Dr Gates' elegant and thought-provoking letter does a superb job in lending clarity to the distinctions between surgical innovation, experimental surgery, and surgical research. I wholeheartedly agree with him that innovation is crucial to the advancement of medical science and that it should be protected and encouraged. As surgeons, our primary responsibility is to our patients. In the course of practicing our profession and caring for our patients, however, we are accountable to a number of outside agencies. These include state licensing boards and hospital credentialing committees, among others. We comply with the requirements of these agencies because we believe that ultimately it is in our patients' best interests. Accountability to a local IRB ought to be viewed in the same light. While it may be cumbersome, and may require paperwork that we would rather not do, it ultimately demonstrates our commitment to our patients and our willingness to put their interests above our own. Accountability does not stifle innovation, it safeguards the interests of both the patient and the surgeon.
Casler JD. Surgical Innovation and Research—Reply. Arch Otolaryngol Head Neck Surg. 2003;129(12):1354. doi:10.1001/archotol.129.12.1352-a