Harpers Magazine report about hernia repairs and mesh: “In the Net”

[Good intentions]

You have to click on the tweet to see the whole conversation. Twitter links don’t paste well.

[Good intentions]

This conversation, below, is surprising. Dr. Heniford seems to have completely gone in to a defensive posture. In the recent past, I had seen him as someone who could actually drive some change in the field of mesh-based hernia repair. He was calling for a registry of all mesh products, so that the problem could be understood. He was very vocal about it. I don’t see that in the Twitter thread.

The lawyers only follow the problem, they did not create it. The hernia mesh problem is just as real as the transvaginal mesh problem. Dr. Heniford knows this very very well. He has changed in just a few short years.

https://twitter.com/THeniford/status/1350912176576487424

• This reply was modified 3 years, 1 month ago by  Good intentions.

Shirin, This paper is important. The issues of pelvic vs hernia mesh, the impact of social media, and how the opinions can be baited and spurred by the legal profession are remarkable. Nicely done

— B Todd Heniford (@THeniford) January 17, 2021

[Good intentions]

Dr. Heniford’s situation is even worse than I realized. Now he seems to be in the “change the perception” effort.

Read the following a few times to really grasp what they’re doing. The goal is to get the patient to accept mesh implantation. They have a problem with potential patients being concerned about mesh. So instead of working with the truth, fixing the mesh problem, they decided to produce their own version to keep the work coming in. Unbelievable.

https://www.sciencedirect.com/science/article/abs/pii/S0039606020308333

“Results
…………After surgeon-directed education and a mesh education handout, all but one patient agreed to and underwent a mesh repair as indicated.

Conclusion
Patients had concerns about mesh and were aware of mesh related complications. Patients performing their own research, as well as females and recurrent hernia patients, had worse perceptions of mesh. Recurrent and incisional hernia patients had greater concerns about complications, recurrence, and recovery. Preoperative education concerning mesh and mesh choice for each operation eased patient anxiety.”

[Good intentions]

One very disappointing thing from the article was to see Dr. Todd Heniford described as one of the surgeons profiting from the pain of mesh implantation. Just a few years ago he was a loud active voice calling for closer examination of the chronic pain problem. But somehow he either just got worn out or was actively suppressed in his efforts.

People like Dr. Felix, on the other had, are celebrated and promoted as “experts”, doing the “good work” of promoting mesh implantation.

[Good intentions]

It’s just hard to believe Dr. Towfigh. The evidence implies otherwise, in the hernia repair field itself, and just in society overall. The IHMR study (Ethicon, publication delayed regularly), the development of the International Guidelines (sponsored by Johnson & Johnson and Bard, linked on the AHS site as a “resource”), Dr. Voeller presiding over the AHS Foundation while also being employed as a Professor at UT Knoxville, these things are all signs of the problem. Tennessee does not require disclosure of funding for their universities. I only choose Dr. Voeller as an example because he is so “pro mesh” and his potential conflict seems obvious.

When I was in school, we got a very expensive piece of equipment donated to us. The manufacturer knew that if we learned on their equipment that we would be more likely to specify that equipment in the future, if we got in to positions with that authority. It reminded me of Intuitive Surgical and their robotic systems. https://centennial.ncsu.edu/partners-directory/intuitive-surgical/

The “blocking” is not direct. It is insidious and indirect. Fill the curricula with one technology so the other gets starved and dies. Mesh techniques wins over pure tissue techniques. No time to teach pure tissue when the Guidelines say that it is irrelevant. It seems well known that pure tissue methods are not being taught at all in the medical universities, beyond comparing them to mesh methods, as inferior.

Here is a broad overview of the problem, from 2017. Considering the last four years I doubt that things are better now. https://www.theatlantic.com/education/archive/2017/04/public-universities-get-an-education-in-private-industry/521379/

I was in school at the tail end of the “golden age of research”, when funding was primarily from government sources, to advance science for the good of society in whole. Today’s funding comes primarily from industry sources, for the good of the universities and industries first, as business entities, both public and private. It’s just the way things are today.

I think that if the sources of university funding were fully disclosed, it would be a shock to many people. Universities aren’t what they used to be.

• This reply was modified 3 years, 1 month ago by  Good intentions.

[drtowfigh]

I have to address misinformation on this post:

There is no corporate influence on the surgical education curriculum. There is no situation in which a corporation prevents or blocks tissue-based inguinal hernia repair during residency.

In my opinion, knowing the hernia world and its players, the article is seems one-sided in its presentation of the problem.

And welcome back, Chaunce!

[DrBrown]

@chaunce12345
I consulted with the editor on the Harpers’ Article and strongly support the move to better inform patients and to encourage medical schools to start training surgeons with the classic non-mesh repairs.
Bill Brown MD

[Good intentions]

The author hit all of the key points, very well-written. A person could bookmark it and use it to answer most of the questions that are discussed on the forum. She could have gone deeper in to the relationship between university funding, at the colleges where the new surgeons are produced, and what the students are taught. I think that the device makers are deeply influential there, and are the ones blocking, probably indirectly, the teaching of pure tissue techniques.

Welcome back.

[ajm222]

Wow, very timely. Thanks for posting. And good to see you back.