Atul Gawande on Priorities, Big and Small (Ep. 26)
I’m here up in Boston with Atul Gawande, and we’re going to talk about health, healthcare, healthcare policy, and Atul Gawande himself.
我和 Atul Gawande 一起在波士顿，我们将讨论健康、医疗保健、医疗保健政策和 Atul Gawande 本人。
On artificial intelligence and CRISPR
关于人工智能和 CRISPR
Let me start with a question about artificial intelligence.
让我先问一个关于人工智能的问题。
How far are we from having an AI that is capable of actually doing diagnosis to people?
我们离拥有能够真正为人类进行诊断的人工智能还有多远？
That is, they might speak into a Skype connection, something like Watson would hear what they say, and they would then diagnose the person well enough that this would be a usable form of healthcare?
也就是说，他们可能会通过 Skype 连接说话，像沃森这样的东西会听到他们说的话，然后他们会很好地诊断这个人，这将是一种可用的医疗保健形式？
Is that far, close?
那是远、近吗？
Massively far.
远得很。
I think it’s one of the hardest things.
我认为这是最难的事情之一。
You want me to tell why?
你要我告诉你为什么吗？
Tell us why, yes.
告诉我们为什么，是的。
OK, the diagnosis process—people imagine what it is, is that people come to you with a crisply defined problem.
好吧，诊断过程——人们可以想象它是什么，就是人们带着一个明确定义的问题来找你。
“I have symptom one, two, three.
“我有症状一、二、三。
I have data to add to it, and now give me the answer.”
我有数据要添加，现在给我答案。”
The reality is, first of all, people come to you often unable to explain what their problem is.
现实是，首先，人们来找你时常常无法解释他们的问题是什么。
“I have pain.” “Where?” “Hmmm.
“我很痛。” “在哪里？” “嗯。”
Well, it’s sort of here.” And they’ll point with a hand.
嗯，好像就在这里。”他们会用手指出。
“Well, do you mean there under your rib cage, or you mean in your chest, or .
“嗯，你的意思是在你的胸腔下面，还是在你的胸部，或者。
.
。
.”
”。
So you have this probing process that is part of it and how they tell the story.
因此，这个探索过程是其中的一部分，也是他们如何讲述故事的一部分。
Then there’s also how their story had evolved over time, and they often have to put it in their words.
然后，他们的故事随着时间的推移而演变，他们经常不得不用自己的语言来表达。
It’s more of a narrative than it is a straight set of data.
它更像是一种叙述，而不是一组直接的数据。
That’s problem one.
这是问题一。
IBM Watson put their AI on this problem, and it would never be the problem I would have put them on.
IBM Watson 将他们的人工智能应用到这个问题上，而这永远不会是我会让他们解决的问题。
The second part of it is that it changes over time, and you’re adding data along the way.
第二部分是它会随着时间的推移而变化，并且您会在此过程中添加数据。
You’re integrating it with a little bit about your view of the understanding of the person and their likelihood to even say that something is a major symptom or not.
你将它与你对这个人的理解的看法以及他们甚至说某件事是否是主要症状的可能性结合起来。
There is no question that you can augment the human capability.
毫无疑问，你可以增强人类的能力。
But the idea that you pull out your phone and it would give you the diagnosis—it is still one of the hardest problems in reducing error in medicine, is the fact that we still have a high rate of error, and the sources of the error have to do with the human being rather than the calculation.
但是，你拿出手机，它就会给你诊断——这仍然是减少医学错误的最困难的问题之一，事实上我们的错误率仍然很高，而且错误的根源与人有关，而不是与计算有关。
But say you only get 15 minutes with your doctor, which is pretty common, and as you know, those conversations don’t always run so well.
但是假设您只有 15 分钟的时间与医生交谈，这很常见，而且您也知道，这些对话并不总是那么顺利。
People are intimidated, they forget the right question to ask.
人们被吓倒了，他们忘记了要问的正确问题。
You could have three hours talking to something like Watson.
你可以花三个小时与沃森这样的人交谈。
Maybe 80 percent of the dialogue is nonsense, but at the end, you apply machine learning.
也许 80% 的对话都是废话，但最终，你应用了机器学习。
And keep in mind, the alternative now is that people use Google, which is in a sense the world’s number one doctor.
请记住，现在的替代方案是人们使用谷歌，从某种意义上说，谷歌是世界第一的医生。
So AI only needs to be better than Google, which is already a form of AI.
所以人工智能只需要比谷歌更好，谷歌已经是人工智能的一种形式了。
In that sense, isn’t it just around the corner that it would be a marginal improvement on what we have today?
从这个意义上说，与我们今天所拥有的相比，这不是指日可待吗？
Yeah, one is the replacement question.
是的，一是替换问题。
Can I simply have something that will make the diagnosis?
我可以简单地通过一些东西来做出诊断吗？
And lots of reasons why that’s difficult.
这有很多困难的原因。
But to augment the human capability, absolutely.
但绝对是为了增强人类的能力。
There already are programs.
已经有程序了。
One example is called Isabel, where the clinician, having elicited all of this information, can simply put the observations into a list.
一个名为“伊莎贝尔”的例子，临床医生在获得所有这些信息后，可以简单地将观察结果放入一个列表中。
It will allow them to recognize, “OK, fine.
这将使他们认识到，“好吧，好吧。
You think that what they have is diagnosis one, but here are eight others in rank order of consideration compared to the one that you think.”
你认为他们拥有的是诊断之一，但与你认为的诊断相比，这里还有其他八个按考虑顺序排列的诊断。”
There have been plenty of studies, and it’s been around for more than a decade without the need for AI.
已经有很多研究，而且它已经存在了十多年，不需要人工智能。
This is just crunching some basic data to begin with that can add real value.
这只是从处理一些可以增加实际价值的基本数据开始。
I think the puzzle of it is that you need that capability to integrate information coming from the person interpreted and be able to get it into these kinds of systems.
我认为它的难题在于，你需要这种能力来整合来自被解释者的信息，并能够将其输入到这些类型的系统中。
And in many cases, people may be able to do some of that over time for themselves.
在许多情况下，随着时间的推移，人们也许能够自己做一些事情。
How worried are you about CRISPR?
您对 CRISPR 有多担心？
Imagine parents sitting down, trying to shape the children they will have, using advanced technology of some kind or another.
想象一下，父母们坐下来，试图利用某种先进技术来塑造他们将要拥有的孩子。
Will those parents on average make the right choices, improving choices?
这些父母平均会做出正确的选择，改善选择吗？
Will this be a disaster?
这会是一场灾难吗？
What’s your view?
你的看法是什么？
So CRISPR.
所以CRISPR。
The great thing about this podcast is, I’m going to presume we don’t need to explain what gene editing is for this audience here.
这个播客的伟大之处在于，我认为我们不需要在这里向观众解释什么是基因编辑。
We don’t need to explain.
我们不需要解释。
We put links in.
我们把链接放进去。
There are plenty of reasons to be worried about CRISPR in my mind.
在我看来，有很多理由担心 CRISPR。
The one you just named is not one of them.
你刚才提到的那个人不是其中之一。
Just like in the days of the first in vitro fertilization and baby Louise who was the first test tube baby, and now what’s going to happen, and we’re going to destroy humanity and all of those kinds of things.
就像第一次体外受精和第一个试管婴儿路易丝的时代一样，现在将会发生什么，我们将毁灭人类和所有这些事情。
I don’t think that’s the case.
我认为情况并非如此。
Yes, there will be some forms of selection.
是的，会有一些形式的选择。
We already have massive amounts of sex selection in the world.
我们世界上已经有大量的性别选择。
And that is a problem.
这是一个问题。
Which is a serious problem.
这是一个严重的问题。
That’s very harmful, but it has nothing to do with advanced technologies.
这是非常有害的，但它与先进技术无关。
It has to do with the basic capabilities of ultrasound and selective abortion going on all over the world.
这与世界各地正在进行的超声波和选择性堕胎的基本能力有关。
The issues with CRISPR have to do with the capacity to add .
CRISPR 的问题与添加能力有关。
.
。
.
。
First of all, there’s unpredictable things that people will discover that you can try to do with gene editing, and then you couple it with capabilities.
首先，人们会发现你可以尝试通过基因编辑来完成不可预测的事情，然后将其与功能结合起来。
For example, CRISPR enables gene editing that basically is fairly fixed.
例如，CRISPR使基因编辑基本上是相当固定的。
But if you now can propagate that edited gene in a mosquito or in another organism, now you can have rapid cycle diffusion of those kinds of capabilities, and I don’t think we’ve thought through that in the least.
但如果你现在可以在蚊子或其他生物体中传播经过编辑的基因，那么现在你就可以实现这些能力的快速循环扩散，我认为我们至少没有考虑过这一点。