For the next Nobel Prize in Medicine,
I nominate…

by Eric Drexler on 2010/11/03

During a three-month test across eight hospitals, several continents, and almost 4,000 patients, a new technology reduced serious surgical complications by 36% and deaths by almost 50% — in raw numbers, over 150 cases of severe harm and nearly 30 patient deaths.

This performance was demonstrated in the spring of 2008 with the prototype version of the technology, applied indiscriminately to surgeries of all kinds — a prototype without the specialized features that would improve performance in (for example) abdominal, cardiac, or neurosurgical procedures.

The surgeon who spearheaded the development and deployment of this technology should, in my view, be the leading candidate for the next Nobel Prize in Medicine. He has earned it, and awarding the Nobel Prize for this accomplishment would speed the adoption of a technology proved to save lives in settings that range from leading surgical centers in the US and UK to a remote hospital in Tanzania.

The prototype hardware consists of a sheet that lists 19 carefully engineered steps. The first step after sign-in — proved by testing to be crucial — is a pause in which the members of the surgical team simply introduce themselves to one another by name.

The name of this innovative surgeon is Gul Gawande, and he’s told the story of the technology in an excellent and many-faceted book, The Checklist Manifesto.

It’s a good read that offers concrete and compelling insights into why buildings stand and aircraft seldom fall out of the sky. Ultimately, it’s about cognition, complexity, knowledge-sharing, and team coordination, all vividly illustrated with stories of surgery gone wrong (and right) and extended in surprising directions with tales of success that range from methodical heroism in modern aviation to methodical investment in high-tech venture capital.

I had planned to skim the book, but after picking it up yesterday I read it cover to cover.

A carefully engineered checklist is a high-value medical technology by any measure you choose. It averts injury, saves lives, saves money, improves morale, and reduces staff turnover. It costs virtually nothing. Only inertia holds it back, and what the humble checklist needs most now is an infusion of glamor and excitement. A Nobel Prize for Dr. Gawande would do more than recognize accomplishment: It would give a boost to a critical technology that could save your life.


Here’s the journal article:
“A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population” (New England Journal of Medicine, 2009).
PDF here.

{ 6 comments… read them below or add one }

Chris Phoenix November 3, 2010 at 6:51 am UTC

It’s amazing, the things people die of in surgery. In Guatemala, surgical patients die when there’s a simple power failure, because there’s no back-up lighting. I know a guy who’s saved several dozen lives by mounting solar garden path lights on the back of muffin tins – the resulting light is bright enough to complete the surgery.

It’s not exactly a medical advance, and I hope it’s not too off-topic. It does demonstrate how very simple it can be to save lives, even in a profession that’s supposedly already dedicated to lifesaving.


Indeed… (“Oy”, says Rosa) — Eric

GK November 6, 2010 at 2:59 pm UTC

“I had planned to skim the book, but after picking it up yesterday I read it cover to cover”

In 1991, when I was a freshman in college, there was a book which I had intended to just skim. I couldn’t put it down and ended up reading it from cover to cover in a few hours.

That book was one of the reasons why I studied science and have a science related career.

The book was called Engines of Creation.

Thank you, Eric.

takchess November 9, 2010 at 12:01 pm UTC

A great book. I would recommend his other two as well:Better and Complications.

A small correction. His first name is Atul.

Brian DeCamp November 13, 2010 at 10:32 am UTC

I’m not sure I would overlook Peter Pronovost for a Nobel Prize in Medicine for this subject. Gawande has done a great job compiling evidence and a compelling case for checklists in medicine, but so much of his writing is based on the practical achievements of Pronovost, that Gawande seems more the messenger. Safe Patients, Smart Hospitals by Pronovost tells the remarkable story of the needless death of a little girl at Johns Hopkins, and the impassioned reaction of a very bright and talented doctor. There seems little doubt that checklists and a new wave of cultural change will have a enormous impact on medicine.

Joel Upchurch November 16, 2010 at 11:28 pm UTC

I read Dr. Gawande’s book also and agree that what he has found and what he has done is remarkable. I suspect that getting the Nobel Prize will be hard, since he work proves that many people die from simple avoidable medical error.

As to Brain DeCamp, I don’t have a problem have Pronovost and Gawande sharing the prize. I think Decamp underrates the messenger. Every Darwin needs his Huxley. Indeed, when you consider Wallace’s work, I wonder if Thomas Huxley might not be more important to the Theory of Evolution than Charles Darwin.

Mark Bahner December 31, 2010 at 5:25 am UTC

“It’s amazing, the things people die of in surgery. In Guatemala, surgical patients die when there’s a simple power failure, because there’s no back-up lighting. I know a guy who’s saved several dozen lives by mounting solar garden path lights on the back of muffin tins – the resulting light is bright enough to complete the surgery.”

I bought 20 9-led flashlights on Ebay for $25. They probably last 30+ hours on a battery charge. There’s certainly no good reason for someone to die in surgery from lack of light.

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