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Keeping Algorithms on Lockdown

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Artificial intelligence and machine learning (AI/ML) are increasingly transforming the healthcare sector. From spotting malignant tumors to reading CT scans and mammograms, AI/ML-based technology is faster and more accurate than traditional devices – or even the best doctors. But along with the benefits come new risks and regulatory challenges.

In the article, the authors explore the new challenges facing regulators as they navigate the unfamiliar pathways of AI/ML.

They consider the questions: 

  • What new risks do we face as AI/ML devices are developed and implemented? 
  • How should they be managed? 
  • What factors do regulators need to focus on to ensure maximum value at minimal risk?

Until now regulatory bodies like the U.S. Food and Drug Administration (FDA) have approved medical AI/ML-based software with “locked algorithms” - that is algorithms that provide the same result each time and do not change with use.  However, a key strength and potential benefit from most AI/ML technology is derived from its ability to evolve as the model learns in response to new data. These “adaptive algorithms”, made possible because of AI/ML, create what is, in essence, a learning healthcare system, in which the boundaries between research and practice are porous. 

Given the significant value of this adaptive system, a fundamental question for regulators today is whether authorization should be limited to the version of technology that was submitted and evaluated as being safe and effective, or whether they permit the marketing of an algorithm where greater value is to be found in the technology’s ability to learn and adapt to new conditions.

The authors take an in-depth look at the risks associated with this update problem, considering the specific areas which require focus and ways in which the challenges could be addressed.

The key to strong regulation, they say, is to prioritize continuous risk monitoring.

“To manage the risks, regulators should focus particularly on continuous monitoring and risk assessment, and less on planning for future algorithm changes,” say the authors.

As regulators move forward, the authors recommend they develop new processes to continuously monitor, identify, and manage associated risks. They suggest key elements that could help with this, and which may in the future themselves be automated using AI/ML – possibly having AI/ML systems monitoring each other.

While the paper draws largely from the FDA’s experience in regulating biomedical technology, the lessons and examples have broad relevance as other countries consider how they shape their associated regulatory architecture. They are also important and relevant for any business that develops AI/ML embedded products and services, from automotive, to insurance, financials, energy, and increasingly many others. Executives in all organizations have a lot to learn about managing new AI/ML risks from how regulators think about them today.

“Our goal is to emphasize the risks that can arise from unanticipated changes in how medical AI/ML systems react or adapt to their environments,” say the authors, warning that, “Subtle, often unrecognized parametric updates or new types of data can cause large and costly mistakes.”


Babic et al. (2019) Algorithms on regulatory lockdown in medicine. Science. DOI: https://doi.org/10.1126/science.aay9547

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.