Робин Кук - Cell

Langley smiled. “Good. At the outset of the beta test iDoc referred relatively often to the control room for answers, but that number dropped very quickly, meaning iDoc was functioning as planned in a heuristic fashion. In other words, there was a rapid reduction in the number of situations that iDoc didn’t feel capable of handling on its own, demonstrating that it was indeed learning, and learning at a phenomenal rate.” Langley stared at Paula and George, waiting for an acknowledgment that they were keeping up with him.

They both nodded.

“Now, to understand the glitch that occurred, you must know that the algorithm upon which iDoc is based includes a number of subjective issues such as pain and suffering associated with various medical treatments and even with some supposedly preventive testing. Even something simple, like the inability to sleep or eat normally, has been incorporated into iDoc if it is a frequent side effect. What we are essentially talking about here are quality-of-life issues, which are hard to quantify to include for the purposes of digitization. Nonetheless, we tried to incorporate them because we feel strongly that they need to be considered much more in health care decision making than has been done in fee-for-service medicine. And let me mention another variable: cost. The iDoc algorithm is responsibly aware that health care is already taking too big a bite from the GDP and that costs have to come down in order to ensure that health care can be distributed equitably. Am I making sense here?”

Both George and Paula nodded. The phrase it’s not rocket science went through George’s mind.

Langley cleared his throat again. “So here is the truth. No one knowingly used iDoc to kill anyone. The fact that a small number of patients died because of iDoc was a surprise to all of us. What happened was that the iDoc algorithm decided on its own to eliminate certain individuals after taking into consideration the pain and suffering associated with the specific cancer treatments they were facing, the predicted outcome of treatments, and cost consequences. There was no outside interference. In other words, there were no ‘bad guys.’ iDoc made its decision dispassionately with the evidence it already had in terms of the illnesses involved, the treatments available, the suffering that the patients would have to endure, and the cost. And that is basically it .”

There was a prolonged silence. The only sound penetrating the room was the chirping of birds outside the window.

Paula was the first to speak. She was decidedly less angry. “How long has this glitch been known?”

“A week,” Langley answered. “I first received evidence the same day that Amalgamated gave the presentation to potential investors.”

“And what actions have you taken?” Paula asked.

“As soon as we determined what had happened,” Langley continued, “we put an immediate end to what George has termed global dumping commands . Then we wanted to know how it had happened. Our first concern was the same as Dr. Wilson’s, namely the existence of a rogue hacker. But that was immediately ruled out when it became obvious that the dump commands had come from iDoc itself, meaning it was the algorithm that had made the determinations and given the orders.”

“And then what did you do?” Paula asked, taking the words right out of George’s mouth.

“Like I said, we stopped iDoc’s ability to issue dumping commands.”

“The selection of these types of patients... was that also stopped?” George asked.

“No. Because we want to look at the cohort of people that iDoc would have terminated along with how iDoc reached its decision, so that we as programmers could in a sense learn from iDoc: a heuristic event in reverse.”

“How many more patients were there besides the four that George discovered?” Paula asked.

“There were eight others, for a total of twelve,” Langley admitted. “There was one more associated with L.A. University Medical Center that Dr. Wilson was not aware of, four associated with Santa Monica University Hospital, and three with Harbor University Hospital.”

“Did all of these result in deaths?” Paula inquired. She sounded like an attorney taking a deposition.

“Yes.”

“Has iDoc identified anyone as fitting the criteria for a global dump since you stopped such a command from being issued?”

“Yes, there have been three of those. Two at L.A. University Medical Center and one at Santa Monica University Hospital.”

“So, these three people are still alive?”

“Yes, but they are about to undergo very difficult treatments that will severely impact their quality of life with little chance of slowing their respective diseases.”

George interrupted. “I assume iDoc has also identified a group of candidates that would fit the global dump profile that do not have an embedded reservoir to do its dirty work, were it allowed.”

Langley was silent a moment. His eyes flicked toward Thorn. “Yes.”

“How many of those has it identified?”

“I don’t have that exact information available. I can get it for you, though.”

“But that is a good question,” Thorn admitted.

George nodded, then moved on. “Was Zee correct in his assumption that the records of the four cases I investigated had been overwritten to cover up the dump commands?”

“Yes. We did that,” Langley admitted.

“Why did you wipe the patients’ smartphones clean of all data and try to do so with DeAngelis’s phone as well?” George demanded.

“That has been standard procedure since the outset of the beta test. We wipe a phone clean immediately upon confirmation of death. That has nothing to do with the dump commands. It has to do with privacy issues that—”

Thorn interrupted. “Lewis is correct. There was no attempted cover-up with the smartphones. Our damage control was limited to the overwrite of the global-dump commands and their physiological consequences on the servers. And that was to prevent anyone at Amalgamated or our iDoc subsidiary from discovering the glitch. Only the three of us, plus one other individual at Amalgamated, were aware of what happened. Our intent was, and is, to prevent the media from learning what had happened. We know that such information would ignite a media frenzy. Remember what happened when Sarah Palin brought up the subject of ‘death panels.’ And that was only about discussing end-of-life choices with elderly patients. We feel that iDoc is so potentially beneficial to the country and the world that this unfortunate glitch should not derail it. When iDoc’s benefits are known to the world in terms of democratizing medicine and truly focusing on prevention, then dealing with the issue of this glitch can be accomplished without ‘throwing the baby out with the bathwater.’”

Thorn stopped and took a deep breath. Everyone was silent, absorbing Thorn’s impassioned defense of iDoc.

George was the first to speak. “iDoc is going to be good for Amalgamated as well.”

“Absolutely!” Thorn agreed without hesitation. “I want you and Paula to understand that the glitch does not represent any kind of conspiracy on the part of Amalgamated. There was no Amalgamated ‘death panel.’ Nor will there ever be. Frankly, to be perfectly honest, we do not need it.”

“Why didn’t you come directly to George and me instead of snatching us in the middle of the night?” Paula demanded, some of her anger returning. “We could have been seriously injured.”

“I apologize for that. As I mentioned earlier, that decision was made by Butch Gauthier, our security chief. Don’t worry, I’ll be having a word with him very soon. Unfortunately it was one of those situations where the right hand didn’t know what the left hand was doing. The professionals who snatched you had no idea who you were, just that you were dangerous. I understand how you both feel. And for good reason. But keep in mind, the situation was deemed an emergency, which had to be contained as soon as possible. That said, we apologize again.”