AI. Artifact & Intention

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Those who claim that artificial intelligence is like any other tool are mistaken. We do not realize the possible consequences of implementing AI, and we have not agreed on how we want to use it for a better future in healthcare.

Disappearing prestige of the secretary’s work

In 1982, the first personal computer (PC), produced by IBM and marketed a year earlier, was selected as Time magazine’s machine of the year. The development of the new technology was enthusiastically welcomed by innovators and dreaded by those afraid of losing their jobs.

Secretaries found themselves on the front lines. Hardly anyone remembers that by the end of the 1980s, it was still one of the most popular jobs, with high prestige. In 1988, there were 3,373,000 secretaries in the USA (out of a population of 244 million), earning an average of USD 21,710 a year. 30 years later and they numbered 3,786,800 (out of a population of 327 million), with an average income of USD 39,850. In comparing the number of secretaries to the population size, we can see a slight reduction in employment (by about 0.2 percentage points) and a simultaneous increase in wages (by 83%). We could jump to optimistic conclusions: despite the introduction of computers, the number of secretaries did not decrease significantly, whereas their pay rose considerably.

But this is only half the truth. The inflation rate for the years 1988-2018 was about 116%. Anything priced USD 1 in 1988 costs today about USD 2.17. Therefore, real wages fell by about ten percent. According to the US Bureau of Labor Statistics, over the next 10 years the number of jobs for secretaries will fall by a further 7%, to say nothing of rapidly shrinking prestige. Replacing secretary work by technology has not happened overnight, but has been done consistently for years.

A secretary’s job today has changed drastically from 30 years ago. They do not have to file tons of paper documents, as it is now done by computers. While they still organize meetings, they do not take the minutes. Finally, they no longer serve as an accountant or the right hand for the CEO, as was the case a few decades ago. Many competencies have been taken over by managers, or rather their computers, with intuitive software that can handle increasing numbers of tasks.

Technologies can’t do it: social competence

It is hard to find one formula for how new technologies affect the job market. The introduction of ATMs did not lead to a reduction in the number of jobs in the banking sector. Instead, it allowed banks to expand and made cash more available, even in small towns. There are also darker scenarios. Artificial intelligence is slowly replacing simple professions. Translators, which used to enjoy high prestige, will most probably disappear in the next two decades. Texts and speech translated by machines are increasingly approaching perfect. A few years ago, the skills of Google Translate aroused laughter rather than admiration. Today, texts translated by AI contain few mistakes.

An analysis of other professions leads us to a straightforward conclusion: simple jobs and repetitive actions are successfully taken over by machines, and this trend is gaining speed as artificial intelligence continues to develop. But it does not mean that people are losing jobs. The unemployment rate in many countries is currently at the lowest level it has been in years (apart from disruptions caused by the COVID-19 pandemic).

What cannot be substituted for are social competencies – a key component in the work of doctors and nurses. And this is not likely to change in the foreseeable future. The fact that medical records need to be filled in during an appointment bothers both doctors and patients. However, this task can be successfully taken over by artificial intelligence, to everyone’s delight, and without any harm to the medical profession. In this way, competencies related to interpersonal skills remain untouched by AI, even gaining value.

To make this happen, it is not enough to leave technological progress to itself. As a society, we need to determine what kind of healthcare we want, which values are important and should be preserved, and what role should be played by a doctor. It will serve as the basis for a legal framework that will prevent a “rampant technological revolution.”

Caught between productivity, cost, and availability

As opposed to other economic sectors, healthcare should be guided by different values. We all agree that it is not about generating profit at the expense of health. What is much more important is to maximize quality, the availability of medical services, and improving people’s health and well-being. Given that our resources are limited, especially when it comes to human resources, we can only achieve that by increasing productivity. And that’s the problem because productivity is not proportionate to the financial outlays: in the USA, where 18% of GDP is allocated to health, we can observe significant health inequalities. The USA is also an example of how the politicization of health makes it impossible to reach any consensus as to what healthcare model would be generally accepted by society. The free market concept of this sector has turned health into a business and health services into a product too expensive for many to afford. In this ecosystem, artificial intelligence and modern technology will become tools to strengthen current models and thus aggravate inequalities that are already quite significant.

AI is only an artifact, something created by humans with specific intentions. And how we want to use it depends on us as a society. Had we known our objectives and plan 200 years ago, the artifact which manifested as the industrial revolution would not have become the cause of drastic climate change. If we determine our priorities and a legal framework for new technologies today, we will prevent potential negative consequences to healthcare, even those which we cannot really predict.

The best doctor in town or your trusted GP?

Man is by nature a social animal. Even though we have access to search engines that allow us to find specialists when we have a cold, we still prefer to go to a doctor we know well rather than the best expert in the country. It might not remain like this. The new generation, raised on digital services, may have completely different values. If we closed down schools and introduced online education, social ties would be severed, and the upbringing factor, for example, so crucial for many children from dysfunctional families, would be lost.

When it comes to healthcare, we should also look at services from the social perspective and ensure the diversification of providers, solutions, technologies, and models. So that nobody is left behind. Nevertheless, the foundations for the development of such a sustainable ecosystem are determined by us as a society. We already have many shared values, and the intended use of AI should be another one. If they are well-thought-out, they can enable the harmonious development of innovations and a purposeful shaping of the future for healthcare, one that is fairer and accessible to all.

For many years balance in nature was achieved through natural selection, which was then disrupted by the dominance and expansion of mankind. By analogy, technology shouldn’t be a disruptor that develops unattended. It should be used to ensure various forms of diagnosis and treatment, increase the accessibility to healthcare, and take care of all patients, regardless of their needs, age, or wealth.

This is our chance, but as an artifact, AI is just a tool where we need to know how we wish to use it.

N.B.: Secretaries, translators are not the only professions being replaced by AI. There are many more examples. Microsoft is using automated systems to select news stories for the MSN website and Edge browser. Around 50 contract news producers from the Microsoft’s SANE (search, ads, News, Edge) division will lose their jobs at the end of June. Nevertheless, in an official statement, the company said it was part of an evaluation of its business.


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