Thomas H. Jones, MD
Neurosurgeon and
Medical Director,
Santa Barbara
Neuroscience Institute


Dear Colleagues,


The pace of change in medicine seems to be accelerating almost as fast as Moore’s law, which in 1965 successfully predicted the future doubling of transistor density on an integrated circuit board every two years (see illustration). For example, there are currently an estimated 700,000 medical journal articles per year clinicians must contend with.


Along those lines, in early 2011, WellPoint (Blue Cross and Blue Shield) signed a contract with IBM, specifically with Watson. Because of its particularly rapid rate of change, oncology was chosen to be the first branch of medicine used in a trial of the new technology.


The Watson supercomputer, named after the former head of IBM, is the same one that handily defeated the top three Jeopardy players of all time in a televised match. Watson consists of 90 IBM 750 servers powered by 8 core processors—4 in each machine, for a total of 32 processors per machine, with a total processing capacity of 80 teraflops (1 teraflop = 1 trillion operations per second).


In addition, Watson contains Nuance’s voice and clinical language comprehension, which allows it to examine 200 million pages and provide precise responses in seconds. It could potentially help a physician consider all relevant texts, previous similar cases, related journal articles and medical literature when treating a patient with an illness. It also can potentially access all healthcare databases in existence, and in so doing base its search results on trillions of data points to help it arrive at statistically powerful assumptions.


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WellPoint physicians hope the use of Watson will help patient care through the use of evidence-based medicine. They hope it will standardize medical treatment by using this technology to identify best practices.


The dark cloud in all of this will unfortunately become the top-down medical control formulated by this computerized system and abetted by insurance physicians who are incentivized to provide a formulaic, cost-effective approach to medical care. Individualizing our care—that trait which often separates superior from average physicians—will become notably more difficult under such computer-enhanced managed care.

In 1965, Intel co-founder Gordon Moore predicted that the number of components used in integrated circuits would continue to increase exponentially, a trend now called Moore’s law.


As a physician, I can only hope that the powers that be do not harden their treatment algorithms in such a way as to eliminate the art of medicine. With all its computational power, Watson, in my opinion, cannot yet come close to replacing the human brain of an experienced clinician examining a patient with a complex history, numerous symptoms and conflicting physical findings. I would still put my health decisions in the hands of such a physician. At this juncture, I see Watson as a powerful assistant but one that shouldn’t as yet be awarded an MD degree.


At Santa Barbara Neuroscience Institute at Cottage Health System, we will continue to encourage the use of medical algorithms to facilitate the initial management of straightforward clinical problems that are commonplace, such as low back pain, headaches and neuropathy.


However, for arcane or multifaceted clinical problems, we will continue to defer to an experienced physician’s judgment while encouraging the application of best practices in a collaborative environment.



Tom Jones, MD