The difference between the almost right word & the right
word is really a large matter – it's the difference between
the lightning bug and the lightning.

Mark Twain

June 6, 2015

Believe the Hype

It is with good reason truth is said to be stranger than fiction, because even the most stubborn skeptics among us have to concede we are experiencing developments that defy the imagination. What sounds like improbable science fiction one day is in clinical trials a few months later and, before we know it, is already in practice in a number of community hospitals.

I am not talking about robots walking down hospital corridors delivering meals and medications, and hauling out trash while they are at it. That was so 2014! Now we are talking about machines that deliver anesthesia without the presence of an anesthesiologist, and a super computer that can diagnose and treat cancer like the smartest of the smartest oncologists.

Four hospitals in the U.S. are using SEDASYS, a computer-assisted sedation system approved by the FDA for patients undergoing colonoscopies and endoscopies. ProMedica Toledo Hospital in Ohio is one such facility and the Washington Post recently gave a breathless account of an emerging technology that could threaten livelihood of anesthesiologists.

SEDASYS is indicated only for narrow use, but researchers at the University of British Columbia are already testing a device that can fully automate anesthesia for complicated brain and heart surgeries, even in children. Joseph Sferra, vice president of surgical services at ProMedica Toledo Hospital, told the newspaper he looks forward to the day when SEDASYS or similar units are in wider use in his hospital.

It could be a win-win, as some hospitals have a difficult time finding anesthesiologists and many patients have a difficult time paying their fees, which can be as much as $2,000 per procedure. SEDASYS costs patients $150 to $200 per procedure.

As the Post explained it, when the patient is ready to be sedated, a nurse pushes a button on the SEDASYS machine sending a measured dose of a sedation drug flowing into the patient. The machine monitors the patient’s breathing, oxygen levels in blood, and the heart rate. It can be set to parameters that would probably be deemed too conservative by even a cautious anesthesiologist. The machine slows off or stops sedation at the hint of a problem.

Post-recovery time is amazingly short. Colonoscopy patients are ready to leave in 15 minutes, prompting the Toledo hospital to consider eliminating a nurse shift in the recovery room. The machine’s efficiency could also enable the hospital to add two or three more procedures to the current 15 per day in the colonoscopy suite.

The other amazing development wowing observers is IBM's Watson computer system, which is both efficient and omniscient. IBM recently announced that 14 U.S. and Canadian cancer institutes will use Watson to help them choose therapies based on a tumor's genetic fingerprint. Such an individualized approach holds considerable promise, but the problem has been it can take oncologists weeks to decipher a tumor’s genetic makeup. Of course Watson can do it in minutes.

"Watson will sift through the thousands, the tens of thousands, of genetic changes between a patient’s tumor cells and normal cells. It will learn and start finding which genetic changes are important to the cancer. The hope is this will be a tool in our everyday treatment of patients,” says Andrew Godwin, deputy director at Kansas University’s cancer center.

Institutions that are collaborating with IBM or using Watson include Duke, Yale, Memorial Sloan Kettering Cancer Center, University of Texas MD Anderson Cancer Center, the Cleveland Clinic, the Mayo Clinic, and the New York Genome Center.

Watson, not being human, is reluctant to brag but IBM is unrestrained. The company says Watson has learned how to retrieve all the relevant information that's necessary to recommend personalized treatment for a patient – “all the medical information that exists in the world, as well as all the personal information that exists in that person's healthcare record.”

"The era of machine-human collaboration is dawning now," is how Michael Rhodin, IBM's senior vice president in charge of the Watson Group, describes the new day.