CAN A ROBOT BECOME AN INDIAN ‘SURGEON’?

You have heard of robotic surgery, if you have heard of You Tube, the iMac or the subprime crisis. What you may not know about is the story behind the man who devised the first (da Vinci) medical robot.
For a fascinating and short story of Frederic Moll, read this NYT article.
In the past, I had written a rather decent article on medical robots, and you could check it out here.
The capital investment of a robot for laparoscopic surgery is to the tune of $1.6 million. Not much for the rich Indian companies that run hospitals, I thought. I approached a hospital Chief Financial Officer.
“I would love it if you buy the da Vinci robot for my department. I will do great work for the hospital.”
“True, but then what about the return on investment?”
the CFO asked.
“Em, arr, the procedure will cost around $1500 in disposables per case. That comes to around Rs.60,000 only. Plus all the rest of the hospital costs. Imagine how much you can make per case!”
“Great, so a gall bladder surgery will cost around one lakh-odd (around $2500), you think?”
“Yeah, ballpark!”
“Tell me, doctor, how many cases could we get in a month?”

I wonder how many Indian patients could afford to spend that kind of money for a gall bladder surgery, and keep quiet.
“I think you are getting late, doctor?”
“Sure, actually I am. I need to go to the bathroom to rub butt.”
Bottomline: if Intuitive Surgical, the maker of the da Vinci robot, are making millions, someone has to pay for their prosperity. Can we Indians do so? I don’t think so.

26 responses to “CAN A ROBOT BECOME AN INDIAN ‘SURGEON’?

  1. We have a long way to go before we can pay that much! But I wonder if I would trust a robot to do the job. Nope, I don’t think so! I prefer humans to operate on me, with all their baggage of human errors and the like. At least I can find out how good the doctor is and reduce the risks. But a robot? It could well be a defective piece! 🙂

  2. R-Doc: If I were the CFO, this is how I would see it:

    Assuming the same fixed number of operations both with a surgeon and the robot, I get to amortise the depreciation of the robot while writing off maintenance costs as expenses. This means that year on year, the robot costs me less and less, and the net profit or loss – even loss would be a benefit because it would deliver net savings of tax payable – will improve, which should make shareholders happy.

    A surgeon on the other hand must be paid a salary which increases at least at the rate of inflation each year, must be given paid vacation time, and will one day retire. Ergo, the surgeon costs more year on year while not delivering any greater efficiency in operating on more patients as (s)he ages.

    I am surprised your CFO thinks it not worth his time to do this simple maths. 😉

  3. Shefaly: kidding, surely! The robot does not replace a surgeon, (un)fortunately. A surgeon runs the bot, and so the costs are still there for the hospital. But first of all, patients have to enrol for surgery, don’t they? All over the world, hospitals are finding it hard to break even the investments on robotic surgery.
    Nita:
    A robot does not do the surgery. It merely moves as commanded by the surgeon, who controls it on the console. Maybe you should click that link to my old article! 😉

  4. There does not seem to be much financial reason to purchase the robot if the number of surgeries were to stay the same. But would having the robot attract patients who would otherwise go to another hospital?

  5. Here’s an idea, doc:
    Remember the scene in Star Wars: Episode VI – Return of the Jedi-, where the Ewoks take C-3-PO (the golden robot) to be a god, and then luck turns in favor of Hank Solo and Luke Skywalker?

    Tell your CFO to construct a shrine for the da Vinci robot, and have a kumbhabishekham with Sai Baba, Sri2 Ravi Shankar, and Shankaracharya in attendance. You’ll have more patients than you can handle, and soon it’ll be time to construct another shrine for another da Vinci:)

  6. Paul:
    The robot has become an important marketing tool for hospitals in the US: “look, we are modern, we have a robot!” Elsewhere, only centers doing high volume work on prostate cancer and bypass surgery, for example, are able to generate more business.
    TRF: You may be right. I should propose to Ramdev Baba or the others you have mentioned to sanctify a robot to attract patients! 🙂

  7. So a doc controls it. No one is denying that. But you mean to say that automatically means the robot cannot be defective? How about a car which malfunctions? In fact there have been times when some cars in a whole batch have been found defective. That is what I meant.

  8. I agree with you. I don’t think Indians are ready to shell out that kind of a money. Not yet. and even if we install “Da Vinci” here, the % of people(like Nita 😀 ) who would prefer a human rather than a machine operating on them, would not let the machine survive. 🙂
    @Nita : Even a surgeon operating on a person can have a cardiac arrest while he is holding a knife which is half inside the patient’s tummy. Imagine what would happen if he falls down and rips the tummy into two? 😀 Cummon, don’t be so edgy!!! 😉

  9. Amit, I would take my chance with the doc. 🙂 Not with a robot…because how in the world can I know if he is a healthy robot or not? 🙂

  10. Not that I am going to ask the doc for his medical history! It’s just that I’ll choose a doc whose medical history I know. 😉

  11. uh oh, reading through the comments and all the grim scenarios envisaged, I could never consent to an operation by man or machine without going through a full medical report of the surgeon ( done within the past 3 months) or clearance from the machine’s maintenance division!
    And what if the machine turns out like a frankenstein’s monster and disobeys the surgeon and decides to take my liver out in stead of the gall bladder!

  12. @ Usha: The tragedy of technology is that its promise is over-estimated in the short run and under-estimated in the long run. So having seen that through the life cycles of many technologies, we could possibly take a more rational – by which i mean more realistic perspective with respect to risk assessment and mitigation – approach to this, couldn’t we? 🙂

  13. Nita, Amit, All:
    Any tech-driven procedure is liable to equipment failure. This risk, though minimal normally, is inevitable. Like driving from one city to another and having a car breakdown on you. You don’t expect it to happen to you, but when it does, you are screwed (so is the passenger/patient)!
    Usha: What a scenario! That would happen when you have AI (artificial intelligence)-enabled bots that can disobey the master. God help us!
    Shefaly: nice comment!

  14. Shefaly: SIGH……. I guess so!

  15. Like Nita, I would take my chance with a doc,not a robot.
    //“True, but then what about the return on investment?” the CFO asked.//-This has converted the surgeons into robots. A very successful surgeon in Delhi whose annual salary runs in a few crores annually was complaining that he has to run from one end of the city to the other end performing more than a dozen major surgeries everyday. He starts his day at 10 in the morning and is never home before 11 at night. Even then he has to justify his salary by the number of surgeries he has performed per month. In a situation like this a robot would be more dependable than a tired and tense surgeon.
    With robots performing surgeries, after a few years we may not need the surgeon to command the robot. Once the surgeon identifies the problem the robot may take over or later the robot may start doing that too. This is scary!

  16. usha:

    Rest assured, Asimov’s Laws of Robotics are in effect here:
    First Law: A robot may not injure a human being or, through inaction, allow a human being to come to harm.
    Second Law: A robot must obey orders given to it by human beings, except where such orders would conflict with the First Law.
    Third Law: A robot must protect its own existence as long as such protection does not conflict with the First or Second Law.

    If the doc ordered the gall bladder, gall bladder it is, unless of course, the doc had mistaken the gall bladder for the liver 🙂

  17. Doc,
    Are we not headed the wrong way here ? The trend these days is to head East for surgeries and get a spa-vacation on the side — get you hip fixed for 1/10th the cost in the West and test it out around TajMahal and Delhi ! :-).

    Stop evening the cost arbitrage and spoiling the budding medical tourism market !. But Add naturopathy from Kerala and they will rubb butt as a part o the package..

    Shefaly makes a compelling case about the economics but (un)fortunately, like fashion, technology changes every other week (upgraded to WP 2.5.1 yet ?)and we would need to hire a service technician and a telephone operator to keep Mr.Vinci happy.

    Like Nita, I would go for a human..

    Pr3rna, You a Will Smith fan ? Looks like you are describe a plot from iRobot, or it’s ilk 🙂

  18. TRF, only if we can get the bottom-line calculations to include Asimov’s (theoretical) ethical laws. That is indeed the crooked rice pudding. Besides, free market will take care of any robots that don’t follow those three laws – no need to coerce or regulate them. 😉 🙂

  19. Ahtreya:
    What is the upgraded WP?
    Thanks for visiting. Long time!

  20. Amit:
    I wonder how the free market will take care of guys like you!
    🙂

  21. Doc, Thanks for visiting. Yeah it’s been a while. Took a sabbatical went back to my coding roots and cooked up something — the colorfull one you were referencing..

    On the WP-wordpress(damn tecchies and their acronyms!), I was referring to a slew of upgrade notices you keep getting for WP upgrades and it’s plugins — love the software — but it reflects the constant change that’s so innate to technology.

    Thought : We may need to open-source or outsource to bring down the cost ! 😉

  22. Dont know! But the idea of a robot operating my body is sure scary!!!

  23. Ah, the marvels that the transhumanist future holds! The nanobots that I ingest with my Idlis and Sambhar, grinding away those errant cells in my prostate 🙂

  24. I wonder how the free market will take care of guys like you!

    I’m *shocked* that Peikoff or Rand didn’t write an essay that you could quote, and have to wonder instead. 😉

  25. Amit:
    Peikoff has been temporarily admitted to hospital with hysterical laughter syndrome ever since he heard that Ralph Nader is a US Presidential candidate!

  26. Well, Nader and Ron Paul do agree on many issues. So there. 😀

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