The Nuremberg Code and the ethics of the secret ‘Kang Repair’

[pinto]

@Good intentions, please be careful of your misassumptions, as you might benefit by understanding that:
1 We are not all in the USA.
2 Ethics is not culture-bound; it is of universal importance.
3 The related history of “Nuremberg” is not a “US-thing” but a world matter.
I believe your own post demonstrates unwittingly “There’s not much value in writing more words.”

• This reply was modified 1 year, 2 months ago by  pinto.

[Good intentions]

Don’t let one person ruin your experience on an internet forum. Whether it’s me, or Herniated, or Pinto. The internet is a strange place where it is very difficult at times to “not look”.

On other forums that I am member of there is an “Ignore” function that can be chosen that will hide all posts from certain members so that you don’t have to read them. This forum, at the moment, does not seem to have that function.

In the meantime, if we don’t like what somebody is writing we just have to put the effort in to do it ourselves and not look. There is no obligation to respond to every post.

As far as alephy’s comments, I thought that they were reasonable. There is just a difference of opinion, I think, on the inflammatory nature of the word “Nuremberg” and its association with Hitler and the Nazi’s. It might not mean as much there as it does here in the USA. A cultural difference.

Pinto made his point early on and now is just defending his opinion. But there is really no constructive path forward. The points have been made. People’s positions have been established. There’s not much value in writing more words.

[pinto]

@alephy stated:

“I honestly don’t see anything wrong with the topic of this post, or the discussion that followed. However I am reading among the lines of some of the answers strong feelings against any possible criticism of non mesh repairs and the surgeons that offer them, and the more so if you were actually one of their patients.”

You’re in left field in at least a couple of ways: 1 your misdirected support of this thread’s creation; and 2 claiming the “criticism” against this thread equates to opposing any criticism of non-mesh repairs. That certainly can’t apply to me, if so intended, because I have elsewhere defended some mesh doctors as well as cautioned uncritical views of tissue repair. Moreover as I made plain herein, the trouble with this thread is the sensationalized imagery not the critique of tissue repair. As I plainly said, ethics is a matter for any field or situation.

• This reply was modified 1 year, 2 months ago by  pinto.

[William Bryant]

I hope Dr Kang still posts on here as it’s a vital way for some of us to glean information. He has been asked what he does before and has answered. I hope he continues to.

[pinto]

@Herniated claims:
1 “[The K] Repair … in my opinion [is] contrary to the Code [the Nuremberg Code, that is]”.
2 [K] essentially makes up his method as he goes along.
3 By not having an established or firm method, [K] conducts not surgery in the conventional sense but experimentation on patients [by which he can test and develop his method presumably].

In other words, Herniated is saying that patients are unwittingly made to be unconsenting subjects in an experiment because the surgeon’s purpose is to experiment by which he can develop his method rather than– surgery believed by patients likely to correct their medical problem. Herniated calls [K] Repair a “secret” implying that Dr. K purposely keeps details of his method secret as expressed by Herniated himself: “Why are [K Repair details] kept secret? Is that ethical to keep the patient/subject in the dark? I don’t think so!”
Thus Herniated believes Dr. K’s actions trigger violations of the Nuremberg Code [hereafter, NC].

The NC developed in response to the biomedical experimentation on “concentration camp prisoners”—obviously unconsenting subjects. https://www.hhs.gov/ohrp/regulations-and-policy/belmont-report/read-the-belmont-report/index.html The NC thrust was to protect human rights of experimental subjects. https://nazidoctorsandnurembergtrials.wordpress.com/

What evidence is there that Dr. K violates human rights? None! Surely his patients would laugh at the suggestion. Herniated claims are so wild that absolutely one must consider racism as the motivator. Note before I said as much, I asked Herniated what led him to such an extreme approach but received no reply.

I see nothing in Herniated’s post that evinces violations of human rights; therefore his use of the NC is not just unwarranted but irresponsible as well.

[William Bryant]

I was hoping Dr Kang would be invited on to a Dr Towfigh discussion as I’d be keen to learn more.

Experimentation in my opinion is not the right word as Dr Kang uses established techniques and modifies them – as a lot of surgeons do as far as I understand things – especially with Shouldice, even Shouldice do modify their procedures it seems.

If Thunder Rose had not asked her long list of questions to her surgeon, it’s doubtful she’d have known all that was done or going to get done to her. Thunder Rose had an obvious knowledge of anatomy and the surgeries, a lot of it went over my head.

[David M]

Ive enjoyed reading Dr Kang’s posts. He sounds sincere, concerned for his patients and probably proficient.

I think the reference to Nuremberg was overdone and too negative and I’m not sure why Herniated used that reference. However, I think it’s doubtful that there is racism involved.

I do agree with the more general point that it is a bit of a red flag that Dr. Kang has been slow to share more about his techniques with his professional peers. I may be wrong on whether he has done that or not, but that has been my impression.

[Alephy]

Again I don’t see anything wrong with the post. On the other hand you seem make your point by accusing others of being racist and uneducated. Perhaps you should request that the forum take actions and even ban us, I would actually be ok with it as I am not sure I find any value anymore in the discussions that take place here … go ahead and do it

[pinto]

“The Nuremberg Code is a set of ethical research principles, developed in the wake of Nazi atrocities—specifically the inhumane and often fatal experimentation on human subjects without consent—during World War Two.”
https://fullfact.org/health/nuremberg-code-covid/

Ditto @Good Intentions’ commentary about the issue. He is quite correct in saying that @Herniated’s reference to “Nuremberg” fits more a dramatic purpose than substantive. Its strong association cannot help but conjure up Nazi-like wrongdoing. As he indicated Herniated could have simply raised the issue of ethics by using that term.

As far as I know, this surgeon HEALS first and foremost. @Herniated failed to provide evidence that the surgeon contrarily is an experimenter. (Of course nearly any surgeon attempts to further improved practice but that is not the same as “experimentation.”) @Herniated also falls flat in demonstrating his own claimed knowledge of standard IG surgery.

@Alephy you are just as guilty as you support @Herniated’s actions here. Critique is necessary and important but there is no place for racism. However I must admit that commentary opposing @Herniated’s view assumes readers are educated including knowing history and being fairly conversant with critique and what it involves. Lack of education or training is no excuse for either of you promoting racism here.

• This reply was modified 1 year, 2 months ago by  pinto.

[Alephy]

He explained his point in the post, and unless we should change the name of the code itself I am not sure that he can be blamed of any hidden meaning: he also clearly explained that that was not his intention…I didn’t find this post offensive

Ps: I found offensive some of the posts in this forum suggesting that the covid vaccines are deadly, that yes

[Good intentions]

I think that the problem is a matter of degree. The atrocities that happened before and during WW2 that were associated with the development of the Nuremberg Code have very little to do with what Dr. Kang is doing.

There is a saying that you might have heard that mentioning Hitler in a conversation is a sure way to end the conversation.

Hitler = WW2 = Nuremberg

Herniated could have included a reference to the Hippocratic Oath. Or he could have just talked about ethics in general. He could have eased his way in to the Nuremberg Code without using it in the title. There was no good reason to use the word Nuremberg in big bold letters to begin the Topic. Anybody who says that they expected a different response is being disingenuous. Especially somebody who knows so much about the Nuremberg Code.

[Alephy]

I honestly don’t see anything wrong with the topic of this post, or the discussion that followed. However I am reading among the lines of some of the answers strong feelings against any possible criticism of non mesh repairs and the surgeons that offer them, and the more so if you were actually one of their patients.
I understand that this forum is more and more a place to voice anger at the mesh industry, I am not really sure it got started with this idea in the first place though…

[Good intentions]

You chose a sensational term to get attention and got what you wanted. Now you’re off on a tangent. The effort now is not really about Dr. Kang at all. You’re defending yourself instead.

The best thing to do if you really want to discuss hernia related topics is to acknowledge that and move on. Sometimes even intelligent well-meaning people make mistakes. You made a mistake.

If you want to keep the topic going apply your accusation to other areas of hernia repair. How about the use of the 510(k) approval process for the multitude of prosthetics on the market? You can spend a lot of time on it and do some actual good. Your implication that Dr. Kang is experimenting on his patients does nobody any good.

[pinto]

Your post is as much disingenuous as is racist your thread creation. You just sidestepped the chance to show you are knowledgable of the “standard” approach to IG surgery–which you proclaimed to wit by your statement, “The patients summarizing their experience here seem to be in the dark regarding how their surgery differed from standard, well defined procedures.”

If you don’t know what the standard is then your statement is disingenuous. There is no place for racism at this website. Critique is highly valued especially if the poster keeps their bias/prejudices in check. Sir, you did not do that. You made a wild accusation that your targeted surgeon is involved in racially motivated experimentation without patient consent (as comes with WWII imagery of the unlawful medical experimentation made–cf, GI’s post indicating as much).

The issue of ethics is important in any field, actually any human encounter. If you see such issue you can raise it without shrouding it to imply your targeted surgeon conducts racially motivated unconsented medical experiments. Sir, you owe the surgeon your sincerest apology as well as you do readers of this website.

[pinto]

@Herniated, you state: “The patients summarizing their experience here seem to be in the dark regarding how their surgery differed from standard, well defined procedures.”
Please edify us what the standard practice or set of procedures is. Thank you.

[Unknown Member]

Herniated. Thanks for weighing in. I think you go to far here but respect your knowledge. Dr kang has been the kindest of any surgeon I have interacted with. He clearly seems motivated to do the best repair possible. That said I am curious about who you would go to if you needed a tissue repair. Over mesh removal skin. Few docs will do that kang will

[Alephy]

Any new medical procedure should be validated by peers ie doctors or researchers in the field, not by the patients…as should any claim attesting the superiority of this or that surgical procedure! As for the numbers reported eg recurrence rate, without an independent registry it is difficult to make a judgment.

[Watchful]

Dr. Kang did explain his techniques on this forum in the past. Not in every minute detail, but he said what he does.

Based on my understanding of what he wrote:

For an indirect hernia, it’s a Marcy variant. He has his own way of stitching the internal ring, and he has gone through many tweaks of that, but we know what he does in principle.

For a direct hernia, it sounds like a partial Shouldice-type repair where he reconstructs only the direct area, and leaves the internal ring area alone.

[Good intentions]

It’s an interesting topic. But I think that Herniated is really stretching things to imply that Dr. Kang’s work is similar in any way to the Nazi experiments of WW2.

It would be more proper to say that it might be unethical to hold back his knowledge if he has evidence that it is better than prevailing practice. If he has a better way he should share it so that society as a whole can benefit. But, of course, in today’s world there are many that might corrupt his method, like many have done with the Bassini and Shouldice procedures. “Modified” for speed or ease or some other reason, leading to poor results from something that is not what he intended.

If you really want to see how a large professional organization can twist in the wind of ethics, read the SAGES statement about new technologies and techniques.

https://www.sages.org/publications/guidelines/ethical-considerations-regarding-implementation-new-technologies-techniques-surgery/

They end the statement with a wishy-washy acknowledgment that market forces might be competing against individual patient welfare.

“Balancing Responsibilities to Patients and Society

Finally, the cost and value of new technologies, to each of the many constituents in healthcare, must be addressed. Forces impacting health care and its delivery are increasingly important, particularly now as the US transitions to a national health care system. (30,31) At times however, a physician’s responsibility to advocate for individual patients on the one hand, and honor the responsibility to society for stewardship of finite resources on the other hand, may be competing considerations. Physicians do have responsibilities to both, as pointed out by the ACS in its “Code of Professional Conduct” and by the American Board of Internal Medicine (ABIM) in its Physician Charter on “Medical Professionalism in the New Millennium”. (32,33) To guide physicians struggling with conflicting responsibilities, the ABIM establishes the following principle: “Principle of primacy of patient welfare…Market forces, societal pressures, and administrative exigencies must not compromise this principle”.

[Watchnwaitin]

@Herniated : Instead of making such a distasteful post, why not ask Dr Kang more information on his repair procedure here on the Forum? He usually will reply to questions on this forum thankfully or his assistant Stephen will as well.

From Dr Kang’s Gibbeum Hospital Website :

“He saw many patients suffering from chronic pain after mesh inguinal hernia operations, and eventually he successfully treated those patients with severe debilitating mesh pain by removing the mesh inserted by their General Hospital. That dramatic experience forced Dr. Kang to seek a new non-mesh hernia repair, and he began to develop the new repair method based on his past experience with Bassini repairs.

Because old fashioned tissue repairs, such as Bassini repair, have a very high recurrence rate, the most important criteria was to find a way to reduce this rate. After a year or so of development and improvements, the Kang Repair method, which is the new tissue repair, was completed. More than 6,000 Kang Repairs for inguinal hernias were performed by Dr. Kang for about five years from 2013 to 2017 and have wielded extremely positive results.”

• This reply was modified 1 year, 2 months ago by  Watchnwaitin.