Exhibit 2:
The APACHE system

The Acute Physiology & Chronic Health Evaluation (APACHE) system was created by medical researchers and doctors seeking a better way to determine which patients should be retained in a hospital's intensive care unit when beds became scarce. The system worked by comparing key statistics for a particular patient with millions of cases with similar characteristics in order to project likely outcomes. The system capsulized its analysis into a number for each patient, called the APACHE score. A higher score meant that the patient stayed in intensive care; a lower score meant the patient left.

It seems startling that a single, computer-generated number could even be considered useful in making such a potentially life-or-death decision, and even more so that it could carry as much weight as a doctor's personal evaluation. The reasoning behind the APACHE score is that, while there are some things the human brain is very good at, it tends to focus too much attention on two types of occurrences: the recent and the unusual. While that sometimes serves us very well, it is much better, for decisions like this, to take into account every relevant case. That is something that, in an unaided state, the human mind is just not capable of doing.

And the system works. APACHE III "has been shown to be predictive of in-hospital mortality rate. It has performed equally well in community based and academic settings. [But] The APACHE, like other scoring systems presents some limitations. It is dependent on an operator and requires a long period of training to be used efficiently (Murabito, Rubulotta, and Gullo 2008, 349). The point is not that machines are better than the human mind; the point is that the mind and the machine together produce the wisest decisions.


Murabito, P., F. Rubulotta, and A. Gullo. 2008. Quality management in the ICU: Understanding the process and improving the art. In Anesthesia, pain, intensive care, and emergency: Proceedings of the 22nd postgraduate course in critical care medicine, Venice-Mestre, Italy, November 9-11, 2007, ed. A. Gullo, 345-404. Milan, Italy: Springer-Verlag Italia.