40th Anniversary 1972-2012
GENERALSURGERYNEWS.COM
October 2012 • Volume 39 • Number 10
The Independent Monthly Newspaper for the General Surgeon
Opinion
NASH Spikes as Reason For Liver Transplant
Who Shot J.R.? D AVID V. C OSSMAN , MD
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or those of you in your first few years of practice as an MD, you were being breast-fed in 1980 when “who shot J.R.?” was the burning question on the prime-time evening soap, “Dallas.” Almost half a billion people worldwide tuned in to find out who shot J.R. Ewing, the patriarch of an oil-rich family played by Larry Hagman (who obviously wasn’t mortally wounded since he’s back, with a new liver, on a “Dallas” remake). A jilted mistress, of course, with family ties to the Barnes, the archenemy of the Ewings, pulled the trigger. How predictable. And disappointing.
This time, J.R. turned out to be the shooter. Early this summer, J.R. took center stage again in the form of Chief Justice John G. Roberts, only this time it was “J.R. and the Supremes” who captivated the nation’s attention with the pending decision on the constitutionality of the mandate provision of the Patient Protection and Affordable Care Act (PPACA) that requires all Americans to buy health insurance. For intrigue and drama, this was true theater. Audience see PPACA page 34
FROM THE BENCH TO THE BEDSIDE Incorporating a Novel Local Analgesic Into an Opioid-Sparing Strategy for Postsurgical Pain see page 8
Obesity Faulted; Study Shows Transp nsplant Helps Nonalcoholic Steatohepatitis Patients Pat
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merica’s stretched donorr pool and limited resources for transplant will come under further stresss in the next decade as nonalcoholic steatohepatitis (NASH) supplantss hepatitis C as the primary indiccation for liver transplant, experts saay. According to a study presented at the American Sur urgical Association’s annual meetin ing, NASH is now the fastest-growin ing indicator for liver transplant at th he University of California, Los Angeeles (UCLA), which has one of the he country’s largest transplant programs.
drawn fire from the medical device industry, which predicts, despite some counterclaims, that the tax will result in lost profits, vanishing jobs, relocation overseas and a decline in innovation. There is even a Web site, no2point3.com, supported by Cook Medical, with the message, “Kill the med device tax!” In June, the House passed a bill (H.R. 436) to repeal the tax. The bill is
SAN N DIEGO—One in every two bariatric surgeons will be h hit with a medical malpracttice claim during their careerr, a new study shows, but nearlyy 70% of those claims are dropped, dismissed or found in favor of o the surgeon. “Th his survey indicates that malprac actice claims are common eve vents but lawsuits occur most frequently in cases where no negfre ligence is found to have occurred,” li said study author Ramsey Dallal, sa MD, director of bariatric surgery, EinM stein Healthcare Network, Philadelphia. adelphia. Dr. Dallal, chair of the Am merican Society for Metabolic and Bariatric Surgery (ASMBS)’s patientt safety committee, presented the stu udy at the organization’s annual meetin ng. The study is based on a survvey of members of the ASMBS praccticing in the United States. Of 1,6672 eligible members asked to com mplete an email survey detailingg their medicolegal experience,, 330 responded, for a responsee rate of 20%. Surgeons who completed the survey had been in practice for a mean of 15.3 years, representing 5,042 years of bariatric surgery experience. Nearly 40% practiced in a hospital or
see DEVICE TAX page 14
see CLAIMS page 18
see LIVER page 4
Excise Tax Looms ffor Medical Device Industry Manufacturers Argue Tax Will Cause Layoffs, Stifle Innovation
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arring a major political shift, medical device manufacturers will face a new 2.3% excise tax on their products beginning in 2013, which is expected to raise $29 billion over 10 years. Enacted in 2010 as part of the Affordable Care Act (ACA) that is reforming health care, the tax has
Claims Common In Bariatrics, But Outcomes Often Favor Surgeons Exper ert Witnesses a Particularly Conten entious Issue in Bariatrics
B Y C HRISTINA F RANGOU
B Y G EORGE O CHOA
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INSIDE Opinion Physicians’ Thoughts on the 2012 Presidential Election and Its Effect on Health Care .................... 12
Surgeons’ Lounge Experts Debate the Use of Sentinel Lymph Node Biopsy in Melanoma ...................... 20
A Patient With a Large, Malodorous, Fungating Right Breast Mass ...... 28