Bet 43

By 2030 all surgical anesthesia will be administered and monitored by computers, with no need for professional medical supervision beyond the surgeon.
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The terms

I wonder if the bettor might want to say "all surgical anaesthia IN THE UNITED STATES" or something equivalent, unless you really expect the same thing to occur in the outback of developing nations, etc.

Also "all" might invite a strict constructionist loss for the initiator's side eventually. "Nearly all"? "90%"? "Most"?

Wording

I agree with the point of how a "strict constructionist" might handle the wording here. I think input from some medical specialists in this field may be warrented. The real point underneath the claim is that robotic anesthesia is routine and usual. One thing that might handle this: insurance companies might cover non-automated anesthesia only under exceptional circimstances(i.e. research for new procedures etc.).

Robot Doctors?

You underestimate the importance of a living, breathing THINKING doctor. Much must be taken into consideration when administering anaesthetic, most of which cannot be generalized into

Patient.Name="Mrs Johnson"
Patient.Age=87
If allergies = false then GoTo AdministerDrug

(In my opinion, pharmacists will be automated long before any doctor is.)

Automated anesthesia

As a practicing clinical anesthesiologist, I'm quite pessimistic about the 28-year time frame. Automated closed-loop anesthesia has been a tantalizing goal throughout the modern era of anesthesia, and while the inhalation and intravenous agents have markedly improved in safety and controllability today compared with 28 years ago, along with obvious strides in electronic monitoring, there are simply too many unpredictable factors, too much individual variability among patients, and too many unforseen events during surgery to place confidence in the proposed time frame (28 yrs) of anesthesia without human intervention. I might accept 100 years as plausible, however.

Of course an unforseen major conceptual breakthrough in CNS pharmacology is always possible, but following the trajectory of history I would reject the bet.

One more thing: The surgeons (assuming they haven't already been replaced by robots!) are least likely to serve as the fail-safe backup for unforseen crises. The "captain of the ship" doctrine, whereby the operating surgeon is ultimately responsible for the patient's welfare during surgery, was abandoned decades ago.

Re: Automated anesthesia

Good argument, Dr. Sarnat. Perhaps you or you and some colleagues would like to take the bet?

It's a long enough bet, the eventual payoff to the winner's charity could be substantial---perhaps $6,000 in current dollars, for a $1,000 outlay.

You're forgetting the Lawyers

1. As a former member of the medical community and someone who has undergone surgery, I'd much prefer to see a human and have everything explained to me.

2. As a computer programmer/business owner that operates in the healthcare marketplace, I can tell you that no insurance company in the world would give me the liability coverage I would need for the software involved. I couldn't enter into a contract or try to get a patent, from a business perspective, without the insurance.

3. One lawsuit caused by one injury would set this idea back by fifty years...not mentioning the lobbying the AMA's lawyers would do to get congress to pass a bill preventing it.

Surely will happen...in the year 2500

"By 2030 all surgical anesthesia will be administered and monitored by computers, with no need for professional medical supervision beyond the surgeon."

By 2030 they will finish instaling basic computers in South American and African Hospitals.
By 2040 South American, and African countries will have finished paying all there dept, and will start bying and using anesthesia for all hospitals in all regions.
By 2050 these continents will start having enough doctors
to start atendending all there populations.
Maybe a Worldwide date for this bet is in the year 2500

Oh yes

I hope this bet is true, because the pain is sometimes just unbearable. If nothing else, the pressure to make it so, will indeed make it so. Thank you for posting your thoughts on this very important issue.

I hope so

Actually, I saw a piece on computer diagnosis. You still need someone to type in 'sore throat' 'swollen glands' but the computers, when they could conclusively tell through blood tests or what not, did better than the doctors. It didn't do as well in bedside manner. At this point several Japanese firms are working on robots that could care for the elderly.

As for anethesia in particular, I sure hope so. A couple of years ago I went in for shoulder surgery. I watched my anethesiologist, who I heard saying he wasn't feeling well, wash his hands, dry them on a paper towel, then blow his nose on the same paper towel, smear it around his face, and then come over and hook me up. I got poked ten times by the jerk (actually, 6 times by him, 4 by another nurse who took over). I ended up with blood clots. My mother keeps telling me I should sue.

We already have machines that can monitor levels in the blood, from diabetes testers to the coumadin tester I use at the doctors. (Thanks again to the anethesiologist for the blood clots.) We have machines that can monitor how much of something they put into something, (those cool soda machines at some resturants that have a small/medium/large button that fills your cups appropriately. They have a toilet now that tells you your weight, which takes care of the machine knowing the patients body weight. (An addaptation of that technology to a surgical table, I'm not suggesting you put the patient on the toilet to get that information.)

Computers and robots are particularly good at monotonous tasks, and when they get the sophistication to gently help an elderly person turn in their bed so they don't get bed sores, they will probably be much more reliable than humans.

I think the ability of computers/robots to do the same task over and over without getting bored will eventually turn the insurance risk debate around. At some point they will get better than the technician, and the insurance companies will demand it. (On a side note, I think that may be how cars will come to drive themselves. I don't remember seeing any bets on when that would happen on a mass scale, or what they would be running on.)

not WITHOUT human intervention

A previous poster (who apparently has looked into the legal environment for manufacturers of medical devices) was correct in stating that a fly-by-wire anesthesia machine would cost more to insure than it would make for its manufacturers and users.

Anesthesiologists and nurse-anesthetists do more than simply meter anesthetic dosage to the patient in response to vital signs and EEG traces. Robotics, sensor technology, and expert systems are not up to replacing the human in the loop - yet.

There is some interesting technology out there, though. Nicolet Technology has a module that slides into a Handspring Visor PDA which can monitor one channel of EEG (from three electrodes placed above the patient's left eyebrow) bispectrally and provide a usable index (called the SNAP index) of what level of induction of anesthesia is being attained. This is, to me, incredible considering we're talking about something that fits in your pocket.

I'd feel very comfortable saying that within the time frame of the prediction that technology will lower the risk of anesthesia and with that, the malpractice insurance burden. And THAT would be a major improvement over the present state. But we'll still need people in the loop over that time frame.

Re: not WITHOUT human intervention

> We'll still need people in the loop over that time frame.

If the person in the loop is the surgeon, the bet succeeds.

Re: not WITHOUT human intervention

I said:
> We'll still need people in the loop over that time frame (Note: the "loop" being the process of inducing and maintaining general anesthesia).

Thomas Holaday said:
"If the person in the loop is the surgeon, the bet succeeds. "

The surgeon doesn't have anything to do with the administration of general anesthesia.

Anesthesiology is a separate medical specialty, with a totally different education track and licensing procedure from surgery.

The only circumstances I can imagine under which a surgeon would also take responsibility for inducing and maintaining general anesthesia in his or her patient would be expedient ones - such as battlefield or shipboard emergency surgery. By "emergency" I mean surgery which must be performed immediately to save the patient's life.

My point was and is that an anesthesiologist does more than run the gas rack during surgery. While the surgeon devotes his or her entire attention to the surgical field (that hole in the patient during the operation), the anesthesiologist must make a running assessment of the patient's respiration, cardiac function - and in some diseases, when the surgeon manipulates a body structure, an immediate change in blood pressure can happen for which the anesthesiologist must make an IMMEDIATE correction - sometimes, brain wave function, pupillary dilation... a host of variables, the interpretation of which is complex and demanding.

There's a saying that "the manuals of military aircraft are written in blood," alluding to the often lethal process of testing new aviation technology, especially when such technology must by its nature address factors other than pilot or passenger safety first and foremost.

In medical technology, patient safety is ALWAYS first and foremost. I know a little something about clinical trials of new medicines and medical devices, having consulted in the field, and I think that even if the trials of a wholly automated anesthesia device went smoothly at every step, the components which we do not already have to replace the judgment and training of an anesthesiologist would take longer than the period of the bet to move through the design, testing, redesign, concept validation, nonhuman, clinical safety and finally efficacy trials. And none of these stages can be bypassed under current regulations.