THENEWYORKER,APRIL20, 2020 73
Unlike drugs, medical implants are not required to be tested in clinical trials.
BOOKS
THE CUTTING EDGE
As surgeons implant more and more devices in us, who is looking after our safety?
BYJEROME GROOPMAN
ILLUSTRATION BY DAVID PLUNKERT
“
A
chance to cut is a chance to cure”:
I first heard this maxim forty-five
years ago, as a medical student, when
I watched a surgeon extract a tumor
from a woman’s abdomen. Confidence
in the powers of surgery extends back
to the most ancient roots of the field.
There are Neolithic skulls dating from
6500 B.C. with holes that testify to trep-
anation, a treatment that involved drill-
ing through the cranium, presumably
to let out malign spirits. (The practice
remained somewhat common until the
end of the Middle Ages.) The teach-
ings traditionally ascribed to the Indian
physician Sushruta, who probably lived
around the sixth century B.C., describe
a cataract operation, in which a kind of
curved needle was used to displace the
occlusion from the line of sight, and
rhinoplasties, in which the nose was re-
modelled using leaf-shaped flaps of skin
cut from the forehead.
For much of Western history, how-
ever, surgery lay somewhat apart from
the practice of medicine. Hippocrates
was leery of it, writing, “He who wishes
to be a surgeon should go to war”; the
crude practices of the battlefield were,
as Roy Porter put it in his classic his-
tory of medicine, “Blood and Guts”
(2002), “the work of hand not head.”
This suspicion bred an enduring med-
ical division of labor, in which many
healers viewed surgery as inferior. Well
into the modern era, surgical procedures
were the province of the barber, along
with pulling teeth.
But in the eighteenth century the dis-
cipline made its first steps on a journey
toward respectability, eminence, and,
eventually, even glamour. This progress
was accelerated by a number of devel-
opments. The Enlightenment placed sci-
entific method at the heart of medicine,
clearing away theories about the body
that had changed little since the time of
Hippocrates. Surgeons absorbed new
ideas in schools of anatomy, as they prac-
ticed their craft by dissecting cadavers.
Since the nineteenth century, anesthe-
sia—first in the form of nitrous oxide,
then ether and, later, the safer chloro-
form—has made operations more feasi-
ble. Hand washing and the sterilization
of instruments in chlorinated-lime solu-
tion dramatically reduced the sepsis rate
of procedures.
The orthopedic surgeon David Schnei-
der writes in “The Invention of Surgery”
(Pegasus) that, as a result, by the late eigh-
teen-hundreds “surgeons did the unthink-
able. Instead of just operating on people
in extremis, at the point of death, sur-
geons began the practice of elective sur-
gery.” Progress boosted “the stature of
surgeons from the lowliest to the recog-
nized.” Once dismissed as little more than
butchers, surgeons became so trusted that
patients with conditions that were merely
“inconvenient, annoying, or even just aes-
thetically unpleasing” felt secure enough
to go under the knife.
In the twentieth century, the discov-
ery of antibiotics further reduced the
risk of fatal infections after surgery, and
a host of other innovations have brought
the discipline to the point where “brain
surgery” is a byword for something so-
phisticated and difficult. Ultrasound,
CT scans, and MRI scans make it pos-
sible for surgeons to see what they will
cut before the patient is even on the
table. Laparoscopes permit keyhole sur-
gery for hernias, gallstones, and pros-
tate cancer. Endoscopes, long used in
diagnostic procedures such as colonos-
copies, can now be fitted with lasers that
cut the tissue being surveyed—combin-
ing visualization and treatment in a sin-
gle “optical knife.”
As a surgeon, Schneider is known for
his success in the replacement of entire
