Mark Twain (Samuel Clemens) spent his youth deciphering the Mississippi River, a system much more advanced than any synthetic intelligence (AI) algorithm. He discovered that actual understanding calls for nuance, context, and skepticism. Had been he alive immediately, he’d probably see NarxCare, the controversial opioid-risk AI algorithm, as a cautionary story in regards to the risks of changing human judgment with lies, rattling lies, and statistics.
NarxCare scores sufferers primarily based on morphine milligram equivalents and pharmacy procuring patterns, ignoring vital components like tolerance, genetics, and socioeconomic context, components Twain, the good observer of human complexity, by no means neglected. Like river pilots who mistook calm waters for security, NarxCare’s designers imagine prescription information can predict overdose threat with mathematical certainty. However Twain knew higher as a result of beneath calm surfaces typically lurked lethal currents.
Samuel Clemens’ romantic view of the river pale as he discovered its hidden mechanics. In river slang, “Mark Twain” meant “two fathoms deep,” a protected depth for steamboats to navigate, measured by the leadsman’s line and referred to as out to the pilot as a sign of protected passage by unsure waters. Equally, AI strips drugs of nuance, lowering ache care to a mixed threat rating. Sufferers secure for years on medicine are flagged “high-risk” for crossing arbitrary AI algorithm thresholds. Like a pilot misreading a river chart, AI can’t distinguish hazard from routine, a failure of judgment Twain would have derided.
“There are three sorts of lies: lies, damned lies, and statistics,” Twain as soon as quipped. NarxCare inherits its information’s biases, very like AI predictive policing that conflates over-policing with excessive crime. In some communities, increased prescription charges replicate entry or want, however NarxCare interprets this as threat. Twain, who distrusted blind consensus, would have seen this as statistical tyranny.
After which there’s the human value. Twain’s characters—Huck, Jim, the Duke and King—had been messy, flawed, and human. Synthetic intelligence reduces folks to classes. A continual ache affected person turns into a purple flag. A veteran is labeled “prone to misuse.” A trauma survivor is deemed ineligible for aid. Actual persons are harmed. Medical doctors retreat into defensive drugs. Sufferers lose care. Despair follows.
Twain understood that mechanical methods, regardless of how subtle, can’t exchange human expertise and knowledge. Synthetic intelligence, just like the shifting sandbars of the Mississippi, provides the phantasm of management whereas concealing hazard. Twain would warn us, not solely as a result of prediction is ineffective, however as a result of blind religion in flawed AI fashions is perilous. As Twain stated, “It ain’t what you don’t know that will get you into hassle. It’s what you understand for certain that simply ain’t so.”
For all its information, NarxCare AI is aware of far lower than it claims. Twain as soon as learn the river like a guide, every ripple a phrase, every eddy a phrase. That dwelling water formed his imaginative and prescient of America. Right now, our rivers are streams and waves of anonymized information, chilly and unfeeling, feeding methods like NarxCare and AI predictive policing. These promise readability however typically ship distortion. If Twain learn rivers to grasp America, we should be taught to learn these digital currents and waves with equal care.
Twain’s life trusted tiny observations, a flicker within the present, a shadow on the water. AI mimics this vigilance however with out understanding. AI watches every thing and is aware of nothing. Its judgments are detached and infrequently misguided. It lacks the reflexes and humanity of a pilot who knew life and dying trusted delicate clues.
As Twain mastered the river, he mourned the magic misplaced to mechanistic understanding. In Life on the Mississippi, he lamented how poetry gave method to measurement. Right now, we too have traded actuality for purple flag metrics. NarxCare AI reduces human ache aid to a quantity. It replaces doctor-patient relationships with AI black-box choices. Patterns turn into pathology. Nuance is overridden by numbers. We’re left with Rubbish In, Rubbish Out, disguised as AI and run by technocrats who’ve by no means left the river dock. We’ve traded poetry for pc code, and within the course of, misplaced compassion, creativity, and the braveness to see sufferers as folks.
Twain’s river teemed with unpredictable, advanced lives. That chaos gave his writing soul. Right now’s AI algorithms provide no such complexity. A mom in ache turns into a legal responsibility. A veteran turns into a statistic. A survivor turns into suspect. This isn’t assist—it’s hurt. And who advantages? Not the sufferers.
Twain knew freedom concerned threat. The wealthy human tapestry he celebrated is now flattened into spreadsheets. These methods erase complexity reasonably than replicate it. Huck and Jim discovered freedom on the river, however solely by respecting its risks and studying its rhythms. Our digital methods ought to do the identical. NarxCare claims to guard however typically punishes. Individuals lose care not due to wrongdoing, however as a result of an AI algorithm labels them a risk. There isn’t any attraction. No raft. No Huck Finn to flee with.
Freedom within the digital age calls for greater than pc code. It calls for transparency, humility, and safeguards in opposition to AI algorithmic violence. Twain warned: “At any time when you end up on the facet of the bulk, it’s time to pause and replicate.” AI algorithms communicate in a language few perceive, however many obey. They’re maps handed to youngsters anticipated to pilot ships. Designed by the highly effective, enforced on the powerless, NarxCare, like AI predictive policing, wears the masks of objectivity whereas reproducing previous injustices. It doesn’t see folks. It sees chances. It acts not on what somebody has achieved, however what a machine predicts they may. It replaces care with management.
In Twain’s period, the steamboat symbolized progress. However Twain wasn’t seduced. He was no Connecticut Yankee. He knew know-how with out judgment was harmful. The river was alive. It required respect. Misreading it was deadly. AI is our era’s new steamboat—praised for effectivity, but blind to nuance. Twain would have seen by it. He would have acknowledged the hubris in believing machines can exchange knowledge. Heraclitus stated, “You can’t step into the identical river twice.” AI disagrees. It treats folks as static patterns, denying change and redemption.
We should resist this flattening. Actual rivers and actual folks don’t transfer in straight traces. Twain’s river carried rogues and saints, all sharing the identical present. He knew freedom got here with threat, and compassion required understanding. Twain’s river taught him to learn America, its magnificence, blindness, and contradictions. Our fashionable information streams might do the identical, however provided that we strategy them with Twain’s skeptical eye. We should ask ourselves. Who constructed these AI methods? Whose tales are excluded? What truths are erased? What myths are bought as science?
Twain wrote, “The face of the water, in time, grew to become a beautiful guide.” Right now, the face of AI has turn into a harmful fiction. Every metric is a masks. Every rating a sentence. If we don’t be taught to learn it correctly, we threat shedding not simply justice however the follow of medication itself.
Neil Baum is a urologist. Mark Ibsen is a household doctor.
