Brain surgery with regular Bosch power drill

Physician Henry Marsh has been using a standard Bosch power drill to do brain surgery. Twice a year, the London-based surgeon assists colleague Igor Petrovich in Kiev, Ukraine where high-end medical equipment, such as a £30,000 medical drill, is unavailable. So Marsh improvised. From The Times:

Mr Marsh has now taken a drill designed for medical use to Kiev. “I’m not recommending that we should all use Bosch do-it-yourself drills in England,” Mr Marsh said. “But it shows how with improvisation you can achieve a lot. I’ve taught [Mr Petrovich] everything I know. Now he’s able to do things that I can’t.”

Link (via Fortean Times)

Previously on BB:
• Head Like a Hole Link
• History of trepanation Link

David Pescovitz is Boing Boing's co-editor/managing partner. He's also a research director at Institute for the Future. On Instagram, he's @pesco.

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Takuan

depends on the job.I’m sure some things could be done with a twenty dollar drill in a plastic bag, which would be tossed after the job.

I’m equally sure that inserting a fine probe in the center of a brain might need a degree of precision.

Betchya in the end there is still no substitute for a steady, human hand.
El Mariachi

@27:

If you’ve got an “unattentive surgeon” working on your brain, a six million dollar drill isn’t going to solve your problem.

Car analogy time! There’s a saying to the effect of we could engineer a car that is absolutely 100% safe for its occupants no matter what kind of accident it gets into, but each one would cost a million dollars and get two miles per gallon. This drill is like that car.
hellhead

No big deal, not too long ago they were doing lobotomies with ice picks.
artbot

Idiots! Consumer Reports clearly says that Makita or Milwaukee drills are far better for brain surgery than the Bosch. When will doctors learn!
dculberson

Let’s assume the drill gets used for over a hundred surgeries – which seems a safe assumption to me. I would gladly pay 300 extra dollars for brain surgery to have medical-grade equipment used. How much is even cheap brain surgery? A lot, I’m sure.

To those claiming the Bosch drills should be used: if you had the choice, would you accept the Bosch? Even if you were told the Bosch was 50% more likely to kill you or leave you braindead?

And obviously wealthy people aren’t going to accept the cheaper equipment. So you’d end up with an even more drastically tiered medical system.
dragonfrog

I’m surprised no one has mentioned Maximilian Cohen yet.
Red Zebra

The story of Henry Marsh and his travels to the Ukraine to perform brain surgery for free with little to no equipment has recently been made into an incredible documentary called the English Surgeon. http://www.theenglishsurgeon.com/
Article in the Times: http://tiny.cc/d6RmF
For those in London it’s screening at the ICA on Thursday.
squeem

I enjoy the attitude of, “Improvising, because I can.”
zuzu

Â£30,000 medical drill

This is the problem with healthcare. It’s not about lack of insurance coverage. It’s about exorbitant cost, just because the word “medical” is attached to the description. Medical inflation kills people because they cannot afford treatment. The more government bureaucracy controls medical practice, the greater the medical inflation.
Takuan

whatever works

http://scottthong.files.wordpress.com/2007/07/trepanation.jpg
zuzu

How much is even cheap brain surgery? A lot, I’m sure.

That’s the rub! People need to get over their intuition that medical treatments are somehow “inherently” expensive. Imagine if cheap brain surgery were actually cheap.

To those claiming the Bosch drills should be used: if you had the choice, would you accept the Bosch? Even if you were told the Bosch was 50% more likely to kill you or leave you braindead?

If I’m poor, and I cannot afford anything but the Bosch drill, and I’m 100% likely to die from my brain disease, then Bosch it is!

#13 RexRhino already summarized this best in terms of opportunity cost. Not everyone can afford the best treatments known to man. If everyone insists on “the best or not at all”, more people will die because most will get “not at all”, which is precisely how cost containment works in any nation with nationalized healthcare.

We don’t all get to wear the best clothes and eat the best food and live in the best neighborhoods, because we’re constrained by scarcity, so we do the best with what we can, and we should take a cue from poorer regions of the world that have learned to “make due” and apply those more pragmatic values to helping less well off people living in modern economic regions.

It’s a $60,000 drill, for crying out loud! And this guy figured out how to do the same job with a $50 drill. If autoclaving is an issue, hell, just throw out the $50 drill after each use and buy a new one, at those prices!
Lone

Waiting for the Bosch medical journal ad…
WeightedCompanionCube

Medical equipment is expensive because of the engineering that goes into it. For example, a neurosurgery drill has a bunch of features a power dill doesn’t. Precise depth stops, controlled speed, much higher reliability, seals to prevent contamination, and parts that can be autoclaved are just a few… but yeah, a power drill accomplishes the same thing, even if there is more risk to the patient.

I wouldn’t be so quick to blame government bureaucracy: It’s the lawyers that will be quick to file a civil suit (against the doctor, hospital, manufacturer and janitor) if that power drill goes .5mm too deep.
semiotix

Saw it on House.
Saw it on Grey’s Anatomy.
Saw it on E.R.

Come on, real life. You’re going to need to be a lot more creative if you want me to stop watching 14 hours of television a day.
stuiethegod

Everyone keeps talking about the importance of the drill, but seriously, all the drill does is spin the bit, more or less (and I wouldn’t trust a drill that claims to do much else then that). A $30k drill is only as useful as the tool you use to actually make the hole in the person’s head.
zuzu

Medical equipment is expensive because of the engineering that goes into it.

Alot of engineering goes into computers, but they get more powerful and cheaper every year.

I wouldn’t be so quick to blame government bureaucracy

The problem are the barriers to entry and protectionism created by the government regulations and bureaucracy that preventing competition necessary for people to choose whether they want the fancy drill or the Bosch. When the market is artificially constrained to only the fancy drill, then sick people who cannot afford the fancy drill can only opt for no treatment at all. (Which is most often more dangerous than using the Bosch drill.)

The decision of whether to use the fancy expensive drill or the cheap Bosch should be one that a patient makes, with consultation from a doctor. By precluding the choice, the bureaucrats are rent seeking for corporations in captured markets.
jumpin_jon

I met Henry Marsh a few years ago and he is the most amazing person.. the calmness with which he discusses his procedures with patients is incredible. I think most people would utterly freak out at the thought of this man performing brain surgery on you while you are wide awake, but he is utterly calm and at ease and confident, and you cannot help but come away from a consultation with him filled with enthusiasm and hope for what he is going to do for you.
gandalf23

Huh. I’m surprised that the cordless drill spins fast enough. I use a very high speed drill (a Dumore Sensitive drill press) for making holes in bone for knife handles, I got it for $50 used, but it’s a $3,000 drill new (yay craigslist!). Using my regular drill press or hand held drills generally caused the bone to split. Of course, I was drilling in bone that’s “dead” and been dried out a bit, so maybe drilling into fresh, live bone is not as tricky.

ZUZU, there is less demand for medical quality drills, so the price is higher. Bosch sells a brazillion cordless drills, so the price goes down. Can’t really compare specialty tools like cranial drills to consumer grade commodities like computers. Every home and business is a potential customer of a computer, very few homes or businesses wold buy a cranial drill.
RyanH

@ #7

Medical equipment is expensive because of the engineering that goes into it.

Alot of engineering goes into computers, but they get more powerful and cheaper every year.

That’s rather a disingenuous argument. argument. Computers get cheaper every year because new practices allow for more to be done with less and because they are massively produced. Each year they can get more transistors out of the same amount of silicone and then amortize their engineering costs over 100,000 chips.

For a specialty drill? Well, as far as I know, it will take a special kind of breakthrough for us to make two drills next year out of the materials we can make one from today. And if there is ever a yearly demand for brain surgery drills that hits five digits I’ll be very worried.

The silicone chip industry is so unique that applying it to anything else is a blatant strawman argument.
emayoh

Let me get this straight, there’s a guy who drills into your brain with a power drill, and his “colleague” is named IGOR??!

Seriously… this story is nothing if not for Igor.

Cue mob of villagers in 4… 3… 2…
hep cat

“in the same way that contractors soak government jobs with $5000 hammers and $10,000 toilet seats”

I bet you couldn’t build one toilet seat in some arbitrary size to some exact and arbitrary spec for $10,000. Of course if the government would only design bomber jets around standard sized toilet seats you wouldn’t have that problem.

You want something really expensive? Try getting a one off soda pop can.
zuzu

@9 & 10

I think the problem is that you’re just substituting “specialty” for “medical” in your analysis. Obviously the drills are different, but healthcare is a commodity industry even though it doesn’t like to think it is — just like airlines.

Essentially we’re talking about drills. Some drills have different features than others, but those features are things like torque and rotation speed and whatnot. I wouldn’t be surprised if a “medical drill” is also useful in, I dunno, drilling concrete or something. So there’s still economy of scale. The market segmentation is likely illusory…

I find the prospect that manufacturers soak hospitals in the same way that contractors soak government jobs with $5000 hammers and $10,000 toilet seats, because hospitals have the easy money to pay for it, because of medical inflation.
brainologist

@ZUZU #2 and everyone:

Actually the technology that goes into the drills used in brain surgery really is quite impressive. They’re not just super-sterile Ryobi or Craftsman mock-ups.

Surgical drills for operating on the human brain have carefully calibrated sensors that determine the amount of resistance they’re experiencing, which can identify whether they’re drilling through soft tissue or bone. Critically, these sensors prevent the drill from continuing to bore once it’s gone through the skull. This way unattentive surgeons don’t accidentally keep boring into your parietal lobe, or any other critical piece of brain tissue. I’d say $30k for such technology isn’t so unreasonable.

If you’re interested in the technology and techniques of brain surgery, you should definitely check out Katrina Firlik’s Another Day in the Frontal Lobe (2006, Random House). Full disclosure: I have no financial interest in that book. Also, I’m a neuroscientist, not a neurologist, so excuse the lack of details!
Tom

I can’t speak to neurosurgery, but drills used in orthopaedics are substantially similar to drills used in carpentry. Living bone is not that much tougher than hardwood (and for your typical little-old-ortho-patient, often a good deal less tough) Besides, the effectiveness is really down to the bit (k-wire) rather than anything to do with the drill. Ortho drills typically run a few thousand dollars, so far as I know. Ten to fifty times what you’d pay at Canadian Tire.

The added cost of ortho drills is due almost entirely to insurance costs associated with selling medical equipment. The folks arguing that the engineering costs are paramount are not taking into account the slow rate of change of drill models. Companies have many years to amortize their engineering investment, but their insurance risk goes up with every single drill they sell.
Tim

http://youtube.com/watch?v=mSt1m4NFUl8&feature=related
Seeing that drill reminds me of this clip for some reason.
RexRhino

Medical equipment is expensive because of the engineering that goes into it. For example, a neurosurgery drill has a bunch of features a power dill doesn’t. Precise depth stops, controlled speed, much higher reliability, seals to prevent contamination, and parts that can be autoclaved are just a few… but yeah, a power drill accomplishes the same thing, even if there is more risk to the patient.

What we are arguing is that the extra engineering is unnessicary, or inefficient.

There are limited resources to provide health care. There simply isn’t enough health care resources to go around.

A $30,000 drill might be marginally safer than a $100 drill, but how much safer? We may find out, in fact, that the extra $29,900 saved might be spent on other things that will save more lives-per-dollar than a $30,000 drill.

For example, lets say I can either manufacture 10,000 treatments for a rare heart condition, but one out of 100 of those people will die due to flaws in the manufacturing. Or for the same cost I can manufacure 1000 treatments for the heart condition, and no-one treated will die due to flaws in manufacturing.

For option A, 10,000 people will recieve treatment, and 100 will die due to product failure. A total of 9,900 lives will be saved. For option B, 1000 people will be saved, and 9,000 will die for lack of treatment. Clearly, option A saves way more lives, however in real life we would go for option B, because people can sue for product failure but can’t sue for dying on a waiting list to get treatment.

When people look at the costs of medical equipment and treatments, they tend to completly ignore the opportunity costs. It may be that way more lives can be saved by providing a large supply of low-quality health care as opposed to a small quantity of high-quality health care.
seaanemoneman

Saw it on Doogie Howser, M.D.
Exidor

I’d like to see the medical drill that costs 30,000 GBP. I’m pretty familiar with various types of medical drills (for large and small bone surgery) and I can honestly say that this seems incredibly expensive.

The comments above about the engineering are right on. Not only are the required tolerances incredibly tight, you also need to consider the sterilization of the handpiece. There’s a huge amount of work that goes into ensuring that a powered instrument can successfully go through the autoclave and come out clean.

You need to use the right tools for the job. Bosch is great for putting up a shelf but not for putting in a bone screw, reaming out a hip or doing a craniotomy. I know what brand I’d choose if that was my profession (or if it was being done to me) and it’s not Bosch or Dewalt.

Pay attention the next time you watch ER, House or any of the other medical shows. Sometimes they use the real stuff.
Patrick Austin

A computer chip with millions of dollars in R&D has a _huge_ market. They’ll sell tens or hundreds of thousands of them. How many potential customers are there for a new neurosurg drill?

A 90,000 RPM pneumatic drilling system, with tons of special controls and attachments and other dohickeys, capable of being sterilized and reliable enough to use on brains is not the same thing as your average dewalt…

Equipment costs are not the big problem with healthcare. FWIW, they’re not using a vastly different array of tools in european countries (where, if anything, they’re MORE highly regulated) and yet their costs are lower. The problem is personnel: legal, administrative overhead, salary for doctors, etc. Your coronary bypass surgery didn’t cost $100K just because the machine that goes PING! was expensive.