IBM Watson, as the representative of “future medicine”, has been controversial this year. As the exclusive distributor of IBM Watson in China, Baiyang has also been affected by the public opinion crisis of IBM Watson recently.

In the face of doubt, Steve Harvey, vice president of tumor and gene solutions of IBM Watson health, and Nathan Levitan, deputy general health officer and oncologist of IBM Watson health, came to China to interpret IBM Watson together with Wang Biquan, CMO of Baiyang intelligent technology, Jiang zefei, executive director and Secretary General of China Society of Clinical Oncology (CSCO), Professor Xu Qing, director of oncology department and director of oncology teaching and Research Office of Shanghai Tenth People’s Hospital Affiliated to Tongji University.

IBM Watson: giving advice to doctors

Cancer is a common challenge facing mankind all over the world. According to who statistics, the number of cancer patients in the world is increasing by 14 million every year, and the cancer mortality is also increasing. It is estimated that the number of cancer patients worldwide will reach 19 million by 2025.

Three years ago, IBM Watson hoped to combine artificial intelligence and human knowledge to jointly help mankind cope with health challenges. Among them, Watson tumor solution (WFO) and Watson gene solution (WFG) are two cancer treatment solutions launched by IBM Watson.

Watson tumor solution is a decision support system, which can provide decision support in the whole process of doctors’ diagnosis and treatment of patients and provide medical evidence-based evidence. At present, it has covered 13 cancer species, including common cancers with a global prevalence of about 80%. Watson gene solution, by analyzing genome sequencing data and comparing the data with a large number of genomic, clinical, scientific and pharmacological databases, helps to find treatment schemes for tumor genetic mutations.

The positioning of these two products are different: WFG, as a genomic solution, is used for personalized and precise treatment of tumor patients; WFO is mainly used in the hospital scene, which can help doctors improve the standardized treatment of tumor patients.

For the role of the two Watson solutions in treatment, Nathan Levitan repeatedly stressed that they are the “chief of staff” of doctors and give advice to doctors. “Watson tumor solution does not make diagnosis, but only assists decision support. It provides doctors with treatment options. The final decision-making power is in the hands of doctors, not in the hands of WFO, and so is WFG.”

In the specific use process, according to evidence-based medicine, Watson recommends alternative treatment schemes for doctors, provides doctors with evidence of treatment schemes, lists the level of evidence and presents the logic behind each treatment scheme, so as to help doctors make decision support, and finally doctors make specific treatment decisions.

However, in the implementation process of AI assisted medical diagnosis products including Watson, “medical responsibility attribution” has always been a hot topic in the industry. In this regard, Jiang zefei made a vivid analogy: “who will compensate after you hit the old lady with smart phone navigation? Baidu, Google? It must be the driver and the owner of the car. “

IBM Watson, which has been in China for more than a year

Just last year, Baiyang introduced two cancer treatment solutions WFO & WFG from IBM Watson into China.

Wang Biquan said that the original intention of introducing Watson was to improve the five-year survival rate of Chinese cancer patients. With the introduction of more and more drugs and the improvement of treatment methods, cancer will become a chronic disease. In 2017, the five-year survival rate of cancer was 37% in China and 67% in the United States. Now it has increased to 40% in China. However, problems such as insufficient expert resources have led to less than 50% of standardized cancer treatment. On the other hand, it contributes to the harmony of doctor-patient relationship in China. Watson tumor products are trained by MSKCC. MSKCC is the top cancer center in the United States. It has a lot of knowledge and literature and can support the decision-making of treatment plans for 13 cancer species for doctors and patients to choose. Moreover, in each proposal, it will be associated with the corresponding evidence-based medical evidence and logic. In this way, it can help establish a harmonious relationship between patients and doctors.

But in fact, Watson landed in China for more than a year, and “acclimatization” has always been a controversial place. After all, there are differences in medical insurance, treatment concepts and cultural habits across China. Zhang zefei pointed out that Waston has some limitations in localization and localization, but at present, by discussing the compliance rates of different stages and categories, the evaluation system of the guide has also been established to verify the feasibility of Waston.

Wang Biquan added that at present, Waston is highly consistent with MSKCC and China’s top tumor centers, playing stably and not easy to make mistakes; WFO will give an appropriate scheme within the scope of known knowledge, and will not give a scheme that has not been clinically verified; WFO will not be better than the top experts of a single cancer species, but the collection of 13 cancer species will be better than any top experts, and will continue to learn and make progress quickly; Studies have confirmed that WFO can improve the standardization of clinical decision-making and guidelines, and patients with gastric cancer who are consistent with WFO protocol can obtain a better prognosis; WFG can further improve the accuracy of drug treatment through the improvement of concomitant diagnostic ability.

As of November 4, 2018, Watson tumor products have been launched in more than 20 provinces and more than 40 cities. 261 hospitals have been used, 81 hospitals have signed contracts, 1133 registered doctors and 785 used doctors. The number of patients exceeded 10000 last year, and 41000 patients have used WFO as of November 4 this year. WFG has signed contracts with seven second-generation sequencing companies and started to use it.

In addition, Watson has a lot of room for improvement in the future. Globally, it should speed up the updating of cancer treatment progress and literature, and add real-world information and pharmacoeconomic data; In the Chinese market, it needs to learn the Chinese guidelines, join the localization scheme, add CFDA approved drugs, and add local drug medical insurance information and price information. Nathan Levitan believes that this is a step-by-step improvement process. WFO is not a static system. This system cooperates closely with doctors around the world. It will make fine adjustments and improvements according to the specific conditions of the local market, including the subsequent addition of Chinese guidelines to better adapt to the Chinese market.

Those Watson users say so

“If you haven’t used it, you won’t have a say. You can only feel Watson’s advantages after using it,” Professor Xu Qing said after using Watson for more than a year. “Watson’s upgrading and progress are indeed visible to us. Its learning speed is unmatched by humans, and its control and analysis of big data can’t match it.”

According to Professor Xu Qing, at present, Watson has obvious advantages in telemedicine, MDT (multidisciplinary diagnosis and treatment model), medical conjoined model and doctors’ teaching and training. For example, when making MDT, the final plan needs to be decided by someone. Watson’s objective and standardized guidance may guide the general direction of MDT without making mistakes. Like a driver, if you have a good GPS for navigation, you may avoid detours.

Zhang zefei said: “we need doctors who are warm, emotional and love communication. At the same time, we also need loyal assistants who are tireless and don’t lose their temper. AI is to doctors what GPS is to driving. It is easy for new drivers to guide the way and labor-saving for old drivers. ” Moreover, Eric Topol, a future American scientist, once said that the future medical care must be democratic. For example, in the treatment of cancer, doctors used to be paternalistic, and patients and their families listened to doctors completely. However, now and in the future, more patients and family members hope to discuss the treatment plan with doctors. Watson plays a good auxiliary role at this time.

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