Medicine May Be an Art, But AI May Be Artists

Six hundred years ago, Swiss physician/scientist/philosopher Paracelsus disclaimed: “Medicine is not only a science; it is also an art.”  Medicine, most people in healthcare still believe, takes not just intelligence and fact-based decision-making, but also intuition, creativity, and empathy.  This duality is often cited as a reason artificial intelligence (A.I.) will never replace human physicians.

AI-Da and her self portrait.  Credit: Mark Thomas/Rex/Shutterstock

Now, I have to admit, “she” wasn’t on my radar either until recently, when she was imprisoned/impounded at customs by Egyptian authorities on her way to an art exhibit at the Great Pyramids of Giza, where she was scheduled to show her work.  Egyptian authorities first objected to her modem, then to the cameras in her eyes.  “I can ditch the modems, but I can’t really gouge her eyes out,” said her creator Aidan Meller.  After a 10 day stand-off, she was released late last week. 

Perhaps those skeptics have not heard about Ai-Da. 

Let me back up.  Named in honor of famed 19^th century mathematician/programmer Ada Lovelace, Ai-Da is “the world’s first ultra-realistic humanoid robot artist.”  She was created in 2019, and uses AI algorithms to create art with her cameras/eyes and her bionic arms.  She can draw, paint, even sculpt, and had her first major exhibit – Ai-Da: Portrait of the Robot -- this summer at London’s Design Museum.

The description of her exhibit says:

As humans increasingly merge with technology, the self-titled robotic artist, Ai-Da, leads us to ask whether artworks produced by machines can indeed be called ‘art’…Ai-Da can both draw and engage in lively discussion…These features, and the movements and gestures that Ai-Da is programmed to perform, raise questions about human identity in a digital age.

Her website elaborates:

…current thinking suggests we are edging away from humanism, into a time where machines and algorithms influence our behaviour to a point where our ‘agency’ isn’t just our own. It is starting to get outsourced to the decisions and suggestions of algorithms, and complete human autonomy starts to look less robust. Ai-Da creates art, because art no longer has to be restrained by the requirement of human agency alone.  

Here's a video: 

Lest anything think Ai-Da is a one-off, I’d also point to Xiaoice, a Microsoft-built, China-based AI chatbot that is “a poet, a painter, a TV presenter, a news pundit, and a lot more.”  Microsoft spun it off in 2020, the company maintaining the name while renaming chatbot Xia Yubing.  Xia is now creating traditional Chinese paintings, having already mastered Western-style painting during its Microsoft time. 

Xia appears to have passed an art version of the Turing test; according to China Daily: “In 2019, works of art produced by Xia were submitted for an exhibition of postgraduates' work at China's Central Academy of Fine Arts. When Xia's paintings were presented beside those of humans, nobody realized they were generated by AI.”

There are other AI artists besides Ai-Da and Xia.  London had “the first international AI art fair” this month – deeep, featuring “the world’s largest collection of AI created art.”   One reviewer found the works “are equal parts hypnotic, unsettling, and produce an outlook quite alien to traditional styles.”  If step one for AI art is to create art that we can't distinguish from human art, then step two is to create art that only AI could create.   We may already be there.  

If AI-produced art isn’t impressive enough, earlier this year AI was used to finish Beethoven’s famous unfinished 10^th symphony, synthesizing all his other works and his notes, and using them to create something he might have written.  It succeeded: “We challenged the audience to determine where Beethoven’s phrases ended and where the AI extrapolation began. They couldn’t.” The completed symphony had its world premiere earlier this month. 

If you'd like to listen:

In fact, for all you know, this article could have been written by an AI, such as Rytr, which, according to The Next Web, “brings the skill of a talented freelance writer to the digital realm, generating copy that can give flesh-and-blood writers a run for their money.” 

Healthcare certainly hasn’t been ignoring AI.  Every day it seems there are more announcements about AI-powered innovations, as well as funding for AI-based companies with a health focus. 

Just week, researchers at the University of Utah Health/Rady Children’s Hospital reported they’d used AI to parse massive amounts of genetic data to diagnose rare pediatric disorders, in a way humans never could have.  AI is already also increasingly important in drug discovery, and numerous health systems are implementing their own AI-based initiatives, such as a Stanford University Medical Center/Microsoft project on medical imaging datasets and a Mayo Clinic/Google AI algorithm for treatment of brain diseases. 

Last year alone the FDA approved 100 AI/ML (machine learning) devices, with radiology being the big leader, according to a Politico analysis; as Dr. Eric Topel likes to say, it is the “sweet spot of AI.”   

Lenovo’s Sinisa Nikolic believes: “AI is set to transform the future of healthcare,” although he offers the usual cautions: “In all aspects of healthcare, you will always need human-human contact and interaction. Humans have empathy; machines cannot replace that. AI will help us be better, stronger, and healthier.” 

Not everyone is as conservative.  Kai-Fu Li, author of AI Superpowers, predicts: “I anticipate diagnostic AI will surpass all but the best doctors in the next 20 years.” 

Healthcare has come a long way with its acceptance of healthcare, from initially rejecting it, of course, to the now common mindset that, yes, it could be a great help, helping automate common tasks and augmenting clinicians. But crossing that line between augmenting and replacing is hard for many to accept.     

We can accept AI being good at the “science” part of medicine, but we’ve yet to be convinced it could be good at the “art” part of it.  But, as Ai-Da and other AI artists are illustrating, it’s something we’re going to have to face. 

Ai-Da’s website warns: “If Ai-Da does just one important thing, it would be to get us considering the blurring of human/machine relations, and encouraging us to think more carefully and slowly about the choices we make for our future.”  

Let’s hope healthcare thinks carefully – but not too slowly -- about the choices AI offers us for the future. 

You Need a Cyber Team

Maybe you, like me, are an Olympics fan (in my case: Summer Games, track & field).  Most Americans look forward eagerly for the Super Bowl, while the rest of the world (and, increasingly, many in the U.S.) are waiting for the World Cup.  But too few of us are aware that next summer will be the inaugural International Cyber Security Challenge, an esports event that pits teams from multiple countries against each other in cybersecurity skills.  The U.S. is sending a 25 person team. 

So what, you might say?  Well, if you work in healthcare (or any industry, for that matter), or use any kind of digital device, you should care.  Ransomware attacks on healthcare organizations continue to proliferate, the Colonial Pipeline cyberattack this past spring illustrated the weakness of other parts of our critical infrastructure, and we’ve all almost certainly had some of our personal data exposed in data breaches.    

We’re in a war, but it’s not clear that we have the right army, with the right weapons, ready to fight it.  Thus the U.S. Cyber Games.

The U.S. Cyber Games was launched in April, a collaboration between “growth hacking” firm Katzcy and the National Initiative for Cybersecurity Education (NICE) program, which is part of the National Institute of Standards and Technology (NIST).   Katzcy was already offering PlayCyber, an esports Cyber Games aimed to attract “the very best cybersecurity athletes,” while NIST’s mission is “to energize, promote, and coordinate a robust community working together to advance an integrated ecosystem of cybersecurity education, training, and workforce development.”   A marriage made in cyberheaven. 

The U.S. team was chosen through three stages.  The U.S. Cyber Open allowed cyberathletes to compete in a two-week long “capture-the-flag” competition,  From that, sixty of the cyberathletes were invited to the U.S. Cyber Combine, an in-depth eight week screening process.  That led to the Cyber Team Draft, which resulted in the team that will represent us in the International Cyber Security Challenge. 

“Practicing defenses in today’s world when all rules are changing is difficult. This helps them see what attacks look like in real life,“ Jessica Gulick, Katzcy’s founder and CEO, told The Washington Post.    Head Coach TJ O’Connor, who chairs Florida State’s cybersecurity program, added:

Understanding the most likely attack is one thing you gain through Cyber Games. It’s an attack-based curriculum, and then you can plan the most appropriate strategies when they occur…It’s very important to show them how to attack, and it’s not so they become attackers, it’s because you can’t defend against an unknown boogeyman you can’t explain.

Sears Schultz, one of the team’s captains, believes: “Competitions are a great way to get people more excited about cybersecurity.  These actually have a direct relation between the skills and what you can do professionally. It’s a great way for companies to identify and recruit talent.”

So, what is your organization doing to identify and recruit this now mission critical kind of talent?

Healthcare organizations have hired IT talent for decades, but are now struggling to attract people with digital expertise, much less cybersecurity skills.  Mobile health apps are exploding, but – whoops – many have critical vulnerabilities that leave them open to cyberattacks.  The FTC wants to require health apps to report breaches, even though the companies aren’t necessarily subject to HIPAA, but reporting breaches is far short of stopping them. 

Mobile apps, IoT, and cloud computing require a host of new skills, and pose a host of new problems.  Conventional IT talent isn’t going to cut it.

Not every organization is going to be able to recruit one of the Cyber Team’s members (and I’m sure the U.S. Cyber Command and Big Tech will be at the front of that line).  Esports and hackathons are two other nontraditional ways to find cyberathletes.

Esports, in case you weren’t aware, is a billion dollar industry, with tens of millions of viewers.  Athletes can win millions of dollars, such as in the League of Legends tournament that is going on right now, attracting teams from throughout the world.  There are esports venues; universities give out esports scholarships.  It is becoming mainstream.

The International Olympic Committee took a step towards including esports in the Olympics by featuring the Olympic Virtual Series shortly before the recent Tokyo Olympics, and it is widely expected that esports will eventually be added as an Olympic sport.  "The Olympics need esports more than esports need the Olympics," Rod Breslau, an esports and gaming consultant, told CNET.         

Feel free to replace “the Olympics” with “healthcare,” or any other industry.    

“Hacking” sometimes has a negative connotation, but the skills it requires and develops are exactly the ones needed by cyberathletes.  One of the Cyber Team members admitted to WaPo: “I love it.  I really like hacking things…This is definitely something I want to do as a career. I want to do something from the offensive side”    

Hackathons have been around slightly longer than esports, although they haven’t been commercialized in quite the same way.  They are typically conducted over a short period of time, such as a weekend, and participants are challenged to come up with software solutions to problems.  The appeal is that it forces people from a variety of backgrounds/companies to solve problems quickly, often leading to unconventional solutions.

Hackathons have been used by a variety of industries for a variety of problems, including healthcare.  For example, in August the VA hosted a data science hackathon on the thorny but boring problem of medical coding.  The teams didn’t solve the problem but organizers believe participants came away with ideas they could use to improve it.    

MIT Hacking Medicine maintains a database of health-related hackathons, and Hacking Health “fosters inclusive innovation by connecting people to solve real-world health problems…By breaking down barriers and accelerating the pace of innovation.”  It also maintains a list of past and upcoming hackathon events. 

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So, maybe someone your healthcare organization should be paying attention to the International Cyber Security Challenge next summer, or, at least, checking out what schools/programs the athletes come from.  Maybe it should sponsor an esports event or team.  Certainly it should hold or participate in hackathons to address some of the many problems healthcare IT has, and build relationships with Major League Hacking (“the official student hacking league”). 

Or it could just wait for the next cyberattack. 

Get Ready for Deepfakes

The Tom Cruise TikTok deepfakes last spring didn’t spur me into writing about deepfakes, not even when Justin Bieber fell so hard for them that he challenged the deepfake to a fight.  When 60 Minutes covered the topic last night., though, I figured I’d best get to it before I missed this particular wave.

We’re already living in an era of unprecedented misinformation/disinformation, as we’ve seen repeatedly with COVID-19 (e.g., hydroxychloroquine, ivermectin, anti-vaxxers), but deepfakes should alert us that we haven’t seen anything yet. 

ICYMI, here’s the 60 Minutes story:

The trick behind deepfakes is a type of deep learning called “generative adversarial network” (GAN), which basically means neural networks compete on which can generate the most realistic media (e.g., audio or video).  They can be trying to replicate a real person, or creating entirely fictitious people.  The more they iterate, the most realistic the output gets. 

Audio deepfake technology is already widely available, and already fairly good.  The software takes a sample of someone’s voice and “learns” how that person speaks.  Type in a sentence, and the software generates an audio that sounds like the real person. 

Credit: Deepfake Challenge

The technology has already been used to trick an executive into sending money into an illicit bank account, by deepfaking his boss’s voice.  “The software was able to imitate the voice, and not only the voice: the tonality, the punctuation, the German accent,” a company spokesperson told The Washington Post.

One has to assume that Siri or Alexa would fall for such deepfaked voices as well. 

Audio deepfakes are scary enough, but video takes it to another level.  As the saying goes, seeing is believing.  A cybercrime expert told The Wall Street Journal: “Imagine a video call with [a CEO’s] voice, the facial expressions you’re familiar with. Then you wouldn’t have any doubts at all.” 

As is often the case, the porn industry is an early adopter of the new technology.  Last month MIT Technology Review reported on a site that allows someone to upload a picture of a face, and see that face morphed into an adult video.  The impacts on innocent victims are horrifying. 

That particular site (which Technology Review now says is no longer available) was not the first such porn site to use the technology, probably didn’t had the most realistic deepfakes, and won’t be the last.  Sadly, though, deepfake porn is far from the biggest problem we’re likely to have with the technology.

We’re going to see mainstream actors in movies that they never filmed.  We’re going to see dead actors in new movies.  We’re going to see deepfaked business executives saying all sorts of ridiculous things (Mark Zuckerberg may already be a deepfake).  We’re going to see politicians saying things that make their opponents look good. 

Martin Ford, writing in Market Watch, warns:

A sufficiently credible deepfake could quite literally shift the arc of history—and the means to create such fabrications might soon be in the hands of political operatives, foreign governments or just mischievous teenagers.

Hany Farid, a Cal Berkeley professor, told NPR: "Now you have the perfect storm.  I can create this content easily, inexpensively and quickly, I can deliver it en masse to the world, and I have a very willing and eager public that will amplify that for me."

Nina Schick.  Credit: 60 Minutes

Similarly, technology consultant Nina Schick, who has written a book on deepfakes, told 60 Minutes: “the fact that AI can now be used to make images and video that are fake, that look hyper realistic. I thought, well, from a disinformation perspective, this is a game-changer.”

Imagine what the COVID misinformation crew could do with a deepfake Dr. Fauci.

He has been, in many ways, the face of modern medicine and science during the pandemic.  There are countless hours of video/audio of him over the last eighteen months.  He’s usually been right, sometimes been wrong, but has done his best to follow the science.  COVID-19 skeptics/deniers constantly parse his words looking for inconsistencies, for times when he was wrong, for any opportunity to challenge his expertise.

With deepfakes, we could have him telling people not to bother with masks or even vaccines.  His deepfake could tout unproven and even unsafe remedies, and denounce the FDA, the CDC, even President Biden.  Heck, they could have President Biden attacking Dr. Fauci and praising Donald Trump (conversely, of course, a deepfake Trump could urge vaccine mandates). 

We struggle now to find the best health information, about COVID and anything else that worries us about our health.  We look for credible sources, we look for reputable people’s opinions, and we use that information to make our health decisions.  But, as Ms. Schick said on 60 Minutes, deepfakes are “going to require all of us to figure out how to maneuver in a world where seeing is not always believing.”       

That will not be easy.

We’re just starting to realize how deepfakes may impact healthcare.  In a recent Nature article, Chen, et. alia warned:

...in healthcare, the proliferation of deepfakes is a blind spot; current measures to preserve patient privacy, authentication and security are insufficient. For instance, algorithms for the generation of deepfakes can also be used to potentially impersonate patients and to exploit PHI, to falsely bill health insurers relying on imaging data for the approval of insurance claims ⁴⁶ and to manipulate images sent from the hospital to an insurance provider so as to trigger a request for reimbursement for a more expensive procedure.

The authors believe that there is a role for synthetic data in healthcare, but say: “it is urgent to develop and refine regulatory frameworks involving synthetic data and the monitoring of their impact in society.”

So it is generally.  The technology for detecting deepfakes is improving but, of course, so is the technology for creating them.  It’s an arms race, like everything with cybersecurity.  As Ms. Schick pointed out on 60 Minutes, “The technology itself is neutral.”  How it is used is not.

She also believes, though: “It is without a doubt one of the most important revolutions in the future of human communication and perception. I would say it's analogous to the birth of the internet.”

I’m not sure I’d go that far. 

Doctored audio/video have been with us for pretty much all of the time we’ve had audio/video; deepfake technology just takes it to a new, and more convincing, level.  We still haven’t figured out how to use the internet responsibly, and, if they do nothing more, deepfakes remind us that we’d better do so soon. 

You Want to 3D Print What?

You know we’re living in the 21^st century when people are 3D printing chicken and cooking it with lasers.  They had me at “3D printing chicken.” 

An article in NPJ Science of Food explains how scientists combined additive manufacturing (a.k.a, 3D printing) of food with “precision laser cooking,” which achieves “higher degree of spatial and temporal control for food processing than conventional cooking methods.”  And, oh by-the-way, the color of the laser matters (e.g., red is best for browning).   

Very nice, but wake me when they get to replicators…which they will.  Meanwhile, other people are 3D printing not just individual houses but entire communities.   It reminds me that we’ve still not quite realized how revolutionary 3D printing can and will be, including for healthcare.

The New York Times profiled the creation of a village in Mexico using “an 11-foot-tall three dimensional printer.”  The project, being built by New Story, a nonprofit organization focused on providing affordable housing solutions, Échale, a Mexican social housing production company, and Icon, a construction technology company, is building 500 homes.  Each home takes about 24 hours to build; 200 have already been built.

Here's a vide of the process:

No one knows how durable the houses will be over time, but they’ve already withstood a 7.4 magnitude earthquake, something that would have been appreciated, for example, in Haiti.  Most importantly, they’re providing homes for people who might have otherwise been homeless, or living in sub-standard conditions.

Brett Hagler, New Story’s chief executive and co-founder, told The Times: “We know that being able to build more quickly, without sacrificing quality, is something that we have to make huge leaps on if we’re going to even make a dent on the issue of housing in our lifetime.” 

“We’re really looking at the biggest opportunities to have both impact and efficiency gains,” New Story co-founder Alexandria Lafci added.  “There is a very significant gain in speed that you get with 3-D printing, without sacrificing quality.”

There are 3D printed housing projects all over the world, including Austin (TX), Rancho Mirage (CA), and Tallahassee (FL).   The Tallahassee developers boasted: “Make no mistake, these houses are not your average test models. The finished product is far superior in strength, durability, and efficiency.”   

Faster, cheaper, more durable – what’s not to like?

Canada’s first 3D printed house, the so-called Fibonacci House, features curved walls, just because the builders could.  “So now, architectural features that are exciting or adding aesthetics can be done for virtually no cost comparison," said Ian Cornishin, president of the company that built it. 

Here's their video:

That company, Twente Additive Manufacturing, is now teaming up with non-profit World Housing to build a 3D printed community called Sakura Place.  World Housing’s Don McQuaid says: “Our belief is that technology is going to be the solution for homelessness, and we believe that everyone deserves a home.”

The Ruler of Dubai is such a big fan that he has decreed that 25% of all construction – not just houses – are constructed by 3D printing technology by 2030, “to promote Dubai as a regional and global hub for the use of 3D printing technologies.” 

It’s a new world for construction.  Housing expert Brad Hudson noted: “The housing industry hasn’t changed its overall methods of building homes in the past 50 years.  Innovations like 3D and modular construction will start to gain popularity.” 

So it will be for healthcare.  I’ve written before about 3D printing of prescription drugs, which offers the intriguing, if scary, possibility of printing your own meds at home, but that’s just one example of how healthcare is starting to realize 3D printing’s potential.

Scientists at the Israel Institute of Technology have 3D printed a blood vessel network, to support implanted tissue, something that had not been achieved through conventional approaches.  The researchers believe it “is a versatile and adaptable technique that may cement a new path toward fully lab-grown patient-specific tissues.” 

Here's their video:

We’re not yet at the point of 3D printing human organs for transplants, but we’re close, and in the meantime we are 3D printing prosthetics.   The NIH says:

3D-printable prosthetics are changing the face of medicine, as engineers and physicians are able to develop prosthetics that are fully customized to the wearer. Consumer 3D printing is leading to an even bigger revolution: "DIY" assistive devices that can be printed by virtually anyone, anywhere.

Imagine that world. 

Some experts think the 3D printing market for healthcare is already a billion dollar market, and will be a $6b one by 2030, which seems like not nearly enough.  Where is healthcare’s Ruler of Dubai, demanding 25% of healthcare construction (or manufacturing) using 3D printing by 2030?

3D printing helped lessen the shortage of personal protective equipment (PPE) during the pandemic, when demand skyrocketed at the same time supply chains cratered, but not fast enough and not in enough quantity.  Supply chains are again teetering,  but if healthcare organizations have scaled up their 3D printing capabilities to prepare for shortages, I missed it.   

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There are really two types of thinking we need to be practicing here.  One is what are the things we are doing now that could be done at least as well using 3D printing?  It’s like building houses using 3D printing; they’re not reinventing houses, but they are reinventing how they’re built, in hopes of a faster, cheaper way.  Ideally, it could lead to more affordable houses, and perhaps make a big dent in homelessness. 

E.g., in healthcare, more affordable, better fitting prostheses made much faster. 

The second is what are the things we can’t do now that could be done with 3D printing?  The work in human organs, tissues, or blood vessels fall into this category, but shouldn’t be the limit of the category.   

It’s easy enough to see how 3D printing may be one of the things that helps us address the problem of homelessness/affordable housing.  How can it similarly help us address the problem of people lacking access to health care/affordable health care?