ISTAT Study in the frame of the meeting “The epidemic at the time of artificial intelligence”

ISTAT Study in the frame of the meeting “The epidemic at the time of artificial intelligence”

By Claudia Fini, Chair intern

The Neurobioethics Group of the Regina Apostolorum Pontifical University (UNESCO Chair in Bioethics and Human Rights and the Science and Faith Institute) and the BrainCircle Italia presented the digital meeting entitled ‘The epidemic at the time of Artificial Intelligence’, a day of reflection born from the urgent need to develop, in relation to the contingent situation, a series of reflections on the possibility of using artificial intelligence and technology to combat the Covid-19 pandemic.

The SARS-CoV-2 (Coronavirus) epidemic, which has spread in Italy in recent months, has sadly resulted in a large number of deaths officially certified as positive for the virus. In China, the final study of the World Health Organization has recorded 3,259 deaths with a mortality rate of 3.8%. The same mortality in Italy has been shown to have increased to 9% with a peak of 12.1% in Lombardy.

The factors that contribute to the calculation of such data are many. It must be considered that in Italy, the mortality rate is higher due to the presence of an older population and the lack of testing for milder cases which are solely isolated. The development and distribution of official statistical knowledge is therefore of clear importance in measuring the performance of the economy and the community.

In light of this emergency, the National Institute of Statistics Istat has activated a series of actions aimed at ensuring the continuity and quality of statistical production, directing the collection of statistical data on sustainable acquisition techniques with methodological solutions and innovations for the use of data sources in full protection of workers’ health.

Mortality information is an essential element in defining the dynamics of the current pandemic in relation to past events. In his speech, the president of Istat Giancarlo Blangiardo illustrates how, through time, the mortality trend in Italy has been characterized by a series of peaks among which the first appears in 1918, followed by other peaks in 1956, 2015 and 2019.

The current rise in mortality due to the Covid-19 epidemic recalls, at least in the tones that emphasize the socio-health system, the global pandemic known as the “Spanish flu” which, in Italy, manifested its most devastating effect in 1918. Despite the apparent similarity, the comparison between the two pandemics must be carried out carefully. Not only has there been an extraordinary technological leap and medical and health knowledge gap between the present and 1918, but we have also to consider that the post-war years represented a particularly difficult period at a global level, with a population weakened from the end of the war. All this is present in a 1925 essay by Giorgio Mortara that concludes that the “Spanish” pandemic brought about 600,000 deaths.

Covid-19 dramatically affected the elderly component of the population in a similar way to past events that occurred in 1956 and 2015. In 1956, an influenza element, accompanied by record winter minimum temperatures, caused an increase in mortality of around 50,000 deaths compared to the previous year. Similarly, in 2015, mortality saw an equal increase of 50,000 deaths, especially among the elderly, caused by a particularly harsh winter associated with a hot summer, as well as by the refusal to vaccinate by a large percentage of the elderly population.

By observing past mortality peaks, Istat has identified possible changes with respect to the aging process and the seniority rate. According to a first scenario, a 29% increase in mortality is assumed consistently for a period of three months. This first option is relatively favourable and reflects the changes in the risk of death of people over the age of 60 in correspondence with the rise in mortality of 1956. This scenario proposes a relatively limited number of deaths, a slowdown in life expectancy without however changing the aging of the population which will increase moderately. A decidedly more pessimistic alternative is to assume a 63% increase in the probability of death for the population over the age of 65, on a constant basis for a quarterly duration. This increase corresponds to what has been calculated by comparing the probability of death in 1918, the year “disturbed” by the “Spanish” epidemic. A third scenario, perhaps more realistic, and in any case closer to the current reality, consists in starting from a 44% increase in mortality for individuals over the age of 65 observed in March 2020 compared to the same period in 2019. This phenomenon would however, progressively diminish over time, ultimately returning to typical values. The fourth and last scenario resumes the previous model assuming an equal increase in mortality of 44% for two months (March-April) followed by + 22% for May-June and finally 11% for the quarter from July to September. As a variant of the previous scenario, the optimistic approach could be reduced by assuming a more advanced progression of the adverse effects of the pandemic.

The epidemic in the time of artificial intelligence

The epidemic in the time of artificial intelligence

By Prof. Fr. Alberto Carrara, LC, Chair Fellow

The mysterious American writer Emily Elisabeth Dickinson (1830-1886) is mostly known for her unusual life, spent mainly reclused in her house in Amherst, where she was born. Her work, in addition to her well-known poetry on the brain “The Brain is wider than the Sky”, has one poem dedicated to the storm.

Translated by Eugenio Montale in 1945, this poem, number 1593, reads:

There came a wind like a bugle;

It quivered through the grass,

And a green chill upon the heat

So ominous did pass

We barred the windows and the doors

As from an emerald ghost;

The doom’s electric moccason

That very instant passed.

On a strange mob of panting trees,

And fences fled away,

And rivers where the houses ran

The living looked that day.

The bell within the steeple wild

The flying tidings whirled.

How much can come

And much can go,

And yet abide the world!

The world learned about the Coronavirus on January 12th, 2020 when the World Health Organization (WHO) recognised it as “2019-nCoV” (i.e. new Coronavirus 2019) and its related pathology “COVID-19”. The Coronavirus has spread globally as a “storm” striking a globalized and technologized world that moved frantically and almost unstoppably towards the achievement of its growth, production and efficiency objectives, rewarding with fame the typical “hard” and “soft skills” of our industries 4.0.

For months, silence, isolation, the desert of our cities, the solitude of our monuments have become our existential “storm”.

In an evocative, though eerily empty Piazza San Pietro, on March 27th, Pope Francis described this tragic moment with these words:

“Dense darkness has thickened on our squares, streets and cities; it has taken over our lives filling everything with a deafening silence and a desolate void, which paralyzes everything in its passing: you can feel it in the air, you can feel it in people’s gestures and looks. We found ourselves afraid and lost”.

As the Israeli historian Yuval Noah Harari recently pointed out, on the one hand, we are living in the best time to be able to clinically and technologically face this pandemic thanks to the development of molecular medicine, biotechnology and artificial intelligence. On the other hand, the coronavirus storm is exposing our vulnerabilities, leaving uncovered those superfluous certainties with which we have built our agendas, our projects, our habits and priorities.

SARS-Cov-2 (the new Coronavirus) has no boundaries, is not subject to barriers, nor walls, affects everyone, does not look at anyone, does not consider passports, social class and does not read the titles on our business cards. But the same reason why it spreads — our common human nature — makes us rediscover the common antidote: we are not monads closed in on ourselves, but we are all united and intrinsically connected to each other as no one can survive on their own. The Coronavirus should awake us from the deafening frenzy to which we were accustomed, and which now frightens us for its unrecognizable silence. The pandemic that struck us underlines how we are all deeply in communion with each other through the multiple interactions that connect us, so today more than ever we feel the thrill of the common bond to which we cannot escape: to belong as brothers. None of us lives alone, others’ lives are always present in mine in what I think, say, do, work. And vice versa, my life enters that of others.

“We have realized that we are on the same boat, all of us fragile and disoriented, but at the same time important and needed, all of us called to row together, each of us in need of comforting the other. On this boat… are all of us. Just like those disciples, who spoke anxiously with one voice, saying “We are perishing” (v. 38), so we too have realized that we cannot go on thinking of ourselves, but only together can we do this.”

(Pope Francis, 27th March 2020).

On the horizon, we may face a significant, longer-term problem concerning the issue of surveillance and individual control through biometric recognition that states could maintain and implement even after the epidemic crisis. Harari warns us: “one of the dangers of the current epidemic is that it will justify extreme control measures … But even after it, this idea will remain”.

We are called to reinvent our relationships and to discover our deep skills, those relating to our empathic ability, to know how to be with others, to listen, to be in solidarity, but also to be morally sound and responsible.

To reflect on this existential situation we are experiencing, the Neurobioethics Group and Brain Circle Italia organized a day dedicated to the topic “The epidemic at the time of artificial intelligence. A new anthropology for a safer world?” which took place on 23rd April 2020 live from the Neuroscience and Neuroethics Facebook page.

A panel of the highest scientific and cultural depth divided into 5 sessions debated today’s epidemic contingency in an interdisciplinary discussion. Over 5,000 people followed the event.

The digital revolution has the potential to become a new form of coexistence among people who, in their fight against the new enemy presented by epidemics, prompt us to reconsider the concepts of privacy and freedom. The need then emerges for a pact between citizens and institutions to rethink the methods of application of what Hobbes would call a new “law of nature”. But how much of our identity spaces are we willing to give up to fight these invisible threats?

Prof. Claudio Bonito presented and moderated the event. After the greetings from the academic authorities, Viviana Kasam, President of BrainCircleItalia and Father Alberto Carrara, Director of the Neurobioethics Group introduced the topic at hand.

The morning (10:30-12:30) was divided in a first scientific portion with the presentations of:

Gian Carlo Blangiardo, President of ISTAT

Luca Maria Gambardella, University of Lugano, Dalle Molle Institute of Studies on Artificial Intelligence USI-SUPSI.

In the second medical-clinical portion of the conference spoke:

Matilde Leonardi, neurologist, pediatrician, Director of UOC – IRCCS Foundation Neurological Institute Carlo Besta, Milan;

Nicolino Ambrosino, pulmonologist – Maugeri Scientific Clinical Institutes

Stefano Mazzoleni, professor of Computer Science and Big Data Analytics – Bari Polytechnic.

The afternoon (15:30-18:30) opened with the legal session, with the following speakers:

Amedeo Santosuosso, scientific director, European Center for Law, Science and New Technologies (ECLT), University of Pavia;

Avv. Tania Cerasella, lawyer, member of the GdN

Avv. Emanuela Cerasella, lawyer, Coordinator of the Neurolaw subgroup of the GdN.

The technical-analytical-philosophical session followed with the presentation of:

Damiano Sabatino, CEO Travelport and Guido Traversa, philosopher, European University of Rome – Master Coordinator in Philosophical Consultancy and Existential Anthropology.

The conference Concluded with the psychiatric session in which the following speakers are present: Donatella Marazziti, psychiatrist, University of Pisa, Professor at the Unicamillus University of Rome, Head of research BRF Brain Research Onlus Foundation

Armando Piccinni, neurologist and psychiatrist, Professor at Unicamillus University of Rome, President of BRF Brain Research Onlus Foundation.

The challenges of Artificial Intelligence in healthcare

The challenges of Artificial Intelligence in healthcare

by Claudia Fini

Artificial intelligence (AI) aims to reproduce human intellectual faculties in artificial systems to be employed in a variety of fields, from communication networks and services to medicine and healthcare. The development of AI technologies is well described in its potential to lead to substantial improvements in wellbeing and economic growth however, in order to successfully realize this vision, fundamental questions on AI ethics need to be answered first. One of the most arduous challenges of arriving to a fully functional integration of digital services and human life is to take human rights as a starting point for the formulation of policies and guidelines while also offering a unique environment for innovation. In the medical sector, artificial intelligence (AI) systems have gradually emerged as potentially powerful tools to be employed in disease diagnosis and management, mimicking and perhaps even augmenting the clinical thought and decision-making of human physicians. These innovations could not only lead to improved forms of diagnosis and treatment but also to reduced medical expenses which could play an especially important role in countries were access to healthcare is limited by social and economic factors. For both human physicians and AI systems, patients’ data are the most important starting element.

To formulate a diagnosis, physicians frequently use hypotheticodeductive reasoning, starting with the chief complaint and with appropriately targeted questions related to that complaint. After this initial phase, the physician proceeds to investigate secondary or surrounding areas such as familial history, previous physical exam findings, laboratory testing, and/or imaging studies to rule in or rule out the diagnosis. The entire diagnostic process requires time and extensive data but, if automized with machine learning to extract clinically relevant features, it could be temporally and logistically simplified. A first example is represented by a commonly used technique for drug delivery to cerebral parenchyma. Magnetic particles are injected in the brain tissue and warmed with the use of the magnetic radiation, an operation that allows the burning of specific tumoral areas. The intensity of the magnetic field can be calculated using model-based algorithms, but large volumes of training data needs to be provided in order to determine how these values can be affected by individual variables. Despite their usefulness, operations such as these are not only time expensive but also highly energy intensive. In a recent study, researchers at the University of Massachusetts, Amherst, calculated the time/energy relationship for training several common large AI models. They found that the process can emit more than 626,000 pounds of CO2 which equates approximately to five times the lifetime emissions of the average American car (and that includes manufacture of the car itself). The environmental impact of AI is only one of the many ethical issues associated with the development of intelligent forms of technology: careful evaluation must be designed so that costs for AI do not overshoot its performance, both in terms of energy but most importantly in terms of human identity.

Valuable lessons on the integration between human attributes and technological innovations can be taken from the experience of Da Vinci, an advanced robotic system for minimally invasive surgery, employed in a verity of medical areas, from urology to gynaecology and general surgery. Physical robots similar to those used in industries around the world have been implemented in the medical sector since the early 2000’s. Contrarily to industrial robots however, typically performing single and pre-defined actions like lifting, rotating or cutting objects, medical robots are able to perform more sophisticated and precise tasks that overshoot human precision. They are also becoming more intelligent, as other AI capabilities are being embedded in their operating systems. In Da Vinci, the surgeon is located at a physical distance from the operating field, controlling the robotic arms of the surgical system through monitors and controllers connected to the endoscopic instruments. From a strictly practical analysis, this operation drastically reduces typical “human-errors” due to hand tremors but, from a social perspective, the extensive and ever-perfecting use of these intelligent instruments may lead to (1) a progressive loss of physical and emotional contact between the patient and the doctor and (2) an immediate decline of the creative freedoms of the surgeon.

A first attempt aimed at the restoration of the surgeon’s sensory control over the machine was recently offered by a new generation of robotic arms developed to provide what is known as haptic feedback. A haptic feedback is an advanced pattern of vibration and waveforms conveying tactile information on the instrument’s movements. An everyday common example of haptic feedback is the resistance felt on the steering wheel of new generation cars when immediate danger is identified. When implemented to surgical robots, this sensory information is conveyed as a resistance on the instrument controller as the robotic arms advance inside the operated structure. This feedback is aimed at providing additional guidance to the surgeon’s movements thus preventing unwanted damage to vital tissues. Such novel integrations between human sensory skills and technology’s precision, between mechanical touching and human feeling does not only returns some degree or creative control to the surgeon but it also considerably improves surgical performances compared to those performed without haptic feedback.

The development of artificial intelligence technologies should thus not run isolated and independent from the societal landscape but rather align closely with human needs and intellectual faculties and their limitations. Observations on the role of men and women in the contemporaneity of the digital age should in fact be made in the very first stages of the design of AI services to obtain not only better performing systems but also their ethical advancement in the respect of human rights and values.