NYTimes: Dr. George Crile Jr., 84, Foe Of Unneeded Surgery, Dies (in year 1992)

九月 30, 2012

By WOLFGANG SAXON
Published: September 12, 1992

Dr. George Crile Jr., the Cleveland surgeon who angered the medical establishment by insisting that some radical procedures for breast cancer and other diseases met the surgeon’s needs rather than the patient’s, died yesterday at the Cleveland Clinic Foundation. He was 84 years old and lived in Cleveland Heights.

He died of lung cancer, the clinic said.

Dr. Crile’s battle against unnecessary surgery affected the lives of uncounted people in this country, but particularly women stricken with breast cancers.

The controversy of two decades ago swirled around Dr. Crile’s campaign against radical mastectomy — removal of the entire breast and of surrounding lymph notes and major chest muscle — which was routinely performed on breast cancer patients for a century. Instead, he preferred to combat the cancer with a simple mastectomy or, in early stages, with a lumpectomy, in which the tumor and a minimal amount of surrounding tissue is removed by a local incision. Simpler and Safer

This conservative approach was far more common in Europe at the time, and many doctors were concerned when Dr. Crile championed it here. He aroused anger with intimations that some surgeons performed heroics of the scalpel for professional glory, reveling in their skill, or even for the large fees they could command.

Earlier, Dr. Crile had pursued his policy of keeping intrusive surgery to a minimum while specializing in diseases of the thyroid. Among the alternatives he advanced were treatments with new radioactive iodines able to control certain types of thyroid cancer.

His research made surgery simpler and safer. And he brought a simmering medical debate out into the open by encouraging patients to demand information so they might make informed decisions rather than be treated like children who would not understand.

Dr. Bernadine Healy, director of the National Institutes of Health, said yesterday that Dr. Crile was an “unsung hero” who had been the object of “ridicule and scorn” by his peers and had touched millions of American women in an “extraordinarily positive way.” Now, an Accepted Wisdom

“Now lumpectomy is a mainstream and humane treatment for women,” she said in a statement from Bethesda, Md.

Dr. Crile, known as Barney to distinguish him from his illustrious father, who helped found the Cleveland Clinic, spent decades searching for nonsurgical solutions to medical problems. His aversion to routinely performed radical mastectomy is now shared by most doctors.

“I came home from World War II convinced that operations in many fields of surgery were either too radical, or not even necessary,” he once said. “Universal acceptance of a procedure does not necessarily make it right.”

Dr. Crile, who was associated with the Cleveland Clinic for over half a century, retired as head of the department of general surgery in 1968 but continued as senior consultant and, since 1972, as emeritus consultant. In addition to working in his office, he remained a writer, compulsive diarist, world traveler, diver and film maker.

George Washington Crile Jr. was born in Cleveland on Nov. 3, 1907. His father was a distinguished surgeon of the respiratory system who contributed to the study of surgical shock. He also developed the nerve-block anesthesia and was an early user of blood transfusion. A founding partner, he was known at the Cleveland Clinic Foundation as “the Chief.”

Following in his father’s footsteps, the son graduated from Yale University and earned an M.D. summa cum laude at Harvard Medical School in 1929. After his residency at the Cleveland Clinic, he joined the surgical staff in 1937.

He served in the United States Navy in World War II with a team of enlistees from the clinic. Wartime research on ruptured appendixes showed them to be less life-threatening than commonly believed. That suggested that unsupervised emergency appendectomies aboard submarines, while courageous, could do more harm than good.

From that experience grew his impulse to take up the cudgels against orthodoxy. His work with thyroid cancers convinced him that less intrusive alternatives often could take the place of surgery, and his approach succeeded in reducing the need for it.

“With fewer thyroid operations to do,” he recalled, “I looked about for other fruitful fields.” He focused on breast cancer treatments that disfigured thousands of women every year. Sparking a Patients’ Revolt

Originally a firm believer in radical mastectomy, he was influenced by Dr. Reginald Murley, a Scottish physician who combined partial mastectomy with radiation treatment. Dr. Robert S. Dinsmorea, who then headed the surgical staff in Cleveland, was similarly persuaded. Dr. Crile performed his last radical mastectomy in 1954.

He published his first paper on the subject in 1961 to demonstrate that survival rates for lumpectomy or simple mastectomy were comparable to those for radical mastectomy. Doubtful colleagues asserted that this was only because he limited his treatments to women in the early stages of the disease.

But within years, more and more women revolted against the way their surgeons treated them as “cases” in the doctor-knows-best tradition. And a growing number of surgeons began to agree with them and Dr. Crile.

Dr. Crile’s books included “What Women Should Know About the Breast Cancer Controversy” (Macmillan, 1973) and “Surgery, Your Choices, Your Alternatives” (Delacorte, 1978).

Four months ago, the Cleveland Clinic named a new building in honor of the father and the son.

Dr. Crile lost his first wife, the former Jane Halle, to cancer in 1963. He is survived by his second wife, the former Helga Sandburg, daughter of the poet Carl Sandburg; three daughters, Ann Crile Esselstyn of Cleveland, Joan Foster of Atlanta, Ga., and Susan Crile of Manhattan, a son, George Crile 3d of Manhattan, a CBS News producer for “60 Minutes”; a sister, Margaret Garretson of Cleveland; 12 grandchildren and one great-grandchild.

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