Public health has often focused on prevention tools that impact an entire community or population. Before Henry Bigelow MD described the use of Ether in 1846 to mitigate pain during surgery or Joseph Lister MD discovered the value of sterile technique, surgical candidates were few. Even if one were convinced tolerate the pain of surgery, more than half would die from the risk of infection. For most of surgical history, the risk of intervention far outweighed potential benefit. Thus, the percent of the population undergoing surgery were few, and the surgeons role in public health limited.
More than a century later we are performing 230 million surgical procedures per year worldwide. Death from infection after surgery is nearly eliminated, pain minimized and we are performing some of our most challenging cases with greater ease. Consider the Whipple Procedure; among the most technically difficult and highest risk surgeries ever performed and the only curative treatment for pancreatic cancer. In the past it required three separate operations and left many patients dead on the operating room table. We can now perform it laparoscopically in a single operation through penny size incisions with less pain and faster recoveries. For many of our most common procedures, similar advances have evolved.