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This week, the World Health Organization (WHO) released its first global report on AI in health, along with six guiding principles for design, development, and deployment. The fruit of two years of consultations with WHO-appointed experts, the work cautions against overestimating the benefits of AI while highlighting how it could be used to improve screening for diseases, assist with clinical care, and more.
The health care industry produces an enormous amount of data. An IDC study estimates the volume of health data created annually, which hit over 2,000 exabytes in 2020, will continue to grow at a 48% rate year over year. The trend has enabled significant advances in AI and machine learning, which rely on large datasets to make predictions ranging from hospital bed capacity to the presence of malignant tumors in MRIs. But unlike other domains to which AI has been applied, the sensitivity and scale of health care data makes collecting and leveraging it a formidable challenge.
The WHO report acknowledges this, pointing out that the opportunities brought about by AI are linked with risks. There’s the harms that biases encoded in algorithms could cause patients, communities, and care providers. Systems trained primarily on data from people in high-income countries, for example, may not perform well for low- and middle-income patients. What’s more, unregulated use of AI might undermine the rights of patients in favor of the commercial interests or governments engaged in surveillance.
The datasets used to train AI systems that can predict the onset of conditions like Alzheimer’s, diabetes, diabetic retinopathy, breast cancer, and schizophrenia come from a range of sources. But in many cases, patients aren’t fully aware their information is included. In 2017, U.K. regulators concluded that The Royal Free London NHS Foundation Trust, a division of the U.K.’s National Health Service based in London, provided Google’s DeepMind with data on 1.6 million patients without their consent.
Regardless of the source, this data can contain bias, perpetuating inequalities in AI algorithms trained for diagnosing diseases. A team of U.K. scientists found that almost all eye disease datasets come from patients in North America, Europe, and China, meaning eye disease-diagnosing algorithms are less certain to work well for racial groups from underrepresented countries. In another study, researchers from the University of Toronto, the Vector Institute, and MIT showed that widely used chest X-ray datasets contain racial, gender, and socioeconomic biases.
Further illustrating the point, Stanford researchers found that some AI-powered medical devices approved by the U.S. Food and Drug Administration (FDA) are vulnerable to data shifts and bias against underrepresented patients. Even as AI becomes embedded in more medical devices — the FDA approved over 65 AI devices last year — the accuracy of these algorithms isn’t necessarily being rigorously studied, because they’re not being evaluated by prospective studies.
Experts argue that prospective studies, which collect test data prior to rather than concurrent with deployment, are necessary, particularly for AI medical devices because their actual use can differ from the intended use. For example, most computer-powered diagnostic systems are designed to be decision-support tools rather than primary diagnostic tools. A prospective study might reveal that clinicians are misusing a device for diagnosis, leading to outcomes that might deviate from what’s expected.
Beyond dataset challenges, models lacking peer review can encounter roadblocks when deployed in the real world. Scientists at Harvard found that algorithms trained to recognize and classify CT scans could become biased toward scan formats from certain CT machine manufacturers. Meanwhile, a Google-published whitepaper revealed challenges in implementing an eye disease-predicting system in Thailand hospitals, including issues with scan accuracy.
To limit the risks and maximize the benefits of AI for health, the WHO recommends taking steps to protect autonomy, ensure transparency and explainability, foster responsibility and accountability, and work toward inclusiveness and equity. The recommendations also include promoting well-being, safety, and the public interest, as well as AI that’s responsive and sustainable.
The WHO says redress should be available to people adversely affected by decisions based on algorithms, and also that designers should “continuously” assess AI apps to determine whether they’re aligning with expectations and requirements. In addition, the WHO recommends both governments and companies address disruptions in the workplace caused by automated systems, including training for health care workers to adapt to the use of AI.
“AI systems should … be carefully designed to reflect the diversity of socioeconomic and health care settings,” the WHO said in a press release. “They should be accompanied by training in digital skills, community engagement, and awareness-raising, especially for millions of healthcare workers who will require digital literacy or retraining if their roles and functions are automated, and who must contend with machines that could challenge the decision making and autonomy of providers and patients.”
As new examples of problematic AI in health care emerge, from widely deployed but untested algorithms to biased dermatological datasets, it’s becoming critical that stakeholders follow accountability steps like those outlined by the WHO. Not only will it foster trust in AI systems, but it could improve care for the millions of people who might be subjected to AI-powered diagnostic systems in the future.
“Machine learning really is a powerful tool, if designed correctly — if problems are correctly formalized and methods are identified to really provide new insights for understanding these diseases,” Dr. Mihaela van der Schaar, a Turing Fellow and professor of machine learning, AI, and health at the University of Cambridge and UCLA, said during a keynote at the ICLR conference in May 2020. “Of course, we are at the beginning of this revolution, and there is a long way to go. But it’s an exciting time. And it’s an important time to focus on such technologies.”
Thanks for reading,
AI Staff Writer
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