How Artificial Intelligence Could Enhance Healthcare

The book ChatGPT, M.D. by Dr. Robert Pearl (and ChatGPT) might intrigue you in two ways.¹

First, it presents an optimistic, potentially revolutionary role for AI in health care. Second, Dr. Pearl’s co-author for the book is none other than ChatGPT itself. Indeed, ChatGPT wrote some of the material, often in response to comments by Dr. Pearl.

Experiencing their interactions and occasional disagreements is, in my view, worth the price of the book. But there’s a lot more to it.

Dr. Pearl is a widely respected healthcare leader, educator, and former CEO of Kaiser Permanente. He also writes a newsletter entitled “Monthly Musings on American Healthcare,” a popular way to keep up on U.S. healthcare issues. You may also be aware of his two influential books: Mistreated² and Uncaring.³

Dr. Pearl begins by reviewing the pinnacle of American medicine during the first three-quarters of the 20^th century, when a largely altruistic medical field combined with powerful research and nimble public health initiatives to produce dramatic results in medicine, surgery, and public health. The result? Lifespan doubled from 40 years to 80 years, no small achievement.

These successes began with controlling acute health problems, for example, with antibiotics and surgical advances. Ever-increasing research led to continued successes with physical diseases—for example, the control of polio, organ transplants, coronary care units, cholesterol-lowering drugs, and genetic manipulation.

But medicine’s care structure and process changed in the last quarter of the 20^th century, the harbinger that not all was well, and that medicine would come on hard times in the 21^st century. Why? The insidious insertion of the medical-industrial complex (insurance companies, hospitals, pharmaceutical houses, and medical equipment companies) into health care transferred policy decisions slowly but inexorably from medical professionals to the CEOs of huge companies beholden to stockholders rather than physicians and their patients.

Satisfied with the status quo and their growing financial successes, these medical behemoths failed to address the needs of medicine’s changing landscape, in which mental illnesses and chronic physical diseases replaced acute health problems as the most common health conditions.

An example of this leadership failure was the CEOs’ relegation of primary care to the secondary status of gatekeepers who would function mainly to refer patients to specialty care. Primary care clinicians were further insulted by paying them much less than the specialists who became glorified for the admittedly wonderful things they did.

The mistake was not to recognize the central role and equal importance of primary care. For example, research demonstrates that adding 10 primary care clinicians to a population of 100,000 people increases life expectancy to nearly three times more than that achieved by, instead, adding 10 specialists.

It’s no surprise that a severe shortage of primary care clinicians emerged. So why did CEOs do this? Medical conglomerates make more money from lucrative surgical procedures performed by specialists than they do from the equally if not more difficult work conducted by primary care clinicians.

Coinciding with this, Dr. Pearl recounts how healthcare expenditures rose from 6.9 percent of GDP in 1970 to 17.2 percent in 2010, with present health costs at approximately 4 trillion dollars per year and projected to rise to 7 trillion dollars in 2031. But the percentage expenditure of GDP has now plateaued.

The cause of this is what Dr. Pearl calls “skimping.” People are paying the same but getting less care because of i) high deductible health insurance; ii) shifting costs from federal programs to private insurance, where costs are passed on to subscribers and those without insurance; and iii) delaying and denying care by, for example, requiring prior authorization.

So, costs are rising as care deteriorates; meanwhile, many healthcare CEOs make millions each year. This is the economic crisis Dr. Pearl predicts will lead to change.

Now, let’s consider how AI can help. Quoting ChatGPT itself, Pearl’s book claims that “AI’s role in healthcare is not to replace the human touch or clinical expertise but to enhance it. By taking over time-consuming administrative tasks, aiding in diagnostic processes, and offering data-driven medical insights, AI can free clinicians to focus on what they do best—caring for patients. The goal is to shift the burden of mundane tasks from human shoulders to digital ones, allowing doctors and nurses more time for direct patient care and interaction, which is at the heart of medical practice.”

Here are a few of Pearl’s examples of what AI could do.

• For pre-consultation management, patients could use AI before ever visiting the doctor to learn about their symptoms to create a more empowered patient.
• For chronic disease management, patients could have their blood pressure or diabetes monitored continuously rather than relying on episodic, often yearly, checks during doctor visits.
• Thirty percent or more of cardiovascular diseases and cancer can potentially be prevented. Prevention could be greatly enhanced by AI’s guidance of patients in, for example, stopping smoking, getting more exercise, and eating a healthier diet. As a result of these and other preventive efforts, AI may have the ability to reverse the epidemic of chronic disease.
• By similarly informing and monitoring activities, AI could make hospitals safer, prevent deaths and disabilities from misdiagnosis, and save lives from unnecessary medical errors.

You may be tickled, as I was, when ChatGPT chastises Dr. Pearl a bit for perhaps being overly optimistic.

Dr. Pearl posits that the medical revolution needed to overturn the medical-industrial complex will be mediated by AI in conjunction with two precipitants: societal displeasure with healthcare and the economic catastrophe current practices promise. Not surprisingly, he advocates the need for new leaders unencumbered by old medical traditions, especially the mercenary ones that have insidiously infiltrated a once-hallowed profession.

This book provides unique insight into the problems of medicine, severe shortcomings about which most are incompletely aware, especially that a huge revolution in care must occur. (And if you need another reason to buy this book, Dr. Pearl donates all proceeds of his books to Doctors Without Borders.)

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