Artificial intelligence is already in our hospitals. 5 questions people want answered

Artificial intelligence (AI) is already being used in health care. AI can look for patterns in medical images to help diagnose disease. It can help predict who in a hospital ward might deteriorate. It can rapidly summarise medical research papers to help doctors stay up-to-date with the latest evidence.

These are examples of AI making or shaping decisions health professionals previously made. More applications are being developed.

But what do consumers think of using AI in health care? And how should their answers shape how it’s used in the future?

What do consumers think?

AI systems are trained to look for patterns in large amounts of data. Based on these patterns, AI systems can make recommendations, suggest diagnoses, or initiate actions. They can potentially continually learn, becoming better at tasks over time.

If we draw together international evidence, including our own and that of others, it seems most consumers accept the potential value of AI in health care.

This value could include, for example, increasing the accuracy of diagnoses or improving access to care. At present, these are largely potential, rather than proven, benefits.

But consumers say their acceptance is conditional. They still have serious concerns.

1. Does the AI work?

A baseline expectation is AI tools should work well. Often, consumers say AI should be at least as good as a human doctor at the tasks it performs. They say we should not use AI if it will lead to more incorrect diagnoses or medical errors.

2. Who’s responsible if AI gets it wrong?

Consumers also worry that if AI systems generate decisions – such as diagnoses or treatment plans – without human input, it may be unclear who is responsible for errors. So people often want clinicians to remain responsible for the final decisions, and for protecting patients from harms.

3. Will AI make health care less fair?

If health services are already discriminatory, AI systems can learn these patterns from data and repeat or worsen the discrimination. So AI used in health care can make health inequities worse. In our studies consumers said this is not OK.

4. Will AI dehumanise health care?

Consumers are concerned AI will take the “human” elements out of health care, consistently saying AI tools should support rather than replace doctors. Often, this is because AI is perceived to lack important human traits, such as empathy. Consumers say the communication skills, care and touch of a health professional are especially important when feeling vulnerable.

5. Will AI de-skill our health workers?

Consumers value human clinicians and their expertise. In our research with women about AI in breast screening, women were concerned about the potential effect on radiologists’ skills and expertise. Women saw this expertise as a precious shared resource: too much dependence on AI tools, and this resource might be lost.

Consumers and communities need a say

The Australian health-care system cannot focus only on the technical elements of AI tools. Social and ethical considerations, including high-quality engagement with consumers and communities, are essential to shape AI use in health care.

Communities need opportunities to develop digital health literacy: digital skills to access reliable, trustworthy health information, services and resources.

Respectful engagement with Aboriginal and Torres Strait Islander communities must be central. This includes upholding Indigenous data sovereignty, which the Australian Institute of Aboriginal and Torres Strait Islander Studies describes as:

the right of Indigenous peoples to govern the collection, ownership and application of data about Indigenous communities, peoples, lands, and resources.

This includes any use of data to create AI.

This critically important consumer and community engagement needs to take place before managers design (more) AI into health systems, before regulators create guidance for how AI should and shouldn’t be used, and before clinicians consider buying a new AI tool for their practice.

We’re making some progress. Earlier this year, we ran a citizens’ jury on AI in health care. We supported 30 diverse Australians, from every state and territory, to spend three weeks learning about AI in health care, and developing recommendations for policymakers.

Their recommendations, which will be published in an upcoming issue of the Medical Journal of Australia, have informed a recently released national roadmap for using AI in health care.

That’s not all

Health professionals also need to be upskilled and supported to use AI in health care. They need to learn to be critical users of digital health tools, including understanding their pros and cons.

Our analysis of safety events reported to the Food and Drug Administration shows the most serious harms reported to the US regulator came not from a faulty device, but from the way consumers and clinicians used the device.

We also need to consider when health professionals should tell patients an AI tool is being used in their care, and when health workers should seek informed consent for that use.

Lastly, people involved in every stage of developing and using AI need to get accustomed to asking themselves: do consumers and communities agree this is a justified use of AI?

Only then will we have the AI-enabled health-care system consumers actually want.

Stacy Carter, Professor and Director, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong; Emma Frost, PhD candidate, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong; Farah Magrabi, Professor of Biomedical and Health Informatics at the Australian Institute of Health Innovation, Macquarie University, and Yves Saint James Aquino, Research Fellow, Australian Centre for Health Engagement, Evidence and Values, University of Wollongong

This article is republished from The Conversation under a Creative Commons license. Read the original article.

With The Pogues, Shane MacGowan perhaps proved himself the most important Irish writer since James Joyce

Known for his music with The Pogues, and perhaps the most important Irish writer since James Joyce, the venerated and critically acclaimed Shane MacGowan has died in Dublin at the age of 65.

MacGowan was the primary songwriter and lead singer of the folk-punk band who formed in London in 1982 and became best known for their chart-topping single, Fairytale of New York.

A mordantly comedic ballad sung by MacGowan and Kirsty MacColl, this unlikely Christmas favourite – which takes its title from a 1973 novel by the American-Irish writer J.P. Donleavy – is the fourth track on If I Should Fall With Grace From God.

Released to critical and commercial acclaim on January 18 1988, The Pogues’ third album provides us with a helpful means to better appreciate the rich musical and lyrical legacy the complex and notoriously unreliable MacGowan leaves behind.

This album, as with the four others MacGowan recorded with The Pogues, is an intoxicating admixture of the old and new, a heady concoction of the traditional and modern.

The opening song on the record – also called If I Should Fall With Grace From God – is proof. The track, which rattles along at furious pace and features a typically raspy vocal delivery by MacGowan, takes the traditional Scottish song The Bonnie Banks o’ Loch Lomond as a primary point of musical reference.

The thematic preoccupations of the lyrics leave little doubt as to MacGowan’s political affinities:

This land was always ours
Was the proud land of our fathers
It belongs to us and them
Not to any of the others.

Accordion player James Fearnley published an excellent memoir about his tenure as a member of The Pogues in 2012, and has this to say about the album’s opening number:

The song was as elemental as the best of all Shane’s songs. It had mud and land and rivers and oceans and corpses in it, in a landscape as expansive and ancient and threatening as the melody, bringing to mind the high road and low road, one of which – after the Jacobite Rising of 1745 – led to death.

All this, it should be added, in under two and a half minutes.

A lover of literature

Shane Patrick Lysaght MacGowan was born in Kent, England, on Christmas Day in 1957. His parents were Irish immigrants who moved to England for work. As a child, MacGowan divided his time between the south-east of England and Tipperary, where he first learnt to play and sing Irish music.

A gifted writer, MacGowan won a scholarship to Westminster School in London in 1971, but was expelled for drug possession in his second year.

MacGowan’s passion for reading and writing was evident to his family and teachers. By the age of 12, he was reading Fyodor Dostoyevsky, Jean Paul Sartre and D. H. Lawrence.

MacGowan’s love of literature and prowess with language comes to the fore in the songs he wrote while in The Pogues. MacGowan took lyrical inspiration from transgressive and rebellious writers like Jean Genet and Federico García Lorca, both of whom are name-checked on The Pogues’ 1990 album, Hell’s Ditch.

The Irish republican writer and activist Brenden Behan was another enduring literary touchstone for MacGowan. His version of The Auld Triangle, popularised by Behan, can be found on The Pogues first album, Red Roses for Me, from 1984.

With his father, MacGowan read Joyce’s Ulysses and Finnegans Wake. Joyce’s influence on MacGowan and The Pogues was profound and lasting. (He quite literally appears on the cover of If I Should Fall With Grace From God.)

The academic Kevin Farrell reminds us, at the outset of their career, “the band called itself Pogue Mahone, a playful – and Joycean – attempt to slip Irish language vulgarity past the BBC censors”.

The Gaelic phrase póg mo thóin translates as “kiss my arse”, and a variation of the expression can be found in the Aeolus episode of Joyce’s modernist masterpiece, Ulysses. While they couldn’t get the reference past the censors, it is a clear indicator of the band’s love of Joyce, who also struggled against the suppression of expression.

The influence of Joyce

Joyce’s influence on MacGowan can be felt in the lyrics of The Sick Bed of Cuchulainn.

This song, the first track of 1985’s Rum, Sodomy & the Lash, serves as a lyrical statement of artistic and political intent: it fuses Celtic mythology with anti-fascist action. Here is a representative slice of the lyrics, which MacGowan delivers at a suitably frenzied pace:

When you pissed yourself in Frankfurt and got syph down in Cologne
And you heard the rattling death trains as you lay there all alone
Frank Ryan bought you whiskey in a brothel in Madrid
And you decked some fucking black shirt who was cursing all the Yids

At the sick bed of Cúchulainn we’ll kneel and say a prayer
But the ghosts are rattling at the door and the devil’s in the chair.

Cuchulainn is a central figure in The Ulster Cycle, a key work of Celtic mythology. A renowned fighter, the heroic Cuchulainn is often romanticised and deified.

MacGowan, who sees affinities between the mythological Cuchulainn and historical figures like the Irish republican Frank Ryan, takes a very different, and overtly Joycean tack.

Deftly toggling back and forth across temporalities, MacGowan foregrounds and celebrates the corporeal. And as with Joyce’s everyman hero, Leopold Bloom, MacGowan’s Cuchulainn is, as music critic Jeffrey T. Roesgen tells us:

made human, assuming the same misadventures, indulgences, and internal struggles between virtue and vice that consume us.

This also serves, I think, as a fitting description of MacGowan himself.

Alexander Howard, Senior Lecturer, Discipline of English, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Henry Kissinger has died. The titan of US foreign policy changed the world, for better or worse

Henry Kissinger was the ultimate champion of the United States’ foreign policy battles.

The former US secretary of state died on November 29 2023 after living for a century.

The magnitude of his influence on the geopolitics of the free world cannot be overstated.

From world war two, when he was an enlisted soldier in the US Army, to the end of the cold war, and even into the 21st century, he had a significant, sustained impact on global affairs.

From Germany to the US and back again

Born in Germany in 1923, he came to the United States at age 15 as a refugee. He learned English as a teenager and his heavy German accent stayed with him until his death.

He attended George Washington High School in New York City before being drafted into the army and serving in his native Germany. Working in the intelligence corps, he identified Gestapo officers and worked to rid the country of Nazis. He won a Bronze Star.

Kissinger returned to the US and studied at Harvard before joining the university’s faculty. He advised moderate Republican New York Governor Nelson Rockefeller – a presidential aspirant – and became a world authority on nuclear weapons strategy.

When Rockefeller’s chief rival Richard Nixon prevailed in the 1968 primaries, Kissinger quickly switched to Nixon’s team.

A powerful role in the White House

In the Nixon White House, he became national security advisor and later simultaneously held the office of secretary of state. No one has held both roles at the same time since.

For Nixon, Kissinger’s diplomacy arranged the end of the Vietnam war and the pivot to China: two related and crucial events in the resolution of the cold war.

He won the 1973 Nobel Peace Prize for his Vietnam diplomacy, but was also condemned by the left as a war criminal for perceived US excesses during the conflict, including the bombing campaign in Cambodia, which likely killed hundreds of thousands of people.

That criticism survives him.

The pivot to China not only rearranged the global chessboard, but it also almost immediately changed the global conversation from the US defeat in Vietnam to a reinvigorated anti-Soviet alliance.

After Nixon was compelled to resign by the Watergate scandal, Kissinger served as secretary of state under Nixon’s successor, Gerald Ford.

During that brief, two-year administration, Kissinger’s stature and experience overshadowed the beleaguered Ford. Ford gladly handed over US foreign policy to Kissinger so he could focus on politics and running for election to the office for which the people had never selected him.

During the turbulent 1970s, Kissinger also achieved a kind of cult status.

Not classically attractive, his comfort with global power gave him a charisma that was noticed by Hollywood actresses and other celebrities. His romantic life was the topic of many gossip columns. He’s even quoted as saying “power is the ultimate aphrodisiac”.

His legacy in US foreign policy continued to grow after the Ford administration. He advised corporations, politicians and many other global leaders, often behind closed doors but also in public, testifying before congress well into his 90s.

Criticism and condemnation

Criticism of Kissinger was and is harsh. Rolling Stone magazine’s obituary of Kissinger is headlined “War Criminal Beloved by America’s Ruling Class, Finally Dies”.

His association with US foreign policy during the divisive Vietnam years is a near-obsession for some critics, who cannot forgive his role in what they see as a corrupt Nixon administration carrying out terrible acts of war against the innocent people of Vietnam.

Kissinger’s critics see him as the ultimate personification of US realpolitik – willing to do anything for personal power or to advance his country’s goals on the world stage.

But in my opinion, this interpretation is wrong.

Niall Ferguson’s 2011 biography, Kissinger, tells a very different story. In more than 1,000 pages, Ferguson details the impact that world war two had on the young Kissinger.

First fleeing from, then returning to fight against, an immoral regime showed the future US secretary of state that global power must be well-managed and ultimately used to advance the causes of democracy and individual freedom.

Whether he was advising Nixon on Vietnam war policy to set up plausible peace negotiations, or arranging the details of the opening to China to put the Soviet Union in checkmate, Kissinger’s eye was always on preserving and advancing the liberal humanitarian values of the West – and against the forces of totalitarianism and hatred.

The way he saw it, the only way to do this was to work for the primacy of the United States and its allies.

No one did more to advance this goal than Henry Kissinger. For that he will be both lionised and condemned.

Lester Munson, Non-resident fellow, United States Studies Centre, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.