Professor Richard Lilford opens up about artificial intelligence, getting to grips with the brain, living to 140 and the likelihood of an all-robot NHS.
Picture the GP surgery of the future: a robot doctor has replaced its human predecessor, using a super-computer brain to calculate drug doses in seconds with no risk of fatigue-induced errors. What with the advance of AI technologies and the growing issues around NHS staff shortages, this might not seem such a far-fetched concept. But Professor Richard Lilford, chairman of public health at Warwick, is convinced this won’t happen. To think otherwise, he suspects, is to grossly underestimate the complex skills of doctors.
“I’m a sceptic on artificial intelligence,” he says. “I don’t think computers will ever supplant the doctor’s diagnosis. I think things will change – a computer might suggest a diagnosis. If a patient has just come back from India at a time of year when dengue fever is rife, for example, then a computer might be able to prompt the clinician to consider that. So a computer may become a second opinion, or perhaps even a first opinion, but the doctor will still make the final call.”
What’s more, whereas a computer is brilliant when dealing in certainties, Professor Lilford notes: “You’ve [often] got to act in medicine before you’ve got any certainty and that sort of thing the doctor will have to do.” Human intuition, then, shouldn’t be underrated.
Above and beyond this, Professor Lilford believes the fact that a doctor is a comforting, supportive human presence is crucial when you’re ill. “That’s one of the strongest beliefs I have about medical practice,” he says. “It’s lethal to think that you can separate the psychological care from the physical care. They are part and parcel of the same thing,” he argues. “I mean, you could programme a computer to say, ‘I’m sorry’ but…” He laughs. Just how far this would fall short of genuine human compassion is self-evident.
While Professor Lilford might not be convinced that computers are about to do doctors out of a job, he does believe there’s a lot of change in store over the next 50 years. “History is littered with people who said that there were no more discoveries to be made,” he notes. “There was a very famous president of The Royal College of Surgeons who, in 1924 I believe, said surgery had reached its apotheosis. That was before transplant surgery, before bypass surgery, before keyhole surgery, before neurosurgery. So given that history, a person would be foolish to say that there won’t be more discoveries.”
The area in which he believes there’s the greatest scope for major leaps forward is psychiatry and our understanding of the brain. “Our diagnosis in psychiatry is still like medicine was back in 1880,” he says. “It was a descriptor for various phenomena, which you could see physically, but it changed over the next 70 years into diagnosis based on a deep understanding of human biology and the mechanisms of disease. [With most physical diseases now] you can give a very convincing and correct account of how the disease unfolds. That’s not the case in psychiatry. It would be a game changer if it was.”
The future of medicine is as exciting as ever, especially when you look back at the huge advances we’ve continued to make in recent years. Computers are now playing a part in prescribing in some hospitals – issuing warnings about drug doses or combinations calculated to be unsafe for a patient – which Professor Lilford thinks is a great thing in terms of protecting against ‘human fallibility’. And the explosion of the Internet into people’s homes, of course, has allowed the public to be more informed about their health, which he describes as “almost unambiguously a good thing”. Far from stalling then, science and technology has meant we’re reaching new and often unexpected frontiers in health care all the time.
So if medicine will continue to push boundaries – what about those of our own mortality? Will we continue to find ways to extend our life expectancy in the future? “We do know from the biology of ageing that irreparable damage accumulates in our cells as we age and that happens at a reasonably fixed rate,” notes Professor Lilford.
“However, you can influence that rate slightly in animals – if you starve them you can slow that down. And doing a lot of exercise has a similar effect. The same would apply for human beings, I’m quite sure. That suggests that the rate at which DNA is irreparably damaged is not completely out of our control, so it may well be that as years go by we do continue to live longer. Although it’s looking further than 50 years ahead, it’s a very interesting question whether my grandchildren will be able to live for, say, 140 years.”
As well as these big, searching questions, there will undoubtedly be more immediately pressing concerns on the audience’s mind, such as whether we will even have an NHS 50 years from now. “I think the NHS will endure in its present form,” Professor Lilford predicts. “The practical politics of the NHS are that if the population want it to be in this form then it will be in this form. So I think it will limp along as best it can.” Whether or not that’s a good thing, he says, is another discussion.
There was never any question of what career path Professor Lilford would take, and medicine is a field that’s close to his heart for more than one reason. “I wanted to be a doctor when I was 10 years old and never wavered from that. I’ve got three children; one of them is a doctor. So it’s all very personal to me,” he says.
Predicting how medicine will develop in the future, then, is something that has real resonance for him. Still, looking 50 years ahead is no easy task. “What happens if the world becomes very much more right wing, or deeply socialistic, or migration speeds up enormously, or if we have war, or there’s major climate change? These things are almost unknowable and very speculative,” he stresses.
All of these wide-reaching factors, and many more, will impact the direction healthcare will, and must, go in. Still Professor Lilford believes it’s both fascinating and genuinely useful to look forward. The 65-year-old jokes: “Fortunately I won’t be here to be proven wrong in 50 years, anyway.”
Image: Surgery Image 9 by UCD School of Medicine (via Flickr)