#58 Ross Upshur: AI in Medicine, Limits of Evidence Based Medicine, & What Does It Mean to be Human?

Concepts with Shawn Whatley

This episode is (ostensibly) about medicine, not politics.

What does human-centred care mean in a world of AI? Are doctors becoming obsolete, when it comes to decision making? When should we hand over our clinical judgement to AI?

I asked Ross Upshur for his thoughts on logical positivism. Are most doctors positivists?  

"Despite it being... as a philosophical and epistemological doctrine... been rather thoroughly discarded... a long time ago. It's the self understanding of our profession," Ross said.

Of course, ideas about what counts as knowledge are inseparable from our political assumptions. So although we do not mention politics in this episode, these ideas are core to how we approach medical 'systems', 'planning', and politics in general.

Articles:

"Three problems with big data and AI in medicine" (Chin-Yee & Upshur, 2019)

"Looking for rules in a world of exceptions: reflections on evidence-based practice" (Upshur, 2005)

Book:

How Doctors Think: Clinical Judgment and the Practice of Medicine by Kathryn Montgomery (2012)

AI summary:

In this episode of Concepts with Shawn Whatley, we are joined by Dr. Ross Upshur, head of the Division of Clinical Public Health at the Dalla Lana School of Public Health, University of Toronto. With over 30 years of experience in the intersection of theory and practice in medicine, Dr. Upshur provides a comprehensive discussion on the role of AI in medicine, the limitations of evidence-based practices, and the critical importance of human judgment and patient history. We explore the impacts of AI and big data on clinical care, the pitfalls of technological dependence, and the ethical ramifications of potential AI-driven healthcare. This thought-provoking conversation dives deep into the philosophical and practical aspects of modern medical practices, providing listeners with valuable insights into the future of healthcare and what it means to retain human-centered care in an increasingly automated world.

00:00 Introduction: Can AI Replace Doctors?

00:02 The Limits of Evidence in Clinical Practice

00:41 AI and Evidence-Based Medicine

01:03 Wearables and Real-Time Data: A Misguided Direction?

01:35 The Public's Frustration and Acceptance of AI

01:44 Human-Centered AI vs. Bot Care

02:19 Welcome and Guest Introduction

02:56 The Evolution of Evidence-Based Medicine

03:53 The Gap Between Theory and Practice

05:26 Patient Stories: The Heart of Clinical Medicine

10:21 AI's Role in Future Healthcare

11:00 The Challenges of Big Data and AI

14:18 Epistemological Concerns with AI

18:38 The Human Experience vs. Quantifiable Data

25:42 Clinical Tools and Judgment

32:38 The Role of Clinical Judgment in Patient Care

33:48 Challenges with Evidence-Based Medicine

34:10 Interprofessional Model of Care

35:29 The Inferential Gap in Medical Practice

38:08 Philosophical Perspectives on Medical Practice

40:02 The Future of Clinical Judgment in the Age of AI

43:27 The Importance of Practical Wisdom in Medicine

48:09 Concerns About AI and Automation in Medicine

53:31 Final Thoughts and Reflections