Assisting doctors

Not too rocky a ride on the IBM share price

Prompted by an accident backing up some of the stuff on my laptop, I took another look at a short book on the Kindle, that is to say reference 1. Where there is talk of IBM building on its Watson platform to provide a cognitive assistant to cancer doctors.

Some readers may remember the days when IBM was the unchallenged leader in the IT industry, the days when Microsoft and Google were yet to be invented. But they made good use of the cash pile they built in their glory days and they are still a thriving company. Others may remember a contest in 2011 between an IBM computer called Watson (reference 2) and a champion at a game called Jeopardy!, a contest which IBM won.

I don’t know much about Jeopardy! except that it is a very successful general knowledge quiz show on television in the US. I comprehensively failed the candidate player test thoughtfully provided on the web site (reference 3), partly because the questions had a US flavour, partly because my general knowledge was not up to it and the mental agility was not there. So getting a computer to play this game and win was a major achievement by IBM.

They are now leveraging their investment by turning the Watson software into something more general purpose, something that can be tailored to help professionals in all kinds of demanding fields – including cancer doctors, oncologists, in serious hospitals. The relevant bit of the Wikipedia article at reference 4 suggests that this particular project has had a chequered history, and a cursory search of the IBM site fails to find it – although it does find Watson helping with the coronavirus (reference 5). There is also the point that IBM made a major investment in Watson and would be looking for a return. And at some point any such investment would be reviewed by the board – who might well chose to pull rather than to sink more money into the project. You don’t get to be a big and powerful company by pouring good money after bad. The same issue cropped up in the world of big pharma, as touched on at reference 7.

But that is not the present point. Let us suppose instead that IBM succeeded in building a cognitive assistant for oncologists. An assistant which had hoovered up all the scientific papers about cancer, had access to huge numbers of (anonymized) medical records and to the medical records of the current patient, whoever that might be.

An assistant which provided help and support for the oncologist which might not otherwise be available to him on a time scale which was relevant to the patient. The example given in reference 1, written at a time when IBM were more gung-ho about all this than they appear to be now, was a non-smoking lady of Japanese extraction with lung cancer who was worried about losing her hair during treatment. Watson was able to dig up information which was very relevant to this particular lady. He was able to talk to the medical insurance computer about the treatment that he was proposing. All of which sounds entirely plausible and I think it likely that such systems will exist in the near future, even if they are not in routine use just now.

But how would we feel about a corporation like IBM owning a world beating system of this sort? They might be getting most of the data it uses for free – free-loading, as it were, on today’s open access science – but they will certainly be charging to use their system. Reference 2 is all about getting paying customers.

How do doctors learn to trust such a system? There is talk at reference 1 of Watson being good at telling its customers why it has come to the view that it has, at setting out its lines of reasoning, which customers can check for themselves. Bearing in mind, that once such a system is being used routinely, such checking would probably not be practical. Much better to get on with treatment and move onto the next patient.

Would there be problems with getting patients to trust such a system? Would they need to know? Would they need to be told? How would they feel about Watson negotiating with the computer systems operated by their medical insurers about the treatments both appropriate and available to them?

Now my lefty view is that our National Health Service offers a far better model for the delivery of health services than the insurance based model which rules in most of the US. The ‘most’ here prompted by the thought that Veterans’ Affairs (at reference 6) runs a large health service, of the same order of size as our own, despite such things being anathema to most Republicans. Notwithstanding, I was impressed by the thought that there is merit in a busy consultant oncologist having his recommendations for a patient checked by the medical insurance people. They do provide a second opinion, they do stop doctors setting themselves up as infallible gods. It would be interesting to find out how our NHS addresses the issue.

Then how would this affect medical negligence insurance, another big industry in the US and a growing one here in the UK. Who gets blamed when our cognitive assistant makes a mistake, as it will from time to time?

One supposes that anyone, in this case IBM, selling such a system, would need to include insurance cover in their offering. And they might well need to negotiate with the insurance providers about their quality control. How careful had they been to make sure that Watson picked up some obscure paper from some obscure corner of the world – a paper which would have been very relevant to a case which has gone badly wrong? Would it make a difference whether the error was a software error during construction or a clerical error during operation? Perhaps a clerk failing to follow up the non-arrival of any material from said obscure corner? Perhaps a corner which had forgotten to pay its subscription to something or other.

Are there circumstances in which the insurance provider would withdraw cover temporarily, rather in the way that Boeing 737 MAX jets have been grounded – near 400 aircraft for more than a year now. Not to mention the similar number in the production pipeline. In what circumstances might a health service provider be obliged to turn off such a support system, so inflicting massive damage to the service it is able to offer its customers, its patients?

I supposes these same or comparable questions have already been asked about the provision of expensive bits of hardware, like scanners, now an integral part of health service provision. In any event, there are lots of questions.

References

Reference 1: Smart Machines: IBM's Watson and the era of cognitive of computing - John E. Kelly III and Steve Hamm – 2013.

Reference 2: https://www.ibm.com/watson. 

Reference 3: https://www.jeopardy.com/. 

Reference 4: https://en.wikipedia.org/wiki/Watson_%28computer%29. 

Reference 5: https://www.ibm.com/watson/covid-response. 

Reference 6: https://www.va.gov/. 

Reference 7: https://psmv4.blogspot.com/2020/04/a-family-with-troubles.html.

 

Reference 8: https://www.macrotrends.net/stocks/charts/IBM/ibm/stock-price-history. The source of the snap above. They also gave me daily price information since 2nd January, 1962. Near 15,000 lines of it.

Not Wellingtonia

On the Jublilee Way run this morning, I paused at the start of Cox Lane to attend to my warbling telephone and spotted this fine tree, something like a Wellingtonia.

On the spot

But closer inspection revealed leaves like those noticed at reference 1, of the coastal cousin, 

Sequoia sempervirens. I think there was a lot of military in this general area during the second world war so perhaps some tree-hugging camp commandant? Is it as old as that?

Same tree, in StreetView

Odd how different it looked in StreetView, although if you get the angle and direction right, recognisably the same tree. At the junction of Lion Park Avenue and Cox Lane.

Another TB

Turning to our public houses, at around 1630 yesterday afternoon, the Marquis, Wetherspoon's and the Rifleman all open, reasonably busy but not rammed. Rifleman strictly indoors. And around 1130 this morning, the Marquis shut, Wetherspoon's open, but quiet looking from the other side of the market place, Rifleman shut. Tubbs Pubs at the Organ crossroads shuttered. Permanently? TB open by the time I got back there but no-one outside, out front. Maybe there were some punters inside. I was tempted, but in the absence of a key for the lock of my bicycle, desisted.

And turning to car boot sales, that at Hook Road Arena today was present, but not vibrant at noon.

12:03:14

But the cars that are left are well spaced out. Maybe it had been a lot busy earlier. Noon rather late given that in the olden days the sellers used to start to queue to get in around 0600, for an 0800 opening.

PS: regarding Tubbs Pubs and thinking of the example set by the miniature wine bar, more or less opposite the Mitre in Tooting, I believe there is a market for small, niche pubs, perhaps occupying modest retail premises for which there is no further retail use. But sadly, checking, this one seems to have evaporated. See reference 2. Facebook exists, but without a logon (mine having been deleted in the wake of some scandal or other), I can't see whether it is alive or not.

Reference 1: https://psmv4.blogspot.com/2020/07/wellingtonia-11.html.

Reference 2: https://littlebarsw17.wordpress.com/about/.

Group search key: wgc

Wellingtonia 12

Captured yesterday morning in margins of the housing estate which used to be the Manor Hospital. With at least one more scoreable tree in the vicinity. With a close-up of the needles being used in the detail including at reference 1.

Note the juvenile araucaria to its right. But is it juvenile or just stunted by proximity to its big cousin? What will happen in the fullness of time?

Reference 1: https://psmv4.blogspot.com/2020/07/wellingtonia-11.html.

Group search key: wgc.

Wellingtonia 11

At the corner of a road near us, I have been admiring a large conifer for some time, for some years even. Then yesterday it dawned on me that maybe it was a juvenile Wellingtonia.

Juvenile?

I had been confused by the shape, being more used to the more cylindrical, very distinctive shape of the mature trees. See, for example, reference 2. There was also the issue of the colour of the trunk, not the distinctive red I expect. 

Back home, I asked Bing about young sequoia and assembled the snap following.

Bing's young trees

With the story here seeming to be that conical was OK, with the tree on the right perhaps being what happens when you get slow growth in an open, exposed position. 

Then there was the question of the needles.

Needles

After further consultation with Bing, the verdict was that the needles of the candidate capture in the middle panel were consistent with those both to the right and to the left. The latter being a detail from an earlier, confirmed capture.

In the end we thought it reasonable to score the juvenile as a Wellingtonia. It only remains to buttonhole the owner and ask him - although BH thinks that the tree was already there when he arrived so he may not know. Or he may not know any better than us.

Reference 1: https://psmv4.blogspot.com/2020/06/wellingtonias-8-9-and-10.html.

Reference 2: https://psmv4.blogspot.com/2020/06/wellingtonia-6.html.

Group search key: wgc.

A new record

Following the Scrabble score of 66 reported at reference 1, today I managed 102 with 'marrows', a relatively modest triple word, but taken to dizzy heights by the bonus of 50 for using all my letters. Plus a further bonus of making a plural with the 's'.

Our joint score of 576 for the game was probably a record too. From which we learn that to make 600 you need plenty of luck with high scoring letters on triple words - not having done at all badly in that department on the present occasion.

I shall consult the rules committee as to whether it counts if we play together, which could make a lot of difference, rather than against each other - although they may decline to rule on the grounds that one cannot reliably tell one from another.

Reference 1: https://psmv4.blogspot.com/2020/06/patent-application.html.

Trump to Rushmore

Social distancing US presidential style, somewhere near Mount Rushmore, although he and the first lady are not to be seen in this snap, from reference 1. Not many face masks either, at least as far as can be seen in not very many pixels. Turned up by Bing.

No idea how respectable an operation Rawstory is, but they do appear to carry a lot of advertisements for clothes. They also say that there is a minor problem with Mount Rushworth in that the approach road belongs to the Oglala Sioux by treaty, which they think gives them the right to demonstrate there when they feel like it.

Reference 1: https://www.rawstory.com/2020/07/watch-live-trump-holds-mask-option-mount-rushmore-rally-and-fireworks-celebration/.

More shearing

Following the shearing noticed at reference 1, I have been thinking and checking some more about the Wahl Clipper Corporation.

First, they do seem to do sheep, along with cows, horses, dogs and other pets. But do they sell clippers to shear all those sheep in Australia?

Second, I wondered whether they had just become a front for a Chinese manufacturing operation. In effect, the Chinese buy market access to the chosen market, in this case clippers, in the form of a well-established US corporation. They then hollow out the US corporation, moving the manufacturing to China, just leaving the sales and marketing operation in the US. Initially at least, remaining to all appearances a US corporation, a trusted US brand with a long and enviable history. Headquartered, as it happens, at 2900 Locust St, Sterling, IL, 61081 USA. Gradually the centre of gravity moves across the Pacific and eventually the company comes clean as a Chinese operation. Trump gets cross about this loss of business.

Government fails

Not knowing how these things are organised in the US, I had difficulty tracking down information about this company. Reference 2 offered very little. There didn't seem to be any share price information and I eventually decided that Wahl remains a family business, not listed on the stock market at all. I then find my way to the Illinois Secretary of State's website which includes a business search facility, but one which declines to work. Had it worked, I dare say I would have turned up whatever large family owned corporations in the US are supposed to file, Illinois variety. Presumably something more than nothing. Presumably Wahl do file in Illinois.

Google succeeds

In desperation I turn to to gmaps and paste in the address given above. Confusion about whether Locust Street is also sometimes called Pennington Street notwithstanding, I have a picture of the Wahl headquarters, out in the flat open spaces. And for after work, there is the Candlelight Restaurant opposite, which either is or is tricked out to be a converted farmhouse or barn. I suppose the US version of a heritage public house. See reference 3.

But not yet much the wiser about where the centre of gravity is.

Google fails

The company song?

Then Bloomberg tell me about Wahl Clipper Ningbo Ltd at Zhongxing East Road, Xikou Town, Ningbo, 315502 China. Which gmaps turns up OK, a little to the north of the Shanjiang River, quite near Nigbo and south of Shanghai. But, sadly, out of range of Street View. And the web site advertised, reference 4, unlike the US web site, does not seem to be exclusively sales orientated. But it is in Chinese, so I am still not much the wiser.

Reference 1: http://psmv4.blogspot.com/2020/07/the-shearing.html.

Reference 2: https://us.wahl.com/.

Reference 3: https://www.candlelightinnrestaurant.com/sterling.html.

Reference 4: http://www.wahlcn.com/.