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There is another important issue implicit in the article by Treasure,
Hasan and Yacoub. The article implies that a high initial mortality or
morbidity used to be acceptable during development of an innovative
procedure. In the past surgeons made (paternalistic) decisions on what
procedure would be carried out, and offered the patient in front of them
what they believed to be their best option in the form of their innovative
(some would say experimental or untested) version of the procedure. This
was also at a time when the alternative options carried higher risks than
today and there was often an absence of evidence of absolute risks of
either option. Today we could not justify any increased risk for one
individual for the sake of the greater good of future surgical candidates,
risks of most standard procedures have reduced substantially, and data is
available on absolute risks in many scenarios.
How do the authors see a practical way of continuing important innovation
in surgical practice, without taking risks with patients?