DeepMind’s deep-learning system AlphaFold last week cracked one of biology’s critical challenges: predicting the shape of proteins.
As background for the less chemically inclined, a protein is made from a chain of amino acids that folds itself up in a tangled mass. The nooks and crannies of the 3-dimensional structure determines what the protein does and how it interacts with other molecules. And knowing what proteins do and how they can be blocked, for example, is critical to understanding the molecular basis of disease and, ultimately, making the drugs to treat them. So as it turns out AlphaFold can predict the shape of proteins within the width of an atom. This is being done already. The difference is that the current process of discerning protein structure can take years of trial and error, AlphaFold can nail down a protein’s shape in a matter of days.
What may be one of the medicine’s most remarkable applications of AI to date, this got such little medical dialog across social channels. I watch a lot of doctors and this one was effectively overlooked. Sure, there are the realities of COVID, but I’m not sure it would have been too different had this news broke a year ago.
The silence around this is almost its own story. Unpacking this just a bit:
There’s a growing disconnect between technology and doctors
It’s a hard fact that medicine is advancing faster than we can understand. And that includes doctors. I suspect that the average doctor, when presented with a description of the AlphaFold story, may not be able to easily describe how this could impact them or their patients. Of course this it isn’t their fault. We’ve been programmed and trained to see and practice medicine just as it was on the day we graduated medical school. We can’t even see the breakneck pace of change in medicine. Beyond beginning to grasp it, we really don’t know how to keep up or remain involved.
You can argue with me all day on this but we must always remember the inconvenient truth that in the year 2020 we’re a profession that hasn’t figured out how to help a concerned middle age woman interpret a 23andMe report. This captures the disconnect between where doctors are at and where medicine is at.
The gap is ultimately a problem of tech literacy, information flow/overload, current physician workflows, the Clinical Trifecta, and priorities and ‘spaces’ that don’t account for advancing technical knowledge. We’ve just got too much going on.
Doctors suffer from present shock
Beyond tech literacy, most of us have our noses so close to the work in front of us that we just can’t see the bigger picture of where we (or medicine) is going. Borrowing from Douglas Rushkoff’s Present Shock the medical community has become dangerously oriented to the present moment. Everything is live, real-time and always on. Twitter serves as a great illustration of how we engage differently than even a decade ago: Longer-form thinking and writing has given way to fast moving, short-format commentary and sharing. We exist in a distracted present where we react to the ever-present assault of simultaneous impulses and demands. In our present shock we lose sight of our past and we have a hard time seeing beyond the latest crisis. And so in the fog of present shock, groundbreaking advances that may change the trajectory of medicine will seem out of focus or, at worst, invisible.
Quick comment: An early iteration of this post went out in the 33 charts newsletter. As an isolated example of seeing only what’s in front of us, I got feedback that AlphaFold won’t help doctors ‘in practice.’ Directly, this is correct. Indirectly, and over time, it will change everything that we do in practice. It’s a new process that will accelerate the medications and therapies we use going forward.
Doctors may not shape the biggest medical advances in the 21st century
Our disconnect from tech advances like AlphaFold lays bare the fact physicians are not behind this century’s greatest advances in medicine.
In the 20th century and even up to the later decades of the 20th century medical advances came from the major medical schools and teaching hospitals in the major American and European cities. Think Harvard and Johns Hopkins. This is new because we were the innovators and the doers and the tinkerers. Think of the early history of the white coat and the doctor who split his time between diagnosing mysterious diseases and working with test tubes.
But, and this is key, innovation is incompatible with the medical industrialization that steers the modern medical institution. Advances going forward will come from places like DeepMind where free-range thinkers with lots of resources do their thing. Don’t get me wrong, remarkable innovations are happening in medical schools and major teaching hospitals but a lot of it has been offset to the periphery beyond these medical centers. Case in point is AlphaFold.
This idea of us being separated from that role represents a slow trend. This is a hard reality honestly. And it gets to how we see our identity going forward. If we’re not the discoverers and cute creators, what are we and where do we fit in
Who really is shaping the future of health, patients and people? And a question that keeps me up at night: How do doctors remain relevant in this new age? I think it’s important to understand that we are under massive redefinition and we have to play an active role in that redefinition. We have to decide where we’ll fit in.
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