_____________________________________________________________________________ AI in Healthcare
market was worth $14.9 billion; by 2030, it is projected to grow to $164 billion [8]. In 2020, 90% of healthcare organizations indicated they use AI for automation [9]. In the area of mental health, the growth of AI is also expected to increase rapidly. In 2023, in the United States, mental health app market revenue was estimated to be $5.72 billion, with a projected growth to $16.5 billion by 2030 [10]. It is expected that hospitals and clinics will be the largest users of AI in the mental health market, primarily driven by the prevalence rates of mental health conditions and the need for diagnoses and treatments [11]. As of 2024, North America is the dominant player in the global AI market [11]. HISTORICAL EVOLUTION OF AI USE On the surface, it seems as if AI recently emerged in the health and mental health care, but this is not true. In the 1950s, Alan Turing developed a test for intelligence in a computer, requiring that a human should be unable to distinguish the machine from another human by using the replies to questions put to both [12]. This has become known as the Turing test [13]. In 1951, Christopher Strachey developed the first AI program, and at that same time, it was John McCarthy who then employed the term artificial intelligence to refer to the use of science and engineering to make machines intelligent [13; 14]. In 1956, McCarthy organized the Summer Dartmouth Conference on AI, which drew leading scientists, researchers, mathematicians, and engineers to start a dialogue about AI and its practical uses. Some say that this conference laid the foundation to the inception of AI [12]. In terms of initial appli- cations of AI, the first industrial robot appeared in General Motor’s assembly line in 1961, and three years later, the first chatbot by the name of ELIZA emerged on the scene, which was developed by Joseph Weizenbaum at MIT [13]. ELIZA followed the tenets of Carl Roger’s person-centered therapy, which would rephrase and repeat in order to mimic a human conversation [15]. Over the years, there were other chatbots, including A.L.I.C.E. and Apple’s Siri, which laid the founda- tion for AI personal assistants [15]. Many historians have labeled the 30-year time period between 1970 and 2000 as the AI winter, because it was a time of fewer AI developments [13]. The first AI winter was in the late 1970s, during which time many doubted the practical uses of AI. The second AI winter occurred during the late 1980s into the early 1990s, when there was an AI lag prompted by the financial cost of AI development and maintenance of expert digital databases [13]. However, there were still some noteworthy developments. Deep Blue, a chess-playing computer, played against the world champion in chess in 1997 and won [16]. In 2011, Watson, another computer, won a Jeopardy gam played against the two leading rival players [16]. Between 2010 and 2020, electronic health records and large- scale healthcare databases became more prominent, and the question of how to leverage AI with health data emerged. In 2000, the da Vinci Surgical System was introduced as the first robotic surgical platform approved by the FDA [17]. As noted, Apple introduced Siri, a virtual assistant, into iPhones
in 2011, and then in 2014, Alexa, another virtual assistant was released by Amazon [13]. Today, ChatGPT and Copilot are used in many arenas, and this has led to the surfacing of many potential implications and ethical conflicts associated with AI use in various fields/disciplines, including in health and mental health care. One of the main concerns is that many AI applications (e.g., ChatGPT) are not Health Insur- ance Portability and Accountability Act (HIPAA) compliant and content shared with AI applications is generally added to the associated database and shared. ATTITUDES TOWARD AI Overall, AI is viewed with ambivalence and concern. A bit more than half of Americans are concerned about the use of AI in day-to-day life; only 10% express more excitement than concern, and 36% are ambivalent [18]. As of 2023, an estimated 58% of adults in the United States had heard of ChatGPT while 42% were not familiar at all [18]. Pew Research conducted a survey about the public’s attitudes and knowledge of AI in 2022 and 2023. Those who had heard about AI in 2022 were 16 points more likely to express more concern than excitement over AI one year later [19]. Another survey conducted in the United Kingdom found that twice as many of those surveyed thought that AI would bring more benefits than risks (28% vs. 14%). Almost 33% believed it would have a positive impact in the area of health care [20]. In a separate survey study with 427 U.S. participants, respondents were concerned that AI proliferation would result in loss of human contact and personal interactions with healthcare providers, with clinicians ending up as passive decision-makers [21]. In general, it appears that many health and mental health professionals are not familiar with AI, are distrustful of AI, and perhaps even skeptical in its application in health and mental health care. Elsevier, a leading academic publishing company, conducted a global online survey with a sample of 1,999 respondents comprised of clinicians and researchers from 123 countries [22]. This study found that 54% of respondents had used AI, and 31% had utilized it for work. Slightly more (39%) respondents in China are using AI applications compared to the United States (30%) or India (22%) [22]. When asked to identify an AI product, ChatGPT was the most frequently cited [22]. In a 2024 national Chinese study involving 1,243 nursing students, nursing professionals, and other healthcare professionals, 57% reported very little knowledge about AI and almost 66% indicated that they were not familiar with the role of AI in nursing [2]. Almost all (95%) believed that there could be imminent concerns with AI in health care and that more work will be needed in the area of ethics in AI in health care. Most individuals as well as health and mental health provid- ers prefer to have a human provider, even when they were told that the AI could perform the same task better or more accurately. While many professionals appreciate the benefits of AI, they believe it should be used as a supplement to a human provider [23]. Overall, while there is a good amount of empirical research on the role of AI in health care and medicine, much of the work is descriptive and experimental
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