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Do sad stories blind us to medical trade-offs?

The downfall of the power morcellator is another example of how a tragic personal tale can skew our  perceptions of risk, making a reasonably safe medical tool seem dangerous and even evil, a doctor argues in an essay this week in the New England Journal of Medicine.

"Our capacity to speak science to emotion seems to be collapsing," writes Lisa Rosenbaum, a cardiologist at Brigham and Women's Hospital in Boston. "As our patient-safety focus intensifies and physicians' behavior is publically dissected, a story that goes viral has outsize power."

In case you've missed the headlines, the electric morcellator is a tissue-slicing device used in gynecological surgery since the mid-1990s. It enables surgeons to dissect benign uterine fibroids or the whole uterus and remove the tissue through tiny abdominal incisions rather than by cutting open the abdomen. For most patients, morcellation reduces complications and recovery time. But  in rare cases -- an estimated 1 in 498 -- it spreads a hidden, ferocious uterine cancer called leiomyosarcoma. The chance of surviving five years with metastatic LMS is only about 14 percent.

After the worst-case morcellation scenario played out in 2013 for Amy Reed,  an anesthesiologist and mother of six, she and her husband, cardiac surgeon Hooman Norchashm, launched a high-profile campaign to ban the device.  As a result, hospitals, insurers, federal regulators and the leading morcellator manufacturer have effectively disavowed the tool and sharply curtailed its use.

Reed's hysterectomy took place at Brigham and Women's Hospital, where Rosenbaum works. Reed, now 42, and Noorchashm, 43, have since moved their family to Bucks County to be near relatives, as well as colleagues from the University of Pennsylvania, where both earned medical degrees and Ph.Ds in immunology.

Rosenbaum writes that there may be "greater population benefits and lesser risks from continuing than discontinuing morcellator use" because, based on risk estimates, minimally-invasive surgery would save more lives than the lives lost to accidental morcellation of LMS. That same defense of morcellation has been proffered by two gynecological physicians' groups.

Heartbreaking individual   stories like Reed's  are easy for people to imagine. "Meanwhile," Rosenbaum says, "the benefits of morcellation are largely invisible...Who sees the women who undergo a minimally invasive produce, recover quickly, and avoid losing income" by being out of work for six weeks?

Rosenbaum says she talked to a woman who wanted power morcellation: "Ms. B, a 28-year-old black woman" whose health insurance wouldn't compensate most of her recovery time from abdominal hysterectomy.

Stories about bad medical outcomes often take on moral overtones, Rosenbaum writes.  Noorchasm "argues that morcellation is a crime against women, reflecting medicine's corruption by industry greed. "

If nothing else, Rosenbaum's essay shows that the morcellation controversy is unlikely to end anytime soon.

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