Dr. Arta Bakshandeh, Chief Medical Information Officer at Alignment Health, on the exciting future of AI in medicine, the need to implement it faster, and why he can often be found wandering the streets of London!
What initially sparked your interest in medicine?
I didn’t choose medicine; medicine chose me! As a child, I became excited at the sight of ambulances. I’d always be the one who looked out for them on the street and would run to the window to watch the vehicle go by. Later, whenever I saw a stranger fainting in public, I would be the first to jump in and help. That’s why I feel medicine chose me. I love helping people so much that I felt compelled to go into medicine and become a physician.
How about AI in medicine? When did that take hold?
About seven years ago, I was asked to join Alignment Health to realize this concept of a command center that leverages advanced analytics. It was about a year after we came out of the last AI winter so there was a lot of exploration around medical AI. I remember signing up for my first related conference in California and I saw several people speaking about the domain, including Dr. Anthony Chang. The moment I got back, I decided to build a data science team and began learning as much as I could about AI. I’ve always had an interest in technology, but that was the moment when it blossomed, and I have been in it ever since.
Did you find it hard to pivot from medicine to AI and start picking up skills in coding and data analytics?
Yes, absolutely. I’d argue it’s a different part of our brain. But it’s funny because growing up and when I was in college and graduate school, many of my friends and roommates were computer engineers so there was a fair amount of language that I already understood and had stuck in my brain. I think it has led me to be comfortable building the idea of a command center and be able to efficiently articulate the business and medical needs with our engineering team and understand the complex algorithms that are built into the command center.
What are some of your responsibilities as the Chief Medical Information Officer at Alignment Health?
We often jokingly say that I am the Chief Medical AI Officer even though I don’t think that position exists. I meet with our data science team for 15 minutes a day to understand the different models that we are building and how we are going to execute them. We have seven PhD data scientists, and we work closely together, with me functioning as a subject matter expert on medicine and clinical workflow.
I am also the subject matter expert within different lines of business and understand the key problems to build meaningful models. Overall, I am the leader for our entire architecture that we are building in the Cloud so we can plug in not only the clinical data but the non-clinical data from our patient population. We ensure the AI algorithms in our suite of applications communicate efficiently and meaningfully to both patients and healthcare providers.
How challenging is your work?
It’s quite challenging in several areas. I recently read an article talking about how most businesses are unable to tangibly use AI, especially in medicine and that the deployment of AI is difficult. Imagine four or five years ago, sitting down with an executive team and telling them we need to do AI; the need to convince people who have been in the field for long to do something new. That was the hardest. But here we are today with 160 AI models that are deployed within clinical medicine.
Nonetheless, my job continues to be challenging and I think that’s one of the reasons why I love it so much because I get to learn something new from my colleagues every day and vice versa. This is what keeps things interesting and why many clinicians are in medicine in the first place.
What excites you most about the future of AI?
There is so much to get excited about! I can argue drug discovery is going to be huge and there’s also gene discovery and the further understanding of genomics through AI. I think the biggest impact which we don’t give enough credit to is how AI will fundamentally change the way we scale what clinicians are able to do. We know that globally, there’s a shortage of clinicians. There are more patients and medical illnesses than people to take care of them. One of the things I have taught others about AI in medicine is that AI will become a part of us. As we continue to be a clinician, AI can help us keep track of each patient, anticipating their needs and changes during the care trajectory and automate processes. It will scale us as clinicians and if we bring all these to the hands of a primary care provider, which is not happening yet, it will change the way we take care of our population and ultimately create a new paradigm in medicine that no longer revolves around only sick care.
Do you think the implementation of AI in medicine is happening too fast?
No, I think it’s too slow. I have a vision of what I think the world will look like, but I still think we don’t know enough about medicine to make it happen. We are learning exponentially because of AI but we are still not even close to truly understanding everything we need to know including the pathophysiology of the human body, how we interact with the environment, etc. I think there’s just so much to unlock and I don’t think we are going quickly enough.
What concerns you most about the future of AI in medicine?
I am very concerned about bias. There’s so much bias within our datasets and some of them may not be intentional. We need to responsibly utilize the data that we have and run parallel mathematical models around it to make sure that we are either eliminating the bias, aware of what it is or at the very least, let us and the end-users understand the bias.
I think most data scientists have a pure heart regarding what they are trying to do, especially in medicine. But not being aware of that bias is difficult. That’s one of the reasons why we have partnered our data science team with clinicians to help in the understanding of not only the medical care, but certain biases that they may not be aware of, and that’s something we have to do better with.
With that, I guess I need to revisit my previous statement about not going fast enough with AI. Where we need to slow down is where we haven’t spent enough time understanding the bias within our models and what that subsequently will do to the population, especially when we are talking about health.
What advice would you give to someone starting their career in AI?
Read. Read a lot, often and in multiple different areas. Read everything from textbooks to online blogs and spend time really understanding what’s going on and always challenge yourself to learn more. The other advice I’d give is truly love the medical aspect of the domain so that you will appreciate the impact from the AI side of it. That’s a big piece of the puzzle that I think people ultimately don’t always think about.
What was the best piece of advice you ever received?
Don’t go into medicine for money or prestige! My cousin, a board-certified dermatologist, said that to me. She was already a resident in Miami around the time when I was applying for medical school. I remember her asking about my decision and my reply was I wanted to go into medicine because of all these things that have happened in my life, and I feel like I need to test myself to see if I can do it intellectually. She said if you want to do it for money or prestige, don’t, because they aren’t there. It’s very true. People don’t notice the sacrifices that clinicians must make – both from a family and time perspective.
I work around 80 hours a week and that’s a lot of time away from my family. I have patients who don’t care what I have to say because even though I am a physician, they might have found something on the internet, which clearly, I don’t know, or I may not have been prepared from a confrontation perspective and they want to talk to someone else or expect things to be done in a certain way.
Others may not be appreciative as they feel that this is what they wish to be done and if they get sick, it’s still my responsibility to take care of them. Dealing with all these is taking a big toll on people from an emotional standpoint and if you are doing medicine for the sole reason of prestige and money, you are better off elsewhere because those things aren’t there at all. What’s there are the emotional aspects. The will of not giving up, and truly wanting to do it and wanting to be there at the bedside for your patients.
Did you ever think about taking a different career path altogether?
No, because all along I saw myself as a doctor. I also think I’ve been ahead of the game in terms of medical AI. I think AI will be something that’s taught in medical schools, will be part of the residency program, and be an active participant in the medical care of the future. I love Sherlock Holmes and sometimes I’d jokingly say that I wanted to be a detective. That’s why I am an internal medicine physician as I get to figure out what’s wrong with somebody, what odd disease might this be. There’s a lot of detective work going on so I don’t think I would ever want a career change.
What’s left to conquer?
There are a lot of things. Scaling care is one. Bringing responsible care to a broader population is something that’s very near and dear to my heart. There are many things that got me to where I am today and a lot of work that I am doing at Alignment Health that’s setting a stage to be able to do it for a larger population and learning how to operationalize that, which I think is the next chapter of my life.
Who do you admire?
I admire a lot of people. We call it servant leadership, that’s where you have a serving heart, and you lead by an example of serving your community. So, I admire all my mentors who have gotten me to where I am at this point. One of them is Donald Furman, our Chief Clinical Officer, who is ahead of his time and Ken Kim, our former Chief Medical Officer who was my mentor. I admire him for trying to change the way we take care of our population. Outside of work, I also admire those who are parents and those who are trying to give their children a better life, regardless of how they are doing it. I think it’s an incredible thing and I admire anyone who is trying to better their own lives.
How do you relax?
There are three things that I typically do. One is I like to drive, especially taking a long drive. I also love gardening and have been growing my own vegetables for a while. Traveling is another passion of mine. Its great for clearing my head ore re-energising me. London is where I like to go when trying to work through a problem that I am stuck with. Before the pandemic hit, I would go to London and walk the streets for a couple of days and I think that organized chaos would allow my brain to go through whatever it needed to go through, allowing me to be able to say, ‘Okay, this is what I need to do to go forward’. So, London is my happy place.
If you could go in time and edit one thing, what would that be?
I was talking to my wife recently about this. My response to her was I wouldn’t want to change anything because if I did, I could potentially not be who I am today. I am secure and I like being who I am. I think there’s more to learn but I don’t know what I would have changed to learn more now.
However, there is one thing I do regret not following up on. I was doing research in hepatology and had found a specific cell type in the liver that was protected when one has high doses of tylenol or paracetamol. We know that a high dose causes liver failure but what I found is that these cells remained intact while the other cells died. So, I argued that there was an enzyme in the cell that was protecting them, which if we use that enzyme, as an antidote, we may help people who overdose on paracetamol, acetaminophen but I never finished that research project. I went on to complete my residency. I think two graduate students picked up some of the work I left but that was 10-11 years ago, and I never followed or looked back at it again. So, I would like to apologize to my Principal Investigator, Dr. Laurie DeLeve, for the incomplete work done!
Dr. Arta Bakshandeh will be speaking at the AIMed22 Annual Global Summit, January 18th-20th, 2022, at the Ritz-Carlton resort in Laguna Niguel, southern California. This summit promises to be the most enthralling yet, with Drs. Eric Topol and Daniel Kraft also among the keynote speakers.
Full details and early bird tickets can be booked here