What Neurosurgeons Should Do To Succeed in Tomorrow's Scientific and Socioeconomic Environment

There will be major scientific advances and socioeconomic changes in the 21st century that will influence the development of medicine and neurosurgery. These changes will affect those in academic medical centers and the private practitioners of medicine and neurosurgery. Neurosurgeons' philosophy and practice methods must adapt to these trends. Because of the continuing growth in scientific knowledge and the rapid spread of communications of all types, physicians will best work in groups and teams. These group forces will require the physicians to surrender some independence to gain the power of the integrated knowledge and political and social force of a group. Graduate and postgraduate education programs will also change to adapt to these new realities. Those who understand these new shifts will be the most successful in establishing and conducting practices in academic centers and private practice.

Physicians worldwide have been selected from among the most capable and intelligent people to enter their profession. Their education takes years, and most not only look forward to the personal satisfaction of caring for patients but also to financial security. The globalization of economics, however, has placed industry worldwide in competition to produce the lowest-cost products. Driven by expanding populations, health care expenses have risen beyond the ability of industry and government to afford them. In the US we are conditioned to desire the latest medical treatments in the hope of prolonging life, which are regarded as valuable in this and other industrialized cultures. New restrictions on government-sponsored health care expenditures or reduced payments by third parties hired by industry, have limited the reimbursement for physicians, threatening their long-planned careers in terms of financial security and satisfaction. Physicians are reluctant to revise long-set career goals and behavior, and they are frustrated by the socioeconomic changes influencing medicine. Some retire early; others become frustrated in practice, and seek security as salaried employees of large health care systems or insurance plans; but few adapt and change with the new environment.

The purpose of this paper is to outline for neurosurgeons and other physicians the influences leading to changes in the practice of medicine in this century and to propose solutions to allow future success in this new environment.

There are two major areas of scientific growth: biology and technology. In biological science, the extensive research into the molecular events of the cell and the sequencing of the genome will lead to major changes in the practice of medicine. These discoveries will change how we treat cancers of the central nervous system and other diseases. Surgical debulking of brain tumors, which has been performed for the last 100 years, aided by radio- and chemotherapy, has failed to control intracranial neoplasms and often results in serious morbidity. Targeted molecular therapies will become more successful and will prevail in treating cancer and other diseases. Furthermore, these molecular advances will allow us to understand the biochemical sequence of events leading to ischemia-induced cell death. This information will influence the way we treat cerebral ischemia, edema, and trauma. Neurosurgeons will have to be knowledgeable about the metabolic changes occurring in each of these conditions. Specific biochemical treatments will exist for different phases of the metabolic chain reaction that occur with cell injury underlying all of these diseases. We have seen evidence of this in the recent discoveries of the multiple posttrauma phases through which the brain cells pass.

No less important an advance will be cell transplantation, which will restore functions that are lost due to trauma-related cell death, infarction, and degenerative diseases.  Neurosurgeons must be participants in this research and must understand all of the genetic, behavioral, and immunological phenomena involved to achieve success, as did transplant surgeons 25 years ago. If not, the neurosurgeon will cling to a few technical procedures, becoming marginalized while new advances allow other practitioners to take over their patients and treatments. The rise of those performing interventional treatments for aneurysms is an example.

In technology, major advances in neuroimaging will continue to enhance insights into the function of the brain. We will be able to visualize fiber tracts and determine their function noninvasively in each individual. There will be metabolic maps of the brain indicating differences between ill and healthy people. For example, the differences in each patient's reaction to pain will be understood because neuroimaging (positron emission tomography and magnetic resonance imaging) reveals the biochemical, fiber tract, and synaptic diversities among patients. This information will be used to guide computerized surgical approaches to lesions, which will minimize morbidity. Differences among individuals in transmitter concentrations, determined by neuroimaging, will become the basis for selective drug modeling and therapy that will be individually tailored.  The development of nanoscience will allow the creation of implantable prostheses for hearing, vision, and perhaps other functions.

It is and will be impossible for one person to know and understand all the available information. Because of the increasing rate of scientific discovery, the amount of medical-related data doubles every 8 years. This increase of scientific information will continue at an asymptotic rate, requiring even greater specialization among professionals. The flood of new information will necessitate that physicians become interdependent to remain informed about treatments. Specialization in specific domains of neurosurgery will be essential for the neurosurgeon to remain current in the specialty and to provide the best and latest care to his/her patients. Our meetings have already become divided into superspecialty sections; most of these sections also hold independent meetings.

In the academic center, basic scientists, engineers, and magnetic resonance imaging physicists, to name a few, will need to work together with clinicians to develop the advances. Outside the academic center in private practice, neurosurgeons, neurologists, psychiatrists, neuroradiologists, and others will have to share their knowledge to provide the latest and best treatment for their patients.

30 Amazing Facts About Your Brain

Useful Self Development Brain Stuff

1. You have a finite amount of will power each day because to exercise will power you need energy in the form of oxygen and glucose That’s why it’s harder to say ‘no’ when you are tired or not feeling yourself.

2. A thought is a physical pathway in the brain. The more you have that thought the more you groove that path and the easier it is to have it again. That’s why having the thought “Why do I suck?” is never a great idea.

3. Speaking of which, you have approximately 70,000 thoughts per day, although many will be the same ones looping round and round on your grooved cranial highway.

So make sure you don’t think, “Why do I suck?” 50,000 times a day, or suck ye shall.

4. Even if you consider yourself a left-brained person, your brain will still switch over to the right side every 90 to 120 minutes and then back again.

That’s why even left-brained people can have times of the day when they are more creative and right-brained people can sometimes get their taxes in order.

Note: If you want to know how you can tell which side is dominant at any one time, check outCreativity – Guaranteed and  you can then plan your time accordingly.

5. Reading out loud to kids accelerates their brain development.

6. Reframing negative events in a positive light literally rewires your brain and can make you a happier person, as can regular meditation.

Some Numbers To Wrap Your Brain Around

7. The brain is approximately 75% water, but you should never drink it.

8. Your brain only weighs about 3lbs yet the greedy bastard uses between 20% and 25% of your energy supplies each day.

9. There are approximately 10 to the power of 60 atoms in the universe. Your brain laughs in the face of that figure however, as it has 10 to the power of 1,000,000 different ways it can wire itself up.

That’s the number 10 followed up with 1 million zeroes, which is to all intents and purposes (for anybody not called Stephen Hawking or Rob Collins), an infinite amount of ways.

10. Speaking of large numbers, there are approximately 1.1 trillion cells and 100 billion neurons in the average human brain.

11. The slowest speed information passes around your brain is approximately 260 mph

Brain Trivia

12. Your brain was disproportionately large compared to other organs when you were born.

That’s why babies look a bit like aliens. Not yours of course, yours are cute, just other peoples babies.

13. If you lose blood flow to your brain you will last about 10 second before you pass out.

14. Your brain has no pain receptors which is why if I managed to remove the top of your skull without you noticing I could poke around all day without you feeling a thing. The skull removal may hurt a bit though.

15. Even though we say the amygdala regulates danger, the cerebellum motor control, and the limbic system emotions etc, this is somewhat misleading as no part operates independently and all need other parts of the brain to get their job done.

16. Your peripheral vision improves at night which is why pilots are taught to use their peripheral vision when looking for traffic.

Your Brain Is Amazing

17. Leaving aside degenerative brain disease, your brain never loses the ability to learn and change because it’s effectively plastic and constantly rewiring itself.

Leopards may indeed not change their spots, but you’re not a Leopard and you can change yourself and your brain is up for the challenge.

18. It ‘s a self development urban myth that we only use 10% of our brain. We use it all and if you don’t believe me cut a bit out and see what happens.

Note: Unfortunately the new movie, Limitless due out soon is going to re-embed this myth as it’s based on the story line that we use 20% of our brain and you can take a pill to access the other 80%. Ho-hum.

19. If you were to measure your brainwave activity you wouldn’t see any drop off when you’re asleep.

You may be napping, but your brain is still working hard pumping your heart, digesting your food, maintaining your blood pressure and much more to make sure you don’t wake up dead.

20. Research has shown that the hippocampus which which deals with visual-spatial awareness, is larger in London Taxi drivers than normal people. London ‘cabbies’ have to spend months, sometimes years, learning literally every street in the Capital before they are allowed a license.

This process is known as ‘The Knowledge’ and it literally enlarges that part of their brain. Unfortunately, it doesn’t help them with anger management issues when cyclists get in their way.

21. Until relatively recently scientists thought that the brain was the only area of the human body that didn’t generate new cells. We now know that’s not true and the brain does reproduce shiny new cells for you to use

22. You have something in your brain called mirror neurons. If you see somebody stub their toe for example, the same pain area will light up in your own brain causing you to flinch.

Mirror neurons weren’t even known to exist prior to the early 1990’s, but now there is a growing belief in the scientific community they are responsible for us feeling empathy toward others.

23. When somebody takes cocaine their pleasure center (nucleus accumbens) lights up and dopamine and serotonin are released. Fortunately, you don’t have to blow your life savings, act like a dick and lose your nasal lining to get similar results.

Giving to charity or helping people in need also activates the nucleus accumbens. What a win/win that is, eh?

Your Brain Is a Dumbass

24. Multi-tasking is a self development urban myth. You simply cannot do it efficiently no matter what manufacturers of smart phones want you to believe.

According to the University of Utah, there are a few people (about 2.5% of the population) who can do two things consciously* at once without seeing any degradation in performance.

They are called super-taskers.

However, for most people all the brain is doing is going backwards and forwards very quickly and giving the illusion of multi-tasking. The reality is performance is inhibited by this approach not improved.

* I do appreciate that you can do multiple things unconsciously at once such as driving and talking. (Not texting though!)

25. Your brain is constantly lying to you when you have your eyes open. Because it cannot deal with every single detail that you’re looking at, the occipital lobe is joining the dots with what itpresumes is there.

26. Similarly, your brain doesn’t record memories like video as it would be easy to assume. It takes snapshots of the more important bits and then when you recall the event it guesses what happened in between based on prior experience.

27. Your brain finds it very easy to create false memories largely because of the above and the fact that it spends so much time guessing what’s happening.

When scientists exposed people to Photoshopped images of themselves at various event years prior they were soon able to explain what they were doing and recall the event with clarity even though they were never there.

There will be events you swear blind happened the way you remember, but never actually did. A sobering thought.

28. The reason why some Chinese born people struggle to pronounce words like ‘fried’ is not because they can’t be arsed to learn them, as I ignorantly and embarrassingly believed when I was younger.

It’s because no similar pronunciation is needed in the Chinese language.

Therefore, if they are not exposed to the English language before around the age of 3, that part of the brain is allocated to other purposes.

29. Your brain is fairly crap at distinguishing between what’s really happening and what you are merely imagining. Which is why horror films scare people and porn films, er…ahem, well you know.

30. The brain is very poor at concentrating for long periods of time and needs to clear it’s head so to speak about every 90 minutes or so.

Which is why if you’re delivering training and you want to maximize results, you should allow people to take lots of mini breaks rather than one long break for lunch.

I’d love your take. Anything surprising to you? Or do you have any amazing facts of your own? If so let me know in the comments.