Nuclear magnetic resonance, artificial heart, brain electrodes, brain-controlled prostheses: the future of medicine is linked to new technologies. At this rate, will we still need physicians ten years from now? Guy Vallancien, former member of the national medicine and surgery Academy, is the founder of the European surgery school, a private structure which trains surgeons for surgical robotics. He is also the author of Medicine without doctors? The numeric at the patient’s service (Gallimard, 2015). So you could say that he knows everything there is to know about the medicine of the future.
Pluris – Medicine without doctors?, is that a provocation?
Guy Vallancien – In a way, yes! The future of medicine is a medicine without the doctors as we know them today. Today, the doctor’s role is decreasing, it already works with algorithms. His eyes, his ears, his hands are subjective elements, not quantifiable, whereas biology, imaging, nuclear magnetic resonance data are objectives and easily transmittable to the entire planet. The instruments are thus reducing the doctor’s power to examine and make a diagnosis. Besides, diseases are detected at a pre-clinical phase, that is to say before the appearance of signs and symptoms: breast cancer with mammography, prostate cancer with PSA dosage, the prostate antigen, diabetes with the blood sugar level, lung cancer with x-rays, etc.
How can we be sure that computers and robots will be as reliable as a doctor is?
Because to refine its diagnosis, the computer can process a great number of data at an impossible speed for the doctor. It knows how to analyze in a few minutes the billions of bases of a tumor genotype, for instance. Today, I already handle the tools on an operation table from 3 meters away with joysticks. Tomorrow, these techniques will be completely robotized, because the machine does not shake, it is never tired, it works with no breaks, and when it does not understands, it stops. It also has an incredible laxity, the robot’s arm can turn at 360° when the man’s one does not go further than 240°. The tool is thus taking precedence over men’s intellectual and manual capacities.
What will be the doctor’s use?
Knowledge is shared today, everyone can have access to all scientific reviews, and the patient has often read everything on the internet. But what continues to distinguish the doctor from his patient is his professional experience, which will cause that a patient will never completely trust a robot. The general practitioner, the first on the line, will thus become the kingpin of the health system. He will be assisted by operator engineer, anesthetist robots, nurses, surgeons, stretcher bearers, pharmacists, etc. His role will be the one of a data integrator, which demands slow consultations, a lot of listening, and a global management of the patient in all of his personal, familial, social and professional environment. It is a real job, with an important psychological dimension to accompany the patient, and convince him to accept a therapeutic project. And for the more serious diseases, traumas and emergency situations, one will always need a human. The drudge doctor turns into a scout doctor, listening to his patients: that is the nicest role!
What will it imply for medicine studies?
Beside the scientific dimension, the content of medicine studies has not evolved, particularly regarding the doctor’s integration in society. So this must change, and in several dimensions. Firstly, a shortening of the studies by 2 or 3 years, because the simulation tools will accelerate the training, and the student will be able to confront extremely complex situations. Secondly, you will have to get them interested in communication, human relations, health economics, computer studies, and science history too. These young doctors learn about biology but don’t know anything about the health administration system: regional agencies, Ministry of social affairs and health, medicine safety agency, etc.
If future physicians must learn so many things, will they have less scienitific knowledge than the current ones?
Not necessarily. The studies’ scientific content is already much parceled today. It is not normal to wait six years before knowing if you are going to be a general practitioner, surgeon, psychiatrist, specialized in one organ, or a public health doctor. The cursus is the same for six years. Students should be able to choose their options right after the bachelor, at the master level, with a right to a mistake. There is no need to master the complex liver enzyme biology to become a surgeon, or the foot anatomy to become a gastroenterologist, for instance. The general practitioner must learn the great ideas, great themes, the public health doctor, economics, the research doctor, the scientific order, statistics, laboratory work, etc. 60 to 70% of the tasks handled today by a GP could be appointed to a staff with a Bachelor or Master level, nurse, physiotherapist, chiropodist, orthopedist, psychologist, etc.
Who will do medical research in this health system you are describing?
Everyone! Medical research is first about opening your eyes, looking at the world a saying: “well, this is not how we thought it was”. Real medical research breakthroughs are always individual: someone thought differently about an idea that others did not have, and which shakes up the current scientific knowledge to lead to an improvement.
Won’t this much robotized medicine be too expensive?
It will cost the price of the tools. Today, surgical robots are expensive, but competition will lower the prices. Innovation is always expensive because it is heavy investment, without knowing if it will pay, but you have to take the shot. We all have the necessary financial means to integrate these new tools.
And can robotized medicine benefit the entire population?
This medicine will be more efficient, it will imply moving and making telemedicine. It will take political courage to territorially reorganize health and make sure that everyone has access to the best cares no matter how much they have. But in a blocked France, where everyone wants to keep their hospital, their service, their doctor, it seems to be wishful thinking. It is absurd to maintain a high tech surgery service with a very qualified staff in a small hospital, when it would be much cheaper to transfer the patient in the right center with a Google car or helicopter, even for 2500€ an hour.
Is the augmented man the next step following robotized medicine?
You are referring to transhumanism! This field goes way beyond medicine, but it still regards doctors in the first place because they are the ones asked to repair bodies. And why not tomorrow, augment them? That is what happens with plastic surgery, drugs, prostheses, pacemakers, artificial hearts, brain electrodes for parkinsonians. Some prostheses are already controlled by the brain. Bottom line, we are increasingly bionic. That said, transhumanism asks real questions, it makes us rethink our humanity, ask ourselves the question of our identity and our purpose. But when it advocates death’s death, eternal life, I am skeptical. An infinite value loses all its worth. Life is only worth it because it has a time. If we had an eternity to do everything, what would be the point?
TED Talks : The new bionics that let us run, climb and dance, by Hugh Herr
Hugh Herr is a MIT researcher whose legs were amputated after deep frostbites, and who wears bionic prostheses. At the end of the segment, a dancer comes along. She too was amputated after the Boston marathon attacks, but she dances with a second artificial leg.