Wednesday, January 27, 2010

The Lure of Technology

The New York Times this morning published its second article, by Walt Bogdanich, in a series on the problems of radiotherapy treatments. It seems to me that the problems are illustrative of some of our societal blindspots that we are close to dealing with.

Mistakes are being made in the use of machines designed to deliver radiation to, usually, cancerous tumors. The mistakes result in radiation overexposures and serious damage to the patients. The articles (thank you, Walt Bogdanich!) are not just scare pieces on the dangers of radiation and actually try to pinpoint the problems.

But I'd like to illuminate those blindspots even more pointedly.

1. It's hard to be sure from the articles, but it looks like many of the problems would have been avoided by the use of a checklist. Atul Gawande wrote about this a while back in the New Yorker. Pilots use checklists to make sure their planes are working properly before they take them into the air. I've used checklists to make sure that complicated scientific equipment, not unlike the radiation machines mentioned in the Times articles, is working properly. But, as Gawande notes, medical doctors tend to be resistant to using checklists. This is the kind of thing that the health care reform legislation addresses by urging best practices.

2. Apparently the radiation machines don't need to be approved by the FDA? The articles don't say this, but it would seem a good idea.

3. The companies that manufacture the machines are eager to sell them. Well, yes. But the hospitals should be better customers. We're all too eager to have a technological fix for all sorts of things. Sometimes the technological fix works, but it often needs more auxiliary thought than goes into acquiring a machine. In this case, the operators need to be trained, and perhaps educated in what the machine does and how it does it as well. Punching the correct buttons comes more easily if you know how the machine works.

4. We can expand #3 to many other situations. The most obvious is the recent push by the manufacturers of those naked-body scanning machines to install them everywhere, for use by everybody. Particularly in airports, I should say. In that case, there has actually been a fair amount of discussion of the impossibility of stopping every terrorist everywhere all the time and other considerations for installing those machines, like privacy rights. We can hope that the relevant parties are listening.

It's obvious that Bogdanich and his team (Simon Akam, Renee Feltz, Andrew Lehren, Kristina Rebelo and Rebecca R. Ruiz) put a lot of research into these articles. He and the Times are to be commended. This is the kind of thing the MSM should be doing.

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