Robots don’t challenge surgeons such as me – they challenge dogmatic practice | Ara Darzi

On Friday 10 March, I will perform an operation in public for the first time. In a live demonstration, I will aim to show how robots can assist surgeons to cut more safely, with greater precision, and achieve better results for patients.

I should say at the outset that no patient’s life will be put at risk during this event. I will be operating on a surgical mannequin – a specially adapted version of the shop mannequin designed to respond like a human body – and the event will take place at the Science Museum in London.

I will be using the same surgical robot that I used in 2001 when I performed the first such operation on a patient in the UK. It has three arms controlled from a console a few feet away, where I sit, allowing me to cut and stitch with great precision. Almost 16 years on, this will be a nostalgic moment for me. From cutting-edge technology to museum piece in less than two decades.

I am taking part in this demonstration, together with Professor Roger Kneebone, head of the Centre for Engagement at Imperial College, because I know that technological innovation of the kind represented by the robot has transformed surgery. But it will only continue to do so in the future if we have the vision and the courage to support it.

Critics will say that past technological advances have not delivered on their early promise. Certainly there have been challenges. Last year a research paper published in the Lancet comparing robotic with non-robotic surgery for prostate cancer found both achieved similar outcomes after three months.

The Times reported the story under the headline “Robots no better than human surgeons”. The Daily Mail, however, went with “Robots are better than humans at cancer ops”, on the grounds that the patients who had the robot surgery suffered less pain immediately after the operation. Is the glass half-full? Or half-empty?

I am firmly in the former camp. As I wrote in the Lancet at the time, the fact that the robot-assisted surgery achieved an equivalent outcome should be seen as a positive result. It shows that the innovation has preserved the intended purpose of the surgery. Advances in technology such as this provide the platform on which additional innovations can be developed, to further improve the quality and safety of surgery.

The device, called the iknife, can detect almost instantly whether tissue is cancerous or not

Consider where we have come from: in little more than 100 years since the two-part silver scalpel, with handle and replaceable blade, was invented by Morgan Parker in 1915, it has increasingly been replaced by the electrosurgical knife – a probe carrying an electric current that burns through tissue, sealing the tiny capillaries as it cuts, reducing blood loss, improving the surgeon’s field of view and the speed of the surgery.

Now a third advance is imminent, with the invention of an electronic “nose” attached to the electrosurgical knife. This absorbs the smoke given off as the blade burns through tissue and analyses it in a mass spectrometer. The device, called the intelligent knife or iknife, can detect almost instantly what kind of tissue the surgeon is cutting through – whether, for instance, it is cancerous or not. Instead of sending tissue samples to the laboratory and waiting days or weeks for them to be tested, the surgeon will in future be able to tell whether all the cancer has been removed before the operation is complete.

Membership Event: Robot Surgery Live

Advances such as this are ushering in a new era of precision surgery, in which established clinical and pathological signs are linked with state-of-the-art molecular profiling, enabling us for the first time to tailor specific interventions to the individual biology of the patient.

I was delighted with the interest and enthusiasm shown by the Science Museum in displaying the first surgical robot ever used in Britain as part of their robotics exhibition. It will remain with the museum as a donation from the department of surgery at Imperial College London.

But if we are to continue moving forward, we need disruptive innovators who are ready to challenge dogmatic practice and an environment in which they are free to experiment. What today looks revolutionary is tomorrow’s museum exhibit.

Robots don’t challenge surgeons such as me – they challenge dogmatic practice | Ara Darzi

Is there ever such a thing as a "good death"?

The following are merely recommendations drawn from encounter, from which you can consider as much or little as you need to have. Any try to give tips to aid individuals face death can sound glib and hopelessly inadequate for such a tough and personal scenario – but a minor planning goes a extended way.

1. Draw up a strategy. Just as you would draw up a birthing plan, creating one for the other finish of daily life is also a beneficial exercise. What is actually critical to you? Exactly where do you want to be looked right after? What is the next ideal alternative? Do you want tons of medications, or do you want to be as meds-totally free as possible? What other measures do you want taken? Who do you want to be there?

As with a birthing prepare, this is only a guideline, and may nicely go out of the window. But to have it as a starting up point is helpful for the patient, their loved ones, and the health-related staff. Often medical doctors struggle to end treating patients and enable them to get on with dying, so it is useful if you can give a steer on when sufficient is ample.

Drawing up such a program is, of course, not simple. Most individuals struggle, due to the fact to do so implies to admit, to themselves and to other individuals, the reality of their predicament. It indicates searching death in the eye, and many men and women, particularly and understandably the youthful, locate this extremely difficult to do. If you truly feel strongly, write it down.

two. Tie up loose ends. While you are ready to, you need to search soon after any situations that will upset you if you fail to do so. You really don’t want to be paying your final days regretting your inaction, whether it is to do with domestic things or personal matters. If you want to reconcile with an individual with whom you have fallen out, choose up the phone. I often see people reconciling with estranged loved ones at the extremely, quite end of their existence, and I frequently have heard ‘l want l‘d accomplished this sooner’.

If a romantic relationship is so important that you want to reconcile in your final days, certainly it was worth salvaging weeks, months or even years just before, when there was nevertheless time to appreciate it.

three. Appoint a important supporter. Pick a person you love and trust to be your essential supporter. This man or woman is practically like your care manager. They must be aware of the particulars of your plan, of your hopes and requirements. The inevitable truth is that you are not going to be dealing with 1 kindly medical professional, 1 nurse, but with a host of healthcare personnel of varying degrees of seniority, several of whom will almost certainly be run off their feet.

This person need to be your advocate and communicator with the health care employees, notably if you reach a stage where it is difficult for you to make, or communicate, your selections. Choose somebody who will also be trustworthy with you as and when the need to have arises.

It is also beneficial to appoint someone (probably not the very same individual) to communicate with the rest of the family members. There are usually individuals who want to be stored informed, and obtaining one particular person to do this simplifies and streamlines the entire method.

4. Get care of finances. It would seem crass to be contemplating about monetary matters at a time of such heightened emotion, but the last point you want is to be worrying about cash at the very end. Cash matters can quickly turn into really hard. I’ve frequently observed carers get in such a muddle about funds, and worrying about regardless of whether they can afford to travel to hospital, that they cannot look after their own emotional needs, or these of their dying loved a single.

Plan ahead how you will control your finances. Really do not wait for items to go incorrect. And if you require support, make an appointment with an adviser, or an individual from your bank.

five. On the subject of income, if you have got it, use it. ‘Bucket lists‘ are for the properly. Nevertheless, as cancer patient Stephen Sutton lately showed,

It is a sad and ugly truth of existence and death that funds really assists with the fundamentals. Dying can get a lengthy time – and the cash for parachute jumps may well be far more beneficial to get help and added care, and help expedite certain factors of your strategy. Companies perform, but occasionally they use up time that you could not have.

^{Stephen Sutton designed a bucket listing of 46 ‘weird and wonderful’ factors he needed to accomplish ahead of dying – but they did not all involve paying enormous quantities of money}

6. Communicate with every single other. Death requires so considerably emotion, exhaustion and strain it is extremely simple for wires to get crossed that need untangling. Typically the dying person feels they cannot preserve on fighting any more but, specifically if they are younger, they could come to feel that providing up would suggest letting their loved ones down.

At the same time, unbeknown to them, their partner might be feeling exhausted watching their loved 1 struggling. They might be at their wits’ finish, residing on a shoestring, balancing all kinds of responsibilities, and still becoming at hospital morning and night. If absolutely everyone can communicate truthfully and openly, it can stop a lot of needless agony. Often this wants some support to be able to speak openly, to be provided the area to request – is it Ok to end?

Communication applies across the board. Try out to be honest even with people you would like to safeguard, like your dad and mom or your youngsters. Consider and be upfront about the problems, as gently as attainable. I’ve noticed the most painful, confused circumstances exactly where folks, out of the extremely ideal of intentions, have tried to hold the truth from people close to them. It prospects to needless isolation, soreness and muddles with medics and can stop the relief of asking honest question and acquiring truthful solutions. And on that point …

7. Fight the dread. Fear can play this kind of a large component in people’s finish of daily life knowledge. Dying removes management of our bodies, and we grow to be physically and emotionally dependent on other people which can be the most frustrating, frightening and humiliating expertise. Individuals describe it as a sheet of plate glass among themselves and the rest of the globe – isolating and airless. We want answers: Why me? Why now? When will it occur?

Often there are not any. Give your fears an airing. Talk to a person, whether or not it is somebody close to you, or an impartial medical expert. Try an individual else if that particular person struggles to listen and reassure. Occasionally it is the dread of dread itself that is the most destructive. We can elect to remain in the existing and emphasis on what today brings rather than mourn our misplaced tomorrows.

8. Change your mind. Often men and women say that they will favor to die at residence, in familiar, cozy surroundings. But, as time moves on sufferers typically change their mind and want to be somewhere the place healthcare assist is quite readily accessible. Have the self-assurance to do this, if it’s what you want.

For some men and women receiving to know the hospice day- and outreach nursing services is a way into considering about what practical choices are available. Individuals often talk of feeling ‘safe’ in hospices. Everybody understands their job. They are utilized to currently being all around death, and they have the time and the capability to engage with the patient’s loved ones the two before and soon after death. Nevertheless, dependent on in which you reside into the nation, your age, illness and dependency, your access to a hospice could be different.

All around 60 per cent of folks even now die in hospitals, and with an older, frailer population residing alone some distance from operating relatives and assistance, hospices continue to be a little and scarce resource. Dying in a complicated occupied hospital surroundings presents a various challenge to staff and to patients’ families.

It is tough, despite the best intentions, to provide the very same degree of care, privacy and continuity that a hospice offers, and in some methods it is an unfair comparison. I have seen examples of both the extremely ideal and the extremely worst of care in hospitals.

Ann Munro has been a palliative care psychotherapist for thirty years and also works as a clinical ethicist, dealing with ethical dilemmas at the end of lifestyle. She was concerned in Channel 4’s new series, My Last Summer season, which starts on June four at 10pm

Is there ever such a thing as a "good death"?

"No Such Thing As GMO Contamination" Principles Australian Court in Landmark Selection, Rebuffing Organic Activists

As the Genetic Literacy Project reports, in an endorsement of the co-existence of genetically modified and natural farming, the Western Australian Supreme Court today rejected claims by a farmer who contended that his natural licensed farm was “contaminated” by a neighboring farmer growing GM canola.

“I am not pleased that in 2010 Mr. Baxter breached any (lesser) duty of reasonable care,” Justice Kenneth Martin wrote in his judgment.

Natural farmer Steve Marsh had sued his neighbor and former buddy, Michael Baxter, claiming that GM canola from Baxter’s land had drifted onto his organic oats, rye and sheep farm in Kojonup, Western Australia. The Nationwide Association of Sustainable Agriculture Australia (NASAA) temporarily suspended Marsh’s natural certification on about 70 % of his house in late 2010. Marsh sought monetary compensation of $ 85,000 (AU) from Baxter, as effectively as a long lasting court injunction banning Baxter from planting GM crops.

In contrast to the United States, the European Union and Japan, which let trace amounts of GMO crops in natural meals in acknowledgement of cross pollination by wind or pollen transfer, Australia maintains a zero threshold.

Anti-GMO groups have gotten a great deal of traction by branding cross pollination as “contamination.”  Cross pollination occurs naturally but is regarded unacceptable to organic purists, who want natural crops to be entirely cost-free of pollen from GM crops and want individuals demands incorporated into legislation.

Just lately, voters in two southern Oregon counties accepted measures to ban the cultivation of GM crops based on “contamination” issues. The Marsh versus Baxter case has attracted global consideration as it sheds light on how “contamination” claims by organic farmers may be received in other courts.

In the 150-webpage judgment summary, Justice Martin wrote there had been no unreasonable interference with Marsh’s crops. He found that the determination to withdraw natural certification was produced by the Australian organic certifying bodies NASAA/NCO and it was that decision and not natural cross pollination that price Marsh about $ 85,000 (AU) in decreased cash flow.

“Mr. Baxter was not to be held accountable as a broadacre farmer merely for expanding a lawful GM crop and deciding on to adopt a harvest methodology (swathing), which was completely orthodox in its implementation,” he wrote. “Nor could Mr. Baxter be held responsible, in law, for the reactions to the incursion of the Marshes’ organic certification entire body, NCO, which in the conditions presented to be an unjustifiable response to what occurred.” Martin added there was “a really strong physique of proof in this trial to suggest that there was no reputable contractual basis for NCO to decertify” Marsh’s farm.

Natural tolerance requirements challenged

In the course of the eleven-day hearing in February, scientists also testified that Roundup Ready canola swathes have been harmless to animals, people and land even if consumed.

The court case has highlighted contradictions in recent Australian farming and natural certifying regulations. Professor Rick Roush from Melbourne University’s College of Land and Atmosphere stated he believes the situation is exclusive to Australia, simply because the Australian organics industry has a zero tolerance to the presence of any GM materials in certified organic merchandise.

“In other nations, there is a tolerance for quite little levels of legally accepted seeds, or pollen, or no matter what, to be found in a crop, even in organics,” he mentioned. “In the United States, for instance, there are broad-scale examples of GM and natural crops being grown in near proximity. In fact, in some farming operations in the United States the very same farmer will be using both GM and organic production.”

The Australian court ruling has no direct impact upon U.S. law. While related issues and fears of “GMO contamination” are also widespread amid organic farmers in the US, there has been no case in which an organic farmer has misplaced natural certification because of cross pollination. Even so, typical growers have had grain rejected for shipment simply because of the presence of GMO seeds.

The US Department of Agriculture says there is no threshold for the sum of acceptable cross pollination, and handles the concern as such:

As opposed to several pesticides, there aren’t distinct tolerance levels in the USDA organic regulations for GMOs. As this kind of, National Organic Program policy states that trace amounts of GMOs don’t immediately indicate the farm is in violation of the USDA natural regulations. In these instances, the certifying agent will investigate how the inadvertent presence occurred and advocate how it can be much better prevented in the long term.

Decision fallout

Throughout a major overview in 2011-twelve, the USDA Advisory Committee on Biotechnology and 21st Century Agriculture (AC21) endorsed coexistence in between farmers expanding typical, natural and genetically modified crops and rejected calls by natural activists for “zero tolerance”:

Numerous commenters recommended that we set up a “threshold” for the unintended or adventitious presence of items of excluded strategies in natural products. Some commenters argued that a threshold is required because, with no the necessary labeling of biotechnology-derived items, organic operations and certifying agents could not be assured that items of excluded approaches had been not getting utilised. Other folks argued that, without having an established threshold, the laws would constitute a “zero tolerance” for items of excluded techniques, which would be extremely hard to attain.

"No Such Thing As GMO Contamination" Principles Australian Court in Landmark Selection, Rebuffing Organic Activists

Is a co-spend such a negative point? | Declan Green

As a GP, I locate the outrage directed at the notion of a co-shell out to check out a GP intriguing. In overall health policy, it is not common for a proposal to be met with universal derision – so does the sight of politicians, well being advocates and doctors’ groups singing the very same Christmas carol signal a particularly poor policy? Possibly –but I hope it also begins to adjust our mindsets and how Australians see their health technique.

How our overall health policies are implemented is a real problem, and one particular we must concentrate on. For example, current policies aiming to increase accessibility for individuals with chronic illnesses or mental illness to dental or psychological companies were subjected to considerable cost blow outs, resulting in the axing of 1 system and the curtailment of the other.

To think a conserving of under $ 200m a yr will be attained by a co-spend, and that demand for GP visits will reduce by 3% as a outcome, is unlikely. In actuality, human behaviour will change. Individuals will generate buying lists of health-related issues so they get their “money’s worth”, thereby clogging up appointment books, or will try to keep away from the co-payment by requesting prescriptions, referrals and paperwork over the mobile phone. In several circumstances, medical doctors are likely to waive the co-payment to guarantee repeat custom or alter their practice type to exempt shorter, easier consultations from co-payment in buy to maintain each patient throughput and their business’s viability. I really don’t know any GPs who would flip individuals away on the basis of their capacity to shell out, and this will not change.

So why would I support a co-shell out if I feel it will not make a considerable effect on wellness paying? Because even though the policy is underdeveloped, it does set off a debate on a amount of concerns that have been averted by many governments, but which we need to urgently tackle nonetheless.

Firstly, the current mindset that a universal overall health method is a right and not a privilege needs to change. Health care is enormously pricey, but hardly ever does the public see these expenses. I usually point out to bulk-billed pensioners who get hormone injections as element of their therapy for prostate cancer that the ten minute go to to administer their pricey treatment expenses the tax payer about $ two,000. I frequently wonder if the family who want their dear mom to convalesce in the public hospital one more night, as tomorrow would be a much more hassle-free day to take her residence, are aware of the $ 1,000 a night price tag tag. I hope most physicians ponder the cost of that further blood test or scan, and regardless of whether investing an further $ 400 alterations the management of the patient prior to them. With our ageing population and the escalating disease burden that follows, at some stage the health dollar need to be rationalised. Opening the wallet to make a tiny contribution to their care can make the value of universal overall health care momentarily visible to the user.

Secondly, we require to modify our frame of mind to Medicare. It is a public health insurance coverage scheme to which we are all policy holders, and our behaviour determines to what degree our premiums improve yearly. Other forms of insurance coverage offer a very good instance of the issues we face. The other week, my auto was nudged by an additional motor vehicle and sustained a tiny scratch. As the other driver was at fault, I manufactured a claim towards his insurance coverage to get the scratch fixed. I basically turned up to the panel beaters, they fixed the scratch, presented to detail a few a lot more scrapes at no expense to me, and I signed an insurance declare and walked out. Amazing! And this is how most of us interact with Medicare. We do not see the costs, but we all shell out. The at-fault driver’s premium goes up and costs are defrayed across all policy holders in the kind of rising premiums. It encourages us not to consider ahead of we make a declare as in most situations, we really don’t pay or spend really small. If I had scratched my vehicle and faced a co-payment to fix it, I would believe twice about how truly essential that restore work is.

Finally, we need to have to appreciate our wellness technique. Wellness care is the most important cost most produced nations face but most of us have little concept how it all performs. We bemoan its shortcomings and fail to appreciate how fortunate we are to have it. We have greater health than the vast majority of the world, yet we grumble about emergency waiting times, paying out a number of dollars for drugs that expense thousands, and the top quality of hospital meals. In my experience, the elements of our wellness program perform very properly and we by and massive dwell extended, healthier lives.

As the New 12 months approaches, I would like to increase a glass and toast the continued viability of our excellent well being system. Even if it charges me 5 dollars to fill it.

Is a co-spend such a negative point? | Declan Green