The Century of the System with Dr. Atul Gawande (from his Keynote Address at the Advancing Ethical Research Conference, 2014)

Today’s episode of More than Meets the IRB investigates the role of ethical review in a dramatically changing scientific landscape where ineptitude, not ignorance, is becoming a focus of public health. Dr. Atul Gawande reveals a practical solution that is successfully addressing ineptitude among surgery teams across eight different locations around the world.

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Renowned speaker Dr. Gawande is a general and endocrine surgeon, professor at the Harvard School of Public Health and Harvard Medical School, executive director of a lab for health-systems innovation, and chairman of a nonprofit making surgery safer globally.

We've entered a world where ineptitude has become as big a problem as ignorance. Dr. Atul Gawande

Ignorance and Ineptitude

The major change in knowledge today is the emphasis on systems over research. There are two sources of failure in anything humans set out to do:

  1. Ignorance—we have not learned how to solve all of our problems, but research has helped close our gaps in knowledge tremendously.
  2. Ineptitude—knowledge may exist, but people fail to apply the knowledge correctly. Today, we may know a great deal but fail to put the pieces together in solving a problem. What is the best way to address this?

The Importance of Effective Medical Systems

A three-year-old girl in Austria fell into an icy pond and drowned. After not breathing for 30 minutes and having a body temperature of 30 degrees below normal, she was miraculously restored to a breathing, functional state through CPR and several machines over a period of weeks.

She had multiple disabilities initially, but after two years, she regained all of her faculties and became a typical five-year-old girl. The revealing truth was that she was restored—not with cutting-edge medicines or technologies—but with a successful system that coordinated hundreds of professionals in executing standard medical procedures.

The Ethics of Implementing Systems

  • Ethical questions to review boards such as IRBs are now posed amidst the democratization of once-elite methods of science.
  • The "province of professors" has become the domain of medical students, nurses, and pharmacists who interact with data and trials in research.
  • We are tinkering with systems that have known levels of harm, trying proven ideas but not understanding how to put the pieces together. In this setting, how can we ensure the ethics of implementing effective systems?