Believing in black boxes: machine learning for healthcare does not need explainability to be evidence-based.

OBJECTIVE: To examine the role of explainability in machine learning for healthcare (MLHC), and its necessity and significance with respect to effective and ethical MLHC application. STUDY DESIGN AND SETTING: This commentary engages with the growing and dynamic corpus of literature on the use of MLHC and artificial intelligence (AI) in medicine, which provide the context for a focused narrative review of arguments presented in favour of and opposition to explainability in MLHC. RESULTS: We find that concerns regarding explainability are not limited to MLHC, but rather extend to numerous well-validated treatment interventions as well as to human clinical judgment itself. We examine the role of evidence-based medicine in evaluating inexplicable treatments and technologies, and highlight the analogy between the concept of explainability in MLHC and the related concept of mechanistic reasoning in evidence-based medicine. CONCLUSION: Ultimately, we conclude that the value of explainability in MLHC is not intrinsic, but is instead instrumental to achieving greater imperatives such as performance and trust. We caution against the uncompromising pursuit of explainability, and advocate instead for the development of robust empirical methods to successfully evaluate increasingly inexplicable algorithmic systems.

Extended mathematical cognition: external representations with non-derived content.

Vehicle externalism maintains that the vehicles of our mental representations can be located outside of the head, that is, they need not be instantiated by neurons located inside the brain of the cogniser. But some disagree, insisting that 'non-derived', or 'original', content is the mark of the cognitive and that only biologically instantiated representational vehicles can have non-derived content, while the contents of all extra-neural representational vehicles are derived and thus lie outside the scope of the cognitive. In this paper we develop one aspect of Menary's vehicle externalist theory of cognitive integration-the process of enculturation-to respond to this longstanding objection. We offer examples of how expert mathematicians introduce new symbols to represent new mathematical possibilities that are not yet understood, and we argue that these new symbols have genuine non-derived content, that is, content that is not dependent on an act of interpretation by a cognitive agent and that does not derive from conventional associations, as many linguistic representations do.

The limits of machine intelligence: Despite progress in machine intelligence, artificial general intelligence is still a major challenge.

Despite recent breakthroughs in machine learning, current artificial systems lack key features of biological intelligence. Whether the current limitations can be overcome is an open question, but critical to answer, given the implications for society.

Reconciling the opposing effects of neurobiological evidence on criminal sentencing judgments.

Legal theorists have characterized physical evidence of brain dysfunction as a double-edged sword, wherein the very quality that reduces the defendant's responsibility for his transgression could simultaneously increase motivations to punish him by virtue of his apparently increased dangerousness. However, empirical evidence of this pattern has been elusive, perhaps owing to a heavy reliance on singular measures that fail to distinguish between plural, often competing internal motivations for punishment. The present study employed a test of the theorized double-edge pattern using a novel approach designed to separate such motivations. We asked a large sample of participants (N = 330) to render criminal sentencing judgments under varying conditions of the defendant's mental health status (Healthy, Neurobiological Disorder, Psychological Disorder) and the disorder's treatability (Treatable, Untreatable). As predicted, neurobiological evidence simultaneously elicited shorter prison sentences (i.e., mitigating) and longer terms of involuntary hospitalization (i.e., aggravating) than equivalent psychological evidence. However, these effects were not well explained by motivations to restore treatable defendants to health or to protect society from dangerous persons but instead by deontological motivations pertaining to the defendant's level of deservingness and possible obligation to provide medical care. This is the first study of its kind to quantitatively demonstrate the paradoxical effect of neuroscientific trial evidence and raises implications for how such evidence is presented and evaluated.