• President's Message

    • Mar 26, 2017

    Author: Elad I. Levy

    In 1937, the great American inventor and businessman Charles Kettering said, “It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.” My hunch is that if Mr. Kettering were alive today, he would want to double down on that belief.

    History is full of examples where that which was once universally accepted as the truth was eventually replaced with equal conviction of the exact opposite. In 1615, Galileo was placed under house arrest for writing that the earth circled around the sun. Today, anyone alleging the opposite with conviction would be considered a lunatic. In 1846, Ignaz Semmelweis, a physician from Vienna, was put in prison and eventually beaten to death after trying to convince other physicians that patients were dying from infections due to physicians not washing their hands (Figure 1). Today, physicians who insist on not washing their hands before and after touching patients would have a hard time finding employment anywhere in the world. Up until 1982, every respected physician in the world was absolutely convinced the human stomach had far too much acid for bacteria to survive. That is, until pathologist Robin Warren and gastroenterologist Barry Marshall showed that wasn’t true for the bacteria H. Pylori, which, by the way, also happened to be the cause of stomach ulcers. Warren and Marshall won the Nobel Prize for their discovery and saved millions of people from suffering the pain and disability of stomach ulcers.

    Figure 1 – Ignaz Semmelweis, MD

    For those of you who are old enough to remember a rotary phone, how about these former beliefs: The encyclopedia is the most important and reliable source of knowledge. (True, unless you consider this thing called “the Internet.”) Every major city has one morning and one afternoon newspaper, in addition to radio and television stations. (Raise your hand if you were born after 1980 and have either read a printed newspaper or sat down to watch the evening news in the last six months. I thought so.) High inflation is a permanent part of American economic culture. (Thanks, but we’d prefer a 2 percent mortgage over a 16 percent mortgage.) And finally, only seasoned politicians and military heroes are elected president of the United States. (Hey, my state is fire-engine red and we were just as surprised as you.)

    Here are some things I thought were absolutely true until just recently: Only a human being could possibly win a game of Jeopardy! In 2011, IBM’s Watson, a question-answering computer using a cluster of 90 servers with 2,880 processors and 16 terabytes of RAM, beat the all-time Jeopardy! winner Ken Jennings (Figure 2). Here’s another— health care providers are the only ones who can accurately diagnose illness. Who else, after all, can talk to patients, examine them, review labs and imaging studies, think about a differential diagnosis, and make a treatment plan recommendation? Well, it turns out, the some leading health care organizations are betting that Watson is capable of doing just that. After Watson has a query posed describing a patient’s symptoms and other related data, it reviews the patient’s health record for pertinent history, labs, images, notes from other care providers, treatment guidelines, clinical studies, research materials, and comparisons to other similarly situated patients to come up with a differential diagnosis and treatment plan.

    Figure 2 – IBM Watson on Jeopardy! ©Sony Pictures Television

    Now, let’s add this: Today, there are numerous virtual care companies that remotely monitor many patients who have multiple complicated medical conditions (Figure 3). Each of those patients has Bluetoothenabled monitoring equipment in their home for data like heart rate, temperature, respiratory rate, oxygenation, blood pressure, blood sugar, and weight, which is automatically uploaded into a data cloud and transmitted to providers. When their results start to fall out of line, patients receive phone or video calls to put treatment plans in place before an adverse event occurs.

    Figure 3 – Remote health monitoring.

    Can you see where this is going? If you, like me, believed the diagnosis and treatment of human illness was squarely in the hands of other human beings, maybe what we know just ain’t so. We are in a time when many things formerly done by thinking human beings can be reduced to a computer software algorithm, replaced by a robot, or outsourced to those who can do it better, faster, and cheaper. But before some of you get a sinking feeling in your gut and make predictions about the apocalypse, think about these statements. The standard prediction by futurists today is that Artificial Intelligence (AI) will overtake humans in 20 years. What you don’t often read is that this is the same prediction many were making in 1955. Since the 1970s, the biggest increases in the labor force have been in education and health services, which doubled as a percentage of total jobs. During that same time, employment in professional and business services was up 80 percent and hospitality and leisure services are up 50 percent. This indicates a clear trend toward more employment in industries that value human interaction.

    But the trend toward thinking being done by computers is also clear. The analytic skills of math and science are ever more susceptible to lowcost competition and software. College graduates with high cognitive skills like engineers are using those skills less. Since 2000, the amount of brainpower required of college graduates has decreased, and in 2012, it reached the same level as 1980. Cognitive skills are still important, but those who use their cognitive skills in addition to showing an ability to build relationships, persuade, collaborate, and lead are in a superb position to thrive. We have evolved from the industrial era, to the knowledge era, to the relationship era. As people who have dedicated our lives to the care of other people based on our ability to use our knowledge to form a caring relationship with them, this should make us feel hopeful.

    The fact is, change is inevitable. The way we do things, how we achieve our goals, even where we carry out our service to others is going to change. Those changes don’t make us victims, however. If we accept those changes, adapt our thinking around those changes, create and maintain meaningful relationships with each other, as well as those we serve, we become the masters of our fate. Although there is much we don’t know about our future, when we actively engage in creating that future, there is a lot less to be fearful of, and a lot more to look forward to.

    In this edition of the cnsq, you will hear from a number of distinguished neurosurgeons who offer their perspective on change in our profession. John Morrison explores how big data can impact the future of neurosurgery. Joe Maroon offers a perspective of all that has changed over the course of his career, while Fred Barker describes approaching old problems in new ways. Henry Woo discusses some exciting technology in aneurysm treatment that could change how we think about that morbid disease. Allan Levi discusses the changing science of spinal cord injury, and we’ll hear from Alok Ranjan about the rapid growth of medical tourism in India.

    Thank you for your attention and continued support of the CNS. On behalf of the entire staff and executive committee, we truly appreciate your membership.

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