By: Toby Cosgrove, MD
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“First, do no harm.” That’s part of the Hippocratic Oath. Doctors take this very seriously. You don’t intervene where the risk of intervention is greater than the risk of the disease. But the No. 1 innovation on the Cleveland Clinic “Top Ten Medical Innovations” list for 2013 is something Hippocrates never dreamed of: bariatric surgery to treat diabetes.
This has raised some eyebrows. How can we justify performing a major surgery like gastric bypass to treat a non-emergent medical condition like diabetes? Wouldn’t the risk of surgery be greater than the risk of the disease?
You’d think so. But Cleveland Clinic completed a remarkable clinical trial this year. Published in the New England Journal of Medicine, the study compared three groups of obese patients with uncontrolled type 2 diabetes.
One group in the study was treated with optimal medical management (OMM). The next group got OMM plus gastric bypass (bariatric surgery). The last group got OMM and sleeve gastrectomy (another type of bariatric surgery).
At the end of the study period, their clinical indicators for diabetes were compared. The patients who were pharmaceutically treated improved somewhat; the patients who had either of the bariatric procedures were cured. Amazingly, the cure was not achieved through weight loss. These patients’ glycemic numbers started plummeting right after the operations, before they even had the chance to lose any significant weight.
Weighing risks and benefits
Yes, there is a risk to any surgery. But the risk to the patient from these particular procedures is low and is far overwhelmed by the risk of uncontrolled type 2 diabetes, which ends in incurable heart failure and death.
Cleveland Clinic researchers are currently enrolling patients in the second part of this study, which will look at the effect of bariatric surgery on similar groups of patients – but this time, to see how the surgery affects the patients’ risk of heart disease and death.
When you consider that our nation’s high rates of obesity are currently driving an epidemic of diabetes that threatens to bankrupt our healthcare system and overwhelm medical providers, you can see why this was chosen as our No. 1 Medical Innovation of the Year.
As my Harvard Business School friend Michael Porter and his collaborator Elizabeth Teisberg like to say, “Innovation is the only true long-term solution to high quality affordable healthcare.” Here’s the perfect demonstration.