Saturday
Nov202010
Bill Gates and Robot Cesareans
Saturday, November 20, 2010 at 4:50PM
By Jill—Unnecesarean
SmartPlanet reported that Bill Gates told the audience at the mHealth Summit on November 9, 2010:
When asked what’s next in our technological advancement, Gates said there’s no doubt it’s robots. “If you don’t want to go to a convention,” he said, “just send a robot. “When we look at something like infant mortality, there’s a certain level you can’t get below if you can’t do C-sections.” He said doing a caesarean section delivery requires a sterile environment, but Gates said it’s fairly routine, so it could be done by a robot.
Reader Comments (31)
A robot controlled by a doctor who is looking at the operative site remotely maybe.
Some surgeries are already done this way with tiny "hands" controlled remotely. They are called "Waldoes" after the Heinlein story Waldo and Magic Incorporated.
Gates may know about robots, but I don't think he knows much about anatomy. There are too many variations of human anatomy to make a procedure automatic. An infinity of judgment calls which I think is more than we can program a robot to make.
There is also something offensive about the very idea of it. And he isn't exactly an expert on birth, to be making pronouncements about it.
The rate was somewhere down around 5% in the 40's. I don't think the mortality rate has decreased corresponding with the increase in C sections. Someone MIGHT be able to convince me that there was some morbidity which could be decreased by increasing the rate to 10% but they would have to prove it. I hear that cerebral palsy, for instance, has not decreased as it was thought it would once difficult forceps deliveries were replaced by C sections.
He stole the GUI interface from Apple and marketed it better. So he is rich rich rich. It doesn't make his pronouncements about birth worth a bean.
Susan Peterson
I don't know, given some of the comments I've heard out of the mouth of OBs (or heard about), a nice automated robot a couple of nurses and a doula might be an improvement ;)
Oh my.....so many snarky comebacks coming to mind....
PROS:
Having a robot do the surgery might have the benefit of not giving you the false impression that any other outcome was possible.
No annoying personal conversations between surgeon and staff during the glorious moment of your child's birth.
CONS:
If OBs were worried that midwives were going to put them out of business, what would they think of the robots???
Can robots be sued in court for malpractice?
I absolutely see where he's coming from in terms of the infant mortality/global health perspective. From the robot perspective...? Let's not be too trusting of the guy who created Microsoft Windows. (Says the devoted lifelong Mac owner.)
"Fairly routine," until it isn't. Maybe it's okay; but all women's anatomy is not identical, and I'd sure hate for the robot to miss an aberration or "variation of normal" and cut an artery that "shouldn't be there" that a person would recognize, even if a machine doesn't. On the other hand, if it's more precise than a human, it may reduce human errors. But the thought of the first thing touching the baby being a machine rather than a human makes me say *dislike*.
You gotta be fucking kidding me!
This coming from a guy who has performed so many right?
There you go, just what we need. Remove human error. And then, look -- the robots have a 100% accuracy rate! Much better than when we let women birth naturally! Everyone should have a c-section! Can you hear me throwing up over here? Yeah, thanks Bill Gates. Thanks a lot. Taking away that human aspect of it means the medical model of care will become that much less interested in individual, personal care and a lot more interested in text book, one-size-fits-all care. It's not bad enough we're already there, but do we really need to force it that much further down the drain? Absolutely disgusting.
@Susan - re: C/s rate & maternal mortality - actually, one could make the case that the MMR has decreased along with an increase in C/s rate -- to a certain point! When birth started being taken over by doctors and hospitals, the MMR went up, and in 1935 the White House issued a report blaming the high MMR at least in part on the over-medicalization of childbirth, and specifically called on a reduction in the C/s rate. This was in the days before antibiotics (they possibly had had sulfa drugs for a year or two) and before safe blood transfusions. The MMR has gone down basically every year from that time until 1987 (there may have been a slight fluctuation, with one year being slightly higher than the year before, in the 70s and early 80s). But correlation does not equal causation. There were many changes that occurred between 1935 and 1987 that reduced the risks and incidence of maternal mortality (a general increase in health and sanitation, for instance, as most people got electricity and running water, plus improvements in overall medical and birth knowledge), separate from C-sections. Plus, remember the "GIGO principle" -- "garbage in, garbage out" -- the official rate is only as good as what was reported, and while reported MMR may have been as low as 6.6 in 1987 and has doubled since then, in the past the CDC has publicly acknowledged that they miss as many as 30% of maternal deaths that should be counted as MMR. Efforts have been made at improving the accuracy of reporting, so it may be that the *apparent* increase in maternal deaths is at least partially attributable to more deaths being *counted* rather than more deaths *occurring*. But, since all we have to go on is the CDC official stats, either the rate of maternal death has actually doubled in the past 20 years, or there were many maternal deaths that were ignored for the past 3 decades.
Gates, just stick to computers. Seriously.
I'll happily sign up after every dude needing any kind of operation on his penis and/or testicles agrees to use the robots. You first, Billy!
It's one quote that really needs some clarification.
did anyone bring up 'StarWars' where Padme' has her tiwns by robot c-section...no wonder she dies of greif.
Talk about impersonal and dehumanizing
Interesting about the trajectory of maternal mortality. Since the Gates quote mentioned infant mortality, that is what I was thinking of.
If you got the C section rate down where it was in the 40's would more babies die? Would more be impaired? I mean, they don't say, have a C section or YOU will die. They say, have a C section or your baby will die. Or be brain damaged. What kind of proof is there that all these C sections have changed infant outcomes?
Susan Peterson
@Naomi - LOL - I thought the same thing. You 'n me = geeks.
Cesarean sections need to become MORE humanized, not less. Yuck, Bill. #FAIL
Just a perspective for everyone here - there are countries and regions in which c-sections are literally not accessible. There is no one to do them. Bill Gates is drawing on the current understanding of reducing maternal and infant mortality, whose foundational paper is Deborah Maine's "Maternal Mortality -- a neglected tragedy. Where is the 'M' in MCH?" At the time she wrote it (1985) a lot of people thought if you gave women better prenatal care - check-ups, vitamins, etc. - there would be much better perinatal outcomes. She argued that the evidence was that prenatal care didn't do much for mortality, and the real key was access to emergency obstetric care, i.e. medications for hemorrhage and c-section surgery.
Bill Gates is not arguing that robots should do c-sections in the U.S., nor is he making any arguments about the links between maternal and infant mortality and the very high c-section rate in the U.S., nor do I believe he is saying that it's better for robots to do a surgery than for people to do it. He is arguing (rightly) that when you cannot do c-sections because no one is there to do them, you can do everything you want but there will be some babies (and mothers too) that you cannot save. In those situations, would a robot or remotely operated surgical robotic arm be better than nothing? I don't know if it would, and I am skeptical, but let's be real that this is not about the U.S. and not be cavalier about the fact that there are necessareans and millions of women don't have access to them.
Right on Bill, if the doctor wants to improve his/her score on the back nine- they can just send a csectionrobotronicsurgeon.
c-sections: so easy any robot can do it.
Rebecca, here's my comment from Facebook (dualling discussions on here and FB, as usual)...
"I'm assuming he's talking about areas of the world without access to enough cesareans to keep women and babies safe, but if any area is rural enough to lack skilled birth attendants or obstetric care, what would they be doing with state of the art robotic technology? I'm obviously missing something."
Is robotic/robot-assisted technology for use in c-sections really a wise investment for impoverished areas of the world? I don't know the answer. It seems like the future should include more trained birth attendents and obstetric facilties in areas that need them. I look forward to Gates explaining more of his theory.
@Susan - the perinatal & neonatal mortality have likewise fallen since the 1940s. Although I don't have the stats right at my fingertips, I remember one of the arguments supposedly for routine induction at 41 or 42 weeks is that the rate of stillbirth doubles at 42 weeks and triples at 43 weeks (or 2x @43 weeks and 3x @44 weeks); however, the stats that's argued from are from the 1940s or '50s (or possibly '60s) in which the stillbirth rate (a subset of perinatal mortality) was 10x higher than it is today. Again, how much of that is due to the availability of safe C/s, and how much is due to things like, oh, I dunno, reducing maternal smoking, is again something for the pencil-pushers to argue.
Maternal & fetal/neonatal/infant outcomes have gotten much better since the mid-1900s, but I don't think it's been much due to C/s, although there have obviously been some babies and mothers who have been saved through judicious use. With all the improvements in care aside from C/s, it's tough to sift through the data and try to figure out exactly what percentage may or may not have been due to C/s.
@Jill -- I agree. I wonder how much it might cost to set up a robo-doc in one of these countries, and how many wells can be drilled/dug, or how many farms established, or how many rounds of antibiotics and anti-hemorrhagics might be dispensed, for the same price.