Intended for healthcare professionals


John Bunker

BMJ 2012; 345 doi: (Published 23 July 2012) Cite this as: BMJ 2012;345:e4883
  1. Anne Gulland, freelance journalist, London
  1. annecgulland{at}

The man behind the surgery bible

At a time when surgeons enjoyed a god-like status, John Bunker dared to question his role. Bunker was a professor of anaesthesia at Stanford University School of Medicine, and in 1977, with co-editors Benjamin Barnes and Frederick Mosteller, he published Costs, Risks and Benefits of Surgery, a book that became known as Bunker’s bible.1 The book was one of the first to evaluate surgical techniques, and in 2006 a paper in the Journal of Health Services Research and Policy2 included it in a list of the 26 most influential books on healthcare policy in 150 years.

Generating debate

Bunker’s book considered the general principles of evaluation; had accounts of specific surgical innovations and their evaluation; tried to assess the costs, risks, and benefits of established procedures; and assessed new procedures. It generated debate about “unnecessary surgery,” with both the New York Times and the San Francisco Chronicle running stories. According to a 2007 paper …

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