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Gynecological surgery: Second rate training for second rate patients?

9/12/2015

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Today, I just write to link to this Philly Inquirer op-ed by Dr. Hooman Noorchashm, a cardio-thoracic surgeon, who writes about the issues with inadequate surgical training of OBGYNs. 

Link to it here:  Gynecological surgery: Second rate training for second rate patients?
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It makes the world go 'round.

9/4/2015

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If we were to look at scale, given the female population in the U.S. now, a snapshot of numbers, though surgery continues on a rolling basis, could look like this (I promise this is very simple math):

There are ~160M women in the U.S. today.

40% will have a hysterectomy. That's 64,000,000 hysterectomies when those women are between 45-54 (source: Dept. HHS)

55%, or 35,200,000 women, of those women's ovaries would be removed during that hysterectomy.

And that number almost doubles if the women whose ovaries were removed during surgery for benign ovarian cysts are added in...but let's play it safe and say that:

50 million women who are alive in the U.S. at this moment, women who have absolutely nothing wrong with their ovaries that requires removal, could end up having a surgery described this way.

How much would those surgeries bring in at today's rate of $33,180 per surgery average (source: AHRQ)?

$1,659,000,000,000 - that's 1 trillion, 659 billion dollars...just for elective ovary removals folded into hysterectomy/cystectomy elective surgeries.

What was the thinking about this surgery at the end of the 19th century?

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Decisions

9/1/2015

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This question has been, for many women, part of the underlying issue in the debate about women's health and legislation. How possible is it for a majority of men to justly legislate an issue that can never affect them personally? This same question makes sense when applied to the guidance and opinions that come from the ACOG. Of the 65 past ACOG presidents (they change annually), there have been 40% more named Richard than women in entirety. The ACOG's attitude toward the issue of morcellation is well-documented. Their attitude toward removing women's healthy endocrine glands is no different.

As I've been working with doctors in the UK who will be doing a systematic review of all of the studies related to increased disease risk that result from removing the ovaries, they let me know that 8,795 studies that might be related to this surgery have turned up in a Cochrane Library search. My first thought was, "Wow, that's a lot..." My second thought was, "What a devastation. This is science...all curiosity, no conscience." Would this devastation have happened to men in our wildest dreams?

At what point was it going to occur to physicians and researchers that this was a sinister modality - harm women, then study the effects? We've seen this before in history, but never on this scale. Would it have gone on forever? Will it if I am unsuccessful?

Every day, another 1,000 women are made ill when their HPG axis is dismantled and their endocrine circuit board is short-circuited. These women may not participate in studies, but their surgery took place despite what studies have told us for 100 years. The knowledge that this continues unchecked is crushing.

Premature death, Parkinson’s, Alzheimer’s, dementia, cognitive impairment, memory impairment, osteoporosis/fracture, cardiovascular disease, stroke, arteriosclerosis, sexual dysfunction, lung cancer, type II diabetes and metabolic disorder, depression, glaucoma...
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