FUTURE SURGE RY iM Med - Advert - Clinical Services Journal - Third Page - Endo - JAN 2
role to play through the provision of bariatric surgery for the prevention of disease. However, opinions have been divided on this issue. New drugs may take the place of some surgery.
COVID has been disruptive in operational terms, but it is also still having a big impact on excess mortality. This will have an impact for some years. Multimorbidity is also increasing. Thirty to forty years ago, patients often attended with just one problem. However, a majority of older patients have multiple morbidity.
“It is not acceptable to just fix one
part of the problem and leave the rest to someone else – or shifting elderly people around seven or eight different clinics, for predictable clusters of diseases. As a profession, we train to treat single diseases, we issue guidelines for single diseases, we run clinics for single diseases, and we do research for single diseases – and yet this is not the reality,” Prof. Whitty commented. While this is a problem that needs to be fixed, he added that diagnosis is going to transform healthcare in the next 20-30 years. Earlier diagnosis favours curative surgery for most solid cancers and substantial improvements are likely, he explained. Changes will be driven by better radiological imaging, a variety of ‘oscopies’ (sic) inside the body, increasing use of artificial intelligence/machine learning, liquid biopsies to identify blood markers, and screening by genotype and other risk factors. These trends will have a complex impact on what is treated surgically and what is treated through non-surgical approaches, he asserted. This will inevitably disrupt the status quo for the profession. He went on to point out that “breakthroughs” are only for the media. There have been steady increases in 10-year cancer survival for prostate, breast, bowel and melanoma cancers over the years. In the future, improvements in surgery and medicine will continue to be incremental. Unfortunately, 10-year survival for lung
cancer has remained virtually unchanged since the 1970s. He described it as “a cancer that is largely caused for profit”. Prof. Whitty went on to highlight that sometimes doing less is as good or better. He used some line graphs, based on recent studies, comparing mastectomy vs breast conserving surgery (Hamdy et al, 2016) and surgery vs radiotherapy, vs watchful waiting in selected prostate cancer patients (Litiere et al, 2012). They showed very little difference in outcomes. “It is very easy to get excited about the arrival of a new gadget or drug. But we also need to consider whether what we are doing is unnecessary and should we stop?” he continued. “We need to ask ourselves, are we doing too much?”
C M Y CM MY CY CMY
He ended his presentation by thanking delegates for their “impressive achievements” in rising to the extraordinary challenge of the backlog, in the wake of the pandemic. Although “we are not out of the woods yet”, with COVID, he concluded that surgical teams have adapted to new ways of working, and their hard work has enabled the health service to stay “just ahead”. For this, the UK owes surgery professionals a huge debt of gratitude, he concluded. CSJ
K
It is not acceptable to just fix one part of the problem and leave the rest to someone else – or shifting elderly people around seven or eight different clinics, for predictable clusters of diseases. As a profession, we train to treat single diseases, we issue guidelines for single diseases, we run clinics for single diseases, and we do research for single diseases – and yet this is not the reality. Professor Chris Whitty, CMO.
JANUARY 2023
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