Med Professors Say Many Surgeons Perform Some Unjustified Operations

Surgeons currently perform too much surgery in the United States, several Medical School professors said this week at a press conference in Washington.

Benjamin A. Barnes, associate professor of Surgery, and the co-editor of a report calling for application of cost-analysis to common surgical techniques, said yesterday, "With 18 million operations in the country a year, some are obviously less urgent than others."

The report, edited by four professors, three of whom now teach at Harvard, applies the cost-analysis to many of the more marginal operations, such as hysterectomies, and other operations that seldom involve the saving of lives.

Doctors perform the unnecessary operations because they are ignorant of analytical techniques that are not taught in medical schools, and not because of venality or incompetance, Barnes said.

He said surgeons responded to new information about the unnecessary costs of tonsilectomies by reducing the number of this once-common operation.

Barnes said that some people might mistake the report for an attack on surgery although "it's just a way of showing how surgery can be improved."

Cut and Paste

The Center for the Analysis of Health Practices and the department of Biostatistics of the School of Public Health jointly sponsored the report.

The report uses research done by physicians collaborating with experts in other fields during a seminar series at the School of Public Health.

Howard Hiatt, dean of the School of Public Health, and the author of the report's introduction, said in a statement on Monday the benefits of modern surgery are undeniable, but the report focuses on inappropriate surgical expenditure.

Frederick Mosteller, chairman of the Biostatistics Department, said Monday, one of the studies in the report compares the methods of new surgery with the surgery that these methods replaced.

The researchers found that of 36 innovations studied, 20 are actually less beneficial than the old therapies.

John Bunker, a former Medical School professor who edited the report and now professor of Anesthesia at Stanford University, said on Monday that indicators of the necessity of surgery should be both quantitative and qualitative.

The possibility of lives being lengthened by surgery should be assessed, but often analysis of the future quality of life is necessary in non-lethal cases, he said.

Paste and Cut

Hiatt said that the kind of collaboration between physicians and other scholars, such as statisticians that occurred in the writing of the report is needed to spread analytic techniques throughout the profession.

Barnes said on Monday the public must be informed of the results of such investigations to be able to make intelligent decisions about the necessity of certain operations.

For example, in the past "the public has been encouraged to believe that much more is known about the effectiveness of therapy" for diseases such as cancer of the breast, for which the eventual recovery rate is "not high," he said.

He added that surgery was chosen for study because records are easily available for the area, but that similar studies should be done for all medical areas.