A GIANT LEAP

Powerful AI tools for the medical industry are already shaping our digital shadows, diagnosing disease, recommending treatments, and quietly redefining the doctor-patient relationship.

University of California, San Francisco physician and author Wachter surveys the rapidly changing frontier where algorithms meet anatomy. Drawing on a yearlong exploration of artificial intelligence in health care, he interviews clinicians, developers, ethicists, and policymakers to reveal an industry both hopeful and unsettled. The 2022 debut of ChatGPT unleashed a wave of enthusiasm for machine learning in medicine—promising to ease physicians’ data-entry drudgery and help interpret the oceans of electronic health information. But Wachter finds that despite notable successes, there are cautionary tales of flawed models, opaque “black boxes,” and dangerously overhyped results. Regulation, notes scholar Michelle Mello, remains a “hot mess,” tangled in uncertainty over when an AI “decision support” tool becomes a regulated medical device. Meanwhile, the profit-driven structure of American health care complicates matters further—if an algorithm evaluates a patient and recommends treatment, who gets paid? Wachter is alert to these ethical and financial knots, as well as the potential for tech giants such as Google and Microsoft to exert undue influence disguised as impartial counsel. As one member of Congress warns, allowing tech companies to assess their own or competitors’ AI models invites serious conflicts of interest. Wachter argues that AI tools will offer more help than harm, and that the medical profession’s “professional risk aversion, powerful incumbents, spring-loaded malpractice system, byzantine payment structures, and stringent privacy rules” will be effective guardrails against AI risks. Though the book largely skirts the political battles shaping health care, it is an accessible, often fascinating primer on AI tools changing clinical practice—for better or worse.

Essential, illuminating reading for those who fear and those who welcome changes that AI may bring.