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Comment by bonoboTP | Hacker News Reader

Hinton doesn't take social/power aspects into account, he's a naive technical person. Healthcare is an extremely strongly regulated field and its professionals are among those with the highest status in society. Radiology won't be among the first applications to be automated. I see many naive software/ML people trying to enter the medical domain, but they are usually eaten for breakfast by the incumbents. This is not an open market like taxis vs Uber or one entertainment app vs another. If you try to enter the medical domain, you will be deep deep into politics and lobbying and you're going to be defeated.

Better deploy it in fields like agriculture and manufacturing that are already in good part automated. Then later in another generation one can try the medical domain.

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> Radiology won't be among the first applications to be automated

Radiology and a lot of other clinical labwork is heavily outsourced already, and has been for decades [0][1].

Much of the analysis and diagnosis is already done by doctors in India and Pakistan before being returned to the hospitals in the West.

In fact, this is how Apollo Group and Fortis Health (two of India and Asia's largest health groups) expanded rapidly in the 2000s.

It's the back office teleradiology firms that are the target customers for Radiology Agents, and in some cases are funding or acquiring startups in the space already.

This has been an ongoing saga for over a decade now.

[0] - https://www.jacr.org/article/S1546-1440(04)00466-1/fulltext

[1] - https://www.reuters.com/article/business/healthcare-pharmace...

Very counter-intuitive, yet after reading the sources definitely factual. Thanks for pointing that out.

Yeah, that's cool.

But it's not automation.

GP's point is that it will be really hard to take the specialist out of this process, mainly because of regulatory issues.

The point is, if you can substitute even 30-50% of the headcount used in initial diagnostics and analysis, you're profit margins grow exponentially.

The customers for these kinds of Radiology Agents are the teleradiology and clinical labwork companies, as well as MSOs and Health Groups looking to cut outside spend by bringing some subset back in-house.

100% automation is unrealistic for a generation, but 30-50% of teleradiology and clinical labwork headcount being replaced by CV applications is absolutely realistic.

A lot of players that entered the telemedicine segment during the COVID pandemic and lockdown have begun the pivot into this space, as well as the new-gen MSOs as well as legacy telemedicine organizations (eg. Apollo, Fortis).

(Also, why are you getting downvoted? You brought up a valid point of contention)

That's true.

You may always need to keep one or two guys in there but they will be able to do 20x more with the same effort. Definitely plausible.

Outsourcing is indeed a force pushing against doctor power. This just means that radiologists are already under attack and may feel cornered, so they are on the defensive.

I'm not saying automation won't ever happen. But it will need to be slow, as to allow the elite doctor dynasties to recalibrate which specialties to send their kids to, and not to disrupt the already practicing ones. So Hinton's timeline was overly optimistic due to thinking only in terms of the tech. It will happen, but on a longer timescale, maybe a generation or so.

> But it will need to be slow, as to allow the elite doctor dynasties to recalibrate which specialties to send their kids to, and not to disrupt the already practicing ones

That's not how much of medicine from a business standpoint is run anymore.

Managed Service Organizations (MSOs) and PE consolidation has become the norm for much of the medical industry now because the running a medical practice AND practicing medicine at the same time is hard.

Managing insurance billing, patient records, regulatory paperwork, payroll, etc is an additional 20-30 hours of work on top of practicing as a doctor (which is around 30-50 hours as well).

Due to this, single practitioner clinics or partnership models get sold off and the doctor themselves gets a payout plus gets treated as an employee.

> It will happen, but on a longer timescale, maybe a generation or so

I agree with you that a lot of AI/ML application timelines are overhyped, but in Radiology specifically the transition has already started happening.

The outsourced imaging model has been the norm for almost 30 years now, and most of the players in this space began funding or acquiring startups in this space a decade ago already.

Is 100% automation in the next 5 to 10 years realistic? Absolutely not!

Is 30-50% automation realistic? I'd say so.

>This is not an open market like taxis vs Uber

Interesting choice of example. In most places taxis are/weren't an "open market" either but had various laws preventing newcomers from providing taxi rides. In many places what Uber did was illegal. Various locales either banned Uber, changed the laws to allow them, or simply didn't enforce the laws that made them illegal.

Yes, even Uber was pushed out in many places with lawfare and jobs reasons. Taxi drivers do have some moderately strong lobby in many places. So just think about taking on doctors... The discussion was never really about which service is better. It was about whose toes they were stepping on.

In healthcare you can't take the "asking for forgiveness is easier than permission" route. That's a quick way to jail. In taxiing, it's just some fines that fit the budget.

My overall point isn't to argue whether these disruptions are socially beneficial. I'm trying to point at the more neutral observation that who you're taking on and how much power they have will be crucial to the success of a disruptor. It's not just about "product quality" based on some objective dispassionate politics-free scientific benchmarks.

In context, I think GP meant "open" from a sociopolitical point of view. The "taxi-industrial complex" had minimal political power, so Uber was repeatedly able to steamroll the incumbents - exactly as you describe in your final sentence. Medical interests have immense sociopolitical power, so the same playbook won't work. The differences in your positions are merely semantic.

Medallion holders had a weaker more fragmented system. If there was a nation wide system, they would have been able to organize better and kill Uber. Considering groups like the AMA literally dictate how many people are allowed to graduate from med school in a given year, the obviously have more control.

Furthermore, on the state level there are often "Need Based Laws" that require healthcare providers to obtain approval before establishing or expanding certain healthcare facilities or services. This is unironically designed to prevent unnecessary duplication of healthcare services, control healthcare costs and ensure equitable distribution of healthcare resources. Imagine how expensive it would be if we have two many choices!

The cab cartel was more or less city level.

Add in the fact that "health care" is much more politically charged and its easy to find useful idiots that want to "protect people's health" that enforcement is a lot easier, they're entirely different.

Not all conspiracy theories are false.

Good thing most people don't know about this, or they might get really angry at the AMA, perhaps even voting for representatives who might enact laws to reform the system.

Fortunately that would never happen.

I wish there was less focus on AI replacing humans and more focus on AI helping humans do better i.e. Intelligence Augmentation. IA drove a lot of the rapid progress in the earlier days of computing that made computers usable by non-experts.

I suspect a lot of the thinking of replacing humans is driven a lot by the nerd scifi facination with the Singularity, but if a lot of the hype fails to materialize after billions of dollars have been poured into AI there could be an over-correction by the market that would take away funding from even useful AI research.

I hope we'll hear less of AI replacing X, and more of AI enhancing X, where X is radiologists, programmers, artists etc.

People becoming slightly more productive helps people. People being replaced helps quarterly earnings reports.

People becoming slightly more productive also helps earnings reports.

But automation is all about reducing labor costs. Even shoddy automation such as self checkout.

I don't see this changing any time soon.

Replacing is better than helping, though. It frees people up to develop capital – the very source of progress you speak of! More capital development, more progress.

If you still have to do the same job, but better, then you aren't be freed up for a higher level purpose. If we had taken your stance in earlier days of human history we'd all still be out standing in the field. Doing it slightly better perhaps, but still there, "wasting" time.

No, we are clearly better off that almost every job from the past was replaced. And we will be better off when our current jobs are replaced so that our time is freed up so to move onto the next big thing.

You don't think we have reached the pinnacle of human achievement already, surely?

Capital is a tool for progress not the source.

Newton, Einstein etc. didn’t do neither for nor by the capital.

And we all know that those “freed” people are less likely to gain any capital.

Some schools would consider their ideas capital. But, regardless, if what they did wasn't useful in the development of capital, nobody would have cared. It is their contributions to capital development that have made them household names.

I doubt that the contribution to capital development made Newton and Einstein household names.

When the giant magnetoresistance was discovered it wasn’t useful at first. if all is capital focused we likely miss those discoveries.

Well, let's put it to the test. What "useless" scientific discovery has given someone a household name in recent years?

What useful discovery has given someone a household name in recent years?

Household names are more likely celebrities than scientists.

Hinton has become a household name, at least here in Canada. But only within recent years as his discoveries have now proven useful in capital creation. Nobody knew who he was in the 1980s when his discoveries were "useless".

Which stands to reason. People only think about you if you do something for them. Newton and Einstein enabled the creation of capital that changed the world, so they are remembered. The guy who discovered something amazing beside them, but that which we still haven't figured out how to use, remains unknown.

Maybe we should define household first.

Are we talking about HN households or average Joe‘s

Average Canadian Joe, at least.

I don't expect anyone in Zimbabwe knows who he is, just as I cannot name a single person in Zimbabwe despite being sure they too have household names. His capital enablements, while significant, haven't become world changing.

Is it because he won the Nobel Prize or more of a longer lasting fame?

But I doubt people could name a winner after he’s out of the news.

Maybe Canada is different.

The point is he is wrong.

AI isn’t better than humans but we still have now less radiologists.

Now imagine it were a free market:

To raise the profits people get replaced by AI but AI underperforms.

The situation would be much worse.

Perhaps in the US where medicine and healthcare are hugely hugely expensive with loads of vested interests and profiteering and fingers-in-pies from every side of the table, sure.

But everywhere else in the developed world that has universal and free healthcare, I can imagine a lot of traction for AI from governments looking to make their health service more efficient and therefore cheaper (plus better for the patient too in terms of shorter wait times etc).

DeepMind has been doing a load of work with the NHS, Royal Free Foundation, Moorfields for instance (although there have been some data protection issues there, but I suspect they are surmountable)

No one need/should wait for the US govt or the structurally exploitative private sector to reduce prices.

The US has concocted huge myths about why prices cannot fall no matter what tech or productivity gains happen. Its becomes like religious dogma.

Ppl are already flying overseas in the tens of thousands for medical tourism. All Mexico has to do is set up hospitals along the border so people arent flying elsewhere. This is what will happen in the US. The US has no hope of changing by itself.

I agree. These developments will be first deployed in countries like India, Mexico, China. If you're an entrepreneur aiming at making a difference through medical AI, it's probably best to focus on places where they honestly want and need efficiency, instead of just talking about it.

> Perhaps in the US

Medical Systems in countries like the UK [0], Australia [1], and Germany [2] all leverage teleradiology outsourcing at scale, and have done this for decades

[0] - https://www.england.nhs.uk/wp-content/uploads/2021/04/B0030-...

[1] - https://onlinelibrary.wiley.com/doi/abs/10.1111/1754-9485.13...

[2] - https://www.healthcarebusinessinternational.com/german-hospi...

What? Radiology is already full of ML and companies offering quick reporting alongside a traditional slow human report. The UKs Royal College of Radiologists has guidance [0] on how to integrate AI and many hospitals use it alongside other outsourced reporting tools.

This works in radiology because it's not surgery. A hallucination doesn't chop off a limb. Past data protection in training, the risk is low, if done right.

AI offers speedy screening, first-pass results or an instant second opinion. You don't have to —and shouldn't yet— rely on it as your only source of truth, but the ship has sailed on hospitals integrating it into their workflow. It's good enough now, and will get better.

0: https://www.rcr.ac.uk/our-services/all-our-publications/clin...

Or maybe over-confident arrogant CS majors aren't experts on every other irrelevant subdomain and it's not some absurd absence of meritocracy/bad gatekeepers from preventing them from ruining other fields by letting them rely on everything?

Yes, but this mostly plays out in ignoring social factors, like who can take on the blame, etc. CS people also underestimate the extreme levels of ego and demigod-like self-image of doctors. They passed a rite of passage that was extremely exhausting and tiring and perhaps even humiliating during residency, so afterwards they are not ready to give up their hard earned self image. Doctor mentality remains the same as in Semmelweis' time.

Good faith is difficult to assume. I do agree that the real world is much more complex than simply which tool works better.

An analogy could be jury-based courts in the US. The reason for having juries and many of the rules are not really evidence-based. It's well known that juries can be biased in endless ways and are very easy to manipulate. Their main purpose though is not to make objectively correct decisions. The purpose is giving legitimacy to a consensus. Similarly, giving diagnosis-power to human doctors is not a question of accuracy. It's a question of acceptability/blame/status.

Yes, it's the CS majors who are murdering a quarter million Americans annually due to preventable medical errors (including misdiagnoses based on radiology readings), good point.

Nobody, and I mean nobody beats physicians at the Arrogance game.

The very second that ML models begin to consistently beat humans at diagnostics, it would be a moral imperative, as well as an absolute requirement by the terms of the Hippocratic Oath, to replace the humans.

> The very second that ML models begin to consistently beat humans at diagnostics, it would be a moral imperative, as well as an absolute requirement by the terms of the Hippocratic Oath, to replace the humans.

Why is HN so brainrot shit at times man wtf. And you're just proving that you're exactly the type of arrogant techbro I was talking about.

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