In 2017, a research team from a Finnish university did a controlled trial on a common shoulder surgery technique. One group of patients had ‘sham’ surgery, where the surgeon simply made an incision then stitched it up again, while another group received the actual surgery. The team found the real surgery performed no better than sham surgery.
This was no obscure operation being performed by rogue surgeons: “Nearly 21,000 decompression surgeries [were] done in the UK every year, and ten times that many in the United States,” said adjunct professor Simo Taimela, University of Helsinki research director. Their research findings highlight an alarming fact: As many as half of common operations are not supported by reliable evidence that they work.
While some surgeons still perform this operation (the placebo effect gives patients a better chance of recovery than no treatment,) is it rational to expose these patients to the risks of surgery? One in six patients develop post-surgical complications, and one in 35 patients die after surgery worldwide. The people that died might’ve been already seriously ill, but then again, the most common post-surgery complication is something preventable: Infection.
Surgery is not the only way to treat illness that carries inherent risk. For the many benefits, medications come with downsides. If it’s effective, it probably has side effects too. Side effects and their likelihood depends on the medication, but in general, they range from tolerable but annoying (rashes, dry mouth, itching) to life-changing (seizures, migraines) to life-threatening (allergic reaction, cytokine storm.)
Technology is increasingly providing ways to prevent and treat illness that mean patients don’t need to take the risk of surgery or face medication side effects. These recent examples show technology helping us live longer, more pain-free lives.
Brain surgery without scalpels
Stereotactic radiosurgery uses light beams to target cancer cells in brain tumors without making any incisions. The light beams break down malignant cell DNA and create an inhospitable environment for the tumor. For some cancers, it’s as effective as surgery, but without the pain and recovery time.
TED Medical guide to stereotactic radiosurgery
As well as brain tumors, the technology has been successfully used on some lung, pancreatic and liver cancers. It treats animal cancers too.
Unashamedly evoking visions of the future with its spaceship-like design, gyroscopic radiosurgery further refines the technique, using gyroscopic motion to more accurately direct light beams at the tumor.
Flagging errors in prescribing medicines
Doctors are busy. Errors in prescribing medication – such as wrong dosage or not noticing a patient’s medication allergy – are behind a surprising number of hospital admissions. Around 1 in 10 hospital prescriptions and 1 in 20 general practice prescriptions contain potentially harmful errors.
After deep-diving into the reasons behind prescribing failures and what other countries have tried to improve practice, the UK started implementing software that’s making a big difference. Pharmacist-led Information Technology Intervention (PINCER) scans patient records and flags risky prescribing. Since its introduction in 2018, risky prescribing has fallen by nearly 15 percent. The biggest successes of PINCER might be ahead, with roll-outs where most prescribing errors happen: On hospital wards and in emergency departments.
Diagnosis and treatment by artificial intelligence
In 2019, The Lancet published a systematic review and meta-analysis (grouping data from many studies to make for more dependable analysis) showing artificial intelligence (AI) has become reliable enough to be considered an accurate source of diagnosis. This may mean more accurate and earlier diagnoses, avoiding the need for surgery or medication.
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Pharmaceutical company Bayer is also working on software that uses AI to help diagnose complex and rare conditions and develop medications to treat them. The software could help identify more quickly whether medication works. “We’re looking at how we can identify the right patients and sites to run our clinical trials. We would be able to run shorter studies and show where the medication is the right one for those patients earlier,” said Bayer’s head of AI projects, Angeli Moeller.
Some AI-enabled diagnostic innovations haven’t gone so well. Since 2017, the UK’s National Health Service (NHS) has trialed an AI-enabled chatbot and remote consultation app, GP at Hand. Its implementation was plagued with claims that the app’s AI was making mistakes. One doctor wrote to the British Medical Journal (BMJ) to point out that safety and effectiveness claims were based on shaky evidence. To answer concerns, one council commissioned an independent study. The study found the app was viewed positively by users and doctors but was unlikely to benefit the most vulnerable patients because users tended to be young, affluent and in good health. High numbers of users were choosing to stop using the service, but one potentially positive outcome: When connecting with patients through the app, GPs were less likely to prescribe medication. With known over-prescribing problems around antibiotics and antidepressants, less prescribing could be a good thing for our health.
‘Delocalizing’ care with technology
COVID-19 has meant many are now familiar with over-the-phone or video consultations with doctors and specialists. A raft of innovations alongside this shift are helping make remote patient care more effective.
One example we recently covered is the StethoMe digital stethoscope. It lets doctors receive digital waveforms of a patient’s breathing and heartbeat over the internet.
Then there’s Ochsner’s iHealth Ease Cuff, a blood pressure-measuring arm cuff that connects to a patients’ smartphone over Bluetooth, sending results straight to their doctor. The theory was that frequent monitoring and feedback would help patients manage their condition better and let professionals intervene in problems earlier. Trial results seem to back this up, with double the number of patients in a group that received the cuff achieving their health goals compared with the group receiving conventional care.
Recently approved by the US’s Food and Drug Administration (FDA,) Clarius technology enables faster ultrasound scanning in a wider range of settings. The wireless ultrasound scanner connects to an app on tablet or smartphone, making high-quality ultrasound more portable. Paramedics and non-specialists can transmit live scans to a specialist who can review them in real time. The app also uses AI to adjust scanning parameters, reducing user error and the time taken to get results. All this means faster, more accurate diagnosis, and no need to take the patient to the equipment.
There is constant development of new technologies that can improve patient health without surgery or medication. Greater investment in healthcare research and innovation thanks to COVID-19 may further speed the arrival of these new ways of doing medicine at a hospital or clinic near you.
In the laudable rush to do everything we can to save and improve lives, we must not lose sight of the data security and privacy implications of these new technologies. Technologies often do most good in the hands of people who’ve traditionally had less access to healthcare, like older patients and those in isolated areas. This, in itself, makes the need for cybersecurity awareness among patients and practitioners all the more acute. There is no need to hold back innovation, but there is a need to involve the right people in testing and design, and when it comes to cybersecurity, educate, educate, educate.