Surgery without Sufficient Indications: an Update from Russia

Abstract

This review is an update and continuation of preceding papers on invasive procedures applied in Russia with questionable clinical indications. Certain methods have been applied according to instructions by healthcare authorities and publication of leading specialists, facilitated by lacking professional autonomy. Examples are discussed here and in preceding papers: the overuse of Halsted and Patey mastectomy, preventive electrocoagulation of cervical ectropions without cytotological examination, gastrectomy for peptic ulcers, thoracic and abdominal surgery for bronchial asthma and diabetes mellitus, overuse of surgery in tuberculosis and other pulmonary conditions, overuse of bronchoscopy e.g. in conscripts with supposed pneumonia. Among mechanisms contributing to the persistence of suboptimal methods has been the autocratic or military managerial style discouraging criticism and polemics. Other attributes of this style are the paternalistic approach to patients and insufficient adherence to the principle of informed consent. Some invasive procedures with questionable indications were advocated by first generation military surgeons. Personnel training could have been one of the motives. Note that military and medical ethics are not the same. The comparatively short life expectancy in Russia is a strategic advantage as it necessitates less healthcare investments and pensions. Actually, Russia needs foreign help in the matter of healthcare. In view of the current international tensions, the cooperation has been partly interrupted. Obstacles to the import of medical products have adverse consequences. Under these circumstances, the purpose of this article was to remind that, performing a surgical or another invasive procedure, the risk-to-benefit ratio must be kept as low as possible. Insufficient coordination of medical studies and partial isolation from the international scientific community can result in parallelism in research, unnecessary experimentation, and application of invasive methods without sufficient indications.