SURGERY: Your Choices and Alternatives

George Crile has staunchly opposed radical mastectomy for breast cancer and in this book he enlarges on that theme, as well as on the larger issues of when, where, why, and by whom operations should be performed. The tone of the book is harsh, critical, opinionated, and disquieting. We are told that it doesn't matter if your leukemia is diagnosed early or late since nothing can be done anyway; that the annual physical is mostly a waste of time; that surgeons are witting or unwitting slaves to tradition and the belief that more surgery is better than less. Crile misses the point about the annual physical: people don't get them to find out what's wrong; they want reassurance that they're okay--or the mildest of admonitions to take off a few pounds, to cut down on salt or smokes. Moreover, to hear Crile talk you would think that chemotherapy was virtually worthless in cancer. One could say that that's because he's a surgeon; but in fact he is quite hard on his fellow craftsmen, and the nervous patient won't be comforted by his advice (good though it is) to check on the mortality/morbidity record of both prospective surgeon and hospital. The latter part, dealing with medical costs, finds Crile opposed to the fee-for-service tradition and favoring prepaid medical plans and salaried physicians. Given the tone, the biases, and the organ-by-organ approach to ills this is not the sort of book you would give to a friend or relative already filled with medical anxiety. Yet the advice to seek more than one opinion and, above all, educate yourself is sound and good.