New article by Dr. David Chen, President of the Americas Hernia Society
Here is another article worth reading, linked at the bottom. Again, as is common, I am struck by the use of precise numbers to support a view when they support the case (recurrence rates) but a fall back to vague terms when the numbers don’t work or are unavailable (“excellent outcomes with benefits of early recovery and lower rates of chronic pain.” – no citations). It seems ingrained in the minds of the professionals that work in the field. Repeat the talking points. But, he does still mention chronic pain rates above 5%, even though 15% seems clearly established as the rate today. Downplaying the chronic pain rate.
On top of that, he tells a story about an attempt to use the latest “state-of-the-art” repair procedure on a colleague and friend, laparoscopic TEP mesh placement, having problems, and falling back to a Shouldice repair after mesh removal. Then he says the problems could have been avoided if he had used a Lichtenstein repair.
The reason he started with TEP is because, quoted, “The data and guidelines clearly support a minimally invasive approach; ” and “if only the patient had an open Lichtenstein repair, he would have not been a victim of anatomy and probability.”
So, instead of questioning the data and Guidelines he writes on about how complex things are becoming today and more research needs to be done. Overall, the article is much like Dr. Ramshaw’s discussion of his error and the damage it caused and how the “system” led him astray.
If these doctors could just realize that the data and Guidelines are skewed toward the use of more mesh, not for the benefit of the patient, they might be able to avoid the damage they’re causing. Dr. Chen seems to infer that, he seems to understand it, but he does not say it outright. Following the Guidelines caused him to injure his friend and colleague. The data being used and the Guidelines are wrong.
The key word in one of his statements is “evidence”. That’s what is being hidden and is what will guide the society to the truth. I hope that he can find a way to expose it. It will be difficult.
“With such rapid progress and change, never has it been more important to optimize patient outcomes though education, standardization of techniques, and research to provide evidence that progress translates to better outcomes and value. ”
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