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October 10, 1977

Cost, Risks, and Benefits of Surgery

Author Affiliations

Northwestern University Chicago

JAMA. 1977;238(15):1670. doi:10.1001/jama.1977.03280160064033

Human life has traditionally been regarded as priceless. Therefore, no cost should be spared if a life can be saved. However, life-saving methods have now been developed that may well be beyond the capacity of society to pay for them. Perhaps coronary artery bypass surgery and renal transplantation cost more for society as a whole than society is willing to purchase. This book, using the methods of decision theory and cost-benefit analysis aims to clarify thinking rather than to be merely critical.

The first part, background and general principles, introduces the methods of conditional probability, decision trees, and economic analysis. A second section, entitled "Surgical Innovation," shows historically that surgical procedures were devised in the past on the basis of intuition and insight of singular individuals.

Distinguished foreign visitors to this country had an enormous impact on surgical practice. For example, Arbuthnot Lane, in 1909, explained an elaborate pathology of