It can be done'
REAL LEFT SOCIAL PROGRESSIVES tied to US public universities having those US MEDICAL SCHOOLS have all last century created PUBLIC INTEREST MEDICAL DATA investigating whatever global banking 1% industrial development was MOVING FORWARD actually protecting 99% of citizens' public health just as ROB J THE PHYSICIAN -----people having real passion and talent for healing what to put that talent to helping everyone. People looking for any trade to bring them money and power were happy being BARBER SURGEONS calling themselves PHYSICIANS.
We discussed in detail the difference between EVIDENCE BASED SCIENCE creating data with a goal of hiding any adverse effects that limit global health system profits-----vs last century's EVIDENCE-BASED SCIENCE that created data to protect public interest and the interests of civil societies. CLINTON/BUSH/OBAMA have been and still are being allowed to create FAKE MEDICAL DATA to advance harmful and deadly to public health policies and products.
THE TOP GOALS OF TELEMEDICINE TIED TO PROMOTING 5G----IS TO PRETEND THERE IS SOCIAL BENEFIT TO TECHNOLOGY THAT WILL CREATE MASSIVE PUBLIC HEALTH HARM AND CRISES.
As we repeat over and again---SMART CITIES TECHNOLOGY especially 5G is completely tied to building space mining slave colonies on planets, moons, asteroids pummeled with SOLAR RADIATION.
'Living in Space
1929 Hermann Noordung depiction of a space station habitat wheel'.
SMART CITIES is simply development for the SPACE COLONIES below. Planets, moons, meteors to be MINING COLONIES unlike EARTH with its screening atmosphere are belted with punishing solar radiation much of it being MICROWAVES. There is no solar panel developed that can withstand these direct solar rays-----there is no flowing water to product electricity----what global banking 1% are doing is building technology that will harvest MICROWAVES on planets, moons, meteors to be turned into power houses. THIS is why 5G creating that ground-level microwave environment is so critical to SPACE colonization. It kills 99% of WE THE PEOPLE, our quality of life, kills our natural resources----but the goal of mining for gold et al to be trillionaires is far more important.
When US national media articles say that 5G SMART CITIES is an EXPERIMENT---they mean that literally. They will document what happens to our 99% WE THE PEOPLE forced to live in environment saturated with MICROWAVES. This is all sold as being COMMON GOOD-----SOCIAL BENEFIT by selling the idea that telemedicine is a HUMAN RIGHT.
Below we see global banking 1% BUSINESS INSIDER pushing FAKE NEWS as they play down how much microwave radiation covers these planets, moons, meteors creating data making it all sound like exposures from DENTIST X-RAYS.
Here we see 1929-------the goals of global banking to create space colonies may have roots for thousands of years---but it was late 1800s----early 1900s where industrialists made this a top goal.
Living in Space
1929 Hermann Noordung depiction of a space station habitat wheel. Hermann Potocnik (1892-1929), also known as Herman Noordung, created the first detailed technical drawings of a space station. Power was generated by collecting sunlight through the concave mirror in the center. This was one of three components of Noordung's space station. The other two were the observatory and the machine room, each connected to the habitat by an umbilical.
Compared to other locations, orbit has substantial advantages and one major, but solvable, problem. Orbits close to Earth can be reached in hours, whereas the Moon is days away and trips to Mars take months. There is ample continuous solar power in high Earth orbits, whereas all planets lose sunlight at least half the time. Weightlessness makes construction of large colonies considerably easier than in a gravity environment. Astronauts have demonstrated moving multi-ton satellites by hand. 0g recreation is available on orbital colonies, but not on the Moon or Mars. Finally, the level of (pseudo-) gravity is controlled at any desired level by rotating an orbital colony. Thus, the main living areas can be kept at 1g, whereas the Moon has 1/6g and Mars 1/3g. 1g is critical, at least for early colonies, to ensure that children grow up with strong bones and muscles.
Several design groups have examined orbital colony feasibility. They have determined that there are ample quantities of all the necessary materials on the Moon and Near Earth Asteroids, that solar energy is readily available in very large quantities, and that no new scientific breakthroughs are necessary, although a great deal of engineering would be required.
Remote research stations in inhospitable climates, such as the Amundsen-Scott South Pole Station or Devon Island Mars Arctic Research Station, can also provide some practice for off-world outpost construction and operation. The Mars Desert Research Station has a habitat for similar reasons, but the surrounding climate is not strictly inhospitable.
A space habitat, also called space colony and orbital colony, is a space station which is intended as a permanent settlement rather than as a simple way-station or other specialized facility. They would be literal "cities" in space, where people would live and work and raise families. No space habitats have yet been constructed, we do not classify all space stations as a space habitat since they are not a replication of the natural environment necessary to sustain a species population, they are by definition artificially maintained and temporary, but many design proposals have been made with varying degrees of realism by both science fiction authors and engineers.
Is having a goal of building science around a space colony on the moon for example? NO, it is how FAST MOVING FORWARD advances these technologies not caring how 99% of people, the EARTH, our civilized societies are killed. BUSINESS INSIDER gives a global banking 1% myth-making headline that MARS colonists will only face radiation levels 8 times higher than our US government levels of toxic exposure and that is FAKE NEWS---LYING TO PUT LIPSTICK ON A PIG OF A POLICY.
30-40 years ago REAL left social progressive academics at US public medical campuses had already created data surrounding MICROWAVE exposure toxicity both in regards to MICROWAVE OVENS in our kitchens---AND data from computer simulations of exposures to radiation on planets like MARS. Back then we understood how HOSTILE a planet like MARS was to human beings----both in being sterile, dead rocks----and exposures to deadly atmosphere.
Today, we are being fed FAKE SCIENCE DATA to hide this harm and make all of what exists on these planets, moons, and meteors seem LESS TOXIC. These data are created by 5% to the 1% freemason/Greeks tied to LYING, CHEATING, AND STEALING to accumulate wealth and power just as MEDIEVAL BARBER SURGEONS posing as PHYSICIANS.
CLINTON/BUSH/OBAMA GLOBAL BANKING 5% PLAYERS WORKING FOR OLD WORLD KINGS AND QUEENS ARE SELLING SMOKE AS MEDICAL DATA AND PROCEDURES.
Just as XL PIPELINE ALT RIGHT ALT LEFT 5% freemason/Greek players pretending to care about the environment by running to protect the VERY LAST LINK OF CRUDE OIL PIPELINE having had policies and laws passed a few decades ago-----so too are all those FAKE 5% global banking academics coming out to protest NOW what has been in development and KNOWN TO BE HARMFUL AND DEADLY TO HUMANS -----these 5% players are doing so NOW just to get in line to study the public health harm and deadly toxicity in SMART CITIES to know how humans will be effected in planetary mining slave colonies.
PROTECTING AS 5G ROLLS UP------WE THINK YE PROTESTS ARE FAKE.
Top 5G announcements from MWC 2018
We round up the biggest announcements on 5G made during MWC 2018 in Barcelona this week.
By Corinne Reichert | February 27, 2018 -- 14:35 GMT (06:35 PST) | Topic: Mobility
Mobile World Congress (MWC) 2018 has seen dozens of 5G-related announcements, spanning devices, modems, radios, plans, spectrum, and trials.
Nokia 8110 Matrix points to the future for smartphones
Galaxy S9: Should you upgrade?
Sony's Xperia XZ2 adds 3D scanning capabilities
How Samsung's DeX updates improve the enterprise experience
Best and worst of the past five years
First sub-$50 Android Go smartphones due
Huawei focuses on connecting emerging markets
CNET: Latest from Barcelona
TechRepublic: IT pro's guide to 5G technology (free PDF)
We round up the biggest announcements on 5G made during MWC in Barcelona this week, and the information we gained from carriers, vendors, and networking companies.
Intel is working on 5G phones and PCs
Intel is already working with Dell, HP, Lenovo, and Microsoft on bringing 5G connectivity to Windows PCs using the Intel XMM 8000-series commercial 5G modems.
It is showcasing its first 5G-enabled 2-in-1 concept PC during MWC, which is powered by its 8th-generation Core i5 processors and an early 5G modem, with the expectation of bringing 5G-connected PCs to market in the second half of 2019.
Intel GM of 5G Advanced Technologies Rob Topol told ZDNet that 5G-connected PCs will require a complete re-engineering of current 2-in-1s, with the first silicon due at the end of this year, samples at the beginning of next year, and devices in the second half of 2019.
"We wanted to start to experiment with form factors and learn where should we put the antennas. Putting a modem that can support 5Gbps changes even the way that you do thermals and heat transfer inside," he said.
"It doesn't look like a normal tablet or 2-in-1 inside. It really required new engineering, and so those learnings now help us translate them into -- we announced the partnerships with HP, Lenovo, Dell, Microsoft -- to take those learnings and co-engineer in the laptop form factor, as well as using that for tablets and others."
Intel also announced a "multi-year collaboration" with Spreadtrum to produce a 5G phone platform by the second half of 2019 using Intel's XMM 8000-series modem alongside Spreadtrum's application processor.
Huawei unveils its first 5G customer premises equipment (CPE)
Huawei launched its first commercial 5G CPE, a terminal device supporting 3GPP 5G standards with a Huawei-developed Balong 5G01 chipset, as part of its end-to-end 5G solution.
According to the Chinese networking giant, this is the world's first commercial 3GPP 5G chipset supporting download speeds of up to 2.3Gbps across sub-6GHz and millimetre-wave (mmWave) spectrum bands.
"The Balong 5G01 makes Huawei the first company offering an end-to-end 5G solution through its network, devices, and chipset-level capabilities," Huawei said, with the CPE coming in a sub-6GHz model and an mmWave model, as well as indoor and outdoor units.
"The Huawei low-frequency 5G CPE is small and lightweight, compatible with 4G and 5G networks, and has proven measured download speeds of up to 2Gbps -- 20 times that of 100Mbps fibre. This provides an ultra-fast experience, allowing users to enjoy VR video and gaming experiences, or download a TV show within a second."
Claiming to be the only company to launch full 5G end-to-end solution, Huawei also pointed towards its entire 5G portfolio for 2018: Massive MIMO macro, including the AAU5612, the AAU5310i, and the HAAU5213; Massive MIMO pole site, including the HAAU5112 and the EasyBlink; small cell, consisting of its 5G Lampsite product; devices, including the 5G CPE; baseband, including the BBU5900 and CBU5900; transport, including microwave, IPRAN, FO OTN, and WDM products; and core, consisting of its cloud-based product.
ZTE is hoping to have a 5G smartphone by the end of 2018
Like Huawei, ZTE's 5G CPE is already under development, with the fellow Chinese company saying it will launch 5G smartphones and tablets in either late 2018 or early 2019.
ZTE further stated that it will be deploying networking products across commercial 5G networks by the first half of next year, with the Chinese telecommunications technology provider also saying it is "well prepared to help operators deploy 5G".
"Ready for commercialisation, ZTE's 5G solutions are going to be launched soon," the company said. "As a pioneer in the 5G era, ZTE has made the rollout of its 5G solutions the core goal."
Alongside the company's 1.2Gbps-capable smartphone announcement this week, ZTE explained that it is helping partners with technology verification through what it called "the most commercially viable 5G field test network currently available".
Telstra will launch 5G in 2019
Australian carrier Telstra finally announced its 5G launch plans, aiming to provide 5G to major cities and regional areas by the end of 2019 using both sub-6GHz and mmWave spectrum.
According to Telstra's 5G roadmap, 2018 will see the deployment of over 1,000 small cells in metro areas to increase capacity, and 4G and 5G integration trials with Ericsson, Intel, and Qualcomm, including interoperability testing.
"Our objective will be to lead the development in 5G, and be the leader in the rollout of Australia, but it's not just about being first -- it's about making sure you have a fully integrated and extensive 5G set of offerings," Telstra CEO Andy Penn told ZDNet at MWC.
"We've always been a leader in technology and will continue to be so, and as I said it's one thing to just sort of put a flag in the ground, but what's more important is we have an integrated set of 5G solutions for customers, and also we will continue to invest in and develop the capability of 4G as well.
"Because ultimately, whilst 5G might be available commercially in 2019, realistically not everybody is going to suddenly switch to 5G; there will still be many customers on 4G."
Sprint announces first six cities to get 5G
Sprint used MWC to announce that it will be bringing 5G networks to Los Angeles, Washington DC, Atlanta, Chicago, Dallas, and Houston first, with the six cities to begin experiencing "5G-like capabilities" as of April.
The upgrades will begin with the rollout of Massive MIMO in LA, Chicago, and Dallas, with an "aggressive" expansion into additional markets later in the year.
As part of this, Sprint will deploy thousands of Massive MIMO radios from Ericsson, Nokia, and Samsung, as well as 40,000 outdoor small cell solutions, 15,000 stand-mounted small cells, and 1 million Sprint Magic Boxes -- labelled the world's first wireless small cells -- to cell towers.
Sprint CTO John Saw told ZDNet that the carrier will be naming additional markets for its 5G launch in the coming months. Sprint chose its initial six due to their high traffic, he said, and the fact that the carrier holds at least 120MHz of 5G spectrum in those areas.
"Those are big markets. Massive MIMO by itself allows us to add up to 10 times more capacity than a regular LTE site, so you obviously want to put them where you have the most demand, and those are the biggest markets where we have the most customers and the most use," Saw told ZDNet.
"We sat down with partners like Nokia to figure out where do we have a critical mass of sites that we can upgrade, where we know we can move fast on. That's how we picked the first few markets.
"Ultimately, we're going to be naming more markets over the next few months ... we're showing up to this 5G game with I think more spectrum than our competitors."
T-Mobile announces 5G for 30 cities
T-Mobile announced that it will begin building out 5G across 30 cities this year, with Los Angeles, New York, Las Vegas, and Dallas to have the service by 2019.
In an interview with ZDNet, T-Mobile CTO Neville Ray and 5G Americas president Chris Pearson said mobile carriers need more 5G help from the US government on both infrastructure regulations and spectrum availability.
"I think as an industry, we all realise a lot more spectrum is needed for 5G to ultimately succeed in the US market, and that's across all bands," Ray told ZDNet, pointing to the mmWave and 3.5GHz CBRS bands.
"The US has consumed most of the commercial spectrum pretty rapidly over recent years, and for 5G we need a lot more.
"It seems to take an interminable amount of time in the US to bring any spectrum to market."
Pearson said that in addition to making more spectrum available, the government must also work on reducing the barrier to deploying additional infrastructure.
Ericsson CEO says there will be hundreds of billions of dollars in 5G revenue
Ericsson CEO Börje Ekholm announced the Swedish networking giant's guide for how telecommunications carriers can maximise revenues during the transition to 5G, predicting that real-time automation has a revenue potential of $101 billion by 2026.
Enhanced video services came in second, with potential revenue of $96 billion, according to Ericsson, although Ekholm believes enhanced mobile broadband will be the first commercial deployment of 5G.
On net neutrality, Ekholm said that while Ericsson believes in non-discriminatory access to information and data, he added that "not all traffic is created equal" -- and that once critical applications such as remote surgery are being performed over 5G, they should be given priority over other traffic.
The Ericsson CEO also said governments should help enable 5G by making new spectrum available and providing a "stable regulatory environment" and faster permitting processes.
NTT DoCoMo and Intel partner on Tokyo 2020 5G
Intel announced that it will partner with Japanese telecommunications carrier NTT DoCoMo on providing 5G coverage and technology for the 2020 Olympic Games in Tokyo.
Some of the applications that can be expected at Tokyo 2020 according to Intel include 360-degree 8K video streams with real-time broadcasts, including VR applications; drones kitted out with HD cameras; smart city sensors and connected cars, which will enable better transport options throughout Tokyo; and access to data and analytics during Olympic training for athletes.
"As we look to 2020, Intel is excited to unveil today our collaboration with NTT DoCoMo, a National Partner of Tokyo 2020, to provide 5G technology for the next Olympic Games. Intel hopes to establish what's expected to be the world's largest 5G commercial network," Intel SVP and chief strategy officer Aicha Evans said.
The Tokyo 2020 5G network will also provide a glimpse into technology prototypes from the 2022-23 era, Intel said.
AT&T says its 5G leadership is due to focus on virtualisation and edge computing
With US carrier AT&T committing to roll out 5G networks in 12 markets by the end of this year, it is definitely a frontrunner. SVP of Wireless Network Architecture and Design Igal Elbaz told ZDNet this week that this is partially due to its focus on edge computing and network virtualisation.
"We are very uniquely positioned because of our experience in SDN, and because of what we are doing in 5G, and because of what we are doing in edge," he told ZDNet at MWC.
Also: IT pro's guide to the evolution and impact of 5G technology (Free PDF)
"And you're seeing in all three dimensions, we're very active in each one of them; we believe that we have a very unique not just opportunity but an advantage in terms of how we think about the network and how we should deploy it."
Elbaz also pointed towards AT&T's acquisition of FiberTower earlier this month, saying the mmWave spectrum gained as a result "puts us where we need to be". Its focus on not only taking part in but also pushing 5G standards forward while trialling the technology has also put it in a prime position for deployment, he added.
"This is why we think we could be first -- it's because we're very active in the standards, besides we've done a lot of trials in '16 and '17. We're very active in the standards, we believe that's the right way to do it, in fact we've expedited them," he told ZDNet.
AT&T has yet to announce what vendors it's working with, or the remaining nine cities to gain 5G by the end of the year, with Elbaz saying more information on this will be provided in the next month.
Huawei and Intel demonstrate 5G interoperability
Huawei and Intel are using MWC to conduct the world's first 5G New Radio (5G NR) over-the-air interoperability public demonstration using the new 3GPP 5G NR non-standalone (NSA) standards set at the end of last year.
"It will be a fully compliant connection, and that's important because since the standard was just voted on in December, obviously there's only so much time to be able to develop a solution that can support and be fully compliant to every feature in the specifications," Intel GM of 5G Advanced Technologies Rob Topol told media.
Huawei had announced partnering with Intel on interoperability trials based on 3GPP standards back in September.
Huawei Australia's new CEO also praised the Australian government's 5G working group, saying the Chinese networking giant is wanting to push more discussions with government.
"I do see the government as also more and more open to discuss with industry, the vendors," new chief executive George Huang said.
"The government set up a 5G working group last year, I think that's a very good initiative because you know 5G is not only a product or a technology, it is an ecosystem. It really requires the vendors, the customers, operators, industries to work together to make that happen.
"So I do see a very good initiative from the government, and Huawei are also very happy to work with the government. We are quite open to discuss anything with the government."
During MWC, Huang told ZDNet in an interview that Huawei will be pushing into "many industries" to enable their digital transformation, including mining, oil, gas, agriculture, and transportation.
Samsung's 5G fixed-wireless suite gains FCC approval
Samsung announced at MWC that its complete commercial fixed-wireless access (FWA) 5G solution has become the first globally to receive approval by the United States Federal Communications Commission (FCC).
The end-to-end 5G FWA solution operates over the mmWave band, and includes commercial indoor and outdoor 5G home routers and CPE; 5G Radio Access Network (RAN) involving a radio access unit and virtualised RAN (vRAN); a next-generation core; and artificial intelligence-powered 3D radio frequency planning services and tools.
The equipment and solutions received FCC approval last week thanks to what Samsung said was "close collaboration with the FCC's Office of Engineering and Technology".
"Since the beginning of our 5G research in 2012, Samsung stood firm among industry players to trust in the potentials of the millimetre-wave spectrum," Samsung Electronics president and head of Networks Youngky Kim said on Monday afternoon.
"Our efforts towards advancing this technology will see the light this year, making 5G a reality and opening up new territories' possibilities for consumers, operators, and enterprises."
Huawei and BT announce 5G trial
Huawei and BT announced extending their 5G partnership to conduct live trials of 5G NR and CPE across mobile carrier EE.
"The aim is to test real-life 5G performance in a range of environments in preparation for commercial launch," Huawei said.
"Our 5G research has been hugely promising, and this partnership with Huawei will turn that research into reality," BT CTIO Howard Watson said.
"The EE network is already the UK leader for speed and coverage, and with the weight of BT's R&D and partnerships we can ensure that leadership continues with the introduction a world-class 5G experience."
Every single FEDERAL funding awarded to create FAKE MEDICAL DATA surrounding these 5G infrastructure installations as we see below 2012-----happened almost totally during OBAMA several years negating all of last century's PUBLIC INTEREST data surrounding exposure to MICROWAVE ENVIRONMENT and all those 5% academic players pushing FAKE MEDICAL DATA for these global corporations could care less about HUMAN RIGHTS, HUMAN WELFARE-----they are medieval BARBER SURGEONS working for their own fees to gain personal wealth.
'"Since the beginning of our 5G research in 2012, Samsung stood firm among industry players to trust in the potentials of the millimetre-wave spectrum," Samsung Electronics president and head of Networks Youngky Kim said on Monday afternoon'.
One of the recurring themes in THE PHYSICIAN with ROB J----THE BARBER-----THE PERSIAN PHYSICIANS known to be best in the world was the same HIPPOCRATIC OATH DO NO HARM medical treatment known for thousands of years------
NOTHING IS MORE POWERFUL A TOOL FOR DIAGNOSIS OF DISEASE VECTOR AND PATIENT WELL-BEING THAN PHYSICALLY TOUCHING EVERY PART OF THAT HUMAN BODY.
What TELEMEDICINE and the FAKE DATA being sold by national global banking media and 5% player academics is telling us is ---DON'T WORRY about having a PHYSICIAN actually be with you in person-----actually touching you and seeing all that is YOU in person-----ARTIFICIAL INTELLIGENCE and computers can assess all that without anyone actually with you.
All of this goes against MEDICAL ETHICS AND MORALS built for thousands of years and these changes today are being built on FAKE DATA by BARBER SURGEONS selling SMOKE.
The art of PHYSICIAN physical exam was critical in THE PHYSICIAN as ROB J knew as did PERSIAN medical school know. Now, all the SMOKE coming from SALESMEN OF TECHNOLOGY-----not real medicine----it is MEDICINE SHOW. Moving all our several centuries of 99% of WE THE PEOPLE in US, Europe, and Canada away from actually having FAMILY PHYSICIANS takes lots of FAKE NEWS to make TELEMEDICINE sound as good or better.
AMA Journal of Ethics®
Illuminating the art of medicine
Virtual Mentor. February 2007, Volume 9, Number 2: 113-118.
Print | View PDF
Diagnostic Tools and the Hands-On Physical Examination
Douglas P. Olson and Katalin E. Roth, JD, MD
Phoon CK. Must doctors still examine patients?
Perspect Biol Med. 2000;43:548-561.
Technology is continually redefining the practice of medicine. From sophisticated tests in tertiary medical centers to the advanced technology now available daily in outpatient settings, there is no question that new discoveries, devices and laboratory tests have altered the way in which physicians diagnose, treat and palliate disease. Whether or not the introduction of new methods to improve health will alter the role of the physical exam in disease diagnosis—or the patient-doctor relationship itself—is an important topic to consider.
In "Must Doctors Still Examine Patients" , Colin K. Phoon argues that technology threatens to alter the way physicians practice medicine. He defines physical examination as the physician's routine assessment of a patient using the five senses and minimal invasiveness, using, for example, a stethoscope or opthalmoscope but not a colonoscope. Phoon eloquently traces the physical exam back some 6,500 years to the Chinese, showing its evolution throughout the time of the Egyptians, Hippocrates, and up through the era of Osler and Taussig, declaring that the achievements of the latter two physicians are "[mostly] based on observation and physical examination...[and have formed] essentially the medicine of today" , and supporting this idea with a quote by Osler stating that "the whole art of medicine is in observation" .
Phoon goes on to assert that the physical exam serves functions beyond diagnosis, such as improving the patient-doctor relationship and maintaining the revered status of the physician in society. He believes that the physical exam is still the most effective and efficient means of diagnosis despite the high degree of specialization and the availability of so many tests. He acknowledges that, because of advances in technology, the physician's reliance on physical touch to diagnose and interact with patients has decreased, which has distanced the physician from the patient, a point that another author, J.G. Bruhn, made more than 20 years earlier .
Playing devil's advocate, Phoon presents several arguments in favor of the physical exam's becoming obsolete, even citing an article in Time magazine entitled "Will Robots Make Housecalls" ? to bolster the argument from the lay press. Phoon suggests that an alternative to the psychiatric mental status exam may be an analysis of biochemical markers in the brain, and that the heart exam may be transformed into a single, all-powerful scan, before concluding that the physical exam "cannot hope to compete" .
If the aim of medicine were simply to diagnose, the physical exam might well lose out in competition against a "Star-Trek" scanner approach to medicine. But what of assessment, prognosis and the all-important physical connection between doctor and patient? Phoon himself, a proponent of advancing technology, concludes in his article that the "physical examination will remain an important part of the everyday practice of medicine" .
Technology and the practice of medicine have fused well at present. The careful history and physical examination remain the backbone of medical practice. There are a host of pragmatic and ethical reasons for this, a discussion of which follows.
The "physical"—a constant in medicine
The history and physical exam (H&P) are among the few commonalities in medicine, practiced by every physician trained in every country throughout the world. Indeed, anyone who has practiced or observed medicine in resource-poor settings knows that it is often the only method available for diagnosing a patient's illness. While medical care has become increasingly specialty-oriented in the United States, the model of the general practitioner relying on the physical exam as the basis for diagnosis and treatment prevails. Because the majority of the world's population resides in areas where physicians do not have consistent access to the latest available technology, physical examination continues to define the profession. The H&P has received renewed attention in medical schools  and forms an important part of the core curriculum for training future generations of healers. So every patient, whether afforded a technologically advanced scan or test, whether in the United States or the hinterland of a developing nation, whether presenting for a routine exam or being considered for hospice care, can be guaranteed a physical exam. As Phoon states, "If it is good for the patient, shouldn't we use it" ? This is especially apt for the physical exam.
In today's era of rapid global travel, where diseases such as avian flu and SARS (severe acute respiratory syndrome) know no boundaries, when malaria, dengue fever and other diseases are suspected in travelers or immigrants, it is often the physical exam that alerts the astute physician. Sometimes physical signs of the disease become recognizable to physicians before the disease is even understood, as was the case when physicians recognized the classical presentation of AIDS before a lab test was developed for the human immunodeficiency virus.
There are reasons to perform a physical exam that go beyond the universality of the tradition. Current billing regulations by Medicare and Medicaid mandate that physicians perform key components of the physical examination . Physicians who want to be paid must often confirm that they performed these parts of the exam. To simply complete the insurance form and not do the exam is not only unethical but unlawful.
While it is arguably a poor reason to perform medical procedures, the very litigious nature of medicine in the United States demands not only continuation of the physical exam but competence in performing it. Studies have shown that the single best way to avoid legal proceedings against oneself is to have strong, trustful and well-developed relationships with one's patients . The physical exam assists in this by emphasizing the physician's touch, listening ear and empathetic words of concern and advice.
While the litigiousness of U.S. society might demand a physical exam, and while time spent with patients might decrease the number of lawsuits, evidence abounds that patients simply like to spend time with their physicians and are willing to pay for it if they are able to . The skillful performance of a physical examination is of considerable therapeutic importance. Through it, the patient acknowledges his trust by permitting the physician to touch his body, and the physician demonstrates fidelity to the relationship by taking the time to see, hear and feel what the patient's body reveals.
Is reliance on technology eroding skills?
Phoon's skepticism may arise, in part, from his background in cardiology, a field that has seen impressive advances in technologies for diagnosing and treating illness. Other fields still rely more upon skillful physical examination. Dermatology very much depends on human observation and palpation for the recognition of tumors, rashes and other skin conditions. Neurology, while enhanced greatly by noninvasive radiographic scans, depends on the physical exam to correlate pathology with functional changes. Rheumatology, which has been augmented by the development of specific tests for disease, must first rely on the history and physical exam to suggest disease. For example, while the physical exam cannot compete with the specificity of a positive test for the SCL-70 antigen, the test is not currently, nor in the foreseeable future will it be, ordered to diagnose scleroderma in the absence of symptoms identified on physical exam, false positives notwithstanding.
Someday a field like psychiatry, which depends heavily on the patient-doctor interaction, may indeed be altered if a physical test is identified that allows a physician to diagnose schizophrenia on laboratory data. Yet more definitive diagnostic tools will not solve the ethical dilemmas that often permeate the practice of psychiatry. For example, obtaining informed consent for a spinal tap from a schizophrenic patient will continue to be ethically problematic, even if there is a high probability of attaining diagnostic certainty.
How do these arguments fit with observations that the physical diagnosis skills of medical students, residents and fellows are declining? While we may insist that the physical exam remain an integral part of physician training, evidence suggests that trainees' evaluation (or promotion) is not always based on competency in these skills. Several investigators have identified "disturbingly low" levels of competence in bedside cardiac auscultation among physicians in training when compared with competency levels of more than ten years ago [12,13].
It remains to be seen whether new methods of teaching and testing for the skills of physical examination (patient models, heart sound machines, etc.) will actually improve diagnostic assessment. Skills are learned and practiced most during the training years and serve as a base for additional learning, refinement and experience. Skills not emphasized and honed during the training years are unlikely to improve later. Yet, although the physical exam remains a cornerstone of clinical medicine throughout the world, doctors actually touch patients less, and the mastery of examination skills at every level of training has decreased over the years. [13,14].
No one knows whether the decrease in physical exam acuity has affected physicians' abilities as diagnosticians. From a strictly clinical sense, we would argue that it has not; physicians still diagnose disease as well as generations of physicians did before them. But with echocardiography readily available, few physicians would trade a certain diagnosis of a diastolic mitral murmur complete with flow velocities, leaflet visualizations and ejection fractions for a "highly likely" diagnosis by physical exam. Alternatively, a disease presentation "highly suggestive" of rheumatoid arthritis can sometime be both confirmed and followed by laboratory testing including anti-Smith, anti-dsDNA and RA antibodies. Technology aids advanced diagnosis, but determining what must be confirmed or ruled out depends on a proper H&P.
Improving differential diagnosis
This may be where advanced technology can and has helped best—in teasing out differential diagnoses. Initial diagnoses are still heavily observer dependent, and they flow from the physician's experience and clinical acumen. In today's U.S. medical environment, however, whether a cardiology attending physician or a third-year medical student hears a persistent murmur, the patient can be reasonably certain that he or she will be sent for an echocardiogram and EKG.
Is it ethical for technology to have this role in diagnosis? A knee-jerk response might be an emphatic "yes." A more thorough consideration of the question, however, challenges this initial response. In an environment of soaring health care costs, large numbers of uninsured patients and an ever-increasing gap between rich and poor in the United States, should we continue to spend money on advanced diagnostic tests when some of the information might be gleaned more economically from the physical? Unfortunately, unless the litigious nature of medical practice changes, this trend toward dependence on technology will probably continue in the U.S. The flip-side to this is the notion that more time spent listening, examining and physically touching a patient contributes to a decrease in the number of lawsuits . This means that doctors must strike a balance between advanced technology and physical diagnosis, machine testing and bedside acumen.
International medical graduates must demonstrate proficiency in medicine by taking the USMLE Step exams before they are allowed to practice in the United States, even if they were already practicing medicine in their own country. Should the growing number of U.S. medical graduates who want to practice in resource-poor settings and areas that rely heavily on the physical exam be required to show that they can perform one? The requirement for such a competency exam might draw more support from ethical than from legal arguments.
Phoon's take-home message is that technology has greatly influenced medicine and will continue to do so. He proposes several scenarios that might portend an ever-declining role for the physical exam as increased use of technology becomes more prominent in health care. We think, however, for the many reasons explored in this essay, that the physical exam is and will remain firmly entrenched as part of diagnosing disease and developing the patient-doctor relationship.
There is no doubt that the medicine of the last century is not the medicine of today. But one characteristic is constant: the human desire for trust and understanding, especially when one is sick and vulnerable. Upon this constant is established the efficacious and therapeutic patient-doctor relationship. Like the marriage of bench science to improved disease treatment and outcome, practiced by Sir William Osler and many before and after him, physical diagnosis must be fused with technology to diagnose and treat disease. As Osler himself said: "Learn to see, learn to hear, learn to feel, learn to smell and know that by practice alone can you become experts" . Perhaps the fusion of the physical exam, technology and research can help physicians become more accurate, quicker diagnosticians and healers while maintaining the crucial human bond forged through personal interaction and improve patient care in the process: goals embraced by all.
Question for discussion
How should medical education address the convincing evidence that physician trainees of today are less astute at the physical exam than those who came before them?
First, we question these SCIENCE AND MEDICINE data and goals of removing 99% WE THE PEOPLE black, white, and brown citizens from ever accessing a REAL PHYSICIAN just by what global banking 1% media outlets are all selling these same articles -------since the goals of TELEMEDICINE are tied to SPACE TRAVEL AND SPACE COLONIES where there will be no REAL PHYSICIANS or medical teaching and training institutions----people are being made to assume all this TELEMEDICINE technology actually does what global banking 5% players are telling them it does-----
SELLING SMOKE AND MIRRORS TO MAKE PEOPLE BELIEVE THEY ARE RECEIVING HEALTH CARE.
It seems magically that AI and telemedicine technology has already OUT-DIAGNOSED real PHYSICIANS when indeed much of this technology is still in development and much is WISHFUL THINKING.
'Can An Algorithm Diagnose Better Than A Doctor?
Will artificial intelligence solve doctor shortages? Will it be able to replace the art of making a correct diagnosis? Not anytime soon. Many times after my talks, people ask me whether algorithms could theoretically be better at making a diagnosis than doctors'.
'Stanford trained AI to diagnose pneumonia better than a ...
Stanford trained AI to diagnose pneumonia better than a radiologist in just two ... Researchers say AI can help doctors do their job where resources are scarce ...'
The End of Human Doctors – The Bleeding Edge of Medical AI Research (Part 2)
The End of Human Doctors – The Bleeding Edge of Medical AI Research (Part 2)
June 5, 2017 ~ lukeoakdenrayner
Today we continue looking at breakthrough medical deep learning research, and review a major paper from Stanford researchers that reports “dermatologist level classification of skin cancer”, published in Janurary 2017.
As a reminder, a major focus of this dive into the state of the art research will be barriers to medical AI, particularly technical barriers.
This week I thank Andre Esteva, one of the authors of the paper, for answering several questions I had.
Like last week this article is about 3000 words, so I will include another summary box at the end for the TL:DR crowd
Standard disclaimer: these posts are aimed at a broad audience including layfolk, machine learning experts, doctors and others. Experts will likely feel that my treatment of their discipline is fairly superficial, but will hopefully find a lot of interesting a new ideas outside of their domains. That said, if there are any errors please let me know so I can make corrections.
The state of the art
First up, I want to remind everyone – deep learning has really only been around as an applied method since 2012. So we haven’t even had five years to use this stuff in medicine, and us medical folks typically lag behind a bit. With that perspective some of these results are even more incredible, but we should acknowledge that this is just the beginning.
I’m going to review each paper I think is evidence of breakthrough medical automation, or that adds something useful to the conversation. I’ll describe the research, but spend time discussing a few key elements:
The task – is it a clinical task? How much of medical practice could be disrupted if it is automated? Why was this specific task chosen?
The data – how was the data collected and processed? How does it fit in to medical trials and regulatory requirements? What can we learn about the data needs of medical AI more broadly.
The results – do they equal or beat doctors? What exactly did they test? What more can we glean?
The conclusion – how big a deal is this? What does it show that we can extrapolate more broadly?
Stanford’s Nature paper on skin cancer and other skin lesions (February 2017)The task:
Dermatology is the medical specialty that mostly focuses on skin lesions. They deal with skin cancer (10,000 deaths per year in USA) and other neoplasms, rashes and skin manifestations of systemic diseases.
Skin lesions are really varied but really hard to tell apart, even for humans
The authors trained a deep learning system to perform several tasks related to dermatological practice. The headline result is the assessment of “needs biopsy” lesions, which is identifying patients which might have skin cancer and need further workup. They also assessed the ability to identify cancer directly from the images, and a more complicated task trying to diagnose lesion subgroups.
They trained the system with 130,000 skin lesion photos, from 18 different public databases as well as private data from Stanford Hospital. Unfortunately the paper wasn’t super clear about where the data came from and how it was structured, so I am not really sure what the ground truth training labels were. In the paper they describe the data as “dermatologist labeled”, but there is also mention of biopsy results in various locations. I think we can assume that a big chunk of this data is labeled by a single dermatologist, without biopsy results.
Interestingly, how the data was labelled is quite different from last week. Instead of grading images with a score, they looked at all 2032 dermatological diseases they had data for. Since many of these diseases have a handful of examples (and therefore can’t be learned by current ML techniques) they created an ontology of disease. This is essentially a tree-structure that divides the diagnoses up into groups based on appearance and clinical similarity.
Lesions are grouped together by visual and clinical patterns, so each category at each layer of the tree is useful for clinical tasks.By doing this, they can identify lesion groups rather than diagnoses. In the paper they show results for identifying lesions in the top 3 classes (benign, malignant, non-neoplastic) and the next layer down, with 9 classes.
They validated/tested the system on a dataset with 1950 biopsy proven lesions. In the headline “biopsy or not” experiment they compared results against between 21 and 25 dermatologists. In the other experiments they used 2 dermatologists.
The prevalence of disease in the training set is not described in the paper, but reading between the lines the data must be heavily enriched for positive examples of cancer. For example, in Figure 1 it shows that 92% of melanocytic lesions were malignant, presumably describing the training data.
In the test set the prevalence was reported. There were three types of lesion: epidermal, melanocytic and melanocytic with dermoscopy (which a better camera, essentially). Malignancy made up half of epidermal lesions, a third of melanocytic lesions, and almost two thirds of melanocytic/dermoscopy lesions.
The prevalence of these lesions in clinical populations is apparently not clear in the readings I looked at, but it must be below 5%, and is probably below 1%. So the validation sets are heavily enriched.
Regarding the data quality, the skin lesion photographs are typically around 1 megapixel each in resolution. These images were shrunk to 299 pixels square, which is 0.08 megapixels (about 90% less pixels). This is a baked-in property of the network architecture they applied, other image sizes cannot be used.
They also excluded blurry and far-away images from testing, but these pictures were still used in training. They do note that many lesions had multiple pictures (i.e. from different angles) but they went to a good deal of effort to make sure that no lesions were present in both the training and test sets.
They used a pre-trained version of the Google Inception-v3 deep neural network, which is one of the best performing image analysis systems used today. Pre-training typically means they took a network already trained to detect non-medical objects (like photographs of cats and cars), and then trained it further on the specific medical images. This is why the network would only accept 229 x 299 pixel images.
This paper was what I consider the second major breakthrough in medical deep learning. They achieved better performance than most of the individual dermatologists, as well as the “average” dermatologist, from their panel that they presented for comparison.
This is essentially a ROC curve, just flipped over. The dots are dermatologists, and the blue line is the algorithm, which is further to the top right (meaning better performance).Similar to last week, you can imagine drawing a line of best fit through the dermatologists. Unlike last week, this line would actually be worse than the algorithm! Breaking that down, this system was better at identifying lesions that ended up being malignant after a biopsy. It could pick up more positive cases while getting fewer false positives compare to most of the individual doctors*. This is a big deal.
The other experiments are less earth-shaking, but are very interesting. They showed how accurate they are at identifying the top level and second level of their tree ontology.
I’ll explain CNN vs CNN-PA in a little bit, it is super interesting.This shows that at the top level of the tree, performance is better than dermatologists, but at the second order branches performance is only about the same.
This research has some very interesting implications for visual AI systems in medicine.
The task: the headline result is deciding whether a lesion needs a biopsy or not. This is the exact clinical task that dermatologists perform when looking at possibly malignant skin lesions, so it is a great choice.
Essentially, when a doctor makes a choice like this, they want to biopsy all the cases of cancer they can and not biopsy the benign cases. This is because every biopsy performed increases the cost, pain and risk involved.
Since the ROC curve trades off those exact quantities, number of cancers missed vs number of false positives, it is a great way to look at the comparison. And the system outperformed dermatologists. Quite literally, at almost every operating point, the deep learning system had more true positives and fewer false positives. For the first time ever, a deep learning system convincingly beat doctors at a task they are specifically trained to perform.
The data: the major point of interest here is the tree-structure they used to organise their data. This captures the complexity of medical practice (>2000 diagnoses) but also gives us a sensible way to simplify the task. They could choose any level of the tree to train their algorithm and make predictions, a trade off between granularity and data availability.
The reason we can’t train medical AI systems to learn all the diagnoses is because of the rarity of most medical disease. Across medicine, and in dermatology, most conditions are rare. Many occur at less than one in a thousand, and rates of one in a million are not uncommon. I have said previously a good rule of thumb is that a deep learning system needs about 1000 training examples per class to learn effectively, so to have enough examples for the rare diseases you would need hundreds of millions of cases.
The real success of their approach is that they optimised the granularity of their labelling based on the amount of data available. They didn’t just say “let’s use the 3rd level of the tree”, they said “along any branch, let’s use the deepest node that contains 1000 examples“. In some cases, this might be the 3rd layer, but in other cases it might be much further down the tree (as the diagnoses in question are more common and have more examples).
By doing this, they created a label structure with 757 classes. So they can’t do “diagnosis” in the sense that they can’t identify all 2032 diseases in their data (although neither can dermatologists), but their training is a fine-grained as is practical.
And the take home message is that it works. Let’s review that table from the results.
The “CNN” results are when they trained the model on the specific task they were trying to perform – either three way or nine way classification. The “CNN-PA” results are for when the system is trained on their partitioning algorithm – the 757 classes that contain 1000 examples each.
This is sort of a surprise. Training on one task and applying it to a new one is called “transfer learning”, and is generally inferior if you have enough data to train on your task specifically. But because they structured their labels in an ontology where the branches are related to the appearances, they see a benefit in the upper level task with lower level labels.
One way to think about this is that learning is a statistical process. The features a deep learning system learns to recognise a class are simply the features that are most useful for the task. So when you have a broad class (like ‘malignant’) which is made up of multiple different diseases with different numbers of examples, the system will favour learning the most commonly useful features. The less commonly useful features, like those that distinguish between two rare but similar diseases, might not be learned. So when you have get to the edge cases between the super-classes “benign” and “malignant”, a system trained only to recognise those classes might never have learned the features that separate a seborrhoeic keratosis from a squamous cell carcinoma.
This t-SNE visualisation from the paper shows that while the major classes of lesion do cluster together, there are edge cases with overlap. Training on more granular classes should/did help correctly identify these confusing images.
This brings us to a major topic in medical AI – data engineering. We already touched on this last week, but I want to spend some time on it today.
AI has a history of needing humans to codify their knowledge for computers. Initially with expert systems like MYCIN, this meant writing rules that roughly encapsulated human knowledge. These systems were unwieldy and prone to failure when challenged with unforeseen problems. After expert systems, machine learning could take features of data and discover relationships. The problem now was that you had to pick the right features. In image analysis, this meant hand-crafting image features – capturing human knowledge in a mathematical way. An example would be telling a computer system to find the relationship between bone density (measured by the number of bright pixels on an xray) and fractures. This approach was less brittle and less time-consuming to program, but we still had to be able to convert our knowledge into numeric features.
Deep learning goes a step further, it takes in raw images and finds patterns for a task. No human knowledge input, right?
Well, no. Humans still decide on the data that goes in, and the labels that define the task. Pick the wrong data and the wrong labels, and the system won’t work. Last week, the Google team paid many ophthalmologists to score their cases, to increase the accuracy of the labels. Both Google and the Stanford team decided to downsample their images. These decisions were based on expert knowledge, that individual ophthalmologists’ labels are inaccurate and that shrunken images still contain useful diagnostic information.
This week the research team was even more explicit in incorporating knowledge into their data, and they spent a very significant amount of effort to build their ontology. This required experts to identify common disease subgroups, using their knowledge to organise their labels in a way that helped in any task they might want to perform, with any amount of data.
So one way to understand the history of AI is as the transition from knowledge-engineering, to feature-engineering, to data-engineering. We do less work than ever before to codify human knowledge, but it isn’t no work.
This also could tell us something about the future of AI. Each transition has resulted in systems that are less brittle and more able to deal with complex data in more “human” ways. Defeating the need for data-engineering might well be the key to the next stage of AI. If we can, then you could simply supply any data to an AI system, and it will do the best job possible to solve a task. That sounds a lot like general artificial intelligence.
The results: relevant to the idea of narrow vs general intelligence, this research tells us that data is a major limiting factor to the breadth of learning. If we look at the results provided, the system is superhuman at “biopsy or not”, and “benign, malignant, non-neoplastic”, but only human** at the 9-class task.
I think it is safe to assume that this is an issue about data size. As we move down the tree, each node has fewer examples. I suspect that at the next level down, a 22-class problem according to their diagram, the system would be sub-human in performance.
It would be great to know the exact number of cases at each point in the tree to be able to estimate this effect more accurately, but unfortunately that information is not available. Interestingly, and counter to my usual rule of thumb, there should be more than 1000 cases in each of the 2nd and 3rd level nodes, and it doesn’t seem like this is enough for superhuman performance. Maybe we need to expect even harsher data requirements if we truly want to outperform doctors.
The impact: skin lesions are super common, and skin cancers are the most common malignancies in people without much melanin in their skin. Skin cancer is a leading causes of death among middle aged adults, particularly in Australia (where beaches plus the damaged ozone layer increase our risk).
Nowhere near enough people go for mole checkups, and that shows in the death rates. So imagine if you could just take a photo on your phone and get an opinion better than a dermatologist on whether it needs a biopsy.
Well, imagine no longer.
In this recent video from Wired, the group who did this research look well on the way to turning their system into an app for your phone.
It will be very interesting to see how this is regulated. There is a compelling case that this technology could save a huge number of lives (there are more than 10,000 melanoma deaths per year in the United States alone), but it is still currently unclear how thoroughly something like this will need to be tested before it can be put into practice.
When this does hit the market, say in the next year or two, what happens to dermatologists? Looking at lesions is a very significant part of their work. Are they going to see their jobs evaporate?
I doubt it, at least for a while. Dermatologists also do the biopsies, and without a doubt the demand for skin biopsies is going to skyrocket. We may actually see a shortage of dermatologists in the near term.
Longer term though, I suspect we will see task substitution; non-doctors will be trained to do biopsies. Taking the doctor out of the loop here will be a big deal from a regulatory standpoint, but the massive cost savings (particularly as demand increases) will make it inevitable.
What of dermatologists then? Well, this system can only identify 9 subgroups as well as dermatologists, out of 2032 diagnoses. For now, dermatologists have the edge in something like 2023 diagnostic tasks.
But that won’t last, as more data lets the system traverse the tree with more accuracy. The number will shrink over time. How fast that process occurs will define the point where we reach dermatology escape velocity.
So those are my thoughts about the second big breakthrough paper in medical AI, from January 2017. You probably realise that these two major breakthrough happened within two months of each other. For a second there it looked like we would all be out of jobs within the year 🙂
Unfortunately, or thankfully depending on your perspective, we haven’t seen anything quite on this level since. Next week we will look at some other recent papers that don’t quite make the cut, but can still help us understand the limitations of deep learning in medicine.
Once ROB J in his travels from EUROPE and LONDON to PERSIA to attend the best in world medical schools under the best PHYSICIANS who were talented and passionate having that genius to HEAL-----the story does a good job showing how those from royal/rich families having all the benefits of K-UNIVERSITY schools filled with ARTS AND HUMANITIES were often those accepted but ending in wanting only to be BARBER SURGEONS seeking royal positions and wealth. Those with real TALENT and GENIUS as healers were sent off and killed in continuous wars------were subjected to constant fear of reprisal from less talented medical students and faculty-----and those considered the best PHYSICIANS were assigned duty as royal servants there talents wasted.
Today in Baltimore we are seeing all kinds of BARBER SURGEONS installed in the growing deregulation and privatization of all US public health care and systems as all that Federal funding and our MEDICARE MEDICAID TRUST money is being handed out for PAY-TO-PLAY CORRUPTION AND ROBBER BARON third world fleecing killing the best in WORLD HISTORY MORAL AND ETHICAL PUBLIC HEALTH STRUCTURE described in THE PHYSICIAN in PERSIA 1000BC ----1000AD.
Basal skin cancer is one of the easiest for our family doctors to diagnose---these are not breakthroughs.
So, CLINTON/BUSH/OBAMA pushed out all those REAL US PHYSICIANS actually talented and having a genius to heal wanting to help all 99% WE THE PEOPLE needing medical services and replaced them with 5% global banking players ready to LIE, CHEAT, STEAL just as medieval BARBER SURGEONS who mainly put up a shingle for income being tied to the rich and royal families.
We can see the global banking national media outlets selling this FAKE NEWS as real EVIDENCE-BASED SCIENCE.
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Most of our US 99% of WE THE PEOPLE somewhere in our K-12 public education were taught the BARBER POLE origin in its ties to medical development through DARK AGES to modern US medicine. We shared yesterday that our EUROPEAN BARBER TRADE GUILDS were still operating in some European nations LIKE GERMANY-------but for a few hundred years modern medicine broke with medieval BARBER SURGEON status having the BARBER SHOP taken to being simply a place we go for hair cuts and shaving.
We KNOW the practice of BLEEDING AND LEECHES was harmful to human health not helpful and we KNOW our blood is not filled with BAD HUMOURS -----YET, we are seeing BARBER POLES attached to global corporations being installed in US CITIES DEEMED FOREIGN ECONOMIC ZONES ---like Baltimore as MOVING FORWARD sells BARBER SURGEON as REAL MEDICINE again-----watch out for all that BLEEDING when you go for a haircut!
Main article: Phlebotomy (modern)
Today it is well established that bloodletting is not effective for most diseases. Indeed, it is mostly harmful, since it can weaken the patient and facilitate infections.
Here is an article written in 2016 telling us BARBER-SURGEON is extinct when in fact these guilds are soaring replacing our AMA----AMERICAN MEDICAL ASSOCIATION PHYSICIANS guilds.
So, here in DARK AGES BALTIMORE we are seeing our global banking BALTIMORE DEVELOPMENT allowing global corporations tied to BARBER SHOPS complete with BARBER POLES-----may not be medieval yet but that is the goal of MOVING FORWARD TELEMEDICINE ONLY for 99% of WE THE PEOPLE who will be made desperate to access anyone telling us THEY ARE BARBER SURGEONS.
Extinct Professions: Barber-Surgeon
- by Schelly ·
- October 6, 2016
It is probably a good thing that barber-surgeon is today an extinct profession! What extinct jobs did your ancestors have?
Barber-surgeons existed back in the 13th-century or even earlier when almost every population center had its own practitioner and bathhouse. Most were trained through apprenticeships, as long as seven years.
That person provided — in addition to haircuts, shaves, and cosmetic procedures — wound care, setting of broken bones, herbal remedies, dressings, bleeding and cupping. In 16th-century Germany, barber-surgeons began to specialize in tooth-pulling or cataracts. Operations were public entertainment, often at town and country fairs.
Barber-surgeons operating on a boil on a man’s forehead [in the style of Miguel March]
In addition to these procedures, these shops were centers of communication and information, and were probably the source of today’s ideas about clients talking to their hairdressers about everything! There is evidence of a barber-surgeon in Bologna asking for a license to hold public readings of the news from Rome and Venice.
In the 14th and 15th-centuries, medicine and surgery were in their infancy. Printing had just been invented (1452), and Columbus’ voyages to the New World were rather recent (1492). Even though the Salerno (Italy) medical school had been founded in the 11th century, it was barely functioning. At the time, medicine and surgery were practiced by the same persons, and the two specialties were not separated until much later.
Originally surgery was practiced solely by priests until about 1215 when Pope Honorius III gave the practice of medicine to laymen and forced sick people to visit priests in their cloisters. Thus priests became diagnosticians, and the barbers became the surgeons (or technicians).
Until 1638, in many areas, no special qualifications were required. In other places, barber-surgeons had their own guild and, after passing an exam, they became master craftsmen.
In Italy, the profession was not as common because competent physicians were trained at universities in Salerno, Bologna, and Padua.
Some readers might remember that in “Man of La Mancha” (the musical), Don Quixote and his assistant Sancho Panza meet a barber-surgeon, who claims his ability to provide a good shave and also to bandage any mistakes his razor might cause.
One of the most famous barber-surgeons was Ambroise Paré, whose 20 years in that profession made him one of the most famous surgeons in Europe and he was a physician to Kings Henry II, Francis II, Charles IX and Henry III.
A sketch of Paré’s life and accomplishments is here.
Born in Laval, France in 1509, he learned Latin from a priest and apprenticed under a barber-surgeon in his town. Later, he went to Paris to study surgery, worked for a College of France professor, and was a resident at the Hotel-Dieu, the largest hospital in the world at that time. In 1536, at 27, he was appointed surgeon to a colonel-general to serve in Italy. He returned to Paris and had a long innovative career. He published numerous books, was active in promoting the fledgling prosthetics industry and is considered the father of French surgery, modern forensic pathology, surgical techniques and battlefield medicine. He also invented surgical instruments. He died at 81 on December 20, 1590.
What remains of these early barber-surgeons is the distinctive and traditional red-and-white pole outside barber shops. Some scholars say the pole as a symbol that goes back to ancient Greece and that travelers would know that the shop was a place where help could be found. Many sources claim the red stripe is for the blood of various procedures, while the white stands for bandages. In America, blue stripes are often added. Click here for more on the history of the barber pole.
Here is where ROB J and our PERSIAN best of best PHYSICIAN become global banking 21% propaganda for today in THE PHYSICIAN----remember, these global banking 1% LITERARY STARS are always told to sell global banking FADS as societal changes in their writing. Again, the story is great-----it is almost all FICTION with good historical references tied to MEDICAL HISTORY.
The dynamic for ROB J vs PERSIAN greatest of PHYSICIANS revolves around RELIGION killing SCIENTIFIC INQUIRY. ROB J reads GALEN in order to learn human anatomy at a time when religious beliefs do not allow human dissection. This is referred to as DARK AGES----indeed it was 1000AD.
As we read in the story the actual religious text tied to interpretation leading to banning of human dissection when back in ancient times medicine and dissection was quite advanced---it wasn't religious texts keeping ROB J and PERSIA in DARK AGES---it was interpretation. What has this to do with MOVING FORWARD today? Our SCIENCE FOR SCIENCE sake global banking 5% players are trying to end all MORALS AND ETHICS surrounding human rights and dignity tied to HUMAN BODY. So, we don't need our bodies to be intact and buried----selling all our human organs or having them harvested for profiteering and experiment is just fine.
We are skipping the ethics of human dissection and going right into WHAT THE HECK IS ANY REMAINS OF HUMAN BODY needed after death. Only a few world religions take this stance by global banking 1% and HINDI is one......the human body has no value after death. ROB J respected burial of body but forced this issue of GALEN HUMAN DISSECTION.
History of Medicine
Human Dissection – From Galen to the Great Revelations of Andreas Vesalius
by Elizabeth Roberts, MA, CPC | August 20, 2011
Humans have been cutting open cadavers and dissecting corpses almost since the beginning of recorded human history. Ancient Egyptians went to great lengths to mummify their dead, including cutting open bodies, dissecting out organs, and preserving remains. Following closely in their footsteps, ancient Greeks also pursued human dissection, in much more of a scientific vein. Rather than an immoral view of desecrating the human body, Greeks thought of human dissection as an extension of the empirical nature of science.
Two early Greek physicians, Erasistratus and Herophilus made the first systematic, scientific explorations of the human body, and they are now thought to be the first physiologist and the founder of human anatomy, respectively. Together, these two doctors advanced the study of the interior of the human body, which was once a sacrosanct mystery, into a field of scientific query. Herophilus dissected the entire human body, and differed from the authority at the time, Aristotle, when he claimed that consciousness was stored in the brain rather than in the heart. Erasistratus explained the workings of human organs in mechanical terms.
Unfortunately, the spark of empirical study of human anatomy that these two physicians should have set off did not light, as their two schools reverted to bickering over theoretical disputes. As if the fire of human dissection was not already flickering, it was snuffed out completely with the burning of the library of Alexandria and the widespread introduction of Christianity, when it became impossible to dissect human bodies anywhere in the Hellenistic world. This marked a great transition in the study of human anatomy, and for hundreds of years the European world valued the sanctity of the church more than scientific inquiry.
Galen’s Anatomical Influence
The first of the great anatomists was Galen of Pergamon (AD 130-200) who made vast achievements in the understanding of the heart, the nervous system, and the mechanics of breathing. Because human dissection was forbidden, he performed many of his dissections on Barbary apes, which he considered similar enough to the human form. The system of anatomy he developed was so influential that it was used for the next 1400 years. Galen continued to be influential into the 16th century, when a young and rebellious physician began the practice of using real human bodies to study the inner workings of the human body.
Enter Andreas Vesalius
Vesalius, who came from a line of four prominent family physicians, began as a young and precocious anatomy student. As a child, he would often catch and dissect small animals, and later as a medical student, he would go to great lengths to obtain human remains to study. At age 18, he entered the University of Paris, where they strictly adhered to the antiquated works of Hippocrates and Galen, and the medical professors thought it below themselves to perform actual dissections. During any actual demonstrations, the professor would lecture on high as a barber-surgeon did the actual cutting on the dissection floor.
Unlike Britain, in which only the bodies of executed murderers could be used for dissection by medical men, France’s revolutionary edicts made it easy for medically minded men to obtain bodies to study. This did not mean, however, that lowly students such as Andreas Vesalius would have direct access to any of these bodies.
Vesalius and other like-minded anatomy students would raid the gallows of Paris for half-decomposed bodies and skeletons to dissect. They would sometimes find the courage to go outside of the walls of Paris, braving the feral dogs and stench, in order to steal cadavers from the mound of Monfaucon, where the bodies of executed criminals were hung until they disintegrated.
Rather than considering dissection a lowering of his prestige as a doctor, Vesalius prided himself in being the only physician to directly study human anatomy since the ancients. During only his second anatomical lecture, Vesalius stepped onto the dissecting floor, took the knife away from the barber-surgeon, and began cutting at the cadaver himself, demonstrating his great skill with the knife.
His professors quickly noticed his great knowledge and ability, and by the age of 22 he was giving his own anatomical lectures, all of which centered on a dissection. Some of his subjects were animals, but more often than not they were human cadavers. He also suspended a skeleton above the dissecting table during his lectures, and taught that the skeleton was the foundation of the body.
Similar to the influential works of Galen, Vesalius’ work on human anatomy revolutionized the scientific world. The publication of his book De humani corporis fabrica (On the Fabric of the Human Body) stands as a monument in the history of science and medicine. Whereas his contemporaries relied on the antiquated accounts of Galen, who dissected animals rather than humans, Vesalius relied on the actual human body to inform his theories.
Vesalius’ work provided the first accurate description of the internal structures and workings of the human body, and more importantly, revived the use of the scientific method for studying human anatomy. The birth of Christianity supplanted hands-on, empirical study of the human body with the philosophical reliance on a Supreme Intellect. This idea was that every human body part was a product of the Supreme Intellect’s design, whether or not it coincided with what actually lay out on the dissecting table.
Vesalius, on the other hand, could not support the ancient writings of Galen, who relied on this idea of Supreme design. Although he revered him highly, Vesalius often found that his study of the human form did not fit with the descriptions provided by Galen, whose descriptions often matched the anatomies of dogs, apes, or sheep. He eventually found over 200 discrepancies such as these, and publicly announced his break from the Galenic tradition.
A Revolutionary Physician
De humani corporis fabrica, published in 1543, was a turning point in the history of modern medicine. For the first time, the understanding of medicine and the treatment of disease was rooted in an accurate representation of the human body. This book revolutionized the medical world. Similar to the findings of Copernicus and Galileo, Vesalius’ works help spur an empirically-based, scientific study of the world around us.
Like his fellow revolutionary scientists, Vesalius’ masterpiece was met with harsh criticism. Many of these criticisms understandably came from the church, but the most strident of all came from Galenic anatomists. These critics vowed that Galen was in no way incorrect, and so if the human anatomy of which he wrote was different from that which was proved by Vesalius, it was because the human body had changed in the time between the two.
As a response to the harsh criticisms of his work, Vesalius vowed to never again bring forth truth to an ungrateful world. In the same year that he published de humani, he burned the remainder of his unpublished works, further criticisms of Galen, and preparations for his future studies. He left medical school, married, and lived out the rest of his conservative life as a court physician.
Even though Vesalius abandoned further studies of human anatomy, before he died he recognized the great contributions he had made to the scientific world. He understood that his revelations represented an awakening of inquiry into the human body, and a reliance on facts, rather than adherence to an antiquated text.
The remainder of the history of human dissection is just as rocky. Although France in the 16th century was open-minded about the use of human cadavers for scientific inquiry, the rest of the European world was not so revolutionary. Great Britain had its own tradition of illegal trade in dead bodies, and even the United States had a hard time opening up to the idea that human bodies should be used for scientific study.