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How Many Surgeries Are Necessary?

Surgeons at operating room tableAs discussed in Health Attitude, the number one problem with our healthcare system is the high cost. There are many reasons for the high cost including fraud, inefficiency, big pharma runaway pricing, and unncessary tests and procedures. Some estimates put the cost of the latter factor at between $500 billion and $1 trillion. The cost is unsustainable and must be addressed. Two articles in recent news bring focus to the question.

Britain’s Daily Mail reported Sir Bruce Keogh, the National Health Service’s top doctor, said one in seven surgeries are unnecessary (See One in seven operations is unnecessary in the ‘profligate’ NHS, says UK’s most senior doctor). He said the health service should have no shame tackling the $2 billion in waste, enough to  pay the wages of all ambulance staff for three years.

In the U.S., surgeries number in the tens of millions per year at a cost of hundreds of billions per year. Many studies suggest that a significant percentage of the surgeries are not medically necessary. USA Today said more than $150 million of unneeded spinal surgeries were performed in 2011 (See Doctors perform thousands of unnecessary surgeries). The story cited many other examples including a wide range of cardiac procedures, knee replacements, hysterectomies, and cesarean sections performed more often than needed.

In some cases unnecessary surgeries were performed by choice of the patient. The Wall Street Journal had an extensive story last week about medically unnecessary mastectomies (See The Double Mastectomy Rebellion: Defying Doctors, More Women With Breast Cancer Choose Double Mastectomies). Angelina Jolie, whose mother died of cancer, had a preventive double mastectomy in 2013. She had no signs of cancer, but a blood test showed a genetic predisposition for breast cancer. A man might make a similar decision for a prostatectomy. According to the WSJ story, there has a large increase in the number of women who choose a double mastectomy even though it is medically unnecessary. One surgeon advised a woman needing a single mastectomy having a double surgery would be no more effective against further cancer than removing a foot. One woman quoted in the story said she wanted to remain symmetrical.

My opinion is the vast majority of surgeons have the utmost integrity and surgeries they perform are beneficial to the patient. However, a small number of surgeons are fraudulent, and they should be prosecuted. For men or women who decide they want medically unnecessary surgery, they should get a second opinion and be required to pay for the surgery without the help of taxpayers. Read about how the cost of surgical procedures compares to other developed countries and why some people are following medical tourism in Health Attitude.


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