This is a guest article by Silvio Aladjem MD.
“First Do No Harm”, is a statement known in Western civilization as part of the “Hippocratic oath” written by the Greek physician and philosopher Hippocrates, somewhere towards the end of the 5th century BC.
Over centuries, the oath has been considered the basis of the ethical standards guiding physicians in their medical practice. In modern times the oath has been modified to better suit the needs of contemporary medicine. The fundamental basis of these revisions, however, still remain unchanged: “First do no harm”.
Historically, the practice of medicine has evolved with time in what it is today, and it will continue to do so. In the process we try to do our best based on what we think to be the best for the patient at that time. In retrospect “Bloodletting” one of the medicine’s oldest “best practices” may have killed a lot of patients when physicians believed that diseases were the result of “humoral imbalances”. It was practiced for centuries and no one thought they were doing any harm. “Lobotomies” as recently as 1940 & 1950 were performed for psychosis. The originator of the procedure, which involved scraping out the front part of the brain, received a Nobel Prize in Medicine and Physiology. The sister of President Kennedy, Rosemary, had a lobotomy which left her permanently incapacitated. We could continue listing such treatments. None were thought to harm patients.
All this comes to mind as I see the abuse and marketing practices of a procedure developed to treat extreme obesity: bariatric surgery. The Merck manual defines bariatric surgery as “the surgical alteration of the stomach, intestine, or both, to cause weight loss”. Bariatric surgery is a drastic surgery interfering with the normal physiology of the digestive system. As such, there are consequences, some of which are dire. Malnutrition and dumping syndrome (bloating and explosive diarrhea after eating) are such examples. Others are minor, if you consider nausea, vomiting and malaise as “minor”. Additionally, there are also the inherent risks of any surgery: bleeding, blood loss, infections, anesthesia potential problems and other. Bariatric surgery has its own post-operative complications , which may be life threatening.
Bariatric surgery is intended to help extremely obese patients, known as “morbidly obese”, lose weight by either surgically restricting the food they can eat, by interfering with the normal absorption of nutrients, or both. As a rule of thumb, a patient is extremely obese if he/she is at least 100 lbs. over his/her ideal weight. Ideal weight takes into account height, sex, age and other variables. Not everybody agrees what the formula should be. For the purpose of our discussion, the rule of thumb should do.
Since extreme obesity is a disease that leads to other potential complications, like hypertension, heart disease, diabetes, sleep apnea and other, bariatric surgery risks are weighed against the risks of extreme obesity. In carefully selected patients, benefits of surgery may justify its risks.
Unfortunately, bariatric surgery has become almost a fad, where patients who are overweight, but not extremely obese, think they can take a short cut from diet and exercise, and opt for bariatric surgery. After surgery, however, there is no turning back.
Bariatric surgery is now advertised widely. Seminars are available for potential patients to learn their surgical options for weight loss. Hospitals are promoting it for no other reasons than financial. In my opinion it has gotten out of hand. A 30 to 50 lbs. overweight does not justify a surgical procedure and its consequences any more than a bronchitis does not justify a lung transplant.
I have heard that some bariatric surgeries are being justified because the patient is “depressed” that he/she can’t lose weight. I have not yet been able to confirm the veracity of this information but, if true, it is beyond comprehension.
Some bariatric surgeons, unfortunately, stretch their indications to accommodate the patient’s wish for surgery. They should read again the Hippocratic oath. I know patients have to sign a consent before surgery. Patients rarely read the consent, rarely fully understand it and some simply dismiss the listed complications with the wishful “it won’t happen to me”. Today general surgical procedure are very safe indeed, for the most part. Complications directly related to surgery are very low indeed. It can’t be said the same for bariatric surgery. Complications are common, not rare, and most likely will last a lifetime. For example, after a Roux-en-Y procedure, one of the bariatric techniques used, which bypasses the part of the intestine meant to absorb the nutrients ingested, dumping syndrome happens in 70% (not a typo: seventy per cent) of patients according to various published reports. A cursory Google search of “complications of bariatric surgery” is informative. To my knowledge neither the FDA nor the CDC have opined on the overuse of bariatric surgery. It is time they do so, while some bariatric surgeons should remember their oath of ethics “First do no harm”.
SILVIO ALADJEM MD, an obstetrician/gynecologist and Maternal Fetal Medicine (high risk obstetrics) specialist, is Professor Emeritus in obstetrics and gynecology at Michigan State University, College of Human Medicine, in Lansing, MI. He is the author of “10,000 babies: my life in the delivery room” now available on Amazon, Barnes and Noble and other book stores. Dr. Aladjem published extensively in Scientific Medical Journals and wrote several textbooks in the specialty. Should you wish to contact him, you may do so at: firstname.lastname@example.org