• U.S.

Medicine: The Silent Stone

2 minute read
TIME

Anyone who argues that medicine is an inexact science would have found proof positive at the American Medical Association’s convention last week at Miami Beach. Nowhere was a conflict of viewpoints more obvious than in the lengthy debate over what to do about gallstones.

Gall-bladder disease is becoming more common as the proportion of oldsters in the population increases. The usual form is cholecystitis (inflammation of the gall bladder), resulting from the formation of stones in the gall bladder. Sometimes, the stones immediately signal their presence by causing sharp pain. In such cases, surgery is performed promptly. But many gallstones lie dormant for years—and it is this “silent” type that sent the Mayo Clinic’s Dr. Martin A. Adson into debate with fellow surgeons.

To Cut or Not. To Adson’s way of thinking the question was this: If a gallstone is detected while it is still silent and causing no trouble, should it be removed immediately and prophylactically to protect the patient against possible future illness that might threaten his life? Weighing present risk against future peril, and after examining thousands of recorded cases, Adson rather cautiously concluded that prophylactic surgery is sometimes justified. One case in point: a patient under 65 who has coronary artery disease; the risks become far greater, said Adson, if such a patient has to have emergency gall-bladder surgery later in life.

Adson still felt a need to protect patients against those medical men whom he accused of having “surgical genes—an inborn bias in favor of surgery.” To this, Surgeon Kenneth W. Warren of Boston’s Lahey Clinic replied: “We’re a bit more aggressive than Mayo’s in cutting out silent stones.” The difference stirred Florida Surgeon John J. Farrell, moderator of the Miami gallstone session, to cite an overseas situation at the University of London. There, Internist Sheila Sherlock is a leading opponent of surgery on silent stones, but Surgeon Rodney Smith, who operates on most of Dr. Sherlock’s patients, is all for taking them out. “That,” observed Moderator Farrell, “creates an interesting situation. I wonder how they live together.”

More Must-Reads from TIME

Contact us at letters@time.com