
Robots vs. Anesthesiologists - marojejian
http://online.wsj.com/article/SB10001424052702303983904579093252573814132.html?mod=WSJ_hps_LEFTTopStories
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hooande
"If a patient ends up dying because of preventable circumstances, that's not
going to be acceptable because we are trying to save money"

Let's not pretend that every anaesthesiologist has a perfect track record.
Machines can make mistakes with horrible consequences, but so can humans.
Similar arguments are used against many forms of valuable automation, such as
self driving cars. The benefit of using machines is that mistakes are
quantifiable and can be fixed en masse. There's no way to know if any given
anaesthesiologist is having an off day and there's no one fix for the
potential problem. Most automation issues can be fixed with time and more
data.

The outlook is grim for automating similar medical tasks because of the same
problem that Sedasys is facing: the human inclination towards turf protection.
Professional organizations make a lot of dues money from their members, which
is then use to purchase enough clout to delay the FDA at least once. No one
wants to lose a job that they've committed their lives to and the threat of
automation extends across all of society. But we can't afford to be the
species that shoots itself in the foot by refusing to reap the benefits of
ever advancing society.

I look around and see a world filled with repetitive and mundane tasks. I love
it when one of those jobs is automated away. Congratulations to Johnson &
Johnson and I wish them the best in their fight against our own backward
tendencies.

~~~
thedufer
Also, that quote can't possibly be accurate. Are they really claiming that
there is nothing we could be doing to improve patients' odds (however
slightly) that are foregone because they're prohibitively expensive? Because
that's the implication.

I understand that the value of a human life is both high and difficult to
measure. But throwing your hands up and going with $Infinity is not a valid
solution.

~~~
anigbrowl
You have it backwards. They're saying that there are measures that could save
money which are foregone because of the unknown but potentially greater risk.
An aneasthetist could fuck up a bunch of operations. A design error in a
widely-employed robotic anaesthetic device could affect thousands of people.
Juries are not kind to defendants in such cases.

~~~
jerf
For the most part, though, errors must be subtle and small to escape notice
for very long. If, for instance, Device A kills everyone who uses it in five
minutes, this will not go undiscovered for long. Unfortunately, we can not
remove the chance of that happening.

Though if I were standardizing this software, I would seriously consider
mandating that devices MUST NOT (in the RFC vernacular) have real-time human-
calendar clocks on board them. Some sort of calendar-based errors could indeed
be highly correlated and impossible to respond to quickly, and if the device
simply doesn't have it it can't crash because of it.

(I'd also like to mandate buffer-safe languages that aren't C.)

((Also, I'd like a pony.))

~~~
Amadou
_I would seriously consider mandating that devices MUST NOT (in the RFC
vernacular) have real-time human-calendar clocks on board them._

I am in total agreement. My experience with gps-based clocks in high-precision
hard real-time environments taught me that time is really effing hard to do
perfectly, it is full of countless non-obvious corner cases. Some of which
will only bite you two years into deployment.

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gojomo
I opted out of anesthesia for my last colonoscopy, so that I could watch.
(They still insisted on setting me up for potential sedation, I suppose in
case I experienced distress mid-procedure, but it wasn't needed.) The
procedure was quick (maybe 15 minutes); the discomfort was on the same order
as a prostate exam, plus some pain of bloating that came and went repeatedly
as pressurized air is used.

It seems the main dangers the anesthesiologist needs to watch for are those
caused by the anesthesia itself, so going without it entirely felt like the
safest option to me. And since I wasn't drugged, I could drive myself home and
resume normal activities immediately. I suspect far more people could skip
sedation for this procedure, and any risks (for example from some patients
panicking) are likely outweighed by the extra care taken when a patient is a
conscious observer.

~~~
pgrote
Is that a normal option? Was there pushback when you requested no anesthesia?

~~~
Cass
It's quite common here in Germany. I know several doctors who routinely do it
without anesthesia, to avoid the dangers of sedation. Having seen a
colonoscopy done that way a few times, I'd personally insist on sedation. Most
people I've personally observed who were awake for the procedure seemed to
find it almost unbearably painful, although there was a minority who didn't
mind it much.

~~~
gojomo
The unique and worst part was the on-and-off air-bloating pain, but it was
comparable to other quickly-passing episodes of intestinal gas/discomfort, and
especially bearable knowing that it was very temporary and in service of a
goal under expert care. (I've had more painful headaches, scrapes, stubbed-
toes, and sprains – which each lasted longer.)

I could definitely understand those with various kinds of medical- and pain-
anxiety opting for sedation, but I also think such things are highly
suggestible and influenced by social norms about which pains are normal to
shrug off and which pains you communicate for sympathy... so it doesn't
surprise me that in other cultures skipping sedation could be the casually-
accepted norm.

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ChuckMcM
Nice peek at why Health Costs are so screwed up :-) You could ask the patient
(use the machine it's covered, use the Anaesthesiologist and pay his fee (up
to $2,000)) Of course that sort of approach will be made out to be threatening
the poor and those unable to pay with a risk of death.

I've known a couple of anaesthesiologists in my life and something the article
didn't mention was that their malpractice insurance premiums go up linearly
with their patients seen (I can't verify that directly but believed them when
they said it). The argument was that they are one of the 'most sued' doctors
on the planet. Hard to sue a machine of course, we'll see.

~~~
gohrt
Why would you expect [Expected Value of the amount of liability per unit time]
to be anything but linear in the rate of attempted operations (within the
envelope where each operation is routine, non-interfering, statistically
independent event)

~~~
vacri
An anaestheologist treating 20 patients per year is going to have
fundamentally less experience than one treating 200 patients per year.

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DennisP
I'm pretty sympathetic to anesthesiologists after another WSJ article I read a
few years back.

According to that article, anesthesiologists used to have some of the highest
malpractice premiums. Rather than lobbying for liability caps as some other
physicians have been doing, they did a lot of analysis of their own data, and
figured out how have a lot fewer patients die on them. Now they have some of
the lowest malpractice premiums.

~~~
orborde
Link?

~~~
DennisP
I didn't think I'd find it but it googled right up:
[http://online.wsj.com/article/0,,SB111931728319164845,00.htm...](http://online.wsj.com/article/0,,SB111931728319164845,00.html)

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semenko
Nothing says reassuring quite like "supports WiFi" but also "WEP only"
[http://www.accessdata.fda.gov/cdrh_docs/pdf8/P080009c.pdf](http://www.accessdata.fda.gov/cdrh_docs/pdf8/P080009c.pdf)
[pg. 101, section 5-21]

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stephengillie
The Wall Street Journal is losing relevance - because they have made this
article inaccessible/difficult to access, I won't read it, and I'll get this
same information from another source.

It's a brave, new world.

~~~
eli
"Relevance" is perhaps subjective, but the WSJ is the largest newspaper in the
US and its circulation is _growing_ \--both online and in print.

~~~
stephengillie
Really? Last I heard, the NY Times was the largest in the US, and its
readership was declining.

~~~
eli
"The Wall Street Journal, owned by News Corp NWSA -3.04% ., maintained its
position as the country's largest newspaper by average weekday circulation.
The paper had an average weekday circulation of 2.4 million, including print
and digital subscribers, as of March 31, up 12% from a year earlier, according
to the latest figures from the Alliance for Audited Media."

[http://online.wsj.com/article/SB1000142412788732448250457845...](http://online.wsj.com/article/SB10001424127887324482504578454693739428314.html)

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Pxtl
The article appears to completely ignore the issues of liability and
malpractice and whatnot, which are critical to any discussion of anesthesia.
This makes the article somewhat useless.

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hotpockets
I was able to view the article through a google search of its title.

~~~
aaronz8
I just installed a Chrome plugin called "first click free" which does this
automatically. Been doing this manually for too long, haha!

~~~
jaytaylor
I just installed the plugin, but it doesn't seem to be working.

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marojejian
My thoughts: [http://marojejian.tumblr.com/post/62339785940/rise-of-the-
ma...](http://marojejian.tumblr.com/post/62339785940/rise-of-the-machines-
anesthesiologists-are-not-safe)

On the one hand the benefits of such technology are amazing. On the other,
it’s scary to see such high-end professions encroached upon by machines.

But the resolution here is the same as for the cashier or the buggy whip
driver. We need this technology, but we need to ensure that:

a) Our economy is flexible enough to rapidly develop new industries that will
require human workers.

b) Our workers have the education, the infrastructure, the incentives and the
entrepreneurial mindset needed to move with (or ahead of?) the market into new
fields without calamity.

But will there always be new applications for humans? Well not always…. but
that would imply a situation where AI has truly supplanted us in all respects,
and our technology can supply all our needs without us lifting a finger.

Call me when that happens. Sounds nice.

~~~
lukifer
People don't want jobs. They want a good standard of living, and to have a
social role. They want to matter to others. Jobs can deliver on that, but it's
just one social construct among many.

Because our economic engines have been so focused on human labor since the
dawn of agriculture, we now think of jobs as the most significant type of role
to play, tied only with "parent", followed by a long tail of non-profit edge
cases (volunteering, running a racquetball league, etc.)

But while there will always be significant demand for human labor, its value
is steadily diminishing, a trend that shows no sign of stopping, with the
lion's share of the benefit going to those own the hardware and/or the
patents. (Maybe machines make cheaper goods, but who cares if I can't make any
income to buy those goods?)

Maybe we can invent or entrench enough human jobs where a computer can't
compete (a Starbucks bot can get you coffee, but it can't smile at you); but
to assume that that's either possible or optimal seems like putting the cart
before the horse.

While hypothetically our existing political structures could try to solve this
problem (basic income, etc.), those processes have been so effectively
captured and divorced from anything resembling democratic rule that I'm not
very confident in good results.

Ironically enough, this seems like the perfect problem to be solved by
software: allocate resources to ensure basics of survival and dignity,
incentivize desirable social behavior and wealth creation, and create
sufficient negative space for people to also create social value in
unpredictable and unmeasurable ways, by having actual free time.

It's a tough nut to crack.

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lucidrains
future improvements in anesthetic agents, intubation devices, and monitoring
tools will probably allow nurse anesthetists to do more and more what
anesthesiologists do today.

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jtokoph
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