Professor Charles Knowles gave a keynote address at the international Webit meeting in Sofia, Bulgaria on ‘Future challenges for surgical research and opportunities for technology’.
Professor Knowles was invited to attend and speak at the 2019 Webit Festival Europe in May which gathers the tech, digital and policy elite to re-invent and pave the digital future of Europe. The festival is under the patronage of Maria Gabriel, EU Commissioner Digital & Society, the Mayor of Sofia and in collaboration with the Council of Ministers in Bulgaria. It was also attended by the President of Bulgaria, Rumen Radev.
Professor Knowles gave a presentation at Webit Festival Europe's Health Summit entitled, ‘Future challenges for surgical research and opportunities for technology’. His talk focussed on the frailties of the standard explanatory RCT design in delivering answers in surgery and on the justifiable criticism of current attempts at observational studies in surgery with respect to high levels of almost every known bias, failure to collect meaningful (e.g. functional and QoL) outcomes and failure to collect outcomes for long enough (e.g. to detect future harms).
“Observational studies are not fundamentally bad; we (surgeons) just do them very badly”
A consideration of these deficiencies leads one to consider whether there might be a better way provided by the technology at our disposal. Knowles suggests a future where patients are empowered to collect sequential stepped and meaningful observations of their health rather than their sickness (e.g. quality of life, function and ‘happiness’) over time from which the effect (or otherwise) of surgical interventions could be determined by blinded interrupted regression analysis.
The key tenets of his proposal remove the beholder (all main bias comes from the observer), empower patients to curate and own their data for donation or sale (data democracy) and actually improve statistical efficiency (see Hooper & Knowles, Stat Med 2018).
From a technology perspective, such a bold future requires the platform and analytics to deliver and Webit has provided a start to this with key interest from patient IT groups, large commercial providers and existing entrepreneurs in the health space e.g. in data integration by artificial intelligence (this will be required but probably with Bayesian controls) and blockchain (advantages for its publicly distributed ledger, immutability and security by modern cryptography).
Professor Knowles says:
“We will not replace surgical research with AI but surgical researchers who do not embrace AI will be replaced with those that do”.