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An Update on C-Sections

December 04, 1987

The article by Allan Parachini on Caesarean sections, the most frequent hospital-based operation in the United States (1 million a year with 455,000 possibly medically unnecessary) is an excellent review of opinion concerning the shocking overuse of this operation ("C-Sections: Are There Too Many?" Nov. 19).

Apparently, however, it was published too soon to take note of a study from UCLA and the Rand Corp. (published in the Journal of the American Medical Assn. Nov. 20) which sheds some additional light. The UCLA study and other reports in the same issue find that committees of experts (consensus committees) have little effect on practice. Such a committee organized by the National Institutes of Health has ineffectively urged doctors to take specific steps to reverse the trend toward increased use of C-sections. In other medical areas, too, consensus committees were ineffective: treatment of breast cancer, steroid receptors in breast cancer and coronary artery bypass surgery.

Though practitioners trust science, says one of the reports, they are skeptical of scientific publications and of committee decisions which try to represent science. In this case, as The Times article pointed out, self-interest of physicians also tends to outweigh sound medical opinion. Caesarean sections are popular with obstetricians because for the doctor they reduce the risk of malpractice suits, increase income and provide convenience.

The medical profession has been unable to control the rising incidence of C-sections. Unless individual patients and the public outside the medical profession resist overuse of C-sections much more vigorously than they have, we are going to continue to pay for this expensive and often unnecessary surgery.

JOHN LEWIS MD

Santa Barbara

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