There are many different schools of medicine. For example, there are those who elect a long and tortuous course of surgery. Some eventuate in general surgery, others are in specialized areas, while others choose a more nonsurgical bent such as the chemotherapist, radiologist, oncologist. The major point of this story is that all of these practitioners have one thing in common... they all graduated from North American medical schools, and so, they share similar philosophies.

According to the United States Department of Commerce, in 1984 surgeons performed 25.6 million operations, an increase of 5.6 million since 1975.¹ As one might expect, some of these procedures (and the cost associated with them) are not justified as evidenced by second opinions and other defining measures. The extent of unnecessary surgery has been the object of considerable speculation and occasional wild accusation in recent years. Results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations the fraction that are unwarranted could be as high as 20 to 30%.² It is also a well-known fact that the number of operations performed in a community is directly related to the number of surgeons practicing in the same area. In other words, the more surgeons available, the more surgeries performed. This obviously plays an additional role in the cost factor.