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Anesthesiologists had the same problem...

This shows that government can work.

The Anesthesia Patient Safety Foundation has nothing whatsoever to do with government. Never did.

I didn't express myself accurately enough. The anesthesiologists successfully used the model of safety engineering from the aircraft industry, which was managed and developed largely by the government (with civilian input).

I think you'll agree with my main point, that "personal responsibility" isn't the solution to hospital safety. Instead, it takes a systems approach. I think you'll also agree that, if you can solve a problem by telling people to follow a rule, or solve it with an engineered solution that makes it impossible for people to do it wrong, the engineered solution is better.

I don't know enough about sugammadex (or anesthesiology) to comment. I'll keep my eye out for it, though.

Yes, this is what I was thinking of. I remember that WSJ story too.

http://www.apsf.org/about_history.php

A seminal publication from Harvard in 1978 described the use of the aviation-inspired critical incident analysis technique to understand the causes of anesthesia-related mishaps and injuries. In the early 1980's, national media publicity turned a harsh spotlight on anesthesia accidents that injured patients. Thus stimulated, and avoiding the urge to fixate on tort reform, E. C. Pierce, Jr., MD, the 1984 President of the American Society of Anesthesiologists (ASA) constituted a new ASA standing committee on Safety and Risk Management, emphasizing the need to address the causes of patient injury. That same year, Pierce and Harvard colleagues convened the International Symposium on the Prevention of Anesthesia Mortality and Morbidity, which constituted the first organized examination of what was soon to be known as "anesthesia patient safety." There the idea for the APSF was born....

Overall, the combined impact of all the initiatives has been a 10 to 20-fold reduction in mortality and catastrophic morbidity for healthy patients undergoing routine anesthetics...

Anesthesiologists had the same problem...

This shows that government can work.

The Anesthesia Patient Safety Foundation has nothing whatsoever to do with government. Never did.

I didn't express myself accurately enough. The anesthesiologists successfully used the model of safety engineering from the aircraft industry, which was managed and developed largely by the government (with civilian input).

I think you'll agree with my main point, that "personal responsibility" isn't the solution to hospital safety. Instead, it takes a systems approach. I think you'll also agree that, if you can solve a problem by telling people to follow a rule, or solve it with an engineered solution that makes it impossible for people to do it wrong, the engineered solution is better.

I don't know enough about sugammadex (or anesthesiology) to comment. I'll keep my eye out for it, though.

Yes, this is what I was thinking of. I remember that WSJ story too.

http://www.apsf.org/about_history.php

A seminal publication from Harvard in 1978 described the use of the aviation-inspired critical incident analysis technique to understand the causes of anesthesia-related mishaps and injuries. In the early 1980's, national media publicity turned a harsh spotlight on anesthesia accidents that injured patients. Thus stimulated, and avoiding the urge to fixate on tort reform, E. C. Pierce, Jr., MD, the 1984 President of the American Society of Anesthesiologists (ASA) constituted a new ASA standing committee on Safety and Risk Management, emphasizing the need to address the causes of patient injury. That same year, Pierce and Harvard colleagues convened the International Symposium on the Prevention of Anesthesia Mortality and Morbidity, which constituted the first organized examination of what was soon to be known as "anesthesia patient safety." There the idea for the APSF was born....

Overall, the combined impact of all the initiatives has been a 10 to 20-fold reduction in mortality and catastrophic morbidity for healthy patients undergoing routine anesthetics...

Anesthesiologists had the same problem. They worked at different hospitals, with different equipment, and that caused mistakes. They standardized equipment, mistakes went down, fatalities went down, insurance premiums went down.

This shows that government can work.

The Anesthesia Patient Safety Foundation has nothing whatsoever to do with government. Never did. You do need there to be an outside body that keeps looking for the big picture, and maybe the FDA is the right place to do that - but maybe it's not. The FDA, after all, has too much incentive as a regulator to be overly cautious - witness the story of sugammadex, which would have basically retired succinylcholine and neostigmine from clinical practice. In expressing concern over potential hypersensitivity, the FDA completely neglected the possibility that the status quo might be more dangerous.

• General anesthetics. Come in IV (propofol, thiopental) and gas (there are more modern ones, but ether and chloroform are the ones people know) forms. Produce global depression of nerve function so that unconsciousness results.
• Opioids. Morphine, fentanyl, etc. Produce relief of pain without necessarily depressing consciousness. Dangerous in overdoses because they depress the respiratory drive - people quit breathing and die. This is not usually a problem during general anesthesia because there's a tube in your throat that's hooked up to a ventilator - we breathe for you.
• Paralytics. Particularly important at two points: at the beginning, they make putting that tube down easier (you don't fight), and during abdominal or orthopedic surgery, they relax the muscles so that the surgeon can work.
• Anxiolytics. These are IV versions of Valium or Xanax, used to calm people down and make them forget what's happening.

Now, there is a problem with postoperative cognitive dysfunction in the elderly, one that is currently a very hot topic of research, but the elderly don't have a lot of plastic surgery - if they're in for surgery, they usually need it to continue living.

Finally, very few people die - the risk is somewhere less than 1 in 150k for elective surgery, with risks rising for those who are having risky surgeries or who are very ill to start with. Anesthesiologists made a conscious decision in the early 1980s to reduce the risks of anesthesia, and created the Anesthesia Patient Safety Foundation to review all closed claims - that's lawsuits, settled in or out of court - and to look for common factors. We have been enormously successful at this task. Drugs have been pulled off the market because the APSF identified them in series of deaths. Safety equipment has been mandated - for example, the size of the connectors for breathing masks, breathing tubes, and ventilators is specified so that all of it interoperates, regardless of manufacturer.

If you prefer to be unconscious for surgery, it can usually be done safely. Of course, if you want to be awake, that can usually be done safely as well. Ask your anesthesiologist.

I'm a firm believer that the field of biotech needs a new, younger generation to add new ways of thought to the field. It's always the younger generation who make the breakthroughs because they are not hindered by old ways of thinking.

And before we can get to that point, we need to insure that doctors don't actually perform malpractice