Feature Surgical research

Cutting truths

BMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b1722 (Published 01 May 2009) Cite this as: BMJ 2009;338:b1722
  1. Geoff Watts, freelance journalist
  1. 1London
  1. geoff{at}scileg.freeserve.co.uk

    Unlike drugs, surgical techniques are often not evaluated in randomised trials. Geoff Watts investigates why

    Of the 12 million or so NHS hospital admissions that take place during any one year, at least 30% involve surgery. Yet in 2006-7 only 1.3% of government spending on medical research was devoted to surgery. Of course, the notion that research spending should correlate precisely with disease prevalence, medical workload, or any other measure of health burden is naive. But 30% against 1.3% is quite a difference. In the face of a gap this wide, the comment from Norman Williams, president of the Society of Academic and Research Surgery, that: “There’s a mismatch,” seems positively understated.

    Nor is he alone in his worries about the output of surgical research. Commentators have been raising the issue for years.1 Parliamentary committees have discussed it.2 And in the latest university research assessment exercise, the chairs of both panels responsible for appraising most of the work in the field commented on its poor showing. One wrote of “sorely needed capacity building in surgical and anaesthetic disciplines.”


    So why do surgeons do so little clinical research? Time is one factor, according to Martin Birchall, a professor at the University College London Ear Institute. Surgical academics like him have to spend more time doing what they do—operating sessions, seeing patients before and afterwards, dealing with complications and midnight emergencies—than their colleagues in most other specialties.

    Some doctors offer another and more contentious explanation. They view surgeons as “making up in self-confidence what they lack in patience.”3 Surgeons, they say, are required to make important clinical decisions quickly and often on incomplete information. “This quality . . . may make it difficult for them to be consciously uncertain which of two treatments is better.”3 In short (and …

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