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

[Unknown Member]

It’s so hard to trust any of these surgeons. Particularly the US surgeons who wildly embellish their statistics. But I challenge anyone to find me a negative kang review. If you can I will pay pal you 100 bucks.

[pinto]

What thorn in your shoe led you to post such nonsense? Please tell us what is at the root of it.

• This reply was modified 1 year, 3 months ago by  pinto.

[Herniated]

Pinto, you have presented a straw man argument. Nowhere did I imply that Dr. Kang “is involved in

racially motivated

experimentation without patient consent”. Rather I observed that Dr. Kang appears to be failing to provide full and transparent disclosure of the ‘Kang Repair’ to his patients (and the field). Telling patients that they will receive a modified Marcy without detailing the modifications is not full and transparent disclosure. This is especially troublesome because he appears to be conducting what is essentially a clinical trial as he accumulates completed surgeries and tinkers with perfecting the Kang Repair. If so, then informed consent should be an important part of that, as stressed in the Nuremberg Code. Race has nothing to do with the issue.

Perhaps you have conflated the Nuremberg Code with the Nuremberg Trials. The Nuremberg Code is a document that was the foundation of modern medical ethics. Its importance is outlined in the following text from the Wikipedia entry on the Code:

“However, the Code is considered by some to be the most important document in the history of clinical research ethics, because of its massive influence on global human rights. In the United States, the Code and the related Declaration of Helsinki influenced the drafting of regulations promulgated by the United States Department of Health and Human Services to ensure ethical treatment of human research subjects, known as the Common Rule, which is now codified in Part 46 of Title 45 of the Code of Federal Regulations.[16][17] These regulations are enforced by Institutional Review Boards (IRBs). In 1966, the International Covenant on Civil and Political Rights was adopted by the United Nations, and after enough nations had ratified the Covenant, it came into force on 23 March 1976. Article Seven prohibits experiments conducted without the “free consent to medical or scientific experimentation” of the subject.[14] As of September 2019, the Covenant has 173 states parties.

In his 2014 review, Gaw observes that the Code “not only entered the legal landscape, but also became the prototype for all future codes of ethical practice across the globe.”[11] The idea of free or informed consent also served as the basis for International Ethical Guidelines for Biomedical Research Involving Human Subjects proposed by the World Health Organization.[11][failed verification] Another notable symposium review was published by the Medical University of Vienna in 2017: “Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present”. President and Rector Markus Muller writes in his introduction that the Code “constitutes one of the most important milestones in the history of medicine, providing for the first time a proper framework for research on human subjects. This milestone was not a voluntary, precautionary measure, but only came into existence in the aftermath of Nazi atrocities. The Nuremberg Code became a cornerstone of clinical research and bioethics.”[18]

[Herniated]

In honor of the fact that the indirect inguinal is the most frequent hernia type, I’ll address your request indirectly by quoting the Gibbium Hospital’s explanation of the Kang Repair.

“Kang repair for indirect hernia is similar to the one described by Dr. Marcy in the past, but modified to avoid the high recurrences. In fact, most of the internal inguinal ring is occupied by the spermatic cord which contains the testicular vessels, lymphatics and sensitive nerves. So it is very difficult to close the internal inguinal ring securely without damaging the aforementioned sensitive structures. That is why this new sort of procedure has not been developed until now. Kang repair for direct hernia also modified the older posterior wall repair methods to minimize damage to surrounding structures and to make the repair stronger. In Kang repair for direct hernia, the scope of surgery has been much smaller than in the older posterior wall repairs including Shouldice or Desarda. In conclusion, another characteristic of Kang repair is that it minimizes the scope of surgery and closes the hernia hole directly.”

We are told that the Kang Repair for indirect hernias is “similar to the one described by Dr. Marcy, but modified to avoid the high recurrences”. Thus we have a reference to a standard well-defined procedure, the Marcy procedure, but the modifications of the procedure are not specified. How is the patient/subject supposed to assess what will be done to them? Is it rational? What is the evidence that the modifications have the intended benefits? What are the potential complications? Why are they kept secret? Is that ethical to keep the patient/subject in the dark? I don’t think so!

To be more direct regarding the relevant standard indirect procedure, a useful resource is the textbook “Hernia” edited by Lloyd M. Nyhus and Robert E. Condon (see the contribution discussing the Marcy Repair).

[Herniated]

Shouldice Hospital, provided
1. you are essentially healthy and not obese (or are willing to drop weight and keep it off).
2. you have strong tissues (no genetic or other issues resulting in weak tissues that won’t hold sutures).
3. you put in the effort to figure out exactly what you want done, how, and by whom. Then pursue your thoughts with the Shouldice staff to ensure that you and they can agree on a sensible plan.
4. you have or can obtain medical insurance that will cover you for any unforeseen medical events while being treated in Canada.

I am not familiar with the implications of “mesh removal skin”, but preexisting conditions would be an important part of developing your plan with the Shouldice team. If their experience informs them that your case would likely be problematic they will be reluctant to take you on and will tell you so.

[Herniated]

Many others have tried and failed to get clarification of the Kang Repair. A recent example is the Marcy Repair topic started by bobbyj900:

[Herniated]

And questions regarding the proposed treatment of potential patients should be forthrightly and transparently answered. The lack of such openness is cause for caution.

[Herniated]

“Not in every minute detail”. The person presenting as Dr. Kang on this web site has for years been promising to publish the details of the Kang Repair. Deflecting or ignoring multiple independent requests for explanations of how the Kang Repair differs. The patients summarizing their experience here seem to be in the dark regarding how their surgery differed from standard, well defined procedures.

[Herniated]

Straw man argument. I drew no comparisons to Nazis or their experiments. Rather I quoted one of the pillars of contemporary medical ethics, the Nuremberg Code, regarding the ethical necessity to transparently explain what will be done to the patient/subject.