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UNNECESSARY SURGICAL PROCEDURES There was concern that there would be too many surgeons to Summary: share a small surgical caseload.” ¢ In 1974, 2.4 million unnecessary surgeries were per- The previous author spoke too soon: there was no cause to formed annually, resulting in 11,900 deaths at an annual worry about a small surgical caseload. By 1994, there was an cost of $3.9 billion.” increase of 38% for a total of 7,929,000 cases for the top 10 surgi- In 2001, there were 7.5 million unnecessary surgical pro- cal procedures. In 1983, surgical cases totalled 5,731,000. In cedures, resulting in 37,136 deaths at a cost of $122 billion 1994, cataract surgery was number one with over two million (using 1974 US dollars).’ operations, and second was Caesarean section (858,000 proce- It's very difficult to obtain accurate statistics when studying dures). Inguinal hernia operations were third (689,000 proce- unnecessary surgery. Dr Leape, in 1989, wrote that perhaps 30% dures), and knee arthroscopy, in seventh place, grew 153% of controversial surgeries are unnecessary. Controversial surg- (632,000 procedures) while prostate surgery declined 29% eries include Caesarean section, tonsillectomy, appendectomy, (229,000 procedures).” hysterectomy, gastrectomy for obesity, breast implants and elec- The list of iatrogenic diseases from surgery is as long as the list tive breast implants.” of procedures themselves. In one study, epidural catheters were Thirty years ago, in 1974, the Congressional Committee on inserted to deliver anaesthetic into the epidural space around the Interstate and Foreign Commerce held hearings on unnecessary spinal nerves to block them for lower Caesarean section, surgery. It found that 17.6% of recommendations for surgery abdominal surgery or prostate surgery. In some s, non-sterile were not confirmed by a second opinion. techniques during catheter insertion resulted The House Subcommittee on Oversight and in serious infections, even leading to limb Investigations extrapolated these figures an paralysis." estimated that, on a nationwide basis, there In one review of the literature, the authors were 2.4 million unnecessary surgeries demonstrated that there was "a significant erformed annually, resulting in 11,900 rate of overutilization of coronary angiogra- deaths at an annual cost of $3.9 billion.” phy, coronary artery surgery, cardiac pace- In 2001, the top 50 medical and surgica maker insertion, upper gastrointestinal endo- procedures totalled approximately 41.8 scopies, carotid endarterectomies, back million. These figures were taken from the surgery, and pain-relieving procedures".*! Healthcare Cost and Utilization Project . ws A study published in JAMA [November 13, within the Agency for Healthcare Research Allopathic medicine 1987] found the following significant levels and Quality.’ Using 17.6% from the 1974 i of inappropriate surgery: 17% of cases for US Congressional House Subcommittee on is nota purveyor coronary angiography; 32% for carotid Oversight and Investigations as the of health care but endarterectomy; and 17% for upper ercentage of unnecessary surgical i gastrointestinal tract endoscopy.” procedures, and extrapolating from the of disease care. Using the Healthcare Cost and death rate in 1974, we come up with an Utilization Project (HCUP) statistics unnecessary procedure number of 7.5 provided by the US government for million (7,489,718) and a death rate of 2001, the number of people getting 37,136 at a cost of $122 billion (using upper gastrointestinal endoscopy, which 1974 dollars). usually entails biopsy, was 697,675, the Researchers performed a very similar number having endarterectomy was analysis, using the 1974 "unnecessary 142,401, and the number having surgery percentage" of 17.6, on back coronary angiography was 719,949." surgery. In 1995, researchers testifying Therefore, according to the JAMA before the Department of Veterans study, 17%, or 118,604 people, had an Affairs estimated that of 250,000 back unnecessary endoscopy procedure. surgeries in the US at a hospital cost of Endarterectomy occurred in 142,401 $11,000 per patient, the total number of unnecessary back surg- patients; potentially 32%, or 45,568, did not need this procedure. eries each year in the US could approach 44,000 and cost as And 17% of 719,949, or 122,391 people receiving coronary much as $484 million.” angiography, were unnecessarily subjected to this highly invasive The unnecessary surgery figures are escalating, just as are those procedure. These are all forms of medical iatrogenesis. for prescription drugs driven by television advertising. Media- driven surgery, such as gastric bypass for obesity "modelled" by Mortality Rate for Medical and Surgical Procedures Hollywood personalities, seduces obese people into thinking this It is instructive to know the mortality rate associated with route is safe and sexy. There is even a problem of surgery being different medical and surgical procedures. Even though we must advertised on the Internet.” sign release forms when we undergo any procedure, many of us A study in Spain declared that between 20% and 25% of total are in denial about the true risks involved. We seem to hold a surgical practice represents unnecessary operations.” collective impression that since medical and surgical procedures According to data from the US National Center for Health are so commonplace, they are both necessary and safe. Statistics from 1979 to 1984, there was a 9% increase in the total Unfortunately, partaking in allopathic medicine itself is one of the number of surgical procedures and the number of surgeons grew highest causes of death as well as the most expensive way to die. by 20%. The author noted that there has not been a parallel Shouldn't the daily death rate of iatrogenesis in hospitals, out of increase in the number of surgeries, despite a recent large increase hospitals, in nursing homes and in psychiatric residences be in the number of surgeons. reported like the pollen count or the smog index? is nota purveyor of health care but Mortality Rate for Medical and Surgical Procedures It is instructive to know the mortality rate associated with different medical and surgical procedures. Even though we must sign release forms when we undergo any procedure, many of us are in denial about the true risks involved. We seem to hold a collective impression that since medical and surgical procedures are so commonplace, they are both necessary and safe. Unfortunately, partaking in allopathic medicine itself is one of the highest causes of death as well as the most expensive way to die. Shouldn't the daily death rate of iatrogenesis in hospitals, out of hospitals, in nursing homes and in psychiatric residences be reported like the pollen count or the smog index? 34 = NEXUS Allopathic medicine of disease care. www.nexusmagazi ne.com OCTOBER — NOVEMBER 2004