The Machines Will See You Now: Anmol Madan's Human Roadmap to AI Health Care

“The machines today are like toddlers learning how to walk. They stumble. They’re not very good. They make mistakes.” — Anmol Madan   One in three American adults are already using AI for health information — with or without their doctors’ permission. The machines, in other words, are already seeing us. This will chill some Americans in our summer [https://www.wsj.com/tech/ai/the-summer-that-america-became-a-nation-of-luddites-5e6dc3e7?mod=hp_lead_pos5] of luddite discontent. For others, however, like the San Francisco-based medical tech entrepreneur Anmol Madan [https://www.anmolmadan.com/], the appearance of doctor AI in our lives is mostly good news.   In his new book, The Machines Will See You Now [https://www.anmolmadan.com/], Madan lays out what he calls a “human roadmap” to “autonomous health care.” I’m not entirely sure what he means by “human” in a Blade Runner-style world where machine and man are quickly merging. But by “autonomous,” which I suspect is a euphemism, Madan means artificial intelligence.   What worries Madan about our current moment is the broken dialogue over AI. On the one hand, we have tech utopians promising a totally automated healthcare industry. Then we have an anxious establishment struggling to change America’s archaic and often dysfunctional medical system. And, of course, American consumers (if that’s the right word) who are already using ChatGPT or, more troublingly, TikTok, as their doctor.   America spends $4.7 trillion on a healthcare industry which compares poorly with the medical systems of other wealthy countries. Madan’s “parallel universe,” he promises, would cost half as much and double access. The machines will see you now. Like it or not, Dr AI is our all-too-human future.   Five Takeaways   •       One in Three Already Ask the Machines. The KFF poll behind the episode: a third of American adults already use AI for health information, with or without their doctors’ blessing — and if they’re not asking ChatGPT, they’re asking TikTok. Madan’s frustration is the broken dialogue between AI exuberance (“we’re going to automate healthcare”) and medical anxiety, when the right answer is in between: new technology is no excuse for throwing out the guardrails of medical devices and clinical safety. The stakes are the brutal arithmetic of American medicine — $4.7 trillion spent for the worst outcomes among peer nations — and his “parallel universe”: half the cost, twice the access, delivered by AI systems that are tested, safe, and rigorous. Consumer appetite is already there; the safeguards are not. •       The Waymo Scale for Medicine. The book’s organizing framework applies the self-driving industry’s levels of autonomy to healthcare. Level zero is today: 99 percent of decisions — diagnosis, treatment, prescription — made by humans. Level one is doctor assistance, already deployed: radiologists who once hauled backpacks of reports now guided by machines to where to focus. Levels two and three ease machines into the lowest-stakes treatment and diagnostic decisions with human review — and the fully autonomous end state, Madan concedes, may never arrive. To Andrew’s objection that Waymo’s scale ended with the drivers removed, Madan offers the transatlantic pilot: autopilot flies ninety percent of the route, and nobody thinks the pilot doesn’t matter. The structure, he argues, is what lets regulators, doctors, and builders finally talk about the same thing. •       Toddlers Learning to Walk. Madan’s metaphor for today’s medical AI: toddlers — stumbling, error-prone, needing layers of protection, and badly underestimated at their peril and ours. The mistake, he argues, is concluding that because the systems aren’t perfect we shouldn’t try them at all, when a constraine