A blog from the Centre for Research Ethics & Bioethics (CRB)

Year: 2022 (Page 3 of 3)

Illness prevention needs to be adapted to people’s illness perceptions

Several factors increase the risk of cardiovascular disease. Many of these we can influence ourselves through changes in lifestyle or preventive drug treatment. But people’s attitudes to prevention vary with their perceptions of cardiovascular disease. Health communication to support preventive measures therefore needs to take into account people’s illness perceptions.

Åsa Grauman and three colleagues conducted an online survey with 423 randomly selected Swedes aged 40 to 70 years. Participants were asked to answer questions about themselves and about how they view cardiovascular disease. They then participated in an experiment designed to capture how they weighted their preferences regarding health check results.

The results showed a wide variety of perceptions about cardiovascular disease. Women more often cited stress as their most important risk factor while men more often cited overweight and obesity. An interesting result is that people who stated that they smoked, had hypertension, were overweight or lived sedentary, tended to downplay that factor as less risky for cardiovascular disease. On the other hand, people who stated that they experienced stress had a tendency to emphasize stress as a high risk of cardiovascular disease. People who reported family history as a personal risk of illness showed a greater reluctance to participate in health examinations.

Regarding preferences about health check results, it was found that the participants preferred to have their results presented in everyday words and with an overall assessment (rather than, for example, in numbers). They also preferred to get the results in a letter (rather than by logging in to a website) that included lifestyle recommendations, and they preferred 30 minutes of consultation (over no or only 15 minutes of consultation).

It is important to reach out with the message that the risk of cardiovascular disease can be affected by lifestyle changes, and that health checks can identify risk factors in people who are otherwise asymptomatic. Especially people with a family history of cardiovascular disease, who in the study were more reluctant to undergo health examinations, may need to be aware of this.

To reach out with the message, it needs to be adapted to how people perceive cardiovascular disease, and we need to become better at supporting correct perceptions, the authors conclude. I have mentioned only a small selection of results from the study. If you want to see the richness of results, read the article: Public perceptions of myocardial infarction: Do illness perceptions predict preferences for health check results.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Åsa Grauman, Jennifer Viberg Johansson, Marie Falahee, Jorien Veldwijk. 2022, Public perceptions of myocardial infarction: Do illness perceptions predict preferences for health check results. Preventive Medicine Reports 26, https://doi.org/10.1016/j.pmedr.2021.101683

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Exploring preferences

Images of good and evil artificial intelligence

As Michele Farisco has pointed out on this blog, artificial intelligence (AI) often serves as a projection screen for our self-images as human beings. Sometimes also as a projection screen for our images of good and evil, as you will soon see.

In AI and robotics, autonomy is often sought in the sense that the artificial intelligence should be able to perform its tasks optimally without human guidance. Like a self-driving car, which safely takes you to your destination without you having to steer, accelerate or brake. Another form of autonomy that is often sought is that artificial intelligence should be self-learning and thus be able to improve itself and become more powerful without human guidance.

Philosophers have discussed whether AI can be autonomous even in another sense, which is associated with human reason. According to this picture, we can as autonomous human beings examine our final goals in life and revise them if we deem that new knowledge about the world motivates it. Some philosophers believe that AI cannot do this, because the final goal, or utility function, would make it irrational to change the goal. The goal is fixed. The idea of such stubbornly goal-oriented AI can evoke worrying images of evil AI running amok among us. But the idea can also evoke reassuring images of good AI that reliably supports us.

Worried philosophers have imagined an AI that has the ultimate goal of making ordinary paper clips. This AI is assumed to be self-improving. It is therefore becoming increasingly intelligent and powerful when it comes to its goal of manufacturing paper clips. When the raw materials run out, it learns new ways to turn the earth’s resources into paper clips, and when humans try to prevent it from destroying the planet, it learns to destroy humanity. When the planet is wiped out, it travels into space and turns the universe into paper clips.

Philosophers who issue warnings about “evil” super-intelligent AI also express hopes for “good” super-intelligent AI. Suppose we could give self-improving AI the goal of serving humanity. Without getting tired, it would develop increasingly intelligent and powerful ways of serving us, until the end of time. Unlike the god of religion, this artificial superintelligence would hear our prayers and take ever-smarter action to help us. It would probably sooner or later learn to prevent earthquakes and our climate problems would soon be gone. No theodicy in the world could undermine our faith in this artificial god, whose power to protect us from evil is ever-increasing. Of course, it is unclear how the goal of serving humanity can be defined. But given the opportunity to finally secure the future of humanity, some hopeful philosophers believe that the development of human-friendly self-improving AI should be one of the most essential tasks of our time.

I read all this in a well-written article by Wolfhart Totschnig, who questions the rigid goal orientation associated with autonomous AI in the scenarios above. His most important point is that rigidly goal-oriented AI, which runs amok in the universe or saves humanity from every predicament, is not even conceivable. Outside its domain, the goal loses its meaning. The goal of a self-driving car to safely take the user to the destination has no meaning outside the domain of road traffic. Domain-specific AI can therefore not be generalized to the world as a whole, because the utility function loses its meaning outside the domain, long before the universe is turned into paper clips or the future of humanity is secured by an artificially good god.

This is, of course, an important philosophical point about goals and meaning, about specific domains and the world as a whole. The critique helps us to more realistically assess the risks and opportunities of future AI, without being bewitched by our images. At the same time, I get the impression that Totschnig continues to use AI as a projection screen for human self-images. He argues that future AI may well revise its ultimate goals as it develops a general understanding of the world. The weakness of the above scenarios was that they projected today’s domain-specific AI, not the general intelligence of humans. We then do not see the possibility of a genuinely human-like AI that self-critically reconsiders its final goals when new knowledge about the world makes it necessary. Truly human-equivalent AI would have full autonomy.

Projecting human self-images on future AI is not just a tendency, as far as I can judge, but a norm that governs the discussion. According to this norm, the wrong image is projected in the scenarios above. An image of today’s machines, not of our general human intelligence. Projecting the right self-image on future AI thus appears as an overall goal. Is the goal meaningful or should it be reconsidered self-critically?

These are difficult issues and my impression of the philosophical discussion may be wrong. If you want to judge for yourself, read the article: Fully autonomous AI.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Totschnig, W. Fully Autonomous AI. Sci Eng Ethics 26, 2473–2485 (2020). https://doi.org/10.1007/s11948-020-00243-z

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We like critical thinking

Individualized treatment from the patient’s perspective

Individualized treatment, where the right patient receives the right dose of the right drug at the right time, could be interpreted as a purely medical task. After genetic and other tests on the patient, the doctor assesses, from a medical point of view, which drug for the disease and which dose should work most effectively and most safely for the patient in question.

Individualization can also be interpreted to include the patient’s perceptions of the treatment, the patient’s own preferences. Rheumatoid arthritis is a disease with many different symptoms. Several drugs are available that have different effects on different symptoms, as well as different side effects. In addition, the drugs are administered in different ways and at different intervals. Of course, all of these drug attributes affect the patients’ daily lives differently. A drug may reduce pain effectively, but cause depression, and so on. In individualized treatment of rheumatoid arthritis, there are therefore good reasons to ask patients what they consider to be important drug attributes and what they want their treatment to aim for.

In a study in Clinical Rheumatology, Karin Schölin Byvall and five co-authors prepare for individualized treatment of rheumatoid arthritis from the patient’s perspective. Their hope is to facilitate not only joint decision-making with patients who have the disease, but also future quantitative studies of preferences in the patient group.

This is how the authors (very simplified) proceeded. A literature review was first performed to identify possible relevant drug attributes. Subsequently, patients in Sweden with rheumatoid arthritis ranked nine of these attributes. In a third step, some of the patients were interviewed in more detail about how they perceived the most important attributes.

In a final step, the interview results were structured in a framework with four particularly relevant drug attributes. The first two are about improved ability to function physically and psychosocially in everyday life. The latter two are about serious and mild side effects, respectively. In summary, the most important drug attributes, from the patients’ perspective, are about improved ability to function in everyday life and about acceptable side effects.

If you want to know more about the study, read the article: Functional capacity vs side effects: treatment attributes to consider when individualizing treatment for patients with rheumatoid arthritis.

The authors emphasize the importance of considering patients’ own treatment goals. Individualized treatment not only requires medical tests, but may also require studies of patient preferences.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Bywall, K.S., Esbensen, B.A., Lason, M. et al. Functional capacity vs side effects: treatment attributes to consider when individualising treatment for patients with rheumatoid arthritis. Clin Rheumatol (2021). https://doi.org/10.1007/s10067-021-05961-8

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In dialogue with patients

Digital twins, virtual brains and the dangers of language

A new computer simulation technology has begun to be introduced, for example, in the manufacturing industry. The computer simulation is called a digital twin, which challenges me to bring to life for the reader what something that sounds so imaginative can be in reality.

The most realistic explanation I can find actually comes from Harry Potter’s world. Do you remember the map of Hogwarts, which not only shows all the rooms and corridors, but also the steps in real time of those who sneak around the school? A similar map can be easily created in a computer environment by connecting the map in the computer to sensors in the floor of the building that the map depicts. Immediately you have an interactive digital map of the building that is automatically updated and shows people’s movements in it. Imagine further that the computer simulation can make calculations that predict crowds that exceed the authorities’ recommendations, and that it automatically sends out warning messages via a speaker system. As far as I understand, such an interactive digital map can be called a digital twin for an intelligent house.

Of course, this is a revolutionary technology. The architect’s drawing in a computer program gets extended life in both the production and maintenance of the building. The digital simulation is connected to sensors that update the simulation with current data on relevant factors in the construction process and thereafter in the finished building. The building gets a digital twin that during the entire life cycle of the building automatically contacts maintenance technicians when the sensors show that the washing machines are starting to wear out or that the air is not circulating properly.

The scope of use for digital twins is huge. The point of them, as I understand it, is not that they are “exact virtual copies of reality,” whatever that might mean. The point is that the computer simulation is linked to the simulated object in a practically relevant way. Sensors automatically update the simulation with relevant data, while the simulation automatically updates the simulated object in relevant ways. At the same time, users, manufacturers, maintenance technicians and other actors are updated, who easily can monitor the object’s current status, opportunities and risks, wherever they are in the world.

The European flagship project Human Brain Project plans to develop digital twins of human brains by building virtual brains in a computer environment. In a new article, the philosophers Kathinka Evers and Arleen Salles, who are both working in the project, examine the enormous challenges involved in developing digital twins of living human brains. Is it even conceivable?

The authors compare types of objects that can have digital twins. It can be artefacts such as buildings and cars, or natural inanimate phenomena such as the bedrock at a mine. But it could also be living things such as the heart or the brain. The comparisons in the article show that the brain stands out in several ways, all of which make it unclear whether it is reasonable to talk about digital twins of human brains. Would it be more appropriate to talk about digital cousins?

The brain is astronomically complex and despite new knowledge about it, it is highly opaque to our search for knowledge. How can we talk about a digital twin of something that is as complex as a galaxy and as unknown as a black hole? In addition, the brain is fundamentally dynamically interactive. It is connected not only with the body but also with culture, society and the world around it, with which it develops in uninterrupted interaction. The brain almost merges with its environment. Does that imply that a digital twin would have to be a twin of the brain-body-culture-society-world, that is, a digital twin of everything?

No, of course not. The aim of the project is to find specific medical applications of the new computer simulation technology. By developing digital twins of certain aspects of certain parts of patients’ brains, it is hoped that one can improve and individualize, for example, surgical procedures for diseases such as epilepsy. Just as the map from Harry Potter’s world shows people’s steps in real time, the digital twin of the brain could follow the spread of certain nerve impulses in certain parts of the patient’s brain. This can open up new opportunities to monitor, diagnose, predict and treat diseases such as epilepsy.

Should we avoid the term digital twin when talking about the brain? Yes, it would probably be wiser to talk about digital siblings or digital cousins, argue Kathinka Evers and Arleen Salles. Although experts in the field understand its technical use, the term “digital twin” is linguistically risky when we talk about human brains. It easily leads the mind astray. We imagine that the digital twin must be an exact copy of a human’s whole brain. This risks creating unrealistic expectations and unfounded fears about the development. History shows that language also contains other dangers. Words come with normative expectations that can have ethical and social consequences that may not have been intended. Talking about a digital twin of a mining drill is probably no major linguistic danger. But when it comes to the brains of individual people, the talk of digital twins can become a new linguistic arena where we reinforce prejudices and spread fears.

After reading some popular scientific explanations of digital twins, I would like to add that caution may be needed also in connection with industrial applications. After all, the digital twin of a mining drill is not an “exact virtual copy of the real drill” in some absolute sense, right down to the movements of individual atoms. The digital twin is a copy in the practical sense that the application makes relevant. Sometimes it is enough to copy where people put their feet down, as in Harry Potter’s world, whose magic unexpectedly helps us understand the concept of a digital twin more realistically than many verbal explanations do. Explaining words with the help of other words is not always clarifying, if all the words steer thought in the same direction. The words “copy” and “replica” lead our thinking just as right and just as wrong as the word “twin” does.

If you want to better understand the challenges of creating digital twins of human brains and the importance of conceptual clarity concerning the development, read the philosophically elucidatory article: Epistemic Challenges of Digital Twins & Virtual Brains: Perspectives from Fundamental Neuroethics.

Pär Segerdahl

Written by…

Pär Segerdahl, Associate Professor at the Centre for Research Ethics & Bioethics and editor of the Ethics Blog.

Evers, Kathinka & Salles, Arleen. (2021). Epistemic Challenges of Digital Twins & Virtual Brains: Perspectives from Fundamental Neuroethics. SCIO: Revista de Filosofía. 27-53. 10.46583 / scio_2021.21.846

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Minding our language

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