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Yu L, Zhai X. Use of artificial intelligence to address health disparities in low- and middle-income countries: a thematic analysis of ethical issues. Public Health 2024; 234:77-83. [PMID: 38964129 DOI: 10.1016/j.puhe.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/26/2024] [Accepted: 05/22/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVES Artificial intelligence (AI) is reshaping health and medicine, especially through its potential to address health disparities in low- and middle-income countries (LMICs). However, there are several issues associated with the use of AI that may reduce its impact and potentially exacerbate global health disparities. This study presents the key issues in AI deployment faced by LMICs. STUDY DESIGN Thematic analysis. METHODS PubMed, Scopus, Embase and the Web of Science databases were searched, from the date of their inception until September 2023, using the terms "artificial intelligence", "LMICs", "ethic∗" and "global health". Additional searches were conducted by snowballing references before and after the primary search. The final studies were chosen based on their relevance to the topic of this article. RESULTS After reviewing 378 articles, 14 studies were included in the final analysis. A concept named the 'AI Deployment Paradox' was introduced to focus on the challenges of using AI to address health disparities in LMICs, and the following three categories were identified: (1) data poverty and contextual shifts; (2) cost-effectiveness and health equity; and (3) new technological colonisation and potential exploitation. CONCLUSIONS The relationship between global health, AI and ethical considerations is an area that requires systematic investigation. Relying on health data inherent with structural biases and deploying AI without systematic ethical considerations may exacerbate global health inequalities. Addressing these challenges requires nuanced socio-political comprehension, localised stakeholder engagement, and well-considered ethical and regulatory frameworks.
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Affiliation(s)
- Lanyi Yu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Center for Bioethics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaomei Zhai
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Center for Bioethics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Medhi D, Kamidi SR, Mamatha Sree KP, Shaikh S, Rasheed S, Thengu Murichathil AH, Nazir Z. Artificial Intelligence and Its Role in Diagnosing Heart Failure: A Narrative Review. Cureus 2024; 16:e59661. [PMID: 38836155 PMCID: PMC11148729 DOI: 10.7759/cureus.59661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2024] [Indexed: 06/06/2024] Open
Abstract
Heart failure (HF) is prevalent globally. It is a dynamic disease with varying definitions and classifications due to multiple pathophysiologies and etiologies. The diagnosis, clinical staging, and treatment of HF become complex and subjective, impacting patient prognosis and mortality. Technological advancements, like artificial intelligence (AI), have been significant roleplays in medicine and are increasingly used in cardiovascular medicine to transform drug discovery, clinical care, risk prediction, diagnosis, and treatment. Medical and surgical interventions specific to HF patients rely significantly on early identification of HF. Hospitalization and treatment costs for HF are high, with readmissions increasing the burden. AI can help improve diagnostic accuracy by recognizing patterns and using them in multiple areas of HF management. AI has shown promise in offering early detection and precise diagnoses with the help of ECG analysis, advanced cardiac imaging, leveraging biomarkers, and cardiopulmonary stress testing. However, its challenges include data access, model interpretability, ethical concerns, and generalizability across diverse populations. Despite these ongoing efforts to refine AI models, it suggests a promising future for HF diagnosis. After applying exclusion and inclusion criteria, we searched for data available on PubMed, Google Scholar, and the Cochrane Library and found 150 relevant papers. This review focuses on AI's significant contribution to HF diagnosis in recent years, drastically altering HF treatment and outcomes.
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Affiliation(s)
- Diptiman Medhi
- Internal Medicine, Gauhati Medical College and Hospital, Guwahati, Guwahati, IND
| | | | | | - Shifa Shaikh
- Cardiology, SMBT Institute of Medical Sciences and Research Centre, Igatpuri, IND
| | - Shanida Rasheed
- Emergency Medicine, East Sussex Healthcare NHS Trust, Eastbourne, GBR
| | | | - Zahra Nazir
- Internal Medicine, Combined Military Hospital, Quetta, Quetta, PAK
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Maccaro A, Stokes K, Statham L, He L, Williams A, Pecchia L, Piaggio D. Clearing the Fog: A Scoping Literature Review on the Ethical Issues Surrounding Artificial Intelligence-Based Medical Devices. J Pers Med 2024; 14:443. [PMID: 38793025 PMCID: PMC11121798 DOI: 10.3390/jpm14050443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/12/2024] [Accepted: 04/16/2024] [Indexed: 05/26/2024] Open
Abstract
The use of AI in healthcare has sparked much debate among philosophers, ethicists, regulators and policymakers who raised concerns about the implications of such technologies. The presented scoping review captures the progression of the ethical and legal debate and the proposed ethical frameworks available concerning the use of AI-based medical technologies, capturing key themes across a wide range of medical contexts. The ethical dimensions are synthesised in order to produce a coherent ethical framework for AI-based medical technologies, highlighting how transparency, accountability, confidentiality, autonomy, trust and fairness are the top six recurrent ethical issues. The literature also highlighted how it is essential to increase ethical awareness through interdisciplinary research, such that researchers, AI developers and regulators have the necessary education/competence or networks and tools to ensure proper consideration of ethical matters in the conception and design of new AI technologies and their norms. Interdisciplinarity throughout research, regulation and implementation will help ensure AI-based medical devices are ethical, clinically effective and safe. Achieving these goals will facilitate successful translation of AI into healthcare systems, which currently is lagging behind other sectors, to ensure timely achievement of health benefits to patients and the public.
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Affiliation(s)
- Alessia Maccaro
- Applied Biomedical Signal Processing Intelligent eHealth Lab, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (A.M.); (K.S.); (L.S.); (L.H.); (A.W.); (L.P.)
| | - Katy Stokes
- Applied Biomedical Signal Processing Intelligent eHealth Lab, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (A.M.); (K.S.); (L.S.); (L.H.); (A.W.); (L.P.)
| | - Laura Statham
- Applied Biomedical Signal Processing Intelligent eHealth Lab, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (A.M.); (K.S.); (L.S.); (L.H.); (A.W.); (L.P.)
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - Lucas He
- Applied Biomedical Signal Processing Intelligent eHealth Lab, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (A.M.); (K.S.); (L.S.); (L.H.); (A.W.); (L.P.)
- Faculty of Engineering, Imperial College, London SW7 1AY, UK
| | - Arthur Williams
- Applied Biomedical Signal Processing Intelligent eHealth Lab, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (A.M.); (K.S.); (L.S.); (L.H.); (A.W.); (L.P.)
| | - Leandro Pecchia
- Applied Biomedical Signal Processing Intelligent eHealth Lab, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (A.M.); (K.S.); (L.S.); (L.H.); (A.W.); (L.P.)
- Intelligent Technologies for Health and Well-Being: Sustainable Design, Management and Evaluation, Faculty of Engineering, Università Campus Bio-Medico Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Davide Piaggio
- Applied Biomedical Signal Processing Intelligent eHealth Lab, School of Engineering, University of Warwick, Coventry CV4 7AL, UK; (A.M.); (K.S.); (L.S.); (L.H.); (A.W.); (L.P.)
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Mediboina A, Badam RK, Chodavarapu S. Assessing the Accuracy of Information on Medication Abortion: A Comparative Analysis of ChatGPT and Google Bard AI. Cureus 2024; 16:e51544. [PMID: 38318564 PMCID: PMC10840059 DOI: 10.7759/cureus.51544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/07/2024] Open
Abstract
Background and objective ChatGPT and Google Bard AI are widely used conversational chatbots, even in healthcare. While they have several strengths, they can generate seemingly correct but erroneous responses, warranting caution in medical contexts. In an era where access to abortion care is diminishing, patients may increasingly rely on online resources and AI-driven language models for information on medication abortions. In light of this, this study aimed to compare the accuracy and comprehensiveness of responses generated by ChatGPT 3.5 and Google Bard AI to medical queries about medication abortions. Methods Fourteen open-ended questions about medication abortion were formulated based on the Frequently Asked Questions (FAQs) from the National Abortion Federation (NAF) and the Reproductive Health Access Project (RHAP) websites. These questions were answered using ChatGPT version 3.5 and Google Bard AI on October 7, 2023. The accuracy of the responses was analyzed by cross-referencing the generated answers against the information provided by NAF and RHAP. Any discrepancies were further verified against the guidelines from the American Congress of Obstetricians and Gynecologists (ACOG). A rating scale used by Johnson et al. was employed for assessment, utilizing a 6-point Likert scale [ranging from 1 (completely incorrect) to 6 (correct)] to evaluate accuracy and a 3-point scale [ranging from 1 (incomplete) to 3 (comprehensive)] to assess completeness. Questions that did not yield answers were assigned a score of 0 and omitted from the correlation analysis. Data analysis and visualization were done using R Software version 4.3.1. Statistical significance was determined by employing Spearman's R and Mann-Whitney U tests. Results All questions were entered sequentially into both chatbots by the same author. On the initial attempt, ChatGPT successfully generated relevant responses for all questions, while Google Bard AI failed to provide answers for five questions. Repeating the same question in Google Bard AI yielded an answer for one; two were answered with different phrasing; and two remained unanswered despite rephrasing. ChatGPT showed a median accuracy score of 5 (mean: 5.26, SD: 0.73) and a median completeness score of 3 (mean: 2.57, SD: 0.51). It showed the highest accuracy score in six responses and the highest completeness score in eight responses. In contrast, Google Bard AI had a median accuracy score of 5 (mean: 4.5, SD: 2.03) and a median completeness score of 2 (mean: 2.14, SD: 1.03). It achieved the highest accuracy score in five responses and the highest completeness score in six responses. Spearman's correlation coefficient revealed no correlation between accuracy and completeness for ChatGPT (rs = -0.46771, p = 0.09171). However, Google Bard AI showed a marginally significant correlation (rs = 0.5738, p = 0.05108). Mann-Whitney U test indicated no statistically significant differences between ChatGPT and Google Bard AI concerning accuracy (U = 82, p>0.05) or completeness (U = 78, p>0.05). Conclusion While both chatbots showed similar levels of accuracy, minor errors were noted, pertaining to finer aspects that demand specialized knowledge of abortion care. This could explain the lack of a significant correlation between accuracy and completeness. Ultimately, AI-driven language models have the potential to provide information on medication abortions, but there is a need for continual refinement and oversight.
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Affiliation(s)
- Anjali Mediboina
- Community Medicine, Alluri Sita Ramaraju Academy of Medical Sciences, Eluru, IND
| | - Rajani Kumari Badam
- Obstetrics and Gynaecology, Sri Venkateswara Medical College, Tirupathi, IND
| | - Sailaja Chodavarapu
- Obstetrics and Gynaecology, Government Medical College, Rajamahendravaram, IND
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Brereton TA, Malik MM, Lifson M, Greenwood JD, Peterson KJ, Overgaard SM. The Role of Artificial Intelligence Model Documentation in Translational Science: Scoping Review. Interact J Med Res 2023; 12:e45903. [PMID: 37450330 PMCID: PMC10382950 DOI: 10.2196/45903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Despite the touted potential of artificial intelligence (AI) and machine learning (ML) to revolutionize health care, clinical decision support tools, herein referred to as medical modeling software (MMS), have yet to realize the anticipated benefits. One proposed obstacle is the acknowledged gaps in AI translation. These gaps stem partly from the fragmentation of processes and resources to support MMS transparent documentation. Consequently, the absence of transparent reporting hinders the provision of evidence to support the implementation of MMS in clinical practice, thereby serving as a substantial barrier to the successful translation of software from research settings to clinical practice. OBJECTIVE This study aimed to scope the current landscape of AI- and ML-based MMS documentation practices and elucidate the function of documentation in facilitating the translation of ethical and explainable MMS into clinical workflows. METHODS A scoping review was conducted in accordance with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. PubMed was searched using Medical Subject Headings key concepts of AI, ML, ethical considerations, and explainability to identify publications detailing AI- and ML-based MMS documentation, in addition to snowball sampling of selected reference lists. To include the possibility of implicit documentation practices not explicitly labeled as such, we did not use documentation as a key concept but as an inclusion criterion. A 2-stage screening process (title and abstract screening and full-text review) was conducted by 1 author. A data extraction template was used to record publication-related information; barriers to developing ethical and explainable MMS; available standards, regulations, frameworks, or governance strategies related to documentation; and recommendations for documentation for papers that met the inclusion criteria. RESULTS Of the 115 papers retrieved, 21 (18.3%) papers met the requirements for inclusion. Ethics and explainability were investigated in the context of AI- and ML-based MMS documentation and translation. Data detailing the current state and challenges and recommendations for future studies were synthesized. Notable themes defining the current state and challenges that required thorough review included bias, accountability, governance, and explainability. Recommendations identified in the literature to address present barriers call for a proactive evaluation of MMS, multidisciplinary collaboration, adherence to investigation and validation protocols, transparency and traceability requirements, and guiding standards and frameworks that enhance documentation efforts and support the translation of AI- and ML-based MMS. CONCLUSIONS Resolving barriers to translation is critical for MMS to deliver on expectations, including those barriers identified in this scoping review related to bias, accountability, governance, and explainability. Our findings suggest that transparent strategic documentation, aligning translational science and regulatory science, will support the translation of MMS by coordinating communication and reporting and reducing translational barriers, thereby furthering the adoption of MMS.
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Affiliation(s)
- Tracey A Brereton
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Momin M Malik
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Mark Lifson
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Jason D Greenwood
- Department of Family Medicine, Mayo Clinic, Rochester, MN, United States
| | - Kevin J Peterson
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
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Hallowell N, Badger S, McKay F, Kerasidou A, Nellåker C. Democratising or disrupting diagnosis? Ethical issues raised by the use of AI tools for rare disease diagnosis. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100240. [PMID: 37426704 PMCID: PMC10323712 DOI: 10.1016/j.ssmqr.2023.100240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/13/2023] [Accepted: 02/13/2023] [Indexed: 07/11/2023]
Abstract
Computational phenotyping (CP) technology uses facial recognition algorithms to classify and potentially diagnose rare genetic disorders on the basis of digitised facial images. This AI technology has a number of research as well as clinical applications, such as supporting diagnostic decision-making. Using the example of CP, we examine stakeholders' views of the benefits and costs of using AI as a diagnostic tool within the clinic. Through a series of in-depth interviews (n = 20) with: clinicians, clinical researchers, data scientists, industry and support group representatives, we report stakeholder views regarding the adoption of this technology in a clinical setting. While most interviewees were supportive of employing CP as a diagnostic tool in some capacity we observed ambivalence around the potential for artificial intelligence to overcome diagnostic uncertainty in a clinical context. Thus, while there was widespread agreement amongst interviewees concerning the public benefits of AI assisted diagnosis, namely, its potential to increase diagnostic yield and enable faster more objective and accurate diagnoses by up skilling non specialists and thereby enabling access to diagnosis that is potentially lacking, interviewees also raised concerns about ensuring algorithmic reliability, expunging algorithmic bias and that the use of AI could result in deskilling the specialist clinical workforce. We conclude that, prior to widespread clinical implementation, on-going reflection is needed regarding the trade-offs required to determine acceptable levels of bias and conclude that diagnostic AI tools should only be employed as an assistive technology within the dysmorphology clinic.
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Affiliation(s)
- Nina Hallowell
- The Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health and Big Data Institute, University of Oxford, UK
| | | | - Francis McKay
- The Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health and Big Data Institute, University of Oxford, UK
| | - Angeliki Kerasidou
- The Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health and Big Data Institute, University of Oxford, UK
| | - Christoffer Nellåker
- Nuffield Department of Women's and Reproductive Health and Big Data Institute, University of Oxford, UK
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Hallowell N, Badger S, Sauerbrei A, Nellåker C, Kerasidou A. “I don’t think people are ready to trust these algorithms at face value”: trust and the use of machine learning algorithms in the diagnosis of rare disease. BMC Med Ethics 2022; 23:112. [DOI: 10.1186/s12910-022-00842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
As the use of AI becomes more pervasive, and computerised systems are used in clinical decision-making, the role of trust in, and the trustworthiness of, AI tools will need to be addressed. Using the case of computational phenotyping to support the diagnosis of rare disease in dysmorphology, this paper explores under what conditions we could place trust in medical AI tools, which employ machine learning.
Methods
Semi-structured qualitative interviews (n = 20) with stakeholders (clinical geneticists, data scientists, bioinformaticians, industry and patient support group spokespersons) who design and/or work with computational phenotyping (CP) systems. The method of constant comparison was used to analyse the interview data.
Results
Interviewees emphasized the importance of establishing trust in the use of CP technology in identifying rare diseases. Trust was formulated in two interrelated ways in these data. First, interviewees talked about the importance of using CP tools within the context of a trust relationship; arguing that patients will need to trust clinicians who use AI tools and that clinicians will need to trust AI developers, if they are to adopt this technology. Second, they described a need to establish trust in the technology itself, or in the knowledge it provides—epistemic trust. Interviewees suggested CP tools used for the diagnosis of rare diseases might be perceived as more trustworthy if the user is able to vouchsafe for the technology’s reliability and accuracy and the person using/developing them is trusted.
Conclusion
This study suggests we need to take deliberate and meticulous steps to design reliable or confidence-worthy AI systems for use in healthcare. In addition, we need to devise reliable or confidence-worthy processes that would give rise to reliable systems; these could take the form of RCTs and/or systems of accountability transparency and responsibility that would signify the epistemic trustworthiness of these tools. words 294.
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