8 September 2018 | NewScientist | 37response seen in some people, as well as
complex nerve problems affecting the pelvis
and lower limbs.
How many people in the UK are qualified to
insert mesh?
Hundreds are qualified to insert it, but
relatively few are qualified to remove it.
My training involved a lot of complex vaginal
surgery, in particular in women who’d had
really bad, traumatic childbirth. So my skill set
came from that background. Mesh removal is
difficult and occasionally scary surgery. The
mesh adheres to the bladder, urethra, vagina,
blood vessels, nerves and bones. Once removed,
the symptoms of incontinence and prolapse
often return and so one needs to consider
non-mesh options to restore functionality.
That can be difficult in tissue that has been
chronically inflamed or infected by the mesh.
Even though others can do removals,
I understand women seek you out.
Many patients were dismissed for a long time,
so they lost trust in their doctors. They want
somebody who will listen to them. There’s also
a group of women who feel that nobody else
can do their surgery, and there’s an element
of truth to that: many surgeons are starting
to learn how to deal with potential surgical
complications, but many are still not far
enough down the road of experience.You and others face resistance for speaking out
against mesh. What do you think is behind that?
There has been a great deal of resistance, even
anger, from some clinicians, even though
evidence is coming out all the time. I think
there are some who believe this is media hype
and upset, and that women have jumped on
the bandwagon. And of course if a surgeon is
stopped from using mesh, and they haven’tbeen trained in all the other complex surgical
techniques, they cannot offer a surgical option
to their patients, so they have no alternative.
Some doctors are taking it personally: they fail
to recognise that the injury isn’t to them – the
injury is to the women.So, what’s the alternative?
Research shows that over 70 per cent of
women with stress urinary incontinence who
committed to physiotherapy did not need any
further intervention. So, many clinicians are
reverting to conservative measures first before
considering surgery, and some are retraining
in the traditional surgical techniques, which
existed in the pre-mesh era.How do you feel about the issue from a
cultural perspective?
It’s no longer just a mesh issue or a pain issue.
This is about right of access to good healthcare,
and belief in women: it’s a women’s rights
issue. What makes me angry is the fact that
many women affected by complications were
not listened to. They were ignored, patronised,
and many were sent to psychiatrists or
psychologists when their problem was
physical. Sometimes these women couldn’t
walk unaided, couldn’t function, gave up their
jobs, couldn’t look after their families – the
impact on their quality of life was huge.
What has happened in the past few years
has made me sad because it has affected the
way I think about my profession. But
occasionally in life, and especially in medicine,
you must stand up because you have to make
people think differently.Is the situation getting better in the UK?
Until the recent suspension led by Julia
Cumberlege and her team in tandem with
NHS England and the Department of Health,
people were still using continence and
prolapse mesh. The suspension has meant
many have stopped, albeit temporarily. But
we are just at the tip of the iceberg in dealing
with the complications of the mesh already
implanted. This is going to get bigger in years
to come, globally. I have several trainees and
colleagues working with me, learning how to
do removals. And women are becoming much
more aware. Many women are telling doctors:
I’m not having this, thank you very much.
The suspension is a good result for the
women: it is a vindication. I suspect using mesh
will become more difficult from now on. ■Julia Brown is an interview editor at New Scientist“ This crisis is unprecedented.
We still don’t know the
depth of it”Photographed for New Scientist by Dave Stock