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"""For much of Western history, however, surgery lay somewhat apart from the practice of medicine. Hippocrates was leery of it, writing, “He who wishes to be a

"""For much of Western history, however, surgery lay somewhat apart from the practice of medicine. Hippocrates was leery of it, writing, “He who wishes to be a surgeon should go to war”; the crude practices of the battlefield were, as Roy Porter put it in his classic history of medicine, “Blood and Guts” (2002),"the work of hand not head.” This suspicion bred an enduring medical division of labor, in which many healers viewed surgery as inferior. Well into the modern era, surgical procedures were the province of the barber, along with pulling teeth.""" Even now sometimes I wonder is surgery a science? Does it use the scientific method?

mattkrause 7y ago
Yes! It's common to run clinical trials comparing different types of implants, different surgical approaches, and even decisions on when/if to do the surgery at all. On the other hand, they are relatively to run and interpret. For a drug trial, you can give everybody a fixed dose of a drug (X mg; Y mg/kg bodyweight) in a fixed way (pill, injection, etc). Surgery is a lot harder to standardize. Along with the patient-to-patient variability, there's also surgeon-to-surgeon variability. Different surgeons might be faster or slower, cut more (and get a better visualization of whatever they're doing) or less (reduced tissue damage). Moreover, the individual surgeons improve with practice and it sometimes takes a lot (e.g., 100-200 knee arthroscopies) to plateau, which makes it tricky to evaluate a totally new method. This is a nice paper discussing some of the issues in more detail: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415901/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415901/
Ididntdothis 7y ago
I am not sure how much the scientific method applies to medicine in general. Medicine is a very diffuse subject. But I work in medical devices and I know for sure that there isn’t much data available of how well a procedure works. There is no centralized database that tracks outcomes. Most surgeons view a surgery as success if the surgery as such went well. They don’t do much tracking of whether the patient is doing better so there is risk they will keep doing surgeries that don’t really work. The manufacturer gets some information but also not much. There definitely should be a countrywide or even better worldwide database of outcomes.
- noelsusman 7y ago
  There are many centralized databases in the US that track outcomes (e.g. https://www.sts.org/registries-research-center/sts-national-database https://www.sts.org/registries-research-center/sts-national-...).
  - Ididntdothis 7y ago
    I know for sure that my company doesn’t have great long term data about its own devices in the field and even less about competitors. Once implanted, most patients disappear.
    - noelsusman 7y ago
      The hospitals buying your devices probably do, depending on the device. Our long term data is incomplete because people can switch providers, but we actively monitor long term patient outcomes for a wide range of devices that we use.
      - Ididntdothis 7y ago
        But how do you get data from thousands of hospitals? I also assume hospitals don’t exchange much data. The data is just very fragmented.
billfruit 7y ago
A quote from George Eliot's Romola, sort of indicative of how a doctor in 1400s Italy viewed surgery with some contempt, maybe it is exaggerated a bit for effect: """" “It is but fitting that a great medicus like you,” said Nello, adjusting the cloth, “should be shaved by the same razor that has shaved the illustrious Antonio Benevieni, the greatest master of the chirurgic art.” “The chirurgic art!” interrupted the doctor, with an air of contemptuous disgust. “Is it your Florentine fashion to put the masters of the science of medicine on a level with men who do carpentry on broken limbs, and sew up wounds like tailors, and carve away excrescences as a butcher trims meat? Via! A manual art, such as any artificer might learn, and which has been practised by simple barbers like yourself—on a level with the noble science of Hippocrates, Galen, and Avicenna, which penetrates into the occult influences of the stars and plants and gems!—a science locked up from the vulgar!” """

mattkrause 7y ago

Yes! It's common to run clinical trials comparing different types of implants, different surgical approaches, and even decisions on when/if to do the surgery at all. On the other hand, they are relatively to run and interpret. For a drug trial, you can give everybody a fixed dose of a drug (X mg; Y mg/kg bodyweight) in a fixed way (pill, injection, etc). Surgery is a lot harder to standardize. Along with the patient-to-patient variability, there's also surgeon-to-surgeon variability. Different surgeons might be faster or slower, cut more (and get a better visualization of whatever they're doing) or less (reduced tissue damage). Moreover, the individual surgeons improve with practice and it sometimes takes a lot (e.g., 100-200 knee arthroscopies) to plateau, which makes it tricky to evaluate a totally new method. This is a nice paper discussing some of the issues in more detail: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415901/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5415901/

Ididntdothis 7y ago

I am not sure how much the scientific method applies to medicine in general. Medicine is a very diffuse subject. But I work in medical devices and I know for sure that there isn’t much data available of how well a procedure works. There is no centralized database that tracks outcomes. Most surgeons view a surgery as success if the surgery as such went well. They don’t do much tracking of whether the patient is doing better so there is risk they will keep doing surgeries that don’t really work. The manufacturer gets some information but also not much. There definitely should be a countrywide or even better worldwide database of outcomes.

noelsusman 7y ago
There are many centralized databases in the US that track outcomes (e.g. https://www.sts.org/registries-research-center/sts-national-database https://www.sts.org/registries-research-center/sts-national-...).
- Ididntdothis 7y ago
  I know for sure that my company doesn’t have great long term data about its own devices in the field and even less about competitors. Once implanted, most patients disappear.
  - noelsusman 7y ago
    The hospitals buying your devices probably do, depending on the device. Our long term data is incomplete because people can switch providers, but we actively monitor long term patient outcomes for a wide range of devices that we use.
    - Ididntdothis 7y ago
      But how do you get data from thousands of hospitals? I also assume hospitals don’t exchange much data. The data is just very fragmented.

billfruit 7y ago

A quote from George Eliot's Romola, sort of indicative of how a doctor in 1400s Italy viewed surgery with some contempt, maybe it is exaggerated a bit for effect: """" “It is but fitting that a great medicus like you,” said Nello, adjusting the cloth, “should be shaved by the same razor that has shaved the illustrious Antonio Benevieni, the greatest master of the chirurgic art.” “The chirurgic art!” interrupted the doctor, with an air of contemptuous disgust. “Is it your Florentine fashion to put the masters of the science of medicine on a level with men who do carpentry on broken limbs, and sew up wounds like tailors, and carve away excrescences as a butcher trims meat? Via! A manual art, such as any artificer might learn, and which has been practised by simple barbers like yourself—on a level with the noble science of Hippocrates, Galen, and Avicenna, which penetrates into the occult influences of the stars and plants and gems!—a science locked up from the vulgar!” """