I enjoyed reading Robert Wachter’s book A Giant Leap very much. The book chronicles the early missteps in using AI in medicine, particularly in disease diagnosis. It also discusses some of the more recent successful developments, such as assistance with billing.
The book explores the future of AI in medicine, blending in-depth character portraits of many leaders in the field with intelligent common sense and a systematic overview of its many facets. One of the things I found most notable was the contrast between the relatively limited progress of AI in medicine and its remarkable advances in other fields, such as self-driving cars. One of the key differences Wachter points out is the availability of massive amounts of training data for self-driving cars and the difficulty of obtaining comparable data in medicine, particularly given the siloed nature of medical information and persistent privacy concerns.
Wachter also points out that one of the key problems with AI in medicine is that early efforts focused on very difficult problems, such as diagnosis, where the stakes are high, rather than on simpler tasks like transcribing physicians’ notes or assisting with billing, where the stakes are lower and incremental innovation is more feasible. A notable success I particularly got a kick out of was the rapid uptake of the AI scribe for documenting clinical encounters. One reason for this popularity is that the computerization of medicine has created an enormous task of data entry, which Wachter describes as "documentation burden" for physicians; AI scribes help alleviate this. The book also examines the economic forces shaping AI in medicine. One of the most notable for me was the near-monopoly that Epic holds over electronic health records and the potential lock-in effect this creates for applications built on its platform.
The book further explores how AI will impact medicine beyond physicians, including its effects on education and the patient experience. In relation to education, I found it fascinating how Wachter describes AI’s influence at New York University, where it is used in reviewing medical school applications. Given that many applications are now partially written by AI, this creates what seems like a strange arms race.
Another anecdote I found particularly amusing involves Wachter’s discussion of safety in AI-assisted systems in highly regulated fields. While we may worry about the safety of AI in clinical settings, the risks associated with human drivers can be even more immediate. He illustrates this with a hilarious story about an Uber driver who insisted on watching a movie throughout the trip. Is this safe?
Overall, I found this to be a very entertaining read, and I will keep it in mind when thinking about the future of AI in medicine.
