Bloodless. Micro- and Nano-Surgery

Micro- and nanotechnology have started to revolutionize the one medical specialty that always held the closest of analogies to a mechanistic view of the human body: surgery.

The principles are readily obvious:

1. The smaller the invasive mechanical tools, the smaller the required incision, the lower the need for anesthesia, and the lower the impact of overall operative trauma on the organism and the risk of infection.
2. The smaller the invasive mechanical tools, the more likely it is that surgical (that is, mechanical) approaches can be relied on to perform the work previously entrusted to biochemical (that is, pharmaceutical) intervention with its inevitable, often extensive, and often numerous side effects, including the need to rely on complex and uncontrollable therapeutic mechanisms deemed “irrational” from a scientific perspective and generally subsumed under the notion of placebo effects.
3. The smaller the invasive mechanical tools, the closer they come to the molecular level in the category of nanotechnology, the more the distinction between surgical and pharmacological intervention blurs. With one critical distinction, though: conventional wisdom has it that a surgical tool needs to remain under the surgeon’s control at all times whereas the molecules of any pharmacological substance by definition operate on a stochastic basis once released into the human body.
4. The smaller the invasive mechanical tools, the lower or even inexistent the need for blood transfusions becomes – for patients who are Jehovah’s Witnesses it may be a religious tenet while for Muslims transfusions may be limited by religious concerns (such as the faith of the donor) but, aside from such considerations, procurement and management of adequate blood supply is not without substantial risks even in present times.
5. Insertion of micro- and nano-technological mechanical tools into human vessels and body cavities entails certain challenges that can be summarized as issues of “command and control,” not unlike remote tactical direction exercised by a battlefield commander. This involves not only the direction of the tool with precision and accuracy but also fundamentally revolutionized imaging technology in order to maintain orientation, overview, and indeed overall systemic control over the operation.

It also does not surprise that technology developed for medical uses in small, tight spaces very often has multiple uses, sometimes even military, security and industrial ones.

With cardiovascular, cerebrovascular and ischemic disease but also cancer as the primary killers in the U.S. and worldwide accounting for about half of all deaths, the potential market for developing and advancing related technologies probably rivals the customer basis of the pharmaceutical industry. Even if expertise continues to become a lot more ubiquitous through telemedicine including remote surgery and videoconferencing, the cost of surgical intervention will most likely at most times and even in the very long term exceed the cost of a pharmaceutical solution – but not if the therapy requires maintenance drugs that need to be taken for extended periods or even a lifetime, or needs to be weighted by comparative effectiveness. Another factor that requires a paradigm shift in how medical care is reflected in its treatment by accounting standards is the increased promptness with which patients can go home and back to work.

Minimal procedures adapt to the size and location of the problem. Open heart surgery becomes necessary in far fewer instances and there is hope for similar developments in all locations of the human body that permit access through vessels or body cavities in some however indirect and roundabout way. But an extra hour or two of the surgical team’s time can shorten recovery periods by weeks or months, not to mention mortality risks attributable to distinguishable but still surgery-related factors such as infections, hemorrhaging, or delayed effects resulting from structural damage to tissue during surgery.

Methods based on catheters were originally developed in cardiology to address leaky heart valves, arrhythmias including atrial fibrillation (a major stroke risk), and atrial septal defects. Catheters are also the basis of balloon angioplasty and placement of drug-eluting and recently also dissoluble stents, while catheter-based zapping of nerves in the vicinity of the renal region found to be responsible for driving hypertension promises a cure for the condition. Lysis of blood clots in the brain thus far is based primarily on pharmacological methods but may eventually be assumed by nanotechnology.

The more technology advances, the clearer it becomes how many challenges remain unresolved: vascular plaques and blood clots call for maintenance of vascular walls and cardiac valves similar to that of pipe drains. With growing knowledge of dietary and environmental impact over time on our vascular system and recognition of the insufficiency of “diet and exercise,” the systemic nature of this problem and its effect on all organs becomes as obvious as the insufficiency of a solution based on pharmaceuticals alone. While medication may be effective in slowing down the process, it has rarely if ever been shown to reverse it, which would be necessary to begin speaking of a “cure“ in the sense of turning back the clock by a few decades – as would be necessary to create a significant impact on human life expectancy and quality of life.

Minimally invasive microsurgery and surgical nanotechnology are by no means limited to cardiac and vascular issues. Laparoscopic and endoscopic methods have taken over increasingly complex tasks in the abdominal cavity as well as along the entire digestive tract. Fallopian tubes and ovaries are now operated on under imaging magnification factors of 15-30x with heretofore unknown microthread material. Similar developments are taking over surgical interventions also in otorhinolaryngology and, where it is perhaps most noted by the public, in ophthalmology.

But arguably the most challenging frontier is neurosurgery. Interventions in the central nervous system as well as at peripheral nerves become increasingly possible as our tools begin to resemble a fine brush more than a sledgehammer. Operating inside the intact skull and in the extremely tricky anatomy of the spine requires miniaturization of operating tools as well as miniaturization of imaging, remote guidance, and drainage systems. This becomes increasingly accessible with continuing advances in material science, microfiber-optics and IT-supported imaging and control systems. By reducing the size of the solution to the size of the problem, surgical intervention may live up to its original mechanistic view of the human body that has been denied throughout so many centuries by mystics and spiritualists. And yet, in the molecular dimension, the mechanistic view of the body may yet surprise us with a truly spectacular renaissance. 

The Death of Science

What happens when you make a Christian Scientist the chairman of the Committee on Science, Space and Technology of the House of Representatives? Well, he might just start believing that he really is a scientist, and is qualified to review the scientific peer review process. Strike that: to overhaul the scientific review process in its entirety.

Remember that guy, Stalin? He was on to something. The state was not going to sponsor, or even tolerate, imperialistic bourgeois free-roaming research. Fast forward to 2013: Stalin is gone, the Soviet Union is gone, Lysenkoism is gone (look up Lysenkoism, or, better yet, suppressed research in the Soviet Union). Now the US is allegedly the sole remaining superpower, and it makes it plenty clear: The US is not going to sponsor any politically incorrect or otherwise subversive and not directly “useful” research.

The first incredible step happened as recently as in March 2013. Among the 600-something pages of legislation keeping the government from shutting down was a neatly snuck-in amendment saving “the American people”– gasp! – $11 million (that’s less than the cost of one good old F-16, or 8% of one F-35). This brilliant idea suppressed not only ‘wasteful and inessential spending.’ It also took care of politically incorrect intellectuals. In particular, the bill eliminated the source of 95% of funding for political science studies, i.e., the funding by the National Science Foundation, unless such studies are deemed by the NSF director to be “relevant to national security or U.S. economic interests.” Out with unproductive research, make yourselves useful and contribute to the rising glory of The World’s Superpower!

It appeared promising enough as a precedent, and so, only a month later, we have another brilliant proposal: why only political science? Why not subject National Science Foundation’s entire $6.9 billion budget to a test of political and economic usefulness? How about having “every NSF grant application include a statement of how the research, if funded, ‘would directly benefit the American people’”? The Committee on Science, Space and Technology would surely be happy to verify whether this basic criterion has been properly applied, just like its chairman demanded records of the peer review process on such useless and questionable research as “The International Criminal Court and the Pursuit of Justice.” Did putting a man on the moon somehow “benefit the American people”?

My math friends will certainly not be happy. How do you justify with utility a line of research that, by definition, is abstract and ‘pure,’ as opposed to ‘applied’? Are they to change their specialties altogether, so they can justify their research with military or computer security applications? Are they to abandon entire areas of mathematics that, by any conceivable stretch of one’s imagination, cannot be said at the time it is developed – or even ever – to “directly benefit the American people”? And just how much will all this social engineering of scientific research save? Current NSF awards in algebra and number theory total some $111 million (much less than one F-22 at $143 million). Geometric analysis costs the NSF $72 million, and topology, a ground-breaking area of pure mathematics since the late nineteenth century, a mere $66 million. By comparison, the F-35 program costs $396 billion (that's billion, not million), with an additional low estimate of $1.1 trillion in maintenance and servicing costs. It is seven years behind schedule and 70% over cost estimate. A single F-35, of which several may be expected to crash during testing, training, or accidents over time, is expected to “directly benefit the American people” to the tune of an out-of-pocket price tag of $137 million.

If Congress is so concerned with not ‘wasting money’ on research, how about extracting dollars where they are made by relying on purportedly “not directly useful” research? In particular, academic publishers charge university libraries exorbitant prices, up to $40,000 per journal, so academics may gain actual access to the very same research that the NSF and universities originally sponsored. This research is paid for by grants and universities. The editors and peer reviewers are certainly not paid by the journals – they are considered volunteers, honored to serve science. Currently, even formatting is done by authors and editors. So where exactly is the investment of publishers such as Elsevier? Their entire ‘investment’ is spent on paper and distribution. And, in the case of online access, server space. Harvard announced last year that it can no longer afford to pay extortionate prices for scholarly journals costing its libraries $3.5 million a year. Considering that even small university libraries would still have to spend hundreds of thousands of dollars a year to stay abreast of scientific developments, Congress could recover at least part of, if not more than, the money dedicated to research today by tapping into this gold mine that is currently virtually monopolized by a handful of commercial publishers whose substantive contribution to the scientific process and its funding is exactly zero.

And such an obvious and logical move by Congress might actually turn American science back from its way to a hospice. The day this country ceases to be the world's leading producer by a mile of intellectual property and scholarship is the day it will effectively cease to be a superpower. One might envision a lively, controversial discussion with the populist congressional budget-cutters on how that „directly benefits the American people.” America is built on leadership by ideas, after all. Research - even superficially ‘useless’ fundamental research - is utterly indispensable for attracting top talent and thus for obtaining top results. It is a kind of a ‘trickle-down economics’ where talent and results from fundamental and ‘useless’ research (such as pure mathematics!) eventually find uses that change the world and how we see it. One cannot expect a scientist applying for a grant to present a clear and convincing view of the utility of his research before the discovery is made, years and additional grants down the road. Ignoring this reality surely meets one of the many definitions of insanity.

Will Separatist Secession Strengthen Europe by Tearing History Apart?

Lest we forget that the last two millennia of history along with dozens of languages and dialects have bequeathed on virtually every remote corner of Europe at least theoretical desires for autonomy and independence, the process of fermentation seeking to experiment with “regionalist” attacks on the faits accompli of the nation state has reached new heights. The European Union, Nobel Peace laureate of 2012, is currently faced with votes on no less than four attempts at an orderly secession: in Scotland, Flanders, Catalonia, and in the Basque Country. And there are many more to come if any of those succeed. None of the regions currently aspiring to statehood have expressed any desire to leave the EU or to become a tax haven. Quite the contrary, all aspire to renewed membership and Scotland’s movement now even proposes to join the Euro. While the Scottish Independence Movement is supported by a minority only, a ¾ supermajority backs independence in Catalonia, and in the Basque Country the very recent vote of October 21, 2012 produced a verifiable and recognized 64% separatist majority – almost ⅔.

Wittgenstein, Modeling and the Notion of Logical Space

Many attempts at understanding Wittgenstein climax in the wistful prayer that he had himself observed the closing proposition of his Tractatus logico-philosophicus: “Whereof one cannot speak, thereof one must be silent.” And indeed, he never published any other item in his lifetime. Deliberately speaking about logical space without the aid of formulaic language tempts one to reminisce about that mantra. In the terse, minimalistic language of the Tractatus, the facts in logical space are the world. In his ontology, the world is determined by the facts, and by these being all the facts. For the totality of facts determines both what is the case, and also all that is not the case. Mindful that “the world is all that is the case,” “the totality of facts, not of things,” Wittgenstein had entered upon the notion of logical space by reading Bertrand Russell, Georg Cantor and Gottlob Frege. It does not play a major role in his Tractatus but it does conceptually: logical space is, of course, a notion from set theory, an analogy to physical space modeled on Boltzmann’s and Hertz’ idea of a multi-dimensional space of physical possibility, comprising any system of relations that have the same or similar logical properties. The logical space of the Tractatus is nothing other than the set of all potential worlds, of which the real world is merely an element, being the only set of facts in logical space the elements of which are, without exception, facts. Hence logical space is infinite. Logical form, then, represents the possible within logical space. Wittgenstein’s method is that of logical atomism where all possible statements about a complex object consisting of parts can be reduced to the sum of statements about its parts.