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Dr. Bruce Ramshaw acknowledges that “mesh” is not perfect.
Here is a strange opinion article from Dr. Bruce Ramshaw, describing the path to his realization that “mesh” is not as inert or as consistent across patients as he was taught.
The strange part is that he talks right past the most important part – how to get this message out to his colleagues and do something about it, for the sake of the patients getting injured by “mesh” every day – and instead, wanders off into a philosophical discussion about perception and decision-making. He leaves the consequential finding lying behind him, unaccounted for. Like a movie with an unresolved ending.
I hope that Sheila Grant can take the reins and get the word out. Very smart people are learning the truth now, supported by verifiable facts, apparently. Do something good with that knowledge.
Excerpt at the bottom.
Excerpt –
“But in our analysis of explanted mesh, Sheila and I learned that we were both wrong, at least for some patients. For most patients who have a hernia repaired with mesh, the mesh performs fine. But in some patients, the mesh may have been a contributing factor that leads to an unintentional complication. When I first learned this, it made my brain hurt. It was hard for me to understand that the same mesh, placed the same way, in two different patients could undergo vastly different changes and result in different outcomes.?-
This discussion was modified 3 years, 6 months ago by
Good intentions.
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This discussion was modified 3 years, 6 months ago by
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10 Replies
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Dr. Ramshaw does not seem to be alone here. Many of the most common names in complex hernia revision/ mesh explantation seem to be moving on to other things.
I imagine its exceeding challenging. The surgeries are tedious, patients already injured/ upset and have unrealistic expectations. Volumes are low along with reimbursement.
Many doctors are on the brink of burnout the day they graduate residency as it is.
Clearly there are bigger systematic problems in play.
However as we see names like Ramshaw and Belyansky step back from this field, will there be anyone to take their place?
Will the current providers with these skills continue to practice? Will new providers emerge? Or will patients see fewier and fewier options in spite of the efforts of the brave pioneers here?
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Physicians can wear different hats. Sometimes it is necessary to use Dr./MD. so as to indicate the person has the license, qualification as doctor for example in the case of a medical emergency. Contrast that with a doctor being a Little League baseball coach. It would be unlikely he/she would use or be addressed as “doctor.” Within a small community, more likely is addressed as “doc.” Outside of it, his/her hospital, medical society, and so on, but as an author/researcher, he/she would likely be referred to solely by their last name, so as to dispense with social niceties for the sake of intellectual exchange and free thought.
Here in HT, many of us are patients and so we wish to both acknowledge the physician’s qualified status but also social respect for their very kind participation here. For physician non-participants however who are authors being discussed, I don’t think it necessary to use honorific address terms. Doing so could conflict with the examination of ideas. When Dr. Ramshaw dispenses with self-reference of MD it does not necessarily mean he has withdrawn from being a physician. I think he does so to emphasize his wish for the free exchange of ideas in keeping with his philosophy of data science. Even if he has made a career change, I don’t think that would completely stop all uses of his MD self-reference. Sometimes surely it becomes necessary for him.
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Second one (the site does weird things with Twitter):
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Bruce Ramshaw has created a new Twitter account, leaving MD off of the end of his name. Part of the shift.
First one:
https://twitter.com/bruceramshawmd
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This reply was modified 3 years, 6 months ago by Good intentions.
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This reply was modified 3 years, 6 months ago by
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I don’t want to “pile on” with criticizing Dr. Ramshaw. His disclosure about his surgery mistake showed that he was close to burnout. And I’m not a psychiatrist. But it seems like spreading the word about what he’s seen with his research on “mesh” (he says he’s a scientist on his web page) would be therapeutic for him, in dealing with the damage he caused his patient through his oversight. Make up for the mistakes with truly helpful work, that can actually be seen and measured.
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It looks like Dr. Ramshaw is a consultant now, and has given up being a physician.
His goals seem to be so lofty that the hernia mesh problem is small to him. He has a “mission”. Like a man walking past a car accident with victims that need help because he has to get to work to design safer cars. He has important work to do and can’t be bothered with the small stuff. That sounds insulting but that’s what comes across to me, considering his history and his new career path. He showed that he knows how to identify a problem, but not how to go about solving it.
My apologies to anyone who knows him and is offended. It’s just disappointing to see somebody with the knowledge and abilities and background to help with a problem, and the problem sitting right in front of them, well-defined, asking to be worked on, just ignore it to do something that’s more enjoyable and/or more profitable. He has profited from the use of mesh over his career so far, and is now leaving the problems behind for others to deal with.
“Dr. Ramshaw’s mission is to shift the mindset in healthcare by reimagining patient care through applied Systems Science.”
His upcoming book:
“Finding the W(H)ole in Healthcare”“Healthcare data consulting for the real world.”
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@mitchtom6, thank you. You make a good point about the tacit admission matter. In fact my first statement but later deleted (by me) was my applauding the apparent acknowledgment about polypropylene. Haven’t we seen caution/alarm written about this across the ‘net, but not by docs? That’s my impression but could be wrong. I wanted to ask if other docs put the spotlight on polypropylene for its potential danger. However as I went through Ramshaw’s article more, I saw some red flags. Overall it seemed to me that while on the surface there’s an admission about trouble with polypropylene, I think his main purpose is to counter the bad press about polypropylene.
He mentions (I believe if I remember correctly) that some cases of mesh were in pristine condition. They didn’t have the deterioration expected. I presume that Ramshaw is well aware of what chemists and others say about polypropylene not being fit for implanting. So isn’t he countering that by pointing out the pristine cases? So the title suggests that those chemists are wrong.(You see that, right? “both sides are wrong”) And why do you think he tells us–and he does–that he keeps a friendship to this day with Shiela, his guest materials engineer who expressed alarm about using polypropylene for implanting? It is almost like the politician caught in sex scandal who gives a mea culpa at a podium before the public with his wife standing next to him. That is a hint for the public to forgive him because of all people his wife does.
This is just a taste of what I could say. Please however take my rant provisionally because the space, time does not permit it otherwise. I am confident though the author made strategic, stylistic choices along the lines that I am claiming; some of it might only be unconsciously made. How correct the claims remain to be seen. But that is what forums and discussions are all about. 🙂
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Interesting analysis by @pinto. The active/passive grammar probably does offer clues into the psychology, perhaps at an unconscious level. I don’t want to be too presumptuous, but the mere existence of this article seems like a tacit admission that there is a problem with the mesh-for-all approach to hernia repair.
Certainly, it is not so benign as to justify its position as the default approach to small hernia repair, in my opinion.
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Ramshaw might actually still consider polypropylene as being inert. His words betray him by revealing a lack of responsibility. Essentially Shiela asks him, “What material do you use for implanting?” Rather than active case grammar by which the actor/agent is highlighted, his grammar switches to the passive: “the most common polymer used … was polypropylene,” by which he removes himself from the equation.
It is not necessarily the case that surgeons must use the material however widely it is used elsewhere. He had invited her to work with his team (“our team”), so how he describes it, it is likely Shiela was asking about his or his team’s use, which normally would evoke a “we” response (“We use …”). Indeed he used “we” for the reference in her question.
Further in the metaphors he uses about science and medical decision making, it appears to me as if he as a surgeon has his decisions made not by himself but by other entities, such as the human brain. He is not unique for skirting responsibility–it’s a human trait–but it is ironic in contradicting the tenor of his article of being straightforward, etc. The thrust of the article is to say that polypropylene is not necessarily harmful, a claim he weakly substantiates. Here again, we can see a retreat from responsibility by his saying that in patients harmed, polypropylene is not THE factor but a contributing factor, shifting responsibility at least partially onto the patient. As long as responsibility is not grasped by surgeons themselves, hardly will they be expected to push for reform.
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Interestingly, this article matches a blog on his website, verbatim, replete with the opening quote. Only a handful of sentences were edited out for the General Surgery News publication. The blog entry was from 7.5 months ago.
The “high brain/low brain” motif is common to a number of his blog entries, which I have browsed through…..I knew when I read your post that I had seen that verbiage before.
https://www.bruceramshaw.com/blog/evolving-mindset-series-when-both-sides-are-wrong
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