Comment: Training a single AI model can emit as much carbon as five cars in their lifetimes

The results underscore another growing problem in AI, too: the sheer intensity of resources now required to produce paper-worthy results has made it increasingly challenging for people working in academia to continue contributing to research. “This trend toward training huge models on tons of data is not feasible for academics…because we don’t have the computational resources. So there’s an issue of equitable access between researchers in academia versus researchers in industry.”

Hao, K. (2019). Training a single AI model can emit as much carbon as five cars in their lifetimes. MIT Technology Review.

The article focuses on the scale of the financial and environmental cost of training natural language processing (NLP) models, comparing the carbon emissions of various AI models to those of a car throughout its lifetime. To be honest, this isn’t something I’ve given much thought to but to see it visually really drives the point home.

As much as this is a cause for concern, I’m less worried about this in the long term for the following reason. As the author’s in the article stake, the code and models for AI and NLP are currently really inefficient; they don’t need to be neat and compute is relatively easy to come by (if you’re Google and Facebook). I think that the models will get more efficient, as is evident by the fact that new computer vision algorithms can get to the same outcomes with datasets that are orders of magnitude smaller than was previously possible.

For me though, the quote that I’ve pulled from the article to start this post is more compelling. If the costs of modeling NLP are so high, it seems likely that companies like Google, Facebook and Amazon will be the only ones who can do the high end research necessary to drive the field forward. Academics at universities have an incentive to create more efficient models, which they publish and which then allow companies to take advantage of those new models while at the same time, having access to much more computational resources.

From where I’m standing this makes it seem that private companies will always be at the forefront of AI development, which makes me less optimistic than if it were driven by academics. Maybe I’m just being naive (and probably also biased) but this seems less than ideal.

You can find the full paper here on arxiv.

Comment: ‘Robots’ Are Not ‘Coming for Your Job’—Management Is

…in practice, ‘the robots are coming for our jobs’ usually means something more like ‘a CEO wants to cut his operating budget by 15 percent and was just pitched on enterprise software that promises to do the work currently done by thirty employees in accounts payable.’

Merchant, B. (2019). ‘Robots’ Are Not ‘Coming for Your Job’—Management Is. Gizmodo.

It’s important to understand that “technological progress” is not an inexorable march towards an inevitable conclusion that we are somehow powerless to change. We – people – make decisions that influence where we’re going and to some extent, where we end up is evidence of what we value as a society.

Comment: Scientists teach computers fear—to make them better drivers

The scientists placed sensors on people’s fingers to record pulse amplitude while they were in a driving simulator, as a measure of arousal. An algorithm used those recordings to learn to predict an average person’s pulse amplitude at each moment on the course. It then used those “fear” signals as a guide while learning to drive through the virtual world: If a human would be scared here, it might muse, “I’m doing something wrong.”

Hutson, M. (2019). Scientists teach computers fear—to make them better drivers. Science magazine.

This makes intuitive sense; algorithms have no idea what humans fear, nor even what “fear” is. This project takes human flight-or-flight physiological data and uses it to train an autonomous driving algorithm to get a sense of what we feel when we face anxiety-producing situations. The system can use those fear signals to more quickly identify when they’re moving into dangerous territory, adjusting their behaviour to be less risky.

There are interesting potential use cases in healthcare; surgery, for example. When training algorithms on simulations or games, errors do not lead to high-stakes consequences. However, when trusting machines to make potentially life-threatening choices, we’d like them to be more circumspect and risk-averse. But one of the challenges is to get them to identify situations in which a human’s perception of risk is included in the decision-making process. Learning that cutting this artery will likely lead to death can be done by cutting that artery hundreds of times (in simulations) and noting the outcome. This gives us a process whereby the algorithm “senses” a fear response in a surgeon before cutting the artery, and possibly sending a signal indicating that they should slow down and call for help. This could help when deciding whether or not surgical machines should have greater autonomy when performing surgery because we could have mroe confidence that they’d ask for human intervention at appropriate times.

SAAHE podcast on building a career in HPE

In addition to the In Beta podcast that I host with Ben Ellis (@bendotellis), I’m also involved with a podcast series on health professions education with the South African Association of Health Educators (SAAHE). I’ve just published a conversation with Vanessa Burch, one of the leading South African scholars in this area.

You can listen to this conversation (and earlier ones) by searching for “SAAHE” in your podcast app, subscribing and then downloading the episode. Alternatively, listen online at

In this wide-ranging conversation, Vanessa and I discuss her 25 years in health professions education and research. We look at the changes that have taken place in the domain over the past 5-10 years and how this has impacted the opportunities available for South African health professions educators in the early stages of their careers. We talk about developing the confidence to approach people you may want to work with, from the days when you had to be physically present at a conference workshop, to explore novel ways to connect with colleagues in a networked world. We discuss Vanessa’s role in establishing the Southern African FAIMER Regional Institute (SAFRI), as well as the African Journal of Health Professions Education (AJHPE) and what we might consider when presented with opportunities to drive change in the profession.

Vanessa has a National Excellence in Teaching and Learning Award from the Council of Higher Education and the Higher Education Learning and Teaching Association of South Africa (HELTASA), and holds a Teaching at University (TAU) fellowship from the Council for Higher Education of South Africa. She is a Deputy Editor at the journal Medical Education, and Associate Editor of Advances in Health Sciences Education. Vanessa was Professor and Chair of Clinical Medicine at the University of Cape Town from 2008-2018in health and is currently Honorary Professor of Medicine at UCT. She works as an educational consultant to the Colleges of Medicine of South Africa.

Summary: OECD Principles on AI

The Organisation for Economic Co-operation and Development (OECD) has just released a list of recommendations to promote the development of AI that is “innovative and trustworthy and that respects human rights and democratic values”. The principles are meant to complement existing OECD standards around security, risk management and business practices, and could be seen as a response to concerns around the potential for AI systems to undermine democracy.

The principles were developed by a panel consisting of more than 50 experts from 20 countries, as well as leaders from business, civil society, academic and scientific communities. It should be noted that these principles are not legally binding and should be thought of as suggestions that might influence the decision-making of the stakeholders involved in AI development i.e. all of us. The OECD recognises that:

  • AI has pervasive, far-reaching and global implications that are transforming societies, economic sectors and the world of work, and are likely to increasingly do so in the future;
  • AI has the potential to improve the welfare and well-being of people, to contribute to positive sustainable global economic activity, to increase innovation and productivity, and to help respond to key global challenges;
  • And that, at the same time, these transformations may have disparate effects within, and between societies and economies, notably regarding economic shifts, competition, transitions in the labour market, inequalities, and implications for democracy and human rights, privacy and data protection, and digital security;
  • And that trust is a key enabler of digital transformation; that, although the nature of future AI applications and their implications may be hard to foresee, the trustworthiness of AI systems is a key factor for the diffusion and adoption of AI; and that a well-informed whole-of-society public debate is necessary for capturing the beneficial potential of the technology [my emphasis], while limiting the risks associated with it;

The recommendations identify five complementary values-based principles for the responsible stewardship of trustworthy AI (while these principles are meant to be general, they’re clearly also appropriate in the more specific context of healthcare):

  • AI should benefit people and the planet by driving inclusive growth, sustainable development and well-being.
  • AI systems should be designed in a way that respects the rule of law, human rights, democratic values and diversity, and they should include appropriate safeguards – for example, enabling human intervention where necessary – to ensure a fair and just society.
  • There should be transparency and responsible disclosure around AI systems to ensure that people understand AI-based outcomes and can challenge them.
  • AI systems must function in a robust, secure and safe way throughout their life cycles and potential risks should be continually assessed and managed.
  • Organisations and individuals developing, deploying or operating AI systems should be held accountable for their proper functioning in line with the above principles.

The OECD also provides five recommendations to governments:

  • Facilitate public and private investment in research & development to spur innovation in trustworthy AI.
  • Foster accessible AI ecosystems with digital infrastructure and technologies and mechanisms to share data and knowledge.
  • Ensure a policy environment that will open the way to deployment of trustworthy AI systems.
  • Empower people with the skills for AI and support workers for a fair transition.
  • Co-operate across borders and sectors to progress on responsible stewardship of trustworthy AI.

For a more detailed description of the principles, as well as the background and plans for follow-up and monitoring processes, see the OECD Legal Instrument describing the recommendations.

Comment: For a Longer, Healthier Life, Share Your Data

There are a number of overlapping reasons it is difficult to build large health data sets that are representative of our population. One is that the data is spread out across thousands of doctors’ offices and hospitals, many of which use different electronic health record systems. It’s hard to extract records from these systems, and that’s not an accident: The companies don’t want to make it easy for their customers to move their data to a competing provider.

Miner, L. (2019). For a Longer, Healthier Life, Share Your Data. The New York Times.

The author goes on to talk about problems with HIPAA, which he suggests are the bigger obstacle to the large-scale data analysis that is necessary for machine learning. While I agree that HIPAA makes it difficult for companies to enable the sharing of health data while also complying with regulations, I don’t think it’s the main problem.

The requirements around HIPAA could change overnight through legislation. This will be challenging politically and legally but it’s not hard to see how it could happen. There are well-understood frameworks through which legal frameworks can be changed and even though it’s a difficult process, it’s not conceptually difficult to understand. But the ability to share data between EHRs will, I think, be a much bigger hurdle to overcome. There are incentives for the government to review the regulations around patient data in order to push AI in healthcare initiatives; I can’t think of many incentives for companies to make it easier to port patient data between platforms. Unless companies responsible for storing patient data make data portability and exchange a priority, I think it’s going to be very difficult to create large patient data sets.

Comment: DeepMind Can Now Beat Us at Multiplayer Games, Too

DeepMind’s agents are not really collaborating, said Mark Riedl, a professor at Georgia Tech College of Computing who specializes in artificial intelligence. They are merely responding to what is happening in the game, rather than trading messages with one another, as human players do…Although the result looks like collaboration, the agents achieve it because, individually, they so completely understand what is happening in the game.

Metz, C. (2019). DeepMind Can Now Beat Us at Multiplayer Games, Too. New York Times.

The problem with arguments like this is that 1) we end up playing semantic games about what words mean, 2) what we call the computer’s achievement isn’t relevant, and 3) just because the algorithmic solution doesn’t look the same as a human solution doesn’t make it less effective.

The concern around the first point is that, as algorithms become more adept at solving complex problems, we end up painting ourselves into smaller and smaller corners, hemmed in by how we defined the characteristics necessary to solve those problems. In this case, we can define collaboration in a way that means that algorithms aren’t really collaborating but tomorrow when they can collaborate according to today’s definition, we’ll see people wanting to change the definition again.

The second point relates to competence. Algorithms are designed to be competent at solving complex problems, not to solve them in ways that align with our definitions of what words mean. In other words, DeepMind doesn’t care how the algorithm solves the problem, only that it does. Think about developing a treatment for cancer…will we care that the algorithm didn’t work closely with all stakeholders, as human teams would have to, or will it only matter that we have an effective treatment? In the context of solving complex problems, we care about competence.

And finally, why would it matter that algorithmic solutions don’t look the same as human solutions? In this case, human game-players have to communicate in order to work together because it’s impossible for them to do the computation necessary to “completely understand what is happening in the game”. If we had the ability to do that computation, we’d also drop “communication” requirement because it would only slow us down and add nothing to our ability to solve the problem.

Research project exploring clinicians’ perspectives of the introduction of ML into clinical practice

I recently received ethics clearance to begin an explorative study looking at how physiotherapists think about the introduction of machine learning into clinical practice. The study will use an international survey and a series of interviews to gather data on clinicians’ perspectives on questions like the following:

  • What aspects of clinical practice are vulnerable to automation?
  • How do we think about trust when it comes to AI-based clinical decision support?
  • What is the role of the clinician in guiding the development of AI in clinical practice?

I’m busy finalising the questionnaire and hope to have the survey up and running in a couple of weeks, with more focused interviews following. If these kinds of questions interest you and you’d like to have a say in answering them, keep an eye out for a call to respond.

Here is the study abstract (contact me if you’d like more detailed information):

Background: Artificial intelligence (AI) is a branch of computer science that aims to embed intelligent behaviour into software in order to achieve certain objectives. Increasingly, AI is being integrated into a variety of healthcare and clinical applications and there is significant research and funding being directed at improving the performance of these systems in clinical practice. Clinicians in the near future will find themselves working with information networks on a scale well beyond the capacity of human beings to grasp, thereby necessitating the use of intelligent machines to analyse and interpret the complex interactions of data, patients and clinical decision-making.

Aim: In order to ensure that we successfully integrate machine intelligence with the essential human characteristics of empathic, caring and creative clinical practice, we need to first understand how clinicians perceive the introduction of AI into professional practice.

Methods: This study will make use of an explorative design to gather qualitative data via an online survey and a series of interviews with physiotherapy clinicians from around the world. The survey questionnaire will be self-administered and piloted for validity and ambiguity, and the interview guide informed by the study aim. The population for both survey and interviews will consist of physiotherapy clinicians from around the world. This is an explorative study with a convenient sample, therefore no a priori sample size will be calculated.

Article published – An introduction to machine learning for clinicians

It’s a nice coincidence that my article on machine learning for clinicians has been published at around the same time that my poster on a similar topic was presented at WCPT. I’m quite happy with this paper and think it offers a useful overview of the topic of machine learning that is specific to clinical practice and which will help clinicians understand what is at times a confusing topic. The mainstream media (and, to be honest, many academics) conflate a wide variety of terms when they talk about artificial intelligence, and this paper goes some way towards providing some background information for anyone interested in how this will affect clinical work. You can download the preprint here.


The technology at the heart of the most innovative progress in health care artificial intelligence (AI) is in a sub-domain called machine learning (ML), which describes the use of software algorithms to identify patterns in very large data sets. ML has driven much of the progress of health care AI over the past five years, demonstrating impressive results in clinical decision support, patient monitoring and coaching, surgical assistance, patient care, and systems management. Clinicians in the near future will find themselves working with information networks on a scale well beyond the capacity of human beings to grasp, thereby necessitating the use of intelligent machines to analyze and interpret the complex interactions between data, patients, and clinical decision-makers. However, as this technology becomes more powerful it also becomes less transparent, and algorithmic decisions are therefore increasingly opaque. This is problematic because computers will increasingly be asked for answers to clinical questions that have no single right answer, are open-ended, subjective, and value-laden. As ML continues to make important contributions in a variety of clinical domains, clinicians will need to have a deeper understanding of the design, implementation, and evaluation of ML to ensure that current health care is not overly influenced by the agenda of technology entrepreneurs and venture capitalists. The aim of this article is to provide a non-technical introduction to the concept of ML in the context of health care, the challenges that arise, and the resulting implications for clinicians.

WCPT poster: Introduction to machine learning in healthcare

It’s a bit content-heavy and not as graphic-y as I’d like but c’est la vie.

I’m quite proud of what I think is a novel innovation in poster design; the addition of the tl;dr column before the findings. In other words, if you only have 30 seconds to look at the poster then that’s the bit you want to focus on. Related to this, I’ve also moved the Background, Methods and Conclusion sections to the bottom and made them smaller so as to emphasise the Findings, which are placed first.

Here is the tl;dr version. Or, my poster in 8 tweets:

  • Aim: The aim of the study was to identify the ways in which machine learning algorithms are being used across the health sector that may impact physiotherapy practice.
  • Image recognition: Millions of patient scans can be analysed in seconds, and diagnoses made by non-specialists via mobile phones, with lower rates of error than humans are capable of.
  • Video analysis: Constant video surveillance of patients will alert providers of those at risk of falling, as well as make early diagnoses of movement-related disorders.
  • Natural language processing: Unstructured, freeform clinical notes will be converted into structured data that can be analysed, leading to increased accuracy in data capture and diagnosis.
  • Robotics: Autonomous robots will assist with physical tasks like patient transportation and possibly even take over manual therapy tasks from clinicians.
  • Expert systems: Knowing things about conditions will become less important than knowing when to trust outputs from clinical decision support systems.
  • Prediction: Clinicians should learn how to integrate the predictions of machine learning algorithms with human values in order to make better clinical decisions in partnership with AI-based systems.
  • Conclusion: The challenge we face is to bring together computers and humans in ways that enhance human well-being, augment human ability and expand human capacity.
My full-size poster on machine learning in healthcare for the 2019 WCPT conference in Geneva.

Reference list (download this list as a Word document)

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