Good intentions
Forum Replies Created
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Actually, I shouldn’t have asked that question. Because the single anecdotes don’t represent the full population of patients. But, his comments show that he is ignoring the readily available data. Over and over, studies are showing the 15% discomfort/pain rate, or higher. Mesh is the cause of high levels of pain, for a substantial number of patients.
What he’s doing shows that he is not a scientist, or even a good professor. He is ignoring the readily available data. He is essentially a representative, or salesperson, for the mesh device makers, cloaked in minimally invasive surgery (MIS) techniques. MIS needs mesh to be a viable hernia repair technique. If there was no MIS the mesh problem might be smaller. It would be about plugs and the PHS and Lichtenstein. MIS is allowing the problem to spread much farther.
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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.” -
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.
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Dr. Felix seems to enjoy the limelight. He was talking like he invented laparoscopic hernia repair all by himself, I heard many “I”s. I did not watch the whole presentation. Did Dr. Towfigh ask him about his own mesh implantation and whether he was experiencing discomfort or pain? She should have, his name has been mentioned several times on the forum. I watched a very short segment and heard him talking about “getting back to work quickly”. That, to me, is the first evidence of a disingenuous discussion. Everyone today knows that “time off” is the not the big concern with mesh-based hernia repair. It’s chronic discomfort and pain.
There is something going on in society today where people just keep saying the wrong things over and over again, and don’t seem to mind when what they’re saying is shown to be untrue. It’s very strange and disconcerting. Dr. Felix seems more like he’s protecting the things he’s helped develop than actually using scientific methods to determine the best repair method. Very disappointing. He is working hard to get out and propagate the use of mesh, giving presentations and writing articles, ignoring the 15% of people who have discomfort or pain.
Here are a few of his past presentations and a link to the Q&A with Dr. Towfigh. There are others where he actually uses the term “Ten Commandments” like he is comparable to Moses. It’s incredible to see, and to know that he is part of the chronic pain problem, amplifying and spreading it, like a disease vector. There are direct connections from the methods he teaches to the chronic pain problem, but he does not address them, beyond implying that people who complain are mentally or emotionally weak.
https://www.youtube.com/watch?v=vYJ3LXk8C5E
I have three more videos that did not go through the first time. I’ll see if I can piecemeal the post together.
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I don’t know how much it costs to put on one of these meetings. The corporations have the opportunity to help out, apparently. $10,000.
I wish I could understand why students coming directly from medical school say that they were not taught pure tissue hernia repair. Maybe a change of topic to something like that would shed light from a different direction.
Corporations are going to try to influence technology. It’s what they do. Share price does not rise if product revenue is shrinking. Corporations are not focused on healthcare, they are focused on money. If you leave a dog alone with food on the table and the dog eats it, whose fault is it?
https://e4n9e9m2.rocketcdn.me/wp-content/uploads/2020/09/2020-AHS-Virtual-Mtg-Prospectus-3.pdf
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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.
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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.
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JamesDoncaster, and others, I’m at just over three years since mesh removal and still improving. I think that the reason I’m improving is the same reason that the mesh did not work. The body is continuously working to get to a certain state, determined by your DNA. When the mesh is in, the body keeps working to get rid of it. When it’s out, the body keeps working to repair the damage that was caused. I cut off the tip of my finger when I was young and it took about ten years before feeling came back and probably another ten before it softened up enough that it felt normal. The time frame won’t make you happy but the continuous improvement is something to look forward to.
Here is an official document from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). There are a lot of words but they’re not really very filling. I went through it a few times to try to tease something substantial from it, but in the end it seems like the authors were conflicted and kind of lost their way, talking themselves in to circles and contradictions. Ethics discussions are usually difficult. I get the feeling of someone explaining away the deviation from the Hippocratic oath and the focus on the patient, and, instead, justifying the use of all of the new technological “advancements”.
It’s worth reading just to realize that this is the official position paper, regarding hernia mesh among other devices and procedures, of one of the premier medical societies for abdominal surgeons. The “Informing Patients…” section is worth reading at least.
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Here is the start of the Guidelines summary. Seems worded to imply that mesh is better and that Shouldice results are unknown, when anyone who follows the field knows that the opposite is true. Disingenuous, but, look at the sponsors.
“NON-MESH REPAIR
Non-mesh repair is an option if mesh is not available or in shared decision
situations with patients that do not want mesh. The Shouldice is best tissue
repair although in general practice the recurrence rate is higher than mesh
repair and risks of pain are comparable. More research is needed into the
value of non-mesh in cases where risk of recurrence is low (for example
young men with indirect hernia) and into the results of expert clinics. ….”“RECOMMENDATIONS
STRONG: The Shouldice technique is recommended in non-mesh inguinal
hernia repair.MESH REPAIR
Mesh is recommended as first choice, either by an open procedure or a
laparo-endoscopic repair technique. One standard repair technique for all
groin hernias does not exist…” -
Yes, I had a direct hernia and have not had any signs or symptoms of recurrence since having the Bard Soft Mesh removed three years ago. There is still a small piece of mesh remaining though, near the site of the hernia. It was too entangled with critical structures to risk removing. The stiffening and thickening of surrounding tissue that the mesh caused seems to stop any new hernia formation.
For anyone trying to understand the reasoning behind what’s happening, they need to keep in mind that a “market” has been firmly established in medical devices for hernia repair, with a very large revenue stream, flowing out to all of the device manufacturers. These studies in to new products are funded by device makers trying to gain market share or improve their products enough to maintain market share, or, possibly, to deflect from their responsibility and show that they are trying to solve a problem. But, as shown by the International Guidelines document, there is no focus on the best hernia repair for the patient that does not include a device, a mesh-like product. “International Guidelines for Groin Hernia Management” is actually a deceptive title. An honest title would be “International Guidelines for Mesh-Based Hernia Repair”. The group that put the Guidelines together, HerniaSurge, was funded by the mesh makers and they state clearly that non-mesh repairs would not be considered. It’s all about expanding the market for mesh.
All of this work is designed to maintain the billion dollar revenue stream. So, there might eventually be a “best” mesh device, but if pure tissue repairs are actually best for the patient, this type of work will never define that. The device makers would lose revenue and their stock prices would drop. Follow the money.
The people using the Danish hernia registry to quantify things like chronic pain and recurrence are the only ones that really seem to be showing how bad things are. If the medical industry eventually turns toward a long-term results focus instead of short-term their work might become more relevant.
Sorry to bring doom to the discussion again. The business side of things is really in firm control right now though. Marketing and advertising are their tools for influencing.
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Here is a post about a recent study using data from a “real” registry, not a company created and promoted pseudo-registry.
https://herniatalk.com/forums/topic/lightweight-vs-heavyweight-mesh/
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Here is the Ultrapro link to what I posted above.
https://www.jnjmedicaldevices.com/en-US/product/ultrapro-mesh-ethicon
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Ethicon has delayed the publication of the report again, to December 2023. But they’re still using the suggestion that the study supports their products.
“Estimated Study Completion Date : December 31, 2023”
https://clinicaltrials.gov/ct2/show/NCT00622583
“ULTRAPRO Partially Absorbable Lightweight Mesh offers strength with reduced foreign body mass1** and may reduce the risk of patient complications compared with heavyweight mesh.† In a study of patients from the International Mesh Hernia Registry (IHMR), patients demonstrated low rates of intra- and postoperative complications, such as seromas, and recurrence (<1%) after 1 year.2* In the same study, patients reported improvement in pain and movement limitations from baseline at 1 year postsurgery.2*”
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Thank you for the reply Dr. Towfigh. Can you tell me what happened to my other post? It was more critical and detailed and pointed the blame at the device makers, like Ethicon, for promoting unproven ideas in order to sell more product. I thought that it was very rational and reasonable and I supported my comments with links to relevant websites.
If we’re not allowed to post about certain companies, maybe you could create some guidelines to follow so that we know what’s allowed and what’s not. It is frustrating trying to guess at what will be allowed through the filter, whatever the filter is.
Thanks again for allowing this never-ending topic to be discussed somewhat freely.
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To be clear, my point about mesh being developed for situations like yours, should really say it’s meant for the situation that you might end up in because of your condition. Mesh is meant for use AFTER the pure tissue attempt fails.
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I had written a long post that said essentially the same things that alephy said. The surgeon that you talked to sounded like a very common run-of-the-mill laparoscopic mesh repair surgeon. Everything you wrote is what the training of the day is. The “eye” shaped mesh sounds like a 3D product, which seems to be more prone to folding, from anecdotal evidence. “Thin” probably means lightweight mesh, an idea that was introduced to the market through the 510(k) process, but several studies have shown does not have the benefits that it was proposed to have. It’s the same or even worse than the older stiffer mesh. Small entry points (incisions) and quick “healing” are the selling points of laparoscopy, but lap also lets the surgeon insert a much larger piece of mesh than an open implantation. In short, the surgeon did not say anything special, therefore the one in six probability still applies. He’s the same as the other ones.
Your situation still fits the “pure tissue first then mesh if there’s a recurrence” approach that I think should be the standard for all hernia repairs. I would bet that from a patients’ welfare standpoint that the logic supports that approach. There would be less chronic pain and discomfort in the hernia repair population, fewer patients waiting to get a hernia repair (because of the lower pain rate), less pain management necessary, and even a healthier population of surgeons, because they would know they are doing what’s best for the patient instead of best for business. Their patients would be happier and forums like this would go back to what they were intended to be, full of confidence inspiring success stories.
If your tissue is weak and the sutures pull free, or a new hernia forms, then you can still get mesh. That is why mesh was developed, for cases like yours. It has spread like it has due to efforts from the medical device makers. It is a money-maker, much more revenue generated from today’s large mesh implants than selling a few feet of suture material per repair.
Since you have learned so much I think that your odds of having a successful tissue repair are higher than most. Many people, I think, can’t resist the urge to “test” their repair and do things that they know they shouldn’t be doing. You have already learned that your body has weaknesses and have learned to live with them. You’ll probably do the same after a tissue repair and get good results, would be my bet. But, if not, mesh is always ready and there are thousands of surgeons waiting to put it in.
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Here is a typical mesh repair opinion, drgephys (his doctorate is in physics, not medicine), post #1687. This person was very “pro mesh” right after he had his surgery, convinced that he had done his research and chosen the best possible repair method. But you can see that he’s not super enthusiastic about it today. He deals with it, apparently, but he’s not jumping for joy.
https://forum.bodybuilding.com/showthread.php?t=133353003&page=57
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Thanks for posting this. You didn’t state it explicitly, but this is an example of a successful pure tissue repair. Since you’re at one year and healed, there is no reason to expect chronic pain to crop up in the future. If you do have a recurrence, you can always get a mesh repair in the future.
The only similar enthusiasm I’ve seen for a mesh repair is in the body builder forums, because they can go back to lifting heavy weights. Most mesh repair opinions are about how they are better after mesh implantation than when they had the hernia. But not the same as they were before the hernia.