Artificial Intelligence in Medicine Has a Major Cassandra Problem

F. Perry Wilson, MD MSCE
6 min readOct 18, 2023

Some lessons from the priestess of Troy

Today, I’m going to talk to you about a study at the cutting edge of modern medicine — one that uses an artificial intelligence model to guide care.

But before I talk to you about that, I need to take you back to the late bronze age, to a city located on the coast of what is now Turkey.

It’s towering walls made it seem unassailable, but that would not stop the Achaean’s and their fleet of black ships from making landfall, and, after a siege, destroying the city.

The Burning of Troy: Georg Trautmann

The destruction of Troy, as told in the Iliad and the Aeneid, was foretold by this woman — Cassandra — daughter of King Priam and Priestess of Troy.

Cassandra (Inset) Evelyn De Morgan

Cassandra had been given the gift of prophecy by the god Apollo in exchange for her favors… But after the gift was bestowed, she rejected the bright god and, in his rage, he added a curse to her blessing — that no one would ever believe her prophecies.

Thus it was that when her brother Paris set off to Sparta to abduct Helen, she warned him that his actions would lead to the downfall of their great city. He, of course, ignored her.

And you know the rest of the story.

Why am I telling you the story of Cassandra of Troy when we’re supposed to be talking about AI in Medicine? Because AI has a major Cassandra problem.

The recent history of AI and particularly the subset of AI known as Machine Learning in Medicine has been characterized by an accuracy arms race.

The electronic health record allows for the collection of volumes of data orders of magnitude greater than what we have ever been able to collect before. And all that data can be crunched by various algorithms to make predictions about… well… anything. Whether a patient will be transferred to the intensive care unit, whether a GI



F. Perry Wilson, MD MSCE

Medicine, science, statistics. Associate Professor of Medicine and Public Health at Yale. New book “How Medicine Works and When it Doesn’t” available now.