The scene was a dining room in Edinburgh’s New Town in late 1847, where three gentlemen were about to take a giant leap of faith that would revolutionise healthcare.
James Young Simpson and his assistants Dr George Skene Keith and Dr James Matthews Duncan inhaled deeply from a small bottle of chloroform, passed out then woke up; a first step towards it becoming a reliable anaesthetic that would transform surgery and childbirth.
Although many – including Queen Victoria – quickly embraced chloroform’s benefits, it had its opponents. Some obstetricians feared not seeing patients' pain would impact their decision making, a few religious leaders and even patients were far from on board.
Nearly 180 years on and with Scottish researchers and scientists honing a raft of pioneering projects aimed at improving healthcare through technology, and Artificial Intelligence is having its own ‘chloroform’ moment.
Regarded by some as a game-changing tool capable of radically improving patient care and NHS efficiency, others fear its impact on jobs, confidentiality and, particularly following the Post Office computer scandal, what might happen if it goes terribly wrong.
Now with rising numbers of AI-backed projects coming to fruition and Scotland’s world class academics, researchers and scientists collaborating to find new solutions to niggling healthcare problems, NHS patients are being urged to have faith and embrace the potential benefits of machine learning.
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According to Brian Hills, Chief Executive Officer of Edinburgh-based innovation centre, The Data Lab, and Prof. George Crooks, Chief Executive of the Strathclyde-hosted Digital Health & Care Innovation Centre (DHI), healthcare is on the brink of being transformed for the better.
Key, however, is not so much smart technology, but Scotland’s patients themselves.
They say without precious data and patients’ co-operation to help researchers in the quest to develop new AI driven tools, its true potential may vanish into the ether.
The call for Scots to get on board with AI comes as more of us face being asked to give consent to share our data for research or to take part in healthcare trials at our next GP or hospital visit.
But, says Prof. Crooks, there is nothing to be too wary about – as long as new AI supported ways of working are carefully and cautiously developed.
“Artificial Intelligence is not new or scary: it has been around since the 1950s,” he points out.
“It’s the advent of ‘the cloud’ and advances in computer hardware over the last 10 to 15 years that have most weaponised how we can use it.
“And the way we are deploying it in healthcare is to support doctors, nurses and therapists, not replace them.
“AI is incredibly powerful,” he continues, “but it’s an apprentice when it comes to healthcare. It’s not particularly smart, it only knows what it knows and doesn’t understand broader context such as the lived experience of someone.
“It supports decision making and management, and when focused that way it can make a huge difference.”
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However, researchers from Imperial College, London, found patients' concerns over AI outweighed their perception of its benefits, with worries over hacking and cybersecurity, privacy, accuracy and whether enough real data is available to develop effective systems.
The 2021 study highlighted concerns over job losses particularly among radiologists, the loss of the ‘emotional’ element of the doctor-patient relationship, and concerns over who might take responsibility should AI produce a poor health outcome.
A cautious approach is needed, concedes Prof. Crooks. “We are in the foothills of understanding how this technology will add value and we have to take this at measured pace; not rushing in but slowing down and taking our time.
“If we rush it like a bull in a china shop, there will be some high-profile disasters that will set back society being able to access the benefits, because any trust will melt away very quickly.”
Scotland is regarded as perfectly placed to harness the power of AI with expertise stretching six decades to Edinburgh University’s Prof. Donald Michie, an AI pioneer who constructed chess-playing computers and was a contemporary of Alan Turing at Bletchley Park, site of the codebreakers and Enigma.
Alongside are existing world-class medical and biological research facilities and a large patient pool with complex conditions often linked to lifestyle factors: Scotland’s poor health record, it turns out, is good news for AI development.
That has already led to new AI projects aimed at improving patients’ experiences and healthcare efficiency.
Such as AICE, short for AI Supported Image Analysis in Large Bowel Camera Capsule Endoscopy, which aims to speed up the process of checking images captured from suspected bowel and colon cancer patients.
The £6m project works alongside capsule endoscopy technology currently being rolled out across the NHS in Scotland. Rather than requiring a patient to undergo an invasive colonoscopy as part of cancer tests, it uses a ‘smart’ pill equipped with a mini camera.
Once swallowed, it captures hundreds of images of the intestines.
Currently the images are reviewed by trained doctors, but AI would significantly speed up the process, scanning hundreds of images for anomalies in a fraction of the time.
Further research within the project, which involves Strathclyde University NHS Highlands and Islands, The Data Lab and DHI, uses AI to spot the patients most likely to benefit.
Another involving DHI and Abertay University for Macmillan Cancer Support combines AI with technology typically used by the gaming sector to spot players’ patterns of behaviour to ensure cancer patients receive the right support.
In Glasgow, a hotspot for cardiac failure and COPD, AI is helping to spot patients at increased risk of requiring hospital treatment giving clinicians early opportunities to avoid it, and another project now underway at three sites in NHS Greater Glasgow and Clyde uses AI to scan chest X-rays for lung cancer in a bid to improve early detection.
AI is also being put to use in training and drug and therapy development: in August, the UK Government gave Edinburgh’s Heriot-Watt University £644,000 for AI research in keyhole surgery, and almost £600,000 to Edinburgh University for AI research into designing new therapies for rare inherited diseases.
Elderly care presents a range of AI opportunities: NEURii, a partnership spanning neuroscientists, medical research charity LifeArc, Bill Gates’ Gates Ventures and others is using data, AI and machine learning for the prediction, prevention, management and treatment of dementia.
Another project has seen a number of Scottish care homes fitted with information gathering sensors so AI can spot patterns of behaviour which will be used to improve services.
“We know, for example, there are subtle changes in the way patients with neurodegenerative conditions like Parkinson's Disease, MS and early dementia use a keyboard to type or navigate on their mobile phone that can be picked up by technology long before a healthcare professional or even the individual themselves notices there’s a difference,” adds Prof. Crooks.
But, he adds: “It’s very well to have clever and shiny technology but unless deployed to a service ready to accept that, then the technology to make it better it will never be used.
“We have to be good at making our resources and data and lived experiences of citizens in Scotland available to our research community in way that’s open and transparent, and not able to be abused.
“We’ve found that if we are honest and open with people in Scotland, 99 times out of 100 they say yes. If it’s going to benefit them, their families or society in general, in Scotland people are willing to share their data.”
Standards surrounding the use of healthcare data are particularly high, he adds.
“We have an absolute responsibility to respect that gift of data, and deal with it appropriately.”
As for fears over jobs, The Data Lab’s Chief Executive, Mr Hills, suggests there is less reason to be concerned than people may think: “We might have fancy AI, but people are required to make decisions.
“AI can assist and help increase capacity to make best informed decisions, but it’s a tool to be used rather than a replacement.
“Within the healthcare service, we need to enable everyone to have a level of data literacy.
“We’re not asking everyone to be a data engineer, but everyone should have a level of literacy, right up to specialist level.”
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