Beginnings of Artificial Intelligence in Medicine (AIM): Computational Artifice Assisting Scientific Inquiry and Clinical Art - with Reflections on Present AIM Challenges.

backgroundThe rise of biomedical expert heuristic knowledge-based approaches for computational modeling and problem solving, for scientific inquiry and medical decision-making, and for consultation in the 1970's led to a major change in the paradigm that affected all of artificial intelligence (AI) research. Since then, AI has evolved, surviving several "winters", as it has oscillated between relying on expensive and hard-to-validate knowledge-based approaches, and the alternative of using machine learning methods for inferring classification rules from labelled datasets. In the past couple of decades, we are seeing a gradual but progressive intertwining of the two.

objectivesTo give an overview of early directions in AI in medicine and threads of some subsequent developments motivated by the very different goals of scientific inquiry for biomedical research, and for computational modeling of clinical reasoning and more general healthcare problem solving from the perspective of today's "AI-Deep Learning Boom". To show how, from the beginning, AI was central to Biomedical and Health Informatics (BMHI), as a field investigating how to understand intelligent thinking in dealing professionally with the practice for healthcare, developing mathematical models, technology, and software tools to aid human experts in biomedicine, despite many previous bouts of "exuberant optimism" about the methodologies deployed.

methodsAn overview and commentary on some of the early research and publications in AI in biomedicine, emphasizing the different approaches to the modeling of problems involved in clinical practice in contrast to those of biomedical science. A concluding reflection of a few current challenges and pitfalls of AI in some biomedical applications.

conclusionWhile biomedical knowledge-based systems played a critical role in influencing AI in its early days, 50 years later they have taken a back seat behind "Deep Learning" which promises to discover knowledge structures for inference and prediction, both in science and for clinical decision-support. Early work on AI for medical consultation turned out to be more useful for explanation and teaching than for clinical practice, as had been originally intended. Today, despite the many reported successes of deep learning, fundamental scientific challenges arise in drawing on models of brain science, cognition, and language, if AI is to augment and complement rather than replace human judgment and expertise in biomedicine while also incorporating these advances for translational medicine. Understanding clinical phenotypes and how they relate to precision and personalization of care requires not only scientific inquiry, but also humanistic models of treatment that respond to patient and practitioner narrative exchanges, since it is the stories and insights of human experts which encourage what Norbert Weiner termed the ethical "human use of human beings", so central to adherence to the Hippocratic Oath.