Transcontinental anaesthesia: a pilot study (2013) | Hacker News Reader

Transcontinental anaesthesia: a pilot study (2013)

bja.oxfordjournals.org

25 pointsdluc29 comments

Holy cow, that's a confusing title. I clicked on it trying to figure out why you'd give pilots anesthesia on a transcontinental flight.

In case anyone hits the comments first and has the same confusion: it's a "pilot study" in the sense that it's the first of its kind, and "transcontinental" refers to controlling the process remotely. Basically: can your anesthesiologist be off-site and do his work over the internet instead of having to be in the operating room?

My first thoughts were on similar lines: A study on how to put economy class transcontinental-flight passengers out of their misery, pack them like sardines and resuscitate them on arrival. Wierdly enough, I might be tempted to opt for such a dystopian travel machinery than the one that exists now.

If it could be demonstrated to be safe, I have trouble seeing any downside to your idea!

Probably because anaesthesia has significant risks, and even if it was safe, most people would spend the first few hours on arrival puking (a very common side effect of anaesthesia).

Even at that, you have to be able to evacuate a commercial airliner in ~90 seconds. How do you fix this?

Each person sleeps in a coffin that is also an autonomous vehicle. When the emergency alarm is raised (and the plane is on the ground), all of the coffins get dropped off the bottom of the plane and they all drive their individual passengers off to safety.

EDIT: Heck, I don't see why you couldn't also put a parachute on the thing.

It doesn't have to be an airliner; if you get to "sleep" for the whole journey, why not stretch the trip to a few days or weeks on a train or bus or boat?

Because we have just 10-15 days of vacation per year.

Unfortunately, being unconscious and relatively immobile for that long would be extremely bad for your health. People in a coma require a lot of specialized nursing care -- for example to avoid developing bed sores -- and anyone immobile for a long time risks cardiovascular problems and muscle atrophy. You can get quite deconditioned from just a week or two of bed rest.

The "stasis" approach for long trips would probably have to be something higher-tech than just regular anesthesia...

https://en.wikipedia.org/wiki/The_Jaunt

Could change the title to "applying anesthesia from a remote site: a pioneering study".

There are powerful forces disallowing such innovations:https://www.google.ca/amp/s/www.technologyreview.com/s/60114...

> But the professional group said the idea of a machine replacing human expertise was dangerous.

Not surprising given that those doctors' job is on the line here.

Anaesthesiologist seems like one of the first doctors that could be entirely replaced with a robotic system. They are basically there to monitor and asses multiple vital factors, which seems entirely appropriate for a control system.

Pharmacist is the medical job that is already completely obsolete and could be eliminated if not for unions and inertia.

Pharmacists almost never do compounding anymore. They just take pills off a shelf and hand it to you. If manufacturers and doctors could agree on standard drug regimens, counting out pills would be unnecessary as well (or could be replaced by minimum wage labor or robotic/vending machine-like devices). Most pharmacies have a computerized drug-interaction checker, so even that minor function of the pharmacist is unneeded.

I wonder how recent pharmacy graduates feel about spending years of studying and training and major expense for what turns out (in today's world) to be a clerical job?

I expect that within 5 to 10 years, pharmacist will be one of those jobs like telephone operator or travel agent that used to employ hundreds of thousands of people, but is now only seen in old movies.

Good point. From what I've heard, many hospitals have already gone this route internally with automated drug dispensers. Publicly, this might take a lot longer since there is an ageing population that is simultaneously more reliant on pharmaceuticals and very adverse to change and technology.

Machines already count the pills.

(top search result: http://kirbylester.com/kirby-lester-products-and-technology.... )

Pharmacists are still well paid, which implies they are doing something of value (even at big chain stores they have good salaries).

The pharmacy degree is very difficult to get from what I understand (years of effort and limited opportunity) plus each pharmacy is required to have one on staff. So one aspect is a supply/demand. Secondly they take on some legal responsibilities so if things get screwed up they are at fault. They are there as a safety check and to resolve any ambiguities in the prescription. Much of this is being automated by computers now. Lastly they give out advice. You don't want to read a 5 page list of rare side effects...

Pharmacists are a protected class of workers. Legally mandated if you open a pharmacy. Thus, the fact that they are well-paid isn't evidence of anything, as it would be in a free market.

I mean completely automated with no human except for the customer. Customer feeds in his prescription and gets back a container of drugs and a receipt and printouts of side effects to be aware of.

Regarding well paid: That's just union (licensing agency) controlling the supply of pharmacists. Look at the airline industry: United Airlines pilots who started in the 1970s with powerful unions still make $300k a year. Newly hired pilots today make $25k now that the unions lost their stranglehold.

Philip Greenspun makes a compelling argument that the new pilots making $25k and working the longest hours under the worst condition is a desired side-effect of union negotiations. The senior pilots, controlling the union and thus its negotiating policy, improve their outcome as much as possible. The junior employees are only nominally represented by the union, and their welfare is not a objective of the negotiations.

Source: http://philip.greenspun.com/flying/unions-and-airlines

Pharmacists are well paid and will continue to be well paid because they, as a profession, do things engineers don't:

- Create industry groups that advocate for the profession as a whole, using their seat at the table to influence policy makers

- Oversight over education institutions to ensure quality of graduates

- Collectively organize to ensure fair base pay, sane work schedules, and safe work environments

Create laws to restrict competition, automation and innovation.

Monopolize education to restrict supply and prevent deskilling.

Collectively organize to extract rents from the consumer in the name of safety.

That's only the aspect of the job consumers see at the walgreens counter. There is more. Go to any hospital and watch pharmacists do the job of organizing the system that delivers, evaluates and supervises drugs. They are the ones dealing with the software that checks for overdoses in prescriptions. They are the ones freeing doctors from the regulatory hurdles surrounding all manner of drugs. Ask a doctor to describe the steps to acquire a shipment of a morphine tablets.

Ask a doctor how much a specific drug costs as opposed to a different treatment. Ask which treatment better fits the lifestyle of the patient. Then ask a pharmacist. There is value in the profession.

My fiancee is a recently graduated pharmacist. I was surprised by how much of her work is just counting pills and managing insurance.

But, as with many jobs, a robot can't handle the edge cases.

Doctors can be surprisingly ignorant about the medications that they prescribe and she's the last check to make sure they aren't going to poison a patient.

She also provides advice and clarification for patients receiving drugs that could kill them if they're misused.

The vast majority of pharmacist work will likely be automated, but it will be quite difficult.

I guess this is one of the rare cases today where removing the middleman DESTROYS value.

Most of the time they might just handle the medication they're asked for. But they ALSO VALIDATE the treatment.

Think of them like a firewall. A human one, mostly silent.

Anesthesiologists are immune from automation due to rent-seeking via licensure.

If you think about the costs and dangers of surgery as a whole, I don't think it's worth the risk trying to completely automate something like anesthesia.

The personnel really has to have a holistic understanding how the patient is doing and not just look at one number on a screen.

I would go the exactly opposite direction.

What better monitoring and tools should provide is better quality anesthesia, which is a whole big story in itself with many interesting components.

For example if you can monitor better, you don't need to give so much drugs "just to be sure". This has all kinds of benefits like faster recovery for the patient.

(Disclaimer: I've worked in a very related field.)

> What better monitoring and tools should provide is better quality anesthesia, which is a whole big story in itself with many interesting components.

To add to this, my wife is studying to be a Nurse Anesthetist and I'm always amazed that there are plenty of docs who insist on using the intubation tool that doesn't have a camera vs the one that does. I'd say around 20-50% the time they have to get the one with the camera to help out anyways. Why not just use the one with the camera if it's there.

There's a lot of value to be added in the complementarity of humans and machines, particularly in anesthesia.

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