Drs Tishler and Reiss were critical of my commentary regarding the findings of gastric bypass' effectiveness in assisting Medicaid patients to return to work. They point out a number of deficiencies in the study's execution, none of which are inconsistent with the points I made in the commentary. I did conclude that we should strive to generate more compelling data, but we surgeons have to live in the real world.
The scientific basis for most of what we do in surgery is weak. Rather than the result of carefully controlled, large-scale clinical trials, the indications and execution for most of the operations we perform result from the long experience of surgeons managing difficult problems that cannot be treated by less aggressive means. Very few operations that have proven efficacy by virtue of years of experience have been tested with the sort of scientific rigor Tishler and Reiss have proposed, yet we know that most of what we do saves lives and improves our patients' quality of life.