Elective cesarean section

It was with utter dismay and surprise that I read Mary Hannah's commentary on planned elective cesarean section.¹ Given that there has never been any scientific proof of benefit from unindicated surgery, how can the literature for indicated procedures be used to justify our willingness to acquiesce to the wishes of the consumer? And just because indicated procedures have low rates of complications and appear safe, we should not use those data to bend to current trends in consumerism. Are we physicians so afraid of disappointing the consumer that we are willing to perform unnecessary procedures? I find it rather hypocritical that we misuse and contort the literature to justify this approach and then turn around and call ourselves scientists practising evidenced-based medicine. If we want to practise what amounts to cosmetic surgery, then by all means, let's do so and bill patients for these services independently.

John R. Fernandes Assistant Professor Department of Pathology and Molecular Medicine Forensic Pathologist and Obstetrician/Gynaecologist Hamilton Health Sciences Centre McMaster University Hamilton, Ont.