A Blog by Jonathan Low


Nov 7, 2021

The Ways That AI Could Make Doctors More Effective

Applying AI to digitized databases including medical images and electronic health records, doctors are increasingly able to better identify both problems and solutions than they have been able to do in the past. JL

Allen Ripp comments in the Wall Street Journal:

30-plus projects use AI tools to fortify health, from early cancer detection to improving point-of-injury treatment and suicide prevention. The big breakthroughs are coming from harnessing information aided by “massive” computing power and robust electronic health records. "We’ve created algorithms from some medical imaging to help improve diagnoses and to research new therapeutics. (With) pathology database digitization and algorithms, pathologists can interface with the slides, devising new models to detect cancers such as prostate, colon and metastatic breast tumors, with greater precision and accuracy.”

Hassan Tetteh has one of the coolest-sounding jobs in medicine. His official title is Warfighter Health Mission Chief for the Department of Defense Joint Artificial Intelligence Center. The Pentagon established the JAIC, or “Jake” as he pronounces it, in 2018 to ensure that America’s combat operations don’t fall behind rivals in using machine learning to enhance troop readiness, cybersecurity, joint maneuvers and “lethality.”

Dr. Tetteh, 49, heads the JAIC’s health mission. A decorated Navy captain, he’s also a cardiothoracic surgeon who has deployed in Afghanistan and on warships in the Persian Gulf as well as at Walter Reed hospital. He’s an unabashed medical “nerd,” part of a cadre of physicians board-certified in clinical informatics—the use of statistics and information technology to improve patient care.

“What the X-ray or anesthesia were to medicine generations ago, AI is today in its essentiality,” he says. “You can call me an evangelist, a proselytizer or a broken record—it’s all fine. Vladimir Putin had it right when he predicted whichever nation leads in artificial intelligence will dominate. In the arms race for healthcare AI, I want to make sure the United States doesn’t come in second.”

At the JAIC, Dr. Tetteh (rhymes with “meta”) has had a guiding hand in 30-plus projects using AI tools to fortify war-fighter health, from early cancer detection to improving point-of-injury treatment and suicide prevention. Some of that work is described in his book published this year, “The Art of Human Care With Artificial Intelligence.”

The author is a booster for his employer. “The U.S. military has driven many advances in medicine,” he says, citing Gen. George Washington’s mass inoculation of the Continental Army in 1777 using smallpox pustules. He traces the advent of blood transfusions to Civil War battlefields and cites Army blood banks, which became standard hospital practice after World War II. Emergency trauma centers have similarly benefited from whole-blood pack transfers field tested in Afghanistan war zones.

Today, the big breakthroughs are coming from harnessing information, which Dr. Tetteh notes is aided by the military’s “massive” computing power and robust electronic health records covering service personnel’s lives from “lust to dust.” For sheer size, he points to a medical imaging portfolio across the Defense Department, housing 850 million slides—CT scans, MRIs, X-rays. “At the JAIC, we’ve created algorithms from some of this portfolio to help improve diagnoses and to research new therapeutics,” he says. “It’s akin to the human genome project in scale and long-term importance.”

Another JAIC priority is its collaboration with the Joint Pathology Center, a repository of 55 million tissue specimens the military has collected for 100 years. “Throughout my medical career, whenever pathologists—civilian or military—are unsure of what they’re dealing with under the microscope, they send samples to what used to be called the Armed Forces Laboratory,” he says. “No other healthcare organization has a pathology database of this magnitude. The JAIC has accelerated the pace of the JPC’s digitization and created algorithms so that pathologists can interface with the slides, devising new models to detect cancers such as prostate, colon and metastatic breast tumors, with greater precision and accuracy.”

He is especially proud of Project Orion, the JAIC’s suicide-prevention initiative. “Depression is a serious problem in the military, and suicides are investigated with a forensic analysis of a soldier’s entire life,” Dr. Tetteh says. He describes 300-page reports that mine not only service records and job history but personal finances, family dynamics, romantic relationships, social-media posts, drug use—“basically every factor that could have contributed to taking one’s life.”

“With Orion,” he says, “we’ve applied AI to use natural-language processing that can detect patterns and outlier events across the documents to identify societal, emotional and other triggers that took the service person to the edge.” The analysis is assisted by behavioral experts at major medical institutions, including Harvard and Johns Hopkins. “Already our effort has gleaned trends, including many unobvious ones, that can pick up signals for suicide ideation or high-risk behavior by future service members that can be flagged for military commanders and medical providers. It may sound grandiose, but Orion is about ontology”—the branch of philosophy concerned with the nature of being—“and the totality of a person’s existence.”

Dr. Tetteh and his JAIC colleagues have also turned their AI sights on Covid, supporting a platform in “predictive logistics” that forecasts supply-chain shortages of equipment, drugs and essential goods. Project Salus, named for the Roman goddess of well-being, analyzes data from manufacturers, distributors, retailers and government agencies to inform the Northern Command and National Guard of potential outages.

Early in the Covid-19 pandemic, Dr. Tetteh called on health cloud-computing company Humetrix, which was extracting troves of Medicare claims data. “At the time there were no patient codes for Covid, but we knew the virus was hitting the over-65 population hard,” he says. “We figured we might learn something by examining Medicare records covering hospitalizations and ICU admissions for flu, pneumonia and respiratory illnesses among older patients.”

Thanks to data-sharing agreements between Humetrix, the Centers for Medicare and Medicaid Services, and the Health and Human Services Department, “we were able to see clearly how Covid was progressing through the U.S. elderly, down to ZIP Code level. We applied those insights to Project Salus to direct supplies of PPEs”—personal protective equipment—“and providers to communities overrun with cases. We’re using the same platform now as a surrogate marker for Delta variant in the wider population. It can also be used to monitor supplies of booster vaccines.”

Though the JAIC was formed before the pandemic, Dr. Tetteh says the center has reached peak relevance because of it. “The virus has underscored that health of the nation is our greatest national-security imperative,” he says. “Nothing in my lifetime ever took a Navy aircraft carrier out of commission short of a munitions attack. But Covid did when the USS Teddy Roosevelt, with two on-board nuclear reactors and a 4,800-person crew, had to park off Guam for more than a month because of a virus no one could see. That represents a huge threat.”

A Brooklyn, N.Y., native, the young Hassan Tetteh was an aspiring graffiti artist and “semi-hoodlum” who tagged subway cars and wall murals. He was accepted into one of New York’s specialized art high schools, but his parents steered him to Brooklyn Tech and then SUNY Plattsburgh, where he studied biochemistry and nearly died from a bout of bacterial meningitis contracted sitting next to a woman “with a very productive cough” on a flight to Baltimore. “Being intubated in the ICU at age 20, with seizures and months of fatigue, was an eerie foreshadow to the world we live in today,” he says.

Dr. Tetteh earned his medical degree at the borough’s SUNY Downstate Medical Center. The M.D. was but a windup for his higher learning. With an interest in public policy—and to disprove a high-school guidance counselor’s assertion that he wasn’t Ivy League material—he obtained a master’s at Harvard’s Kennedy School. Later he worked at the Congressional Budget Office. Drawn to the business and financial side of medicine, he gained an M.B.A. in medical management at Johns Hopkins, and followed that with informatics training at Stanford. He then earned a master’s in national-security strategy at the National War College. His thesis title: “AI and Military Medicine.”

He did all that while serving in the Navy and maintaining a hyperactive surgery practice. His specialty is harvesting hearts and lungs for transplant—operations that can pop up at a moment’s notice and go deep into the night. Many are performed at hospitals in and around Washington, where he lives with his wife, their two teenage children and the dog they adopted during the pandemic.

“I guess the GI Bill came in handy,” he says, but he admits his urge for schooling was a family gift. “I’ve always been enamored with education, thanks to my mom and dad.” Both parents were West African immigrants who came to New York in the 1970s. His mother, Amy, from Sierra Leone, was a nurse’s aide; his father, Edmund, from Ghana, drove a cab and pursued a college degree.

Dr. Tetteh has experienced his own Covid losses, including two favorite aunts and an uncle who gave him his first job, working the grill at McDonald’s. But his most chilling encounter with the virus was in a Washington operating room, preparing a man’s lungs for transplant. “It was a young gunshot victim, and his lungs presented pink and spongy, in great shape for a recipient waiting in Pittsburgh,” he recalls. “Within several hours the lungs turned gray, then black, and hardened like cactus. We were watching Covid ravage these healthy organs in real time. It was an alarm that’s still ringing in my head.”

Recently Dr. Tetteh noticed disturbing data points creeping into his practice. “Where there used to be a range of events that brought donors to our unit—accidents, trauma, illness—the vast majority of organ recoveries we’ve made the past year have come via suicide and overdoses,” he says. “Moreover, a disproportionate number are from Ohio and Tennessee, two states with rampant opioid usage. We’re still developing analytics to find correlates and make predictions, but you can sense from our sample how the stresses of Covid are playing out in society. It’s why we say transplants are a window onto the world.”

For all his love of algorithms and informatics, Dr. Tetteh argues that technology can’t work without empathy for patients. Addressing first-year med students recently at his alma mater SUNY Downstate (where my son is in the class of 2025), he told a favorite story about Hippocrates encountering a middle-aged man who collapsed exiting the ancient Greek Temple of Asclepius, where he’d paid a princely sum to be treated by shamans. Doctors threw the latest techniques at him, including rituals involving snakes, dogs and food deprivation, but failed to pose a single question about the man’s family, diet, habits and lifestyle. Hippocrates did just that and returned the man to health. “Always listen to your patients before running tests—they will tell you their diagnosis,” Dr. Tetteh told the students.

“This is a great time to become a physician,” Dr. Tetteh says. “Pandemics change the world permanently. But dating to the Black Plague and continuing through polio, AIDS and Ebola, society and cultures emerge stronger from health crises. We’ve acquired so much knowledge through this virus, in immune response and therapeutics as well as telemedicine and resiliency. I encourage young doctors to seize the hell out of the data, use all the technological tools available, and you will be a better care-giver and find your purpose.”


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