Are Doctors Too Quick to Cut?
Does the American medical culture rely too heavily on surgical treatments?
Where Culture Comes In
February 9, 2011
Barron H. Lerner, professor of medicine and public health at Columbia University Medical Center, is the author of “The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America” and “When Illness Goes Public: Celebrity Patients and How We Look at Medicine.”
“A chance to cut is a chance to cure.” “Heal with steel.” “Cut well, tie well, get well.” These phrases may simply sound like clever aphorisms, but they speak to important cultural understandings of surgery.
Prior to the mid-20th century, few effective treatments for disease existed. There were no pills for high blood pressure, no antibiotics for infections and no chemotherapy for cancer. Radiation therapy was just being introduced. Operations, to fix broken bones and to remove tumors and kidney stones, were among the few effective interventions available to physicians.
After World War II, many surgeons who had performed lifesaving operations on the battlefield came back emboldened by what they believed that surgery could achieve. Thus, in the 1940s and 1950s, tens of thousands of tonsillectomies were done for indications ultimately shown to be dubious. In this same era, Dr. Alexander Brunschwig of New York’s Memorial Hospital devised a “brutal and cruel procedure,” pelvic exenteration — the removal of the ovaries, uterus, bladder and even rectum — to treat women with advanced gynecological cancers.
Meanwhile, neurosurgeons performed lobotomies to treat schizophrenia and other mental illnesses.
The new fascination with surgery struck a chord with the public and the media. A 1963 Time magazine cover article was entitled “Surgery: The Best Hope of All.” A tagline read, “If they can operate, you’re lucky.”
The new fascination with surgery struck a chord with the public and the media. A 1963 Time magazine cover article was entitled “Surgery: The Best Hope of All.” A tagline read, “If they can operate, you’re lucky.”
Despite its scientific basis, medicine is influenced by the surrounding culture. The acceptance or rejection of various treatments may have less to do with the data than with who is promoting the therapies, what type of technology is being used and how much publicity there is.
Based on what we have learned about cancer in the past several decades — that it spreads early in its course — the JAMA study showing that removal of cancerous lymph nodes does not improve survival is not surprising. The question is whether we can incorporate these new findings into a cultural environment that has placed so much hope and faith on cancer surgeons’ ability to “get it all.”
Change can occur. We no longer perform needless tonsillectomies, pelvic exenteration or lobotomies. But it will take time.
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