To do or not to do, that is the question that has been on my mind today. Just because we CAN doesn’t always mean that we should.  During our morning conference this am, we had a discussion about a case involving a newborn with multiple anomalies, including her liver in her chest, and an abnormal heart structure. She had a very low likelihood of survival at all, but even less a likelihood of “meaningful survival,” of being a normal child.  The hospital team went ahead and put her on ECMO (heart-lung bypass) anyway and then took it away after two weeks of futile efforts, costing ungodly amounts of money for little benefit (to my mind at least).  One of the arguments made at the conference was that advances in medicine are often made when seemingly “futile” procedures are done experimentally. But I can’t help but think that if I was this baby’s mother I would rather he died peacefully in my arms that surrounded by doctors and two 3/4″ cannulas in her neck. 

This week’s Newsweek had an article about a new procedure that surgeons at UCSD have been trying what’s called “Natural Orifice Surgery.” Basically, a camera is inserted through the mouth and snaked all the way to the appendix. Then the appendix is removed from the inside.   For the brave man who first had this procedure done, the operation took three hours, instead of about 30 minutes for a regular procedure.  Who is supporting this research?

Some of natural-orifice surgery’s biggest cheerleaders are device makers: since 2005 at least 10 new companies have sprung up to manufacture technology for the emerging field. Established players, like Covidien and Ethicon, also work closely with doctors.

Not surprising.  I remember when I was a surgical resident, the makers of a robotic surgical device set up a “learning station” on live pigs where the residents could practice the technique.  The equipment was worth more than $1 million dollars, and the set up was tedious– an operation that could be performed safely in minutes was turned into one that could last hours and (to my mind, at least) not as safe. So why bother? It was technology in search of an application. (Interestingly, University of Chicago is touting it’s robotic heart surgery heavily in local and nationwide media.) 

It’s astonishing to think how many children could be vaccinated with the money spent on ECMO run, or how many people with heart disease could get their medications with one robotic heart surgery.  Why are our priorities dictated by what we CAN do in