Theoretically, Artificial Intelligence (AI) applied to Evidence-Based Medicine (EBM) is a marriage made in digital heaven. AI’s algorithms, founded on reliable RCT evidence that’s updated as new findings come in, will whip through mountains of data, leading to improved diagnosis, more accurate screening and better testing protocols; all guaranteed to improve performance and cut costs.
Mmmm, well, yes. EBM is certainly a good idea but the notion that it is ready for such a union involves large dollops of optimistic unicorn fantasy – to borrow a useful Brexit shorthand. And not just the obvious issues around garbage in leading to garbage out or the malign effects of human bias, which are regular worries about its implications for officially sanctioned treatments.
AI could also have a damaging effect on efforts to develop new approaches to the big chronic killers – such as obesity, diabetes, cancer and Alzheimer’s. Ones which don’t just involve researching and prescribing an increasing number of drugs. Drugs, of course, have their place, but their massive financial muscle has given them the power of a giant cuckoo, able to shoulder all other solutions out of the medical nest on the grounds of lack evidence.
Various grassroots revolutions by independent clinicians and expert patients have recently been having considerable success identifying the failings of official treatments and promoting the importance of lifestyle and other approaches. These include the treatment of low thyroid, chronic fatigue or ME, nutritional advice and mineral and vitamin supplements. Just bolting on AI in areas like these is likely to boost cuckoo power with little benefits for patients.
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Medical orthodoxy cheerfully ignores EBM rule-breaking
Given the growing tendency to dismiss or block challenges to medical orthodoxy, modifying apps to reflect grassroots challenges seems unlikely. Easier to ignore them.
And ignoring evidence-based challenges to treatment based on a trial widely accepted to be high quality and a basis for Nice guidelines, is something the medical establishment is prepared to do. This is precisely what happened when a group of patients with a condition involving chronic fatigue, known as ME/CFS,
re-analysed the data gathered in a trial that supported the orthodox treatment.
Known as the PACE trial, published in 2011, it had reported that 22% of patients getting treatment- a combo of psychotherapy plus gradually increasing amounts of exercise – recovered, compared with just 7% of those who got no therapy. The re-analysis carried out by senior, independent clinicians in 2016, found that the results had been massaged to produce a favourable result. Without the fancy statistical manipulation, just 3% recovered and 7% showed some improvement.
It’s a long-running and complicated story but it shows not only a readiness to play fast and loose with the data but also an ability by the psychiatric establishment to totally ignore a carefully conducted and devastating critique. The authors continued to assert that the treatment was beneficial and the Lancet – the journal that had published the PACE trial – ignored all calls to withdraw it or even to publish letters about it.