In the April 2003 issue of the Journal of the American Medical Association (JAMA), the AMA asked some thought provoking questions about the effectiveness of weight loss surgery, and also about the safety of the procedures, long term.
No studies on Weight Loss Surgery were included in this issue which was dedicated to the treatment of obesity and the bariatric surgery we see advertised so often on TV with smiling faces like Carnie Wilson and Al Roker, was only included in a comment article.
"As bariatric surgery for the treatment of patients with morbid obesity surges in popularity in the United States, ethical and scientific questions about the approach are mounting." commented author, Mike Mitka in his article entitled "Surgery for Obesity Demand Soars Amid Scientific, Ethical Questions"
Mitka added that there are "scientific questions about safety and effectness and ethical issues such as potential conflicts of interests among surgeons."
A long hard look was taken at the heavy advertising of Weight Loss surgery on TV etc. "Some physicians", wrote Mitka, were beginning to "question whether the profession is handling this therapy properly.", adding that some surgeons had a year long waiting list for the procedures.
"You have physicians advertising like crazy. You can't watch television without seeing an ad," said Edward H. Livingston, MD, a professor of surgery at the University of Texas Southwestern Medical Center in Dallas. "-This is the highest paying general surgical procedure there is, and a lot of patients will pay."
The JAMA article admitted that the short term results of Weight Loss surgery were impressive showing large weight losses as well as improvement of disorders like diabetes type II. But it also stated:
..long-term consequences remain uncertain. Issues such as whether weight loss is maintained and the long-term effects of altering nutrient absorption remain unresolved."".
Dr Ernsberger of Case Western Reserve School of Medicine feels that these "issues" might be more resolved than some are willing to admit. On a recent Donahue show, he stated:
"Well, the gold standard in medicine is the controlled clinical trial. We don't go subjecting 100,000 people to a surgical procedure without doing a controlled clinical trial or dozens of clinical trials, and then looking at the results. Do you know how many clinical trials have been published on weight-loss surgery or gastric bypass? Zero. None of them have compared it to clinical conservative treatment and found it to be superior for life expectancy or for anything else other than, you know, risk factors.
A number of trials have been started, and the final results have never been reported. We have to ask, you know, why haven't we seen the final results? I think it's because it's bad news. "
Dr Edward Livingston stated in the JAMA article, that we need a REAL trial comparing medical treatment of obesity to the surgical treatment. Livingston added that he believed such a trial would show that the benefits of surgery had been "overestimated".
Interestingly enough, the US government has provided for such a study, spanning 5 years, to begin soon which, like the HERS study on HRT might be very enlightening.
In the meantime, the AMA's advice to surgeons in order to workaround the ethical and scientific issues with this surgery was to tell patients that Weight Loss surgery is 'investigational' and to also inform patients that it is not known whether these procedures will help the patient.
"This is the classic problem in surgery-innovation without the research to guide it. So all this should be brought under experimental protocols," said Laurence B. McCullough, PhD, a professor of medicine and medical ethics at Baylor College of Medicine in Houston, Texas. "That's how you handle the conflict of interest make sure you tell the patient, `The procedure is investigational; we don't know if it will help you."'
The AMA's attitude toward current bariatric procedures differs greatly from the TV ads which call this surgery the only 'safe' way to 'lose weight permanently'.
It's probably very good advice for patients to research the surgery with additional sources to those who are selling the procedures - just like when we want to know about a car, we consult "Consumer Reports" first, before we expose ourselves to the salesperson wishing to sell us the car. Should we take less care with our bodies?
Source: JAMA, April 9, 2003-VoL 289, No. 14, pg 1761-2
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