A few years ago, IBM’s new computer was a game-playing curiosity. Now Watson is poised to change the way human beings make decisions about medicine, finance, and work.
Photo by Dan Winters
The woman was gravely ill. Her name was Ms. Yamato. Thirty-seven years old, born in Osaka, Japan, she had never smoked, and yet there it was anyway: a spot on her lung.
A doctor had already performed a bronchoscopy and had made the diagnosis of cancer. Then he referred the patient to Mark Kris, an oncologist at Memorial Sloan-Kettering Cancer Center in New York. Seated alongside me in his office on the Upper East Side of Manhattan, Kris is showing me Ms. Yamato’s electronic medical record on an iPad. “I’m preparing for the first visit,” he explains, swiping the screen to show what that entails. He’s interested in running at least two tests on the patient. The first is an MRI, to find out if the cancer has spread to her brain. The second involves a deeper diagnostic regimen. Lung cancer tumors are not all the same; there are thousands of variations. So a test that examines the mutations within a tumor will be crucial, he says. It so happens that cancer patients born in East Asia who have never smoked often have a particular mutation that responds well to a medication by the name of Erlotinib. That may be the case here. One can hope.
The woman is not real. She happens to be a character within an app that IBM has created for Watson, its new computer. Watson’s special talent, its reason for being, is a singular ability to grasp the intricacies of human language and answer exceedingly difficult questions. You may have heard about Watson already. Back in 2007, a group of computer engineers at IBM’s research labs in upstate New York began building the machine—named for IBM’s founder, Thomas J. Watson—with the goal of creating a question-and-answer technology that would be more authoritative and powerful than anything on the planet. The initial objective of the Watson group was simple: to win in the game show Jeopardy!, something Watson famously achieved in February 2011. Yet the group had a far more important goal: to turn Watson into a business, hopefully one of some scale. So starting in late 2009, a business development team at IBM began holding meetings outside the company in an effort to understand the ultimate worth of this new technology. No doubt it could be a business one day. But what kind of business?
“The first thing that hit us about Watson,” recalls John Kelly, IBM’s chief of research, “was that this thing could be applied almost anywhere.” Early on, IBM executives decided to focus on a field in which Watson could have a notable social impact while also proving its ability to master a complex body of knowledge. The team chose medicine. They believed Watson could help doctors make diagnoses and, even more important, select treatments. Specifically, they thought Watson could be the perfect tool to chart the complex decision trees that cancer specialists like Kris negotiate every day as they weigh treatment options that might involve radiation, surgery, and any of countless chemotherapy drugs. Watson can ingest more data in a day than any human could in a lifetime. It can read all of the world’s medical journals in less time than it takes a physician to drink a cup of coffee. All at once, it can peruse patient histories; keep an eye on the latest drug trials; stay apprised of the potency of new therapies; and hew closely to state-of-the-art guidelines that help doctors choose the best treatments. Watson never goes on vacation. And it never forgets a fact. On the contrary, it keeps learning.
This fall, after six months of teaching their treatment guidelines to Watson, the doctors at Sloan-Kettering will begin testing the IBM machine on real patients. The Ms. Yamato app shows how it will work. After Kris inputs the results of her medical tests, Watson begins deliberating. “It’s going through its algorithms,” Kris says as we stare at the iPad. “It’s seeing where the data sends it today.” On the screen, a colorful globe spins. In a few seconds, Watson offers three possible courses of chemotherapy, charted as bars with varying levels of confidence—one choice above 90% and two above 80%. “Watson doesn’t give you the answer,” Kris says. “It gives you a range of answers.” Then it’s up to Kris to make the call. He regards the options on the screen and wonders how they might change if Ms. Yamato happened to develop a common symptom: hemoptysis, or coughing up blood.
“Let’s try that,” he says. He inputs the information and shows me the result approvingly. Watson has dropped one drug from the top chemo regimen. That’s just what Kris would have done.
To make sense of all this—that is, to gauge both the value of Watson to a hospital like Sloan-Kettering and its potential to change forever the worlds of medicine and business—you could follow two different paths. You might consider Watson’s evolutionary promise. Watson can almost certainly generate huge administrative benefits. Already, one large health insurer—Indiana-based Wellpoint—has begun using a Watson computer in its Virginia data center to speed along the authorization for medical procedures. Usually, authorizations are evaluated by a team of trained nurses and can sometimes take weeks to come through. Watsonizing the process would speed it up—a boon for a doctor like Kris, who now must wait while assistants exchange faxes with insurers before he can get clearance for any expensive tests.
Kris shows me what happens when Watson’s treatment plan calls for an MRI. A button pops up on his screen to ask for preauthorization. “I just click that,” he says, and it’s done instantly.
I ask him what if Watson’s request is denied.
Kris seems amused by the question. Watson has already consulted the latest medical literature, and it’s been trained by the best cancer doctors in the world. “Who is the authority that is going to trump that?” he asks. Insurers balk at paying for unnecessary procedures; Watson’s expert opinion essentially guarantees the necessity.
But the more intriguing path is the second one—a consideration of Watson’s potential to do something revolutionary. This is the trail that captivates Kris. Eventually, he thinks, Watson could provide any doctor anywhere with the world’s best second opinion. A physician in a community hospital in the Midwest, or at a remote medical center in China, could have instant access to everything that the medical field’s best oncologists—people like Kris and his colleagues at Sloan-Kettering—have taught Watson. What is more, Watson will be able to excavate facts beyond the ken of Sloan-Kettering’s current lineup of specialists. As Kris says, “We could ask Watson: What is the best treatment for this rare condition based on all of Sloan-Kettering’s records?” It could then go through several years of cancer cases looking for the most successful outcomes. In time, it could even look at hospital records from around the world. As Manoj Saxena, the IBM executive now in charge of commercializing Watson, tells me: “It’s like being able to take a knowledge worker—cancer specialist, nurse, bond trader, portfolio manager, whatever—and equip that person with the best knowledge, and have it available at their fingertips.” As Watson evolves, Saxena believes, these knowledge banks will significantly alter how, and how well, humans make decisions