="par0050" class="elsevierStylePara elsevierViewall">One of the authors most interested in the positive impact of AI in medicine is the American cardiologist Eric Topol.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In the final chapter of his book<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> he provides a masterful analysis of how, led by empathy, the crucial elements of AI applied to medicine must be emphasised through good design and use of AI. It is a bid for the improvement of human emotional intelligence in clinical practice thanks to advances in technology. Human intelligence is perfectly prepared to handle, with variable success, the emotions that allow us to love, laugh, cry, dream, fear, rejoice, trust, among many others, and we humans find it difficult to accept that machines can replace us. How do we imagine AI telling us, for example, that our illness is about to end our life, and do so in an empathetic way, capturing our feelings of response? Topol provides some insights and quotes in his book William Osler, the father of modern medicine, as saying that time is essential to the quality of patient care, a topic of debate even today, more than 120 years later; incidentally, it is an issue that some studies show great variability in the time spent on medical visits across countries.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> AI can help improve these outcomes by providing real-time data on tests performed, aiding decision making, enabling immediate <span class="elsevierStyleItalic">online</span> consultations or administrative tasks by allowing the doctor to spend as much time as possible on his or her own task, something fostered by the needed empathy.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> This future scenario is more appealing, and from today's perspective more reasonable, than the one proclaimed by some 'AI gurus'<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> who argued that machines would completely replace humans, and therefore clinical interviews could become robotic chats (chatbots) without human participation.</p><p id="par0055" class="elsevierStylePara elsevierViewall">At present, the controlled use of the now famous chat-GPT (generative AI) by medical professionals in our regular practices or for research or teaching purposes is not an end in itself, but opens the door to new possibilities, as well as new risks<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> that must be taken into account. Among these risks, apart from ethical considerations common to all networked media, special care must be taken regarding disinformation, discrimination on any grounds, breach of privacy or misuse of data. In this regard, in June 2023, the European Parliament passed a first regulation on AI that will lead to the European Union law on AI.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">There is still a long way to go in this medicine and AI pairing, but judging by the speed at which it is developing, we cannot wait with our arms folded. It is true that according to the opinion of some state-of-the-art research, the widespread implementation of AI in healthcare systems still faces many challenges that require a prospective validation of higher quality.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> In this sense, European regulations should incorporate the continuous evaluation of algorithms based on real and proprietary data of the highest quality.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Meanwhile, the vision of doctors, as F. Borrell<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> comments, must always bear in mind that in our care relationships there are always two components, the human and the technical, both of which are intertwined with more or less intensity, but any analysis that ignores one of the two is reductionist.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</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:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tratado de Medicina Interna" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Farreras" 1 => "Rozman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "7ª Ed." 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