“Science is knowledge which we understand so well that we can teach it to a computer. Everything else is art.” Donald Knuth, American computer scientist In past newsletters, we discussed

“At that time, we were not yet in a position to implement a comprehensive digital twin. I had been in the IT industry for over 30 years at the time and was firmly convinced that computers would be powerful enough someday to bring my ideas to life.” -Michael Grieves, American digital pioneer and progenitor of the digital twin conceptExtended reality (XR) includes its myriad of modalities: augmented (AR), virtual (VR), and mixed (MR) reality. Artificial intelligence and extended reality together can create a special synergy to help manage complicated operations and complex systems.

“Maybe that’s enlightenment enough: to know that there is no final resting place of the mind; no moment of smug clarity. Perhaps wisdom… is realizing how small I am, and unwise, and how far I have yet to go.” -Anthony Bourdaine American cook/author and global travelerWe have remained in a viral apocalypse now for almost six months, with no obvious denouement to this virtual lockdown. It is not the “new normal” (as some of you may recall, I do not like this term, along with “social distancing”) but a “better normal” that we work adjusting towards.

“Math is the logic of certainty, and statistics is the logic of uncertainty.”  Joseph Blitzstein, Harvard statistician It is supremely frustrating for scientists who work with a few of the world leaders who have extreme form of confirmation bias and refuse to update their beliefs based on new observations in the COVID-19 reality. A screening test should be designed to reduce morbidity and mortality in the population by detecting the disease at an early phase to render a treatment effective and improve outcome. The scientists have incessantly discussed the critical issue of widespread screening as one of the essential strategies for containing this pandemic. It is therefore timely to discuss the screening tests for COVID-19 as well as its interpretation to having the disease. The two screening tests are: 1) the viral test (reverse transcriptase-polymerase chain reaction, or RT-PCR) is a swab from the respiratory system to check for nucleic acid sequences of SARS-CoV-2 virus and 2) the antibody test requires a blood sample to detect presence of antibodies that indicate a past infection; only the former is for detecting current infection.

“If we are not careful, AI will perpetuate the bias in this world. Computers learn how to be racist, sexist, and prejudiced in a similar way that a child does. The computers learn from their creator-us.” Aylin Caliskan, computer scientist The COVID-19 pandemic and the protests for racial equality rage on unrelentingly as dual forces that are forcing change. There is an underlying irony in that even in the pandemic that can be indiscriminately lethal for any human on this planet, there is a very obvious and disheartening racial disparity in morbidity and mortality with Blacks and Latinos disproportionately affected.

“Algorithms are still made by human beings, and those algorithms are still pegged to basic human assumptions. They’re just automated assumptions. And if you don’t fix the bias, then you are just automating the bias.” -Representative Alexandria Ocasio-Cortez (D-NY) We are in the midst of a second pandemic. No, not the “second wave” of this horrid coronavirus pandemic. The second pandemic is the one that is erupting after it has been in our cultures for centuries and is even more destructive than COVID-19: the pandemic of systemic racism in regions around in the world. The unrelenting protests seen around the world is the final clarion call to rid of this supremely unjust human-inflicted scourge of our societies.

“Simple and complicated contexts assume an ordered universe, where cause-and-effect relationships are perceptible, and right answers can be determined based on the facts. Complex and chaotic contexts are unordered, and there is no immediately apparent relationship between cause and effect, and the way forward is determined based on emerging patterns.“ -David Snowden, in Harvard Business Review’s A Leader’s Framework for Decision Making (in describing the Cynefin Framework) This past Saturday, amidst the COVID-19 pandemic and widespread protests for the unjust death of George Floyd, the U.S. launched two astronauts into space. The vehicle was the SpaceX Falcon rocket with its Crew Dragon capsule and this event opened a new era of space travel. This journey, with Elon Musk as the privileged vanguard, is symbolic of the future with a partnership between SpaceX and NASA and implementation of AI as an essential part of its sciences. A close colleague posited about artificial intelligence: even if we launched SpaceX with an incredulous return of its booster back to Earth (including practice returns on a drone ship at sea), maybe AI is still not as good as we think if we cannot seem to make even reasonable predictions about the course of the COVID-19 pandemic.

“The only thing you can do that will change your future life are the decisions that you make. Otherwise you are not the wind, but the leaf in the wind.” -Ronald Howard, retired Stanford professor of Electrical Engineering There is a supreme imbroglio now with the COVID-19 pandemic as it runs its apocalyptic course around the world. With very few exceptions (Taiwan, Singapore, New Zealand, South Korea, etc), it is obvious that leaders and experts have made and continue to make decisions that lack clarity and foresight. So it is timely to consider: how does one make a good or even great decision?

“Some executives think that artificial intelligence is a sentient being, but it is simply a better way to turn data into actionable insights.“ -Ryan Detert, CEO, Influential Artificial intelligence (AI), with its machine and deep learning, natural language processing, and robotic process automation tools, has become an integral part of many sectors in society and now more than ever in healthcare as well. More than 90% of healthcare executives agree that artificial intelligence improves healthcare, and healthcare AI startups raised close to $1 billion in Q4’2019 alone (Gil Press of Forbes, February 21, 2020). With a coalition of enlightened leaders within a healthcare organization, artificial intelligence enables interdisciplinary collaboration and yields valuable dividends. Here is a list of ten common mistakes that healthcare executives can make and how to avoid them:

“What’s natural is the microbe. All the rest-health, integrity, purity (if you like)-is a product of the human will, of a vigilance that must never falter."  The Plague by Albert Camus, French author SARS. MERS. Ebola. These are familiar names of recent pandemics that strike fear even amongst seasoned global healthcare workers even though the combined mortality (774, 38, and 11325 deaths respectively for a total of 12,137) was less than the number of people who have already succumbed to the current coronavirus pandemic (18,605 worldwide including over 700 in the US of as March 24th).

“What we have done is use natural language processing and machine learning techniques to train this engine to recognize whether this is an outbreak of anthrax in Mongolia versus a reunion of the heavy metal band Anthrax.” -Kamran Kahn, CEO, BlueDot Coronavirus, or COVID-19 (2019-nCov), started in Wuhan, China in December of 2019, was manifested by a cluster of people with pneumonias that may have originated from live animals at the Hunan Seafood Market. As of middle of February, it is estimated that close to 100,000 people have been infected with close to 2,000 deaths worldwide.

“Outwork your potential, don’t fear failure, and create something timeless.” -Kobe Bryant, NBA basketball player The world mourned the loss of star basketball player, Kobe Bryant, whose helicopter crashed near Los Angeles along with 8 others, including his daughter Gianna. He is most famous for his extreme work ethic (his “Mamba Mentality”) as well as his relentless curiosity about everything. We can all aspire to his supreme dedication in our work in AI in medicine and healthcare.

“Our intelligence is what makes us human, and AI is an extension of that quality.“  -Dr. Yann Lecun, Professor, New York University In the spirit of the new year, here are a few of my predictions for this year for AI in medicine and healthcare (five predictions here and another five predictions will be included with the next newsletter):

“We came all this way to explore the Moon, and the most important thing is that we discovered the Earth.”&nbsp-William Anders, Apollo 8 astronaut and photographer of EarthriseIt is time for all of us to contrive an artificial intelligence educational agenda for all students and clinicians to have the background in data science and artificial intelligence (along with other advanced technologies) that we will need for the next few decades. It is of vital importance to review statistics, data and databases, and biomedical informatics as well as principles and applications of artificial intelligence in medicine.

“These are not just numbers. I want to tell the stories of each person“ -Marie Colvin, Deceased War Correspondent Pulmonary edema, heart failure, ventricular tachycardia, pulmonary hypertension, acute respiratory distress syndrome, and pneumothorax are medical terms to the data scientists (more accurately “strings”) working on AI in medicine projects. These are, however, medical issues that I suffered this past week as I learned that I had developed acute mitral regurgitation from a chordal rupture of my mitral valve and needed urgent open heart surgery. While these are medical terms, people suffer to yield these terms. It is daunting to not be able to breathe and become air hungry, for instance, with pulmonary edema (you literally feel like you are drowning). In a special way, I feel even closer to my own patients with congenital heart disease now as I have had the same journey as they have. So for my data scientist and artificial intelligence colleagues, please remember that these medical terms all signify human suffering and pain.