AI, a "break" but which will not replace the doctor-patient relationship (Jean-François Mattei)

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The geneticist, bioethics specialist and former health minister, spoke on January 21 at the opening of the inaugural session of the bicentenary of the National Academy of Medicine. It was indeed created in 1820 by King Louis XVIII.

Among the many current advances that are modifying medical practices, he chose to focus his remarks on artificial intelligence (AI), an "innovation" which according to him could "cause a real medical break".

For several years in fact, studies on the interest of artificial intelligence systems for the diagnosis of pathologies from biological data or imagery are multiplying … but we also see studies appearing evaluating AI to make clinical diagnoses , we note.

The data of artificial intelligence could one day "summarize the medical decision" and "make contingent" the presence of the doctor, he suggested … to better counter this idea with different arguments.

With the massive increase in data, "the machine is necessary to ensure the universality of knowledge" but it is "not endowed with conscience, does not have subjectivity, intentionality, autonomy of decision "from a doctor. She "cannot break the rules at the moment" if the situation requires it.

And she "cannot answer for her choices and her actions".

"The machine has no creative thought". According to the information given to her, "she delivers knowledge and makes conclusive proposals, but these conclusions are based on studies on groups of patients" which lead to artificially creating as a reference an "average patient". However, "the doctor is never faced with an average patient, who has only virtual existence; he is always in front of a person in his singularity".

"The algorithms consider that there is only one answer to a given question." There is a "risk of deadlock".

Faced with the "excellence" of AI in terms of logic and deduction, Professor Mattei put forward the capacity of "emotion" of the human being, who does not oppose reasoning but completes it . "The human being is unsurpassable in his unpredictability" and complex thinking "is both rational and irrational".

"Medicine remains an art: an art of complexity", in which the unique conference remains central, which takes place between the doctor with his experience, his intuition, his ethics, and the patient with "his need to understand, his memory , her personal story ", a" worried person who wishes to be accompanied in the fight she is about to fight ".

"To meet the face of a patient and feel summoned by his suffering, the machine will not replace the eyes of the doctor." While being a "precious decision aid", AI "will not replace human relationships". It must therefore "remain complementary and dependent on human choices".

Jean-François Mattei recalled that "some argue for the creation of a body guaranteeing the placing on the market of algorithms" because the use of an algorithm can have important consequences on people's lives and there is no "safeguard".

Such a body, which he also called for by suggesting introducing his creation at second reading of the bioethics bill, could both protect intellectual property and take care to avoid the negative consequences of the use of algorithms, he argued.

Thus, with the arrival of artificial intelligence in medicine, "the rupture is real, but it is only technological", and medicine has known others which have changed practices, such as X-rays. " Medicine remains permanent, "concluded Jean-François Mattei.

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