Karma and Healthcare Bots

A recent NYT post (9/2/2025) caught my eye. I have repeatedly touted the value of aggressively integrating AI into our healthcare delivery systems, at both the primary care and specialist levels:

My PCP Should Be a BOT | Aletheia Today

My MD Should Be a Bot | Aletheia Today

I am particularly keen on the prospect of AI enhanced diagnosis. No matter how skilled they may be in other areas, not all doctors are good diagnosticians. The skills required are very different from those associated with patient care. 

A study published in the Lancet Gastroenterology and Hepatology found that after just three months of using an A.I. tool, designed to help spot precancerous growths during colonoscopies, doctors were significantly worse at finding the growths on their own…

“This is a two-way process,” said Dr. Omer Ahmad, a gastroenterologist at University College Hospital London who published an editorial alongside the study. “We give A.I. inputs that affect its output, but it also seems to affect our behavior as well.”

Of course it does! What interests me is that Dr. Ahmad seems surprised, “This is a two-way process…” Of course it is, every event is, and this has nothing to do with AI. Anything we do that affects something outside us also affects us. This truism has no exceptions whatsoever. It is impossible for physical entities to act without experiencing a reaction.

Borrowing a meme from Gregory Bateson, let’s agree that an event is “a difference that makes a difference.” What else could it be? To be an ‘event’, something has to be different from what came before it and impact what comes after it. If not, it would just be an unidentifiable stretch of the ontological continuum.

It is a fundamental feature of the Universe, and yet we go through life rarely keeping it in mind: “Every action entails an equal and opposite reaction” (Newton). I fire a rifle; the recoil bruises my shoulder. “What goes around, comes around” (Hippie manual from the 1960s). “Cast your bread upon the waters…” (Ecclesiastes) “Karma.” (Hair) Reciprocity is all around us, yet we are oblivious to it. We’re like fish in water? “What’s water?”

From pre-school on, we are taught two systems for understanding the World: language and arithmetic. Now some say, “If you can’t express it in words or numbers then it isn’t real;” others, “If you can’t measure it, it didn’t happen;” still others go further, “The world consists solely of propositions (sentences) and algorithms (equations).”

Somehow, we’ve convinced ourselves that these representations are more important, more valuable, and even more real than the phenomena they represent. We are like tourists who experience as little of a new city as possible, preferring to hang out near the Visitors’ Center, heads buried in our ‘apps and maps’. 

Or like those who see every sight the city has to offer…but through the viewfinder of a camera. We understand travel as the documentation of experiences we never had, a collection of representations (photos, post cards, souvenirs) designed to help us remember things we didn’t experience.  

Sidebar: Would Remembrance of Things Past be possible today? If Proust had taken his Nikon, or his iPhone, with him to Venice, he might never have experienced the difference between two cobblestones that made it possible for him to telescope several decades into a single event, a quantum of experience. Jean-Luc Picard can’t hold a candle to Marcel Proust.

Today, the map often trumps the territory; like children following the Pied Piper, we’ll obey our GPS, even when it leads us into an abyss. Seeing (or feeling) is no longer a valid criterion for believing. Downloading is!

Where once we relied on reality to verify our ideas, now we rely on our ideas to validate reality. Then, if theory conflicted with observation, we modified the theory; now, if data contradicts our pre-conceptions, we question the data. 

Faced with a new problem or a new data set, we are first and foremost ideologues! “Don’t worry, we’ll find a way to work anything ‘new’ into the existing, and politically appropriate, Weltanschauung.”  

Of course, there’s nothing wrong with mathematics or linguistics; they lie at the heart of our experience of being human. But they are not themselves experiences of the World. Protestations of poets and geeks notwithstanding, you cannot smell rhymes or hear algorithms. 

But back to my MD and PCP Bots. I accept that reliance on AI can dampen native acuity, but there are workarounds. For example, in my model, MD Bot is simply added to a pre-existing diagnostic team. Carbon and silicon work side by side and the efficiency (accuracy) gains pay for the extra team member many times over. 

But even if it turns out that there are no acceptable workarounds, I’d still make the switch to MD Bot.  Almost 1/3^rd of all the money spent in the US on healthcare is spent treating symptoms that have been misdiagnosed, and that’s one club, the ‘33’, that I do not want to join. 

So sorry Doc, I’d sooner put my life exclusively in the claws of MD Bot rather than accept a human substitute. But I also understand that my decision will have consequences for me as well as for you and I accept that responsibility as a price I must pay to be an independent, intentional agent. “I wish you well.”

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Sir Luke Fildes’ The Doctor (1891) depicts a quiet nighttime scene in which a physician attentively watches over a gravely ill child while her anxious parents look on in the shadows. Painted with rich detail and warm light, it honors the compassion, vigilance, and moral dedication of doctors, elevating the physician’s role to that of a steadfast guardian of life