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A heart-to-heart discussion

STUART WHITE
THE WORLD IN BLACK-N-WHITE

A new law comes into effect in the United Kingdom shortly allowing doctors to harvest organs and other body parts from any patient  dying in hospital unless they have given specific instructions to the contrary.

This turns on its head the previous convention whereby  the donor had to have made known their consent or in the case of not having done, permission would then have to be obtained from members of the immediate family to extract transplantable body parts. Before going any further it’s worth having a look at the history of transplants and the rapid advancement in scope and success. 

Though practitioners of medicine had considered the possibility of transplanting body parts for decades, if not centuries (consider Mary Shelley’s famous 1818 horror tale Frankenstein),  the practice only truly began in 1954 when  Dr. Joseph E. Murray  achieved the first successful kidney transplant between identical twins in Boston in 1954.  Murray received the Nobel Prize for Medicine for this pioneering work  in 1990.

However it was 13 years later when arguably the most ground-breaking transplant was carried out, almost on our own doorstep.   On 3 December 1967 at the Groot Schuur hospital in Cape Town, the heart of a young female accident victim was transplanted into a middle aged man, Mr. Louis Washansky,  suffering from intractable heart failure caused by coronary artery disease. He died 18 days later from extensive bilateral pneumonia but this limited success was hailed throughout the world as a major medical triumph and turned Barnard into an international superstar.

His second transplant on a  Dr Philip Blaiberg, was carried out less than two weeks later. The donor was a young man who had had a severe subarachnoid haemorrhage while swimming.  Blaiberg  survived for 18 months following his surgery.  Many people wondered why the world's first heart transplant came to be carried out in Cape Town, South Africa,  rather than one of the leading centres in the United States or Europe but in fact the standard of medicine in Cape Town in the 1960s was advanced and sophisticated with well equipped research laboratories and an ethos in which research and initiative were encouraged with a staff complement of full time doctors who combined their clinical care and teaching with experimental work in the adjacent medical school, headed by Barnard.

Much damage was done to the image of heart transplantation by the immediate unseemly scramble to get on the bandwagon. In 1968 107 transplants were carried out by 64 surgical teams in 24 countries. These were of poor clinical capabilities, matching of donors and recipients was poor and there was little appreciation of the need for meticulous aftercare and the management of rejection. 

The major problem was the tendency of the body’s immune system to become activated against the foreign organ and to mount a response designed to kill the invader (rejection). In order to prevent rejection, patients were given strong medications to suppress their entire immune system that in turn left them susceptible to life threatening infections. It was not until 1978, when the immunosuppressive drug Cyclosporin was introduced, that many of the problems of rejection were controlled.

Since then, other drugs have been developed and today, one-year survival rates for most organs are between 70% and 90%. As transplant medicine accelerated, it produced a wealth of legal and ethical concerns, the most critical of which related to the determination of death. Technology had improved to the point where the body could be maintained with artificial support long after the brain had died.

A new definition of death was required to include situations where the entire brain and brain stem had irreversibly ceased to function (brain death). This  is critical as it allows recovery before cessation of blood flow to the organs. Prior to brain death, organs could only be recovered after the heart had stopped beating, which limited transplants to kidneys and livers only. Brain death allowed the additional recovery of the heart, pancreas, lungs and intestines, eyes and even skin.

Which brings me back to the new British law.  There is no doubt that there is an urgent need for more organ donation.  400 people died last year whilst on the transplant list in the UK and in the US an average of 20 people die daily and certainly some of those deaths could be avoided if people were compelled to agree to post-mortem donation.  But there is a huge moral and ethical leap being made here which assumes that dead bodies are effectively state property and that is a worrying development.

A huge scandal broke out in the UK in the 1990s when it emerged that organs and tissue from children who died in the Alder Hey and Bristol  hospitals had been harvested and stored for use in research without the parents’ knowledge or consent, yet only a quarter of a century later this is now to become state-sanctioned.  In addition the practise, whilst not specifically banned in any of the major religions, is condemned under differing interpretation of ancient tracts and precepts. 

There is further confusion concerning the terminology and litmus test of ‘brain dead’ in the light of new research on long-term, comatose patients. So a pioneering step in organ donation and potentially life-saving legislation or a massive state intrusion into that most basic possession of the human being – his or her own body?  We might even say that’s at the very heart of the problem.

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Export Processing Zones: How to Get SEZA to Sizzle

23rd September 2020
Export Processing Zone (EPZ) factory in Kenya

In 2005, the Business & Economic Advisory Council (BEAC) pitched the idea of the establishment of Special Economic Zones (SEZs) to the Mogae Administration.

It took five years before the SEZ policy was formulated, another five years before the relevant law was enacted, and a full three years before the Special Economic Zones Authority (SEZA) became operational.

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Egypt Bagged Again

23rd September 2020
Samson

… courtesy of infiltration stratagem by Jehovah-Enlil’s clan

With the passing of Joshua’s generation, General Atiku, the promised peace and prosperity of a land flowing with milk and honey disappeared, giving way to chaos and confusion.

Maybe Joshua himself was to blame for this shambolic state of affairs. He had failed to mentor a successor in the manner Moses had mentored him. He had left the nation without a central government or a human head of state but as a confederacy of twelve independent tribes without any unifying force except their Anunnaki gods.

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‘RO, ‘RO ‘RO YOUR ‘BOT

23rd September 2020

If I say the word ‘robot’ to you,  I can guess what would immediately spring to mind –  a cute little Android or animal-like creature with human or pet animal characteristics and a ‘heart’, that is to say to say a battery, of gold, the sort we’ve all seen in various movies and  tv shows.  Think R2D2 or 3CPO in Star Wars, Wall-E in the movie of the same name,  Sonny in I Robot, loveable rogue Bender in Futurama,  Johnny 5 in Short Circuit…

Of course there are the evil ones too, the sort that want to rise up and eliminate us  inferior humans – Roy Batty in Blade Runner, Schwarzenegger’s T-800 in The Terminator,  Box in Logan’s Run,  Police robots in Elysium and  Otomo in Robocop.

And that’s to name but a few.  As a general rule of thumb, the closer the robot is to human form, the more dangerous it is and of course the ultimate threat in any Sci-Fi movie is that the robots will turn the tables and become the masters, not the mechanical slaves.  And whilst we are in reality a long way from robotic domination, there are an increasing number of examples of  robotics in the workplace.

ROBOT BLOODHOUNDS Sometimes by the time that one of us smells something the damage has already begun – the smell of burning rubber or even worse, the smell of deadly gas. Thank goodness for a robot capable of quickly detecting and analyzing a smell from our very own footprint.

A*Library Bot The A*Star (Singapore) developed library bot which when books are equipped with RFID location chips, can scan shelves quickly seeking out-of-place titles.  It manoeuvres with ease around corners, enhances the sorting and searching of books, and can self-navigate the library facility during non-open hours.

DRUG-COMPOUNDING ROBOT Automated medicine distribution system, connected to the hospital prescription system. It’s goal? To manipulate a large variety of objects (i.e.: drug vials, syringes, and IV bags) normally used in the manual process of drugs compounding to facilitate stronger standardisation, create higher levels of patient safety, and lower the risk of hospital staff exposed to toxic substances.

AUTOMOTIVE INDUSTRY ROBOTS Applications include screw-driving, assembling, painting, trimming/cutting, pouring hazardous substances, labelling, welding, handling, quality control applications as well as tasks that require extreme precision,

AGRICULTURAL ROBOTS Ecrobotix, a Swiss technology firm has a solar-controlled ‘bot that not only can identify weeds but thereafter can treat them. Naio Technologies based in southwestern France has developed a robot with the ability to weed, hoe, and assist during harvesting. Energid Technologies has developed a citrus picking system that retrieves one piece of fruit every 2-3 seconds and Spain-based Agrobot has taken the treachery out of strawberry picking. Meanwhile, Blue River Technology has developed the LettuceBot2 that attaches itself to a tractor to thin out lettuce fields as well as prevent herbicide-resistant weeds. And that’s only scratching the finely-tilled soil.

INDUSTRIAL FLOOR SCRUBBERS The Global Automatic Floor Scrubber Machine boasts a 1.6HP motor that offers 113″ water lift, 180 RPM and a coverage rate of 17,000 sq. ft. per hour

These examples all come from the aptly-named site www.willrobotstakemyjob.com    because while these functions are labour-saving and ripe for automation, the increasing use of artificial intelligence in the workplace will undoubtedly lead to increasing reliance on machines and a resulting swathe of human redundancies in a broad spectrum of industries and services.

This process has been greatly boosted by the global pandemic due to a combination of a workforce on furlough, whether by decree or by choice, and the obvious advantages of using virus-free machines – I don’t think computer viruses count!  For example, it was suggested recently that their use might have a beneficial effect in care homes for the elderly, solving short staffing issues and cheering up the old folks with the novelty of having their tea, coffee and medicines delivered by glorified model cars.  It’s a theory, at any rate.

Already, customers at the South-Korean  fast-food chain No Brand Burger can avoid any interaction with a human server during the pandemic.  The chain is using robots to take orders, prepare food and bring meals out to diners.  Customers order and pay via touchscreen, then their request is sent to the kitchen where a cooking machine heats up the buns and patties. When it’s ready, a robot ‘waiter’ brings out their takeout bag.   

‘This is the first time I’ve actually seen such robots, so they are really amazing and fun,’ Shin Hyun Soo, an office worker at No Brand in Seoul for the first time, told the AP. 

Human workers add toppings to the burgers and wrap them up in takeout bags before passing them over to yellow-and-black serving robots, which have been compared to Minions. 

Also in Korea, the Italian restaurant chain Mad for Garlic is using serving robots even for sit-down customers. Using 3D space mapping and other technology, the electronic ‘waiter,’ known as Aglio Kim, navigates between tables with up to five orders.  Mad for Garlic manager Lee Young-ho said kids especially like the robots, which can carry up to 66lbs in their trays.

These catering robots look nothing like their human counterparts – in fact they are nothing more than glorified food trolleys so using our thumb rule from the movies, mankind is safe from imminent takeover but clearly  Korean hospitality sector workers’ jobs are not.

And right there is the dichotomy – replacement by stealth.  Remote-controlled robotic waiters and waitresses don’t need to be paid, they don’t go on strike and they don’t spread disease so it’s a sure bet their army is already on the march.

But there may be more redundancies on the way as well.  Have you noticed how AI designers have an inability to use words of more than one syllable?  So ‘robot’ has become ‘bot’ and ‘android’ simply ‘droid?  Well, guys, if you continue to build machines ultimately smarter than yourselves you ‘rons  may find yourself surplus to requirements too – that’s ‘moron’ to us polysyllabic humans”!

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