AI, real world edition

The ideas and innovators shaping health care

Dec 05, 2023 View in browser   By Shawn Zeller, Ruth Reader, Carmen Paun, Daniel Payne, Erin Schumaker and Evan Peng POLICY PUZZLE Biden's tasked his agencies with devising rules to govern AI. | Chip Somodevilla/Getty Images Evaluating artificial intelligence tools in health requires a wider lens than regulators have proposed to this point. That’s according to a pointed warning from researchers published in the data science journal Patterns. How so? Advanced AI goes mostly unregulated today, but the few existing guidelines focus too narrowly on the tools’ performance alone, argue the researchers from Carnegie Mellon University, the Hospital for Sick Children, the Dalla Lana School of Public Health, Columbia University and the University of Toronto. They say that evaluation of AI must take into account the broader context within which it’s implemented. That means considering when health care workers should use the technology and how they should respond to its guidance. The researchers lay out a six-part checklist for health care providers looking to adopt an AI tool. Each provider should have: 1. A use case, including how a proposed system is expected to help patients and improve health system efficiency or treatment equity 2. A clear specification of the task the system performs to achieve those goals 3. Benchmarks to evaluate the system’s success or failure 4. An understanding of how the system performs for different groups of people 5. A grasp of a system’s limits and when it shouldn’t be used 6. A protocol for monitoring systems to ensure it’s working under real-world conditions Distinguishing real-world outcomes from those of the theoretical, best-case scenario, is key, said co-author Alex John London, a professor of ethics and computational technologies at Carnegie Mellon: “Tools are not neutral. They reflect our values, so how they work reflects the people, processes, and environments in which they are put to work.” Even so: The researchers said they’re not arguing that it’s necessary to fully understand how an AI system works before implementing it. “Many interventions in medicine lack these properties in the sense that their clinical benefits have been demonstrated in well-designed trials but we do not know the precise mechanism by which they bring about that effect,” they write. WELCOME TO FUTURE PULSE Longwood Gardens, Kennett Square, Penn. | Shawn Zeller This is where we explore the ideas and innovators shaping health care. Air polluted by climate changes' effects can dry out mouths and make people more susceptible to tooth decay, so a Harvard researcher is using AI to pinpoint communities most affected. Share any thoughts, news, tips and feedback with Carmen Paun at cpaun@politico.com, Daniel Payne at dpayne@politico.com, Evan Peng at epeng@politico.com, Ruth Reader at rreader@politico.com or Erin Schumaker at eschumaker@politico.com. Send tips securely through SecureDrop, Signal, Telegram or WhatsApp. Today on our Pulse Check podcast, host Ben Leonard talks with POLITICO health care reporter Alice Miranda Ollstein, who explains why calls by former President Donald Trump to replace the Affordable Care Act are running up against the law's popularity. Listen to today’s Pulse Check podcast DANGER ZONE There's a link between youth suicides and opioid abuse, a new study asserts. | AP The massive toll of fatal opioid overdoses understates the problem, according to a new study that asserts opioid use also contributes to youth suicides. The study suggests that suicide in 10- to 17-year-olds isn’t on the rise because of an increase in youth opioid use but instead because of the ripple effects of adult opioid abuse. Researcher David Powell, senior economist at the RAND think tank, compared child suicide rates against opioid misuse rates in each state from 1980 to 2020. Purdue Pharma took steps in 2010 to stem abuse of its prescription opioid OxyContin, prompting people who’d become addicted to it to switch to more dangerous street drugs. “A simple extrapolation exercise suggests that OxyContin reformulation can explain about half of the growth in child suicide rates since 2010,” Powell writes. What he found: Child suicide rates rose in tandem with illicit opioid misuse starting in 2010, and states with more illicit opioid use saw disproportionately higher rates of child suicide. What else? In addition to suicide rates, Powell found that child food insecurity rose, as did rates of foster care and children not living with a parent. Opioid abuse is already associated with child neglect, which is linked to suicide risk in children. The study suggests that children are increasingly suicidal because of the stress of living with family members addicted to opioids. Why it matters: Powell says the results reinforce the need for policymakers to invest in access to opioid treatment and the development of alternative pain medications. Even so: Powell notes that while there’s growing evidence that investments in stemming the opioid crisis could deliver substantial returns, policy options “are limited,” and he’s pessimistic about the future of child suicide rates. LIFESTYLE Lay off the suds to live a healthier life, the World Health Organization says. | Getty Images Increase taxes on alcohol and sodas to incentivize healthier behavior, the World Health Organization urged governments Tuesday. Why it matters: This policy would reduce some of the 2.6 million deaths from alcohol and 8 million deaths caused by unhealthy diets around the world every year, the global health body said. The WHO cited a 2017 study showing that increasing alcohol prices by 50 percent by levying taxes on booze would save over 21 million lives over half a century and create $17 trillion in additional revenues. How so? Research shows that taxing alcohol and sugary drinks helps reduce their use and gives companies a reason to make healthier products, the WHO said. Reduced consumption also prevents injuries and ailments such as cancers, diabetes and heart disease. The global picture: Most countries have already applied excise taxes to alcohol — average taxes range from 17 percent for beer to 27 percent for some spirits — but loopholes remain, according to the WHO. Wine is exempt from tax in 22 countries, most of them in Europe. As for sugary drinks, 108 countries are taxing them but the average global tax is only 7 percent. Half of these countries are also taxing water, which the WHO doesn’t recommend. Case study: Lithuania, which increased its alcohol tax in 2017 saw decreased deaths from alcohol-related diseases, from 23.4 per 100,000 people in 2016 to 18.1 per 100,000 people in 2018. Budget revenue also went up by almost $100 million between 2016 and 2018, according to the WHO.   Follow us on Twitter Carmen Paun @carmenpaun Daniel Payne @_daniel_payne Ruth Reader @RuthReader Erin Schumaker @erinlschumaker Evan Peng @thepngfile   Follow us

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