Elsevier

Metabolism

Volume 69, Supplement, April 2017, Pages S36-S40
Metabolism

Artificial intelligence in medicine

https://doi.org/10.1016/j.metabol.2017.01.011Get rights and content

Abstract

Artificial Intelligence (AI) is a general term that implies the use of a computer to model intelligent behavior with minimal human intervention. AI is generally accepted as having started with the invention of robots. The term derives from the Czech word robota, meaning biosynthetic machines used as forced labor. In this field, Leonardo Da Vinci's lasting heritage is today's burgeoning use of robotic-assisted surgery, named after him, for complex urologic and gynecologic procedures. Da Vinci's sketchbooks of robots helped set the stage for this innovation. AI, described as the science and engineering of making intelligent machines, was officially born in 1956. The term is applicable to a broad range of items in medicine such as robotics, medical diagnosis, medical statistics, and human biology—up to and including today's “omics”. AI in medicine, which is the focus of this review, has two main branches: virtual and physical. The virtual branch includes informatics approaches from deep learning information management to control of health management systems, including electronic health records, and active guidance of physicians in their treatment decisions. The physical branch is best represented by robots used to assist the elderly patient or the attending surgeon. Also embodied in this branch are targeted nanorobots, a unique new drug delivery system. The societal and ethical complexities of these applications require further reflection, proof of their medical utility, economic value, and development of interdisciplinary strategies for their wider application.

Introduction

Artificial intelligence (AI) is generally accepted as having started with the invention of robots. The word robot, spelled robota in Czech, was introduced into the literature by the writer Karel Capek in his 1921 play, “R.U. R” (Rossum's Universal Robots). It signified a factory where biosynthetic machines are used as forced labor. In the middle of the last century, Isaac Asimov immortalized the word “robot” in a collection of short stories of modern science-fiction. The first mention of a humanoid automaton, however, can be traced back to the third century in China when a mechanical engineer, Yan Shi, presented to the Emperor Mu of Zhou, a human shaped figure of mechanical handiwork built with leather, wood and artificial organs [1].0 In the 12th century, a Muslim golden age scholar, polymath, inventor, and mechanical engineer named al-Jazari created a humanoid robot able to strike cymbals. During the Renaissance period, Leonardo da Vinci made a detailed study of human anatomy to design his humanoid robot. His sketches drawn in 1495, were only rediscovered in the 1950s. Leonardo's robot was a knight robot that was able to stand-up, sit-down, wave arms and move head and jaw. It was operated by pulleys and cables. More important than his accomplishments in this area, da Vinci's sketchbooks were a source of inspiration for a generation of robotic researchers, some of whom worked at NASA.

In medicine, a surgical system made by the American company, Intuitive Surgical, was named Da Vinci in recognition of his inspirational impact. It was approved by the Food and Drug Administration (FDA) in 2000, and the number of units in operation around the world is now over 5000. Da Vinci surgical systems facilitate complex surgery using a minimally invasive approach, and can be controlled by a surgeon from a console. The system is commonly used for prostatectomies and gynecologic surgical procedures. It is starting to be used for cardiac valve repair.

The evolution of robots made a change in direction with the first robot to be recognized as revolutionary in its mechanical realistic conception being the “Flute Player”, conceived in the 18th century by the French inventor, Jacques de Vaucanson, as an innovative “automaton” playing the pipe. It had a repertoire of 12 songs. Two centuries later, William Gray Water became famous in 1948 for the fabrication of the first electronic autonomous robot, which he named Machina Speculatrix. His goal was to demonstrate how the brain functions. It revealed that connections between a small number of “brain cells” could lead to very complex behaviors. John McCarthy coined the term “artificial intelligence” (AI) in 1955, defining it as “the science and engineering of making intelligent machines”. He was very influential in the early development of AI. With his colleagues he founded the field of AI in 1956 at a Dartmouth College conference on artificial intelligence. The conference gave birth to what developed into a new interdisciplinary research area. It provided an intellectual framework for all subsequent computer research and development efforts.

During the following years, computers started to solve many complex mathematical problems that soon became of interest to the Department of Defense of the USA. Then, after a period of slowdowns in the 80’s, a new golden era restarted with the use of logistic data mining and medical diagnosis. Instruments with increasing computational power were developed. This new capability allowed Big Blue to finally beat the world Chess champion, Gary Kasparov on May 11, 1997.

Today, AI is considered a branch of engineering that implements novel concepts and novel solutions to resolve complex challenges. With continued progress in electronic speed, capacity, and software programming, computers might someday be as intelligent as humans. One cannot neglect the important contribution of contemporary cybernetics to the development of AI.

Defined as a trans-disciplinary approach, cybernetics aims for control of any system using technology that explores system regulation, structure and constraints, most notably mechanical, physical, biological, and social. The origin of cybernetics is attributed to Norbert Wiener [2], who formalized the notion of feedback, with implications for engineering, systems control, computer science, biology, neuroscience, philosophy, and the organization of society. Fields that were most influenced by cybernetics are (if we exclude game theory) systems theory, sociology, psychology (especially neuropsychology and cognitive psychology), and theory of organizations.

Today literature on AI is abundant and unbridled. AI was portrayed as a possible threat to the world economy during the 2015 economic forum held at Davos, where Stephen Hawking even expressed his fear that AI may one day eliminate humanity [3]. We will not discuss here the use of this rapidly developing field in military, security, transport or manufacturing; instead, the focus of our chapter is on medicine and health systems.

Section snippets

Artificial Intelligence in Medicine: The Virtual Branch

The application of AI in medicine has two main branches: virtual and physical. The virtual component is represented by Machine Learning, (also called Deep Learning) that is represented by mathematical algorithms that improve learning through experience. There are three types of machine learning algorithms: (i) unsupervised (ability to find patterns), (ii) supervised (classification and prediction algorithms based on previous examples), and (iii) reinforcement learning (use of sequences of

Artificial Intelligence in Medicine: The Physical Branch

The second form of application of AI in medicine includes physical objects, medical devices and increasingly sophisticated robots taking part in the delivery of care (carebots) [13]. Perhaps the most promising approach is the use of robots as helpers; for example, a robot companion for the aging population with cognitive decline or limited mobility. Japanese carebots are the most advanced forms of this technology. Robots are used in surgery as assistant-surgeons or even as solo performers [14].

Use of Robots to Monitor Effectiveness of Treatment

Robots can also be useful in the evaluation of changes in human performance in such situations as rehabilitation [16]. Another area where AI might be helpfully employed is for monitoring the guided delivery of drugs to target organs, tissues or tumors. For example, it is encouraging to learn of the recent development of nanorobots designed to overcome delivery problems that arise when difficulty of diffusion of the therapeutic agent into a site of interest is encountered. This problem occurs

Conclusion

AI for personal use is going to stay with us much as genetics will continue to provide personal services. It is therefore important to consider how AI will also serve the development of our health care systems. Takashi Kido [20] proposed MyFinder as a personalized community computing to resolve challenges of personalized genome services, acting jointly with AI and shaping the personalized and participative health care of the future. The goal of this platform is to provide personal genome

Conflict of Interests

None.

Acknowledgments

The authors would like to thank Professor Ted VanItallie for his excellent comments and suggestions and for the editorial review of their manuscript. Publication of this article was supported by the Collège International de Recherche Servier (CIRS) and Canada Research Chairs to PH. The authors are members of CIRS.

References (20)

There are more references available in the full text version of this article.

Cited by (1129)

View all citing articles on Scopus

Publication of this article was supported by the Collège International de Recherche Servier (CIRS).

View full text