“- The real problem is not whether machines think, but whether men do.” — B. F. Skinner
“If you are designing a machine, you had better think of everything, because a machine cannot think for itself.”
— Edgeware: Insights from Complexity Science for Health Care Leaders, 1998
Obsession with medical technologies and machines characterizes American’s cultural expectations. We tend to think of our bodies as perpetual motion machines, to be preserved in perpetuity. If the face of our machines sag, we lift its faces up. If our pipes clog, we roto rooter them out or stent them. If impurities gum up our machinery, we filter them out. If our joints give out or lock up, we replace them. If we want to remove something in the machine’s interior, we take it out through a laparoscope. If the fuel or metabolic mix is wrong, we alter the mix or correct the metabolic defect with drugs If anything else goes wrong, we diagnose it and rearrange it electronically.
We are reluctant to let nature take its course. We rely on half-way technologies and machines to do the job of keeping us looking young, active, functioning , and alive. This fixation on machines and technologies is the big reason American health care is 50% more costly than that of other nations. With rapid access to machines and our reliance on them, we deliver a different product than other countries – more technologies and more machines, faster and more often. Our belief system is : Give a specialist a machine, and he or she will do the job, and we or the government will pay for it.
We love machines – heart lung bypass machines, dialysis machines, heart rhythm machines, imaging machines, Internet-run machines, ventilation support machines to keep us alive at the end of life. . Patients and lawyers expect us to use these machines, doctors constantly innovate to produce more machines, and we tend to use them – no matter what the cost.
Go to a cardiology convention, and you will witness display after display of heart rhythm pacemakers. Go to an orthopedic convention, and you will think you are in an industrial exhibit, with new devices as far as the eye can see and the mind can comprehend. Go to an orthopedic operating room, and you will hear the sounds of hammers and chisels and rods being inserted. Go to a hospital convention, and much of the chatter will be about new technologies and machines that attract more patients and more specialists, reverse the ravages of disease, and to enrich the bottom line.
The latest and most talked about machine in hospital marketing and in the hands of surgical specialists such as urologists, heart surgeons, and gynecologists is the da Vinci surgical robot, a $1.4 million machine named after Leonardo da Vinci. It is designed to be less invasive, to cut blood loss, to minimize complications, to increase hospital market share and revenues, and to attract both patients and specialists to hospitals.
The price is high, $1 million to $2.25 million per machine depending on the model, $140,000 a year for maintenance, and $1500 to $2000 per procedure for replacement parts. The manufacturer of da Vinci, Intuitive Surgical, Inc, must be doing something right. Last year it had a profit of $233 million on sales of $1.05 billion. It is deployed in 853 hospitals, large and small.
But, as with all medical machines, da Vinci is not infallible . It relies on the expertise and experience of its physician users (See Wall Street Journal, May 5, “Surgical Robot Examined in Injuries.”)
The human body is not a machine, and not all of its problems and eccentricities , given the individualities and variabilities of the human condition, lend themselves to automatic or flawless operation and correction. Complications happen. Human judgment is still required.
Richard L. Reece, MD, is pathologist, editor, author, speaker, innovator, and believer in abilities of practicing doctors and their patients to control and improve their health destinies through innovation. He is author of eleven books. Dr. Reece posts frequently at his blog, Medinnovation.
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“Well hello Boys and Girls,
Its so nice to see you again, did you bring the 19 Billion Dollars?”
These are the words of the EHR industry as paraphrased by their frontmen known as HIMSS. When you get a chance , please drop your Congressman a line or e-mail telling them a full Congressional Hearing with transparency is in order to uncover the full extent of HIMSS’ influence in government that PROMOTES the legitimization of unsafe medical devices. If not for the good of the general public then for the good of the families whose loved ones have been harmed by the reckless implementation of EHRs that threatens health and safety on a global scale. A hearing is needed to demonstrate how HHS interoperates with the EHR industry which has now placed its soldiers directly in government offices and agencies and facilitates the revolving door to private industry giants like GE, Siemens, Cerner and others. Lets take a look at government agencies that are supposed to be doing the job of regulating for safety. Humm, the FDA comes to mind with the rhetorical question– does that agency even exist anymore? Funny, it seems like everyone is out to lunch with Sebelius on the taxpayers dime. You know , networking to create jobs and place more of their own kind in key positions. Oh I almost forgot to mention an examination of which big EHR companies gave lots of campaign bucks to whom and over what period of time as it would be interesting to know how much was actually paid for the privilege of by-passing ALL safety testing protocols whatsoever on EHR products. To date these products are not even classified, the government acts as if they don’t exist from a product safety viewpoint so Congress can ask how can we spend billions of dollars on what is beginning to look like the Digital Pinto of our age, complete with exploding gas tank?
Don’t forget to write those e-mails because you know HIMSS has its 20,000 members writing to every Congressman on a continuous basis.
Dr. Reece, I would love for you to elaborate on that. There are multiple things that come to mind:
1) Americans seem to be particularly prone to machinistic and overly simplified explanations of complex physiologic processes (both physicians offering them ad patients expecting them).
2) The US has a culture of medical technology enthusiasm that is probably unmatched worldwide, leading to true innovation as well as nonsensical pseudoprogress.
3) From what I read, it is the UK that has developed the counterculture of technology skepticism and a stingy, conservative approach to medical technology. France and Germany are, as a whole, probably inbetween.
4) If the body is a machine, then any problem has to be explainable in mechanistic terms. Medically unexplained symptoms are extremely common, and yet few Americans are willing to entertain the thought that their symptoms may be related to anxious overobservation and psychiatric disease. And the latter, of course, is a chemical imbalance of brain transmitters.
I am all for innovation. I have written a book promoting it Innovation-Driven Health Care, and I have spent the last three years blogging at Medinnovationblog, which now has 1321 entries. In this particular blog, I was simply trying to say we ought to put medical machines in perspective. They work, they save lives, we love them, they cost a lot of money, and they have created a vast industry.
I meet most mornings for coffee with a group of 65 year + males, and all of us have experienced an invasive medical procedure – cataract surgery, coronary stents, abdominal aneurysm stents, hip and knee replacements, rods in the vertebral column – and I’m happey to report because of these wonderful procedures, we’re all productive and functioning.
On the payment side, however, collectively these procedures, more widely available and more quickly accessible than in any other country, are driving Medicare over the financial cliff.
Obamacare promises to cut $535 billion out of Medicare. Can this be done without rationing these procedure in some way and without running into stiff political resistance from those of us who have come to expect the benefit of these technological innovations.
I am no Luddite. Instead I am a medical machine advocate. My fondest hope is that we about to enter the age of Disruptive Innovation and Disruptive Decentralization, already signaled by Health 2.0 and portable devices that can be deployed in physicians offices and patients homes, to be put into action at lower costs in more convenient settings. In my medinnovation blog I give practical examples of these disruptive devices that are already at work.
What a wonderful post. If this idea can be combined by an individual visiting http://www.websightmd.com/index.html i hope things will totally work together for good.
So I guess ECMO, dialysis, Bypass pumps, Defibrillators should all have been nonstarters? By extention, there was no need to invent the refrigerator since folks were getting by with ice-boxes. Bring on the Luddites.
Food for thought. Thank you for the perspective and well written blog. We appreciate anything & everything that keeps the inner machine (brain) operating smoothly.