KNOWLEDGE AND TECHNOLOGY - AN UNENDING TUSSLE

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URGICAL KNOWLEDGE  and SURGICAL TECHNOLOGY are two comets which we are trying to ride at the same time. They both are fast and we have no control over them. We are holding on, with great difficulty, to the tail of these two Comets, hoping that they will take us to the right place at the end of the ride. Sometimes we pray that we can hold on for the entire ride. Sometimes we find ourselves praying that the Almighty God will be merciful and just let us fall off. What we shudder to think is what will happen when next time the two Comets choose to move in opposite directions as they have undoubtedly done in the past.

While it is so true that we can not hold on to the older proven techniques and should continue to strive for excellence at all times, the reality is that all that is new and for offer is not invariably good and useful. There is a lot of market driven euphoria and baseless jingoism with quite a few so called new gadgets and hence our reluctance to succumb to them like nine pins. When confronted with a new machine / technology we should ask whether we the masters or the slaves of the technology ? Once we understand that we must be the master the rest is fairly simple. The ultimate purpose of any technology is to help its master to do his or her job better. Our job is to cure patients, improve the quality of recovery and patient’s well being and reduce the sufferings of those we can not cure. We also must make treatment efficient and cost effective. If a product of new technological boom does not meet these criteria we must ask “ Why are we doing this ?”

State of the art Technology  is no substitute for the State of the art Knowledge, in fact it is quite useless and on most occasions downright harmful without it. Technology has not always taken us to the crest of success every time. The moment we have allowed it to lead our Knowledge it has led us astray, or more correctly we have allowed technology to lead us astray.  Extracorporeal Shock Wave Lithotripsy ( E.S.W.L.) has broken millions of stones in the kidney, ureter and bladder.  Thinking it to be a stone breaking machine a few among us tried to crush stones in the Gall Bladder expecting them to disappear like magic.  We conveniently forgot to compare the anatomy and physiology of the two organs - in one clear urine washes down the debris through a straight ureter and in another thick viscid bile slowly finds its way down across a spiral course and through a valve. The result was a disaster of enormous proportion and all because we did not do our homework well. The marriage of Knowledge and Technology is a very turbulent one as both are highly ambitious and growing very fast. A postal delay in delivery of two Journal issues leaves one fairly behind in patient care and ignoring Seminars and Conferences makes one antique.

If necessity is the mother of invention, then strategy should be its father. Technology should not evolve spontaneously. Its evolution should be our responsibility.  Where do we go from here ? What technologies are on the horizon ? How do we open our minds without closing too many doors?  Surgeons are looking at technologies that could enormously improve patient care and even put them out of business; that can fix things without touching them,  and touch things without seeing them. These are weary times but also exiting!

The future very often arrives faster than expected. In 1996, a renowned biologist, Lee Silver of Princeton University, wrote that it is impossible to clone mammals via cell-nucleus transfer. His book had not even reached the bookshops that scientists of the Roslin Institute in Scotland announced that they had succeeded in cloning Dolly the sheep. The best way to predict the future is to invent it because the visions of the future created by research laboratories, think tanks, science fiction authors and other visionaries not only form a matrix for the social perception of tomorrow's world but also open up the associated opportunities. Such futuristic thoughts are known as memes which propagate in society like a cultural gene. The mass media dictate collective expectations of the society and hence, can analyze the memes. Cinema can project new technologies as being real even if they are in the developmental stage and society will accept it, at least in the subconscious mind. The most radical ideas from science and fiction may find solutions to problems which we face in real life. On the other hand, consumer expectations are also programmed in this way. Micro-vascular transplants of severed limbs were seen in comic strips half a century ago, today they are a reality in a general hospital near you! 

Human life might also become programmable. Families will be designed and children selected according to catalogs. The gender of children might be reversible during the course of pregnancy and the little brother will be a robot. (!!!!!) Thus, our notion of family happiness might get programmed and human beings would like to make the entire world a theme park where spectacular experience boosters are available. One minute holidays and artificial hibernation of unproductive times will become the order of the day.

In the healthcare sector of the future, less emphasis will be placed on curing illnesses than on prevention and well-being. Beings and machines will merge; body and consciousness will be rewired. The new combination of natural and artificial hardware and software will create mechanical humans and human machines. Death might become optional with artificial parts increasingly replacing diseased organs. The secret of self-healing will be decoded changing the treatment pattern in dentistry. But the human evolution will continue and result in new intelligent beings.

The future belongs to those who tell the best stories about the future; in other words, only creative thinkers will get an opportunity to contribute towards future professional needs. Plastic Surgery is generally considered as a skill-based specialty but we have begun to establish our knowledge base. As a knowledge-based specialty, adoption of new technology is a natural extension of our commitment to patient care and not to skill-based bravado. Many new technologies are adopted from other fields viz . nanotechnology, lasers etc. With a solid knowledge base, we will not be afraid of technological failures and adopt technology as early as possible. 

Many technologies are popularized by corporate investments which may not be inherently interested in patients but be more of business opportunities. The profession has to manage the pressures of the market without ignoring the science because ignoring them totally will be fatal to our future growth. Knowledge has to remain a step ahead of Technology and riding these two Comets, though not easy, has to be done throughout the active professional life of a Surgeon , or shall I say, any Professional