Of inscrutable AI and humor

Interview with doctor and comedian Eckart von Hirschhausen.

Mediziner und Komiker Dr. Eckart von Hirschhausen.

And your greatest fear or worry about AI?

Eckart von Hirschhausen: Well, as an expert in the human mind I always see artificial intelligence in combination with human stupidity, and that’s infinite, as Einstein once said. So that means the opportunities for delegating that to algorithms does not absolve us from having to think about the kind of world we want to live in. The digital revolution came with a promise of democratizing knowledge. What we see today after 20 years of the internet is that the world hasn’t gotten smarter. It's gotten dumber. Smart systems were introduced in the hospital, promising to relieve us of routine tasks. That’s happened, but many things haven’t become simpler as a result. Rather what we now have is lots more paperwork. Time with the patient is what counts. If digital solutions help me spend more time looking after patients, talking to them, explaining things to them, then that’s great! But I actually believe that the biggest lever for change in health care does not come from the established players, but from the patients, and that’s where I pin my hopes that those patients will understand: Now I can get much more information from the net before a doctor’s appointment, before a hospital stay than I used to be able to. I can provide the transparency that has changed the system over decades.

You said earlier that AI or “artificial intelligence” can analyze large volumes of data faster and often better than a human. Will AI provide an even more powerful lever in future to combat diseases such as cancer or even dementia?

Eckart von Hirschhausen: Data does not change diseases. Rather the things that add 15 years to people’s lives, make their lives better, boil down to five simple things: not smoking, doing exercise, eating vegetables, eating less meat, not drinking as much alcohol, and, expressed in spiritual terms, growing up yet remaining a child, staying curious. Software cannot do all that for me. I’d like for us to see more realistically what people need for their body, for their mind. We already know that young people that spend lots of time with digital media are more depressed. They even have less sex. That means that what we were built for in evolutionary terms, namely interacting with each other, touching one another, and not just being glued to a screen, where you swipe something or other, all that gets lost, and it’s something that truly worries me. I’m definitely not a cultural pessimist, but I see that this society is falling apart, and the thing that actually connects us, i.e. sharing joint experiences, only takes place in front of a device. So why then do soccer fans turn up in their droves at stadiums? To watch the match for one, but above all to enjoy a positive communal experience again. I still go to church, for instance. There are few institutions that make a mark on people’s lives over generations and lots of what I see in the digital world means there are fewer and fewer groups that I interact with. Less and less genuine interaction, fewer and fewer genuine encounters take place, even though it’s of course fantastic what this new world now lets us do. With my foundation I’m leveraging the digital opportunities to further educate care staff, promoting mental well-being because many people don’t dare go to the psychiatrist or to the physician if they think “Jeez, is that normal? Am I depressed? Do I need help?”. In this respect it’s a huge blessing that you can find information online before taking the step. But if you think that can be a substitute for human contact, then you’re sadly mistaken.

Yes, that brings me to my next question or rather the next two questions. So there are lots of big companies working on super-algorithms or on diagnostic tools that they are developing. What’s that like in your view? What repercussions will that have on our health care system and how is that set to change or what is set to change?

Eckart von Hirschhausen: What I’m worried about is black-box algorithms deciding what is relevant and what not. If I enter serious health issues into the Google search box, the engine comes up with myriad hits. But what isn’t clear is whether the engine takes me to pages containing evidence-based, scientifically sound medicine, whether I’m dealing with maverick views, whether the hits are advertising-driven, or whether someone is trying to sell me certain drugs? All that must be transparent. And it isn’t transparent at present. This upshot is today’s fierce battle to determine who has the sole right of interpretation on the net. Who does all this smart data ultimately belong to? Who utilizes it for their profit? Who utilizes it for the common good? And we’re still just beginning to regulate this information effectively in some way so you don’t end up having to pay for information that we, as the community, financed in any case.

And do you think it’s realistic that in the future, whenever and whatever that may be, we won’t need to visit the doctor at all, thanks to these tools?

Eckart von Hirschhausen: Say I’ve got a wound that is healing well. I may end up spending hours in the doctor’s waiting room, after having traveled miles to get to the country practice, just for the doctor to have a look and say: “Yes, it’s healed nicely.” If the doctor can reach the same conclusion from a photo, then I’m a great fan of sorting it out using telemedicine. So I don’t see it as an either-or decision. We can’t turn back the clock either, but the key question will be: Who defines these processes? Who has what interests as part of this? And that’s why I find it good that you as an enterprise also campaign for societal responsibility.

Your foundation “Humor hilft heilen” aims to bring greater humanity into medicine and you previously also spoke about sensible digitalization. Can you just summarize again for us what that is in your view?

Eckart von Hirschhausen: Humor hilft heilen, HHH for short, translates as Humor helps heal. Humor was given to us as humankind’s greatest cognitive skill, so we can deal with paradoxes, with contradictions, with life’s imponderables. And that’s something a digital computer can’t do for us. A computer has never written a good joke. So in my opinion, it’s the last domain that will definitely remain analog and will also work on an interpersonal level. After all, we can’t make ourselves laugh. My foundation Humor hilft heilen came into being ten years ago as a remedy, however modest, for this unbelievably brutal way in which health care is being turned into a business, so we could say: “Let’s make the children’s wards more humane by bringing in clowns.” Meantime we are doing a great deal for care staff. We run workshops for the existing teams and also programs for nursing schools. And we’re in the process of developing an app that includes content from psychology, which you couldn’t find anywhere else, such as how do I deal with stress, how do I deal with stressful situations, how do I discuss conflicts in the team? All the things that are actually taken for granted in enterprises, the kind of things you teach people, have not found their way yet into hospitals.

Thank you.

Eckhardt von Hirschhausen

AI in medicine

Eckart von Hirschhausen on artificial intelligence, patients and humour.