International Urogynecology Journal

, Volume 20, Issue 7, pp 765–767 | Cite as

Commercial pressures and professional ethics: Troubling revisions to the recent ACOG Practice Bulletins on surgery for pelvic organ prolapse

  • L. Lewis WallEmail author
  • Douglas Brown
Current Opinion / Update


Commercial interests are reshaping the practice of gynecological surgery by promoting the use of trochar-and-mesh surgical “kits” for the treatment of stress incontinence and pelvic organ prolapse. In this article, we discuss the ethical implications of changes in surgical practice that are driven by commercial interests. We point out the dangers inherent in the adoption of new procedures without adequate and documented evidence to support their safety and efficacy. We discuss the most recent American College of Obstetricians and Gynecologists (ACOG) Practice Bulletins on pelvic organ prolapse (numbers 79 and 85) which were altered without explanation to downplay the experimental nature of these commercial products. We suggest that in so doing, ACOG is not meeting its fiduciary responsibilities to patients and is undermining important professional values.


Medical devices Ethics Surgical innovation Surgical ethics Surgical mesh Prolapse Sling operations 


Conflicts of interest



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Copyright information

© The International Urogynecological Association 2009

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Campus Box 8064Washington University School of MedicineSt. LouisUSA
  2. 2.Barnes-Jewish Hospital Ethics ProgramSt. LouisUSA

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