Clinical Harm as Policy

The main topic of this book is invasive procedures used in Russian healthcare without sufficient indications. Related issues are discussed in separate chapters: scientific misconduct, medical education and postgraduate training. Among others, the following is analyzed: the overuse of gastrectomy for peptic ulcers, of thoracic surgery for tuberculosis, bronchial asthma and other respiratory diseases, overtreatment of radiation-related lesions, spleno-renal anastomosis in diabetes, excessive and compulsory treatments of alcoholics, cauterization of cervical ectopy regardless of the presence of epithelial dysplasia. Considering the breast cancer incidence, millions of women in the former Soviet Union underwent Halsted and lately of Patey mastectomy with removal of pectoral muscles without indications, often sans informed consent. Justifications of surgical hyper-radicalism, described in this book, could be heard in private conversations among medics, for example: "The hopelessly ill are dangerous" i.e. may commit reckless acts undesirable by the totalitarian state. For example, glioblastoma patients were routinely operated on, while it was believed by some staff that the treatment was generally useless, just forcing many patients to spend the rest of their lives in bed. The training of medical personnel has been another motive. This topic is interconnected with certain features of Russian healthcare, namely paternalism, authoritative management style, occasional disregard for the principles of informed consent, professional autonomy and scientific polemics. In conditions of paternalism, misinformation of patients, persuasion and compulsory treatments are deemed permissible. Considering shortcomings of medical practice, research and education, a simple increase in funding is unlikely to be a solution. Measures for improvement of the healthcare in Russia must include participation of authorized foreign advisers. Unfortunately, current international tensions are not contributing to this development.
Some human factors and guidelines in Russian healthcare have not substantially changed since the Soviet time.