By Bobby Stroup
Artificial Intelligence (AI) isn’t magic, but there is value in telling a magical story to non-technical stakeholders to describe how we’ll govern this transformative technology. In fact, President Joe Biden himself could benefit by borrowing from an existing legend.
Let’s pick a story that’s already popular and one where heroes successfully overcame a dangerous technology. That technology should be simple, but also one that embodies the idea of harms caused by design. Focusing on a simple device avoids the distraction of technological details, allowing us to more easily ponder the bigger picture.
With the above parameters in mind, I suggest we discuss the technology of an “evil ring.” No, I don’t mean that Ring. I’m saying we should analogize health care AI to Sauron’s One Ring from J.R.R. Tolkien’s The Lord of the Rings.
Why The Lord of the Rings?
First, if you’re unfamiliar with Tolkien’s tale, I recommend you find a way to learn the story. The books are great. The movies are also enjoyed by all types of people. I’ve even hyperlinked scenes of the movies in this article for reference. As a warning, if you’re a diehard fan, you should know my use of movie clips means I may not be sticking with strict Tolkien textualism.
Also important for this discussion is that The Lord of the Rings does not demonize all technology. The story is, more specifically, about how a technology with evil design harmed people and thus needed to be destroyed. Within health care AI, what needs to be destroyed is not all use of technology. We dislike a specific kind of tech, the kind with bad design that hurts people.
We can therefore leverage The Lord of the Rings to better understand health care AI policy. Furthermore, we should encourage President Biden and his administration to be like Gandalf.
Gandalf probes history
Gandalf sets a good example from the beginning. At the start of our tale, we see Gandalf starts with research. After noticing something strange about Bilbo’s ring Gandalf chose to explore the records. He read ancient scrolls to understand what this ring might be. Gandalf studied history and then pushed for progress.
The Biden Administration, too, must start by studying history. Given Biden has already released an Executive Order on AI, you would be reasonable to think it might be too late. However, in our analogy, we can imagine the entire Executive Branch together as “Gandalf.” If so, the regulator arm of “Gandalf” is still in the planning phase. That means the “hobbits” of AI industry are still largely awaiting orders. It is not too late for the Biden-Administration “Gandalf” to study history.
The administration’s officers must understand both the history of AI and the history of American health care. Neither story is simple on its own, and combining the two topics makes the discussion even more complex. Nonetheless, history will enable leaders to identify chronic, systemic problems in health care, like bias, which affects the development of AI.
Additionally, history can provide lessons on the impact of changes to the health care workforce. Understanding those dynamics is relevant regardless of whether AI is replacing or complementing existing employees.
Gandalf practices humility
Gandalf recognized his own limitations and intentionally assigned the crucial mission to someone else (Frodo). Yet the reason Gandalf delegated these duties was not for lack of expertise. As mentioned before, it was he who first identified the threat through his studies.
Gandalf delegated the Ring, because the risk of the One Ring in Gandalf’s hands was far greater than ineptitude. If Gandalf took control over the One Ring, “it would wield a power too great and terrible to imagine.”
Perhaps government control of health care AI would lead to technological stagnation due to lack of expertise; however, this concern misses the biggest risk.
The nationalization of health care AI poses incredible risks, but some still support it. Biden’s Executive Order on AI does set certain requirements and limitations on AI , but this policy isn’t nationalization. National standards are simply a bar that all organizations, public and private, must meet. Nationalization is also not just any government use of AI. Nationalization means exclusive government control.
We must not allow the federal government exclusive ownership. Among many flaws, if the federal government was the sole organization with a right to use AI in a health context, such a policy would prohibit AI’s use in self-care. Denying this type of health intervention would violate “core components of promoting and protecting people’s right to health.” Biden should heed Gandalf’s wisdom and avoid this treacherous path.
Gandalf propels hobbits
Finally, Gandalf understands the urgency of dealing with dangerous tech. As soon as he learns of the dangers Frodo faces with the Ring, Gandalf sends him to Rivendell. Though it’s one small step, Gandalf’s mandate initiates necessary progress toward eliminating the Ring.
Biden’s Executive Order on AI also recognizes the urgency of the threat. His Executive Order mandates federal agencies work toward regulatory solutions starting now. For example, one key due date is in Section 8(b)(iv)–(v). Only one year after the order, by October 29, 2024, HHS, the DoD, and the VA must establish a framework to mitigate AI harms and develop a strategy for AI regulation in drug development. These demands for agency regulations should, in turn, lead to requirements for industry to initiate necessary progress toward eliminating harmful AI.
Hobbits on their own would likely be disinclined to pursue this adventure of fighting the power of evil. Risk aversion is ingrained in their culture. Even the most adventurous hobbit describes going out your front door as “dangerous business.”
Like in the Shire, the small players in Silicon Valley are also not very excited about the journey of good vs. evil (at least as it exists via AI regulation). Despite this cultural aversion, government leaders must understand the bigger picture, just like Gandalf saw the real threat was life or death, not social faux pas. The Biden administration should not underestimate the potential threat of failing to regulate AI models, even for “small” corporations.
There and Back Again
In conclusion, Gandalf succeeds as a leader because he effectively leverages his wealth of experience. President Biden would be wise to do the same. If he does, he may even make it back for a second term.
