{"id":12457,"date":"2012-06-11T10:00:41","date_gmt":"2012-06-11T14:00:41","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=12457"},"modified":"2012-06-10T17:00:06","modified_gmt":"2012-06-10T21:00:06","slug":"watson-a-love-story","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2012\/06\/watson-a-love-story.html","title":{"rendered":"Watson: a love story"},"content":{"rendered":"

Before you read this post, think of a time when you had a crush on someone. Think about that swirl of emotions, the highs and the lows. That\u2019s where I was a couple weeks ago, except it wasn\u2019t about a person.<\/p>\n

I fell hard for Watson<\/a>, IBM\u2019s hot new outboard brain. I\u2019d heard he was smart, kind of a know-it-all, but also trainable, a good listener, and maybe the answer to people\u2019s prayers and complaints about the rising flood of information.<\/p>\n

At least, that\u2019s what I hoped as I found a seat in Martin Kohn\u2019s Health Foo session. (What’s Health Foo? Read this<\/a>.)<\/p>\n

Kohn began with an explanation about why Watson\u2019s first public task was to compete \u2013 and win \u2013 on the game show Jeopardy. Playing Jeopardy was not a long-term business model, he said with a smile, but a means to an end: mastering a complex English-language challenge.<\/p>\n

Kohn dazzled me and many others with Watson\u2019s voracious appetite for information. My tweet, \u201cDoctors have only an estimated 5 hrs of reading time per month; IBM\u2019s Watson can read 72,000 hours per day\u201d was an instant hit as people re-tweeted it and began firing back questions. Tim O\u2019Reilly tweeted, \u201cIn the 3 seconds of a Jeopardy question, Watson could read and understand 200 million pages of text,\u201d which set off another flurry of interest.<\/p>\n

But I was too much in thrall to answer questions on Twitter. He (and yes, the developers call Watson \u201che\u201d too) can dynamically evaluate the quality of information sources, ie, \u201cThe New York Times<\/em> is more often my source for the right answer than Wikipedia, I\u2019ll prioritize that source next time.\u201d He also develops a confidence-level threshold that changes dynamically according to a risk assessment, such as the state of the Jeopardy game or the amount of money at stake.<\/p>\n

Joy was welling up inside me as I heard Kohn explain that the health care version of Watson will never say, \u201cThis is the answer.\u201d Instead he returns prioritized possibilities. Watson will be an enabler of the information-sorting process, not an instigator (which would answer most of the push-back questions pouring in via Twitter).<\/p>\n

As Kohn put it, Watson is the friendly, diplomatic voice in your ear reminding you to think more broadly. Kohn compared Watson to the experienced nurses he worked with as a doctor-in-training, who quietly asked, \u201cHave you considered X? Would you like me to start Y?\u201d<\/p>\n

Kohn also shared that one of IBM\u2019s goals is to empower knowledgeable patients with information because they will then be more likely to understand and follow a care plan.<\/p>\n

That was it. I had a crush. I was ready to introduce Watson to my friends, the next step in any courtship.<\/p>\n

Luckily a big group of them was there with me. People started asking questions, such as, \u201cWatson has the potential to break the traditional medical journal publishing model. He reads all the journals so doctors don\u2019t have to. Will this spawn new subscription models?\u201d Kohn acknowledged, but didn\u2019t answer that intellectual property question since it was not in IBM\u2019s business plans to disrupt the publishing industry. He agreed that Watson helps overcome the flaw of availability (you only consider the options that come to mind) and the flaw of self-reinforcing bias (an enlarged ego can cloud decision-making) by taking in all of the published medical literature.<\/p>\n

Wait, what was that? I stopped dreaming and looked up. Another question from the group: \u201cYou say that Watson will take in all published studies \u2013 what about unpublished studies, such as those submitted to the FDA during a drug-approval process?\u201d And another: \u201cWhat about the medical knowledge not captured in published journal articles \u2013 will Watson be equipped to take in that information?\u201d And another: \u201cYou say that Memorial Sloan-Kettering is your first client. Their clinicians do not tell kidney cancer patients about a certain treatment \u2013 will their version of Watson be taught this bias?\u201d<\/p>\n

Uh-oh. The answers to these questions \u2013 and others \u2013 whipsawed me between hope and disappointment. Hope that Watson is potentially what we\u2019ve been waiting for \u2013 a learning system to assist medical decision-making. Disappointment that Watson is potentially reinforcing the traditional model of \u201cdoctor knows best,\u201d instead of the new, participatory medicine model of \u201cdoctor knows a lot, but let\u2019s work on this together.\u201d<\/p>\n

Here\u2019s the thing about Health Foo: You can\u2019t get through your slides without being interrupted by such questions. \u00a0My sense is that the questions stem from curiosity and collegiality. We want you to succeed. We want to fall in love with you and your ideas. But we also want you to be the best you can be and will let you know if we see a flaw, like, um, an amazing tool that is going to be trained according to the old model of health care, not the emerging model.<\/p>\n

And so, within the space of an hour, I fell in and out of love with Watson. Like many a jilted lover, I gathered with friends to hash out why I was so upset, even angry. I had set Watson on a pedestal, if only for about 15 minutes, and when reality came rushing in, I felt betrayed. Why couldn\u2019t he be perfect?\u00a0 By the end of our conversation I had come back to a feeling of hope. Watson may not be perfect, but he\u2019s on the path. Maybe he has a younger brother.<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

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