Dissemination of new surgical techniques

Today was the first day of the Breast Oncology Program Retreat here at UCSF. I got some free food, listened to some cool presentations and also read a lot of posters. One thing really got me thinking.

One of the doctors had a poster on a relatively new type of surgery for breast cancer called a total-skin sparing mastectomy. After reviewing the poster, it was apparent that this results in wayyy better cosmetic outcomes, and if done properly, avoided any additional complications. Really, very cool. Then I asked her, how many other surgeons are doing this in the US? She said about 10. Now, it only started two years ago, and they needed to get data on the results, but it got me thinking. When will this new technique be disseminated across the country so that every breast surgeon in the country is not only aware of it, but technically mentored on how to do it? This thought made me sad, I wish that every woman in the country could have this option available to them, and this is just not the case.

I think that one of the reasons this problem is so compelling to me is that it reminds me of technical events in track and field. Take the high jump for example, until Fosbury came along, everyone was round-housing over the high jump bar, now with the Fosbury flop, we have men and women jumping a whole foot higher!! I wonder how this new technique was advanced and spread throughout the world? Another event that comes to mind is the javelin, do you throw with a bent knee or a straight knee? Do you torque or do you not torque? Does more speed always mean farther throws? I clearly was not the origin of any of these techniques, since I don't have the answers, but I am sure that someone out there does, and why don't I know about it??? Athletes and physicians are sometimes in the same boat. We want to lift up our sport (or specialty) to new levels, but we also have our individual desires to fulfil that cannot be sacrificed. Learning new techniques can be difficult and cumbersome. How can we help to aid the widespread distribution of technical advancements in the sport of track and field? In the specialty of surgery? Really intriguing, and an easy answer escapes me.