Sam,
I respect the fact that you are a doctor, but you most clearly have a bias in your perspective based on your comments. In the case of AN's I learned a long time ago that just being a doctor doesn't make one an expert in that specific area.
Do we want to educate people where to go for the least chance of facial paralysis, or not?? Sure, let's put all the clinical studies on the table. I've yet to see a study on radiosurgery that had a paralysis risk of greater than 1%, regardless of size. Surgery, in small AN's is probably as high as 95% , even at HEI and drops in percentage as the size of the AN increases.
Do we want to educate people that HEI has the only internist in the WORLD, whose full time job is pre and post-op care of AN pts!! Sure, we can tell people that although I'm not clear what an internist "dedicated to pre / post op AN pts" does to have any impact on facial / hearing nerve preservation or anything else related to the surgical outcome. I guess I need some help understanding the benefit of this beyond a marketing aspect.
but some experienced groups (eg HEI) have such outstanding results from surgery, that the tumor is GONE!!! with extrememly rare recurrance. Don't have to worry about is it necrosing or not. I'm sure you have some studies from HEI that support your position, but the best surgical outcome studies I've seen are around 95% while radisourgery typically comes in at 98%. Even if you want to say radiosurgery is something less, it is still equal or better than surgery. One can argue against having it dead and doing no further harm vs. having it physically removed at the expense of the trauma to tissue it causes. As a doctor, I'm sure you would also agree with the risk of post surgical complications or noscomial infection associated with a hospital stay. While I'm not a clinician, I have been involved with medical supplies and the clinicians who use them for 25 plus years and have a pretty good understanding of how many people have prolonged hospital stays or don't check out at all because of those risks and HEI is not immune to that either.
I'm not biased, I'm a doctor, which is Greek for teacher. I don't get paid by HEI. I don't know Greek, but I do know a good teacher creates an environment where the students are provided information in an open environment from which they can challenge and draw their own conclusions. I have responsibility for 10 business units doing over a Billion dollars in revenue and involving a thousand employees, so my role involves teaching every day. There is a fine line between moderating a meeting with competing points of view for an educational purpose and being adversarial and trying to influence the audience. As Phyl said in her initial post in this thread, I think the evidence is pretty compelling that both treatment options can be viable and effective. If you're positioning the discussion along those lines from the start then that's very fair, and I sincerely hope that is your intent.
Mark
