Algorithms are the new drugs? Reflections for a culture of impact assessment and vigilance

In this paper we propose that Artificially Intelligent (AI) systems in medicine are the new drugs. Through study and comparison of the existing corporate pharmaceutical models, we advocate a new approach in how the performance of AI solutions (both for diagnostic and prognostic aims) is measured and promoted, on how the impact of these solutions is assessed and evaluated in terms of both outcome and safety (about which the new term technovigilance has been introduced), and how education and a better awareness of the impact of these systems on heath care by multiple stakeholders should be promoted. Any drug must be evaluated in terms of efficacy and safety, but also in terms of real-world effectiveness, efficiency and cost-effectiveness, that is in terms of its role as a component of a wider and more complex socio-technical system where it must fit a broader process of inquiry and care, which involves patients, care givers and many other stakeholders. For this reason, we also propose, as a priority, changes in the current wide-spread attitudes that evaluate machine performance against humans, and instead to adopt a collective knowledge approach. In this light, the leading metaphor informing the public debate on the role of AI in medicine should not be that of cognitive augmentation, with its risks of feeding unrealistic expectations and restoring the harmful image of the medical hero, but rather of a collaboration-oriented adjunct in more redundant and tighter teams of competent decision makers. Not only could this lead to a more efficient and automated health care, but we argue to a better collective endeavour aimed at the well-being of patients as well as at the satisfaction of physicians.